#psychiatric medicine

[dorianbrightmusic]

New Antipsychotic FDA Approval – Cobenfy

Cobenfy (xanomeline/trospium chloride) has just been approved for schizophrenia treatment in the US. This is huge. It's the first antipsychotic in decades to not target dopamine directly. It's got a much, much better side-effect profile, and it might work for negative and cognitive symptoms.

FOR MORE READING – news report/patient-centred plain language overview: See here.

FOR MORE READING – scientific evidence report: See here (note: the drug is referred to as 'KarXT' in this report).

I couldn't be happier right now. People with psychosis go through so, so much trying to find medications that are both useful and tolerable, and psychiatry has historically neglected psychotic people's needs so, so awfully. (Not to mention how little there is that actually helps with anything other than positive symptoms.) So I'm really, really hoping that with the proof that we can, in fact, make antipsychotics that aren't based on the same old pharmacological things we've tried before. Cobenfy is a muscarinic agonist/antagonist in fixed combination – and it also indirectly regulates dopamine and glutamate. And given that we know both dopamine and NMDA are probably involved in schizophrenia somehow – AND that treating things to do with either is hard – this is so, so, so exciting.

This isn't to say Cobenfy doesn't have side-effects (the most common ones being nausea, constipation, dyspepsia, vomiting, hypertension, dry mouth, and tachycardia. We also know that there is a small risk of extrapyramidal symptoms, and that prolactin-related side-effects do happen, unfortunately). We don't know much about how it affects folks in the long-term, or much about the long-term tardive dyskinesia risk. But even so, it's progress compared to some of the worse antipsychotic side-effects.

Moreover, there is a possibility it might be useful for negative and cognitive symptoms. Holy crap.

I'm really really really excited. I hope this is the start of a shift in psychiatry towards better standards of patient-centred care for psychosis. Y'all have deserved better for far too long – here's hoping this is the start of more ethical, effective treatment.

[ruindunburnit]

When I eventually pivot my video essays from House of Night to Death Note, I will finally tackle what I call the Glass Cell Theory, which the TV Drama made most clear:

Light only acts the way he does through the Yotsuba Arc and the Near Arc because of his solitary confinement. And in fact he is a perfect case for why we should not be doing that.

[atthecenterofeverything]

Overall it is difficult to characterise the effects of the SSRIs. Firstly, in most cases they appear to have fairly trivial physiological and subjective effects. They may have a mild stimulant effect after a single dose but this is uncertain, especially because of problems with interpretation of the Critical Fusion Flicker test of attention. In the longer term they may be associated with sedating effects and mild cognitive impairment in some realms. However they do appear to possess a sort of activating effect, in that they impair sleep and cause restlessness and agitation in a proportion of patients. This seems to be qualitatively different from the activation associated with classical stimulants. There is some evidence that they cause emotional blunting or an apathy syndrome with long-term use. However no studies have explored the effects of antidepressants in relation to other drugs in this respect and they have also been associated with emotional disinhibition (Garland & Baerg 2001). We know that the neuroleptic drugs induce a characteristic state of psychic indifference and this seems to be an intrinsic part of their action. What is uncertain is whether SSRIS and other antidepressants also produce a characteristic state of this sort, or whether their effects on emotional reactions are simply a non-specific consequence of being drugged.

The Myth of the Chemical Cure, Joanna Moncrieff

[mujsilenejdenik]

Stacionář, den třetí.

Dneska ráno se mi vůbec nechtělo vstávat. Venku bylo pošmourno a lilo jako z konve. Když jsem se převaloval v posteli, přemýšlel jsem dokonce nad tím, že se z dnešního stacionáře omluvím. Ovšem smysl pro povinnost ve mě zvítězil, a tak jsem vstal a šel si připravit snídani. Říkal jsem si totiž, že když se budu ze stacionáře omlouvat, nebude to na mne vrhat dobré světlo (to za a) a navíc z terapeutického hlediska by to postrádalo smysl (to jakože za b). Když jsem pak do stacionáře dorazil, v kuchyňce si uvařil dnes už druhé kafe a usadil se s ním ve společenské místnosti, měl jsem ze sebe dobrý pocit.

Musím přiznat, že byť se tady cítím dobře a v bezpečí, do hovoru s ostatními pacienty se zatím příliš nezapojuji. Nevadí mi sedět někde poblíž a poslouchat jejich štěbetání a pokud se to očekává, tak něco prohodím, ale spíš velice poskrovnu. Se sestrami a terapeuty komunikuju vzorně, to zase ano, ale prostě co se týče mých “kolegů”, hájím si (zatím) svůj osobní prostor. Myslím ale, že se to časem poddá. Absolvoval jsem už dvě hospitalizace, ze kterých jsem si odnesl několik přátelství a obzvláště z té první kontakt s jednou dívčinou, který je mi posilou a vzpruhou do dneška.

Na ranní komunitě se nás sestra ptala, jestli by někdo z nás byl ochotný popovídat si s mediky, kteří tady v nemocnici mají praxi. Jelikož jsem něco podobného absolvoval při svojí první hospitalizaci a věděl jsem, co to bude zhruba obnášet, přihlásil jsem se. Seminář, mohu - li to tak nazývat, vedl doktor, s kterým jsem absolvoval vstupní pohovor a medici byli nakonec jenom dva, takže to bylo velice komorní. Přihlásil jsem se hlavně proto, abych si vyzkoušel, jak mi vlastně bude, a jak se budu cítit, když budu muset předstoupit před cizí lidi a konverzovat s nimi. Výběrové řízení se totiž blíží svinským krokem, a tak jsem si řekl, že je načase začít trénovat.

Medici se mě vyptávali na moji anamnézu, na moje dva pobyty v psychiatrické nemocnici, na to, jak dlouho se léčím. Pověděl jsem jim o tom, jaké to bylo, když jsem slyšel hlasy nebo měl ozvučené myšlenky. O tom, že jsem kdysi trpěl bludy a byl jsem přesvědčený, že se proti mě spikla celá společnost. O svých problémech ve škole a panických atakách, když tam mám jít, a že bez Rivotrilu momentálně nedám ani ránu. Prostě všechno. Myslím si, že i tohle může mít z terapeutického hlediska smysl a pozitivní dopad, takhle to všechno ventilovat.

Jinak na programu dnes byla samozřejmě taky skupina, kdy jsem se celkem rozpovídal o svých vztazích s rodiči a o tom, jak se vlastně staví k tomu, že mají bláznivého syna. Před obědem byla ještě relaxace, kterou jsem absolvoval poprvé a musím uznat, že to bylo velice příjemné a uvolňující. Po obědě jsme měli volný program na oddělení, a tak jsem se uvelebil s knížkou, kterou jsem si s sebou přinesl z domova a ponořil jsem se do četby. Čas mi tak uběhl celkem rychle a už tady byla závěrečná komunita. Probrali jsme jednotlivě, jak se cítíme a jak jsme prožili dnešní den a pak jsme byli propuštěni domů.

Vzhledem k tomu, že dnes bylo tak ošklivé počasí, cestoval jsem taxíkem tam i zpět. Měl jsem kvůli tomu na sebe trochu vztek, ale pak jsem si uvědomil, co by mi řekl asi každý terapeut, a to, že si to nemám vyčítat. Koneckonců, zítra je taky den.

[kkoct-ik]

secondhand trauma is so fucked up because you have these horrible doom feelings and you dont even know why. youve been told the world is scary and you believed it and it was never something you made your own mind up about. its just part of life. and how do you argue with parts of life

[innerward]

[dumbsofsuperficialtextonlysearch]

Alien invaders socially engineering society so that discussion of or belief in advanced technology or aliens is viewed as signs of a psychiatric medical condition and a doctor can have an individual accused of having such a condition committed against their will to a psychiatric hospital and locked up there and drugged against their will without the requirement of any sort of trial or review prior.

[omenfailure]

I have this neat angsty Miquella/Mohg sketch/draft that I like the idea of but I hate the composition. I also wanna do some Trina/Mohg hurt/comfort with Trina lulling Mohg to eternal sleep and comforting him as the spell breaks and he's bursting with confusion

[gynandromorph]

Why does narrator's juncture use the word anamnesic instead of mnesic?

That's why--

[sophieinwonderland]

Oh wow, we didn't even know the ICD-11 is the standard. Another case of morally clouded Americans, damn. Of course they want their vague conclusions to be the correct one instead of what's accepted as the international standard.

Definitely!

If you want more information about the ICD, a good place to look for a comparison is the source you would expect to be the most biased against it... the APA.

This article actually suggests that ICD will eventually replace the DSM for diagnoses, leaving the DSM as a useful textbook for mental disorders, but no longer a separate diagnostic system.

The DSM isn't useless, and it is the main book used for diagnosis in the US and Canada at the moment, but it really is a book made for and by one country, and its days as the primary diagnostic guidebook, even in the countries that use it, are probably numbered.

[vulturesawake]

"Your mental illness is actually just a product of living under capitalism! You don't need those drugs they call 'medicine'!" Glad that's your experience. I'm legitimately batshit crazy though

[science-lover33]

Understanding Borderline Personality Disorder and the Role of Lamotrigine in Treatment

Borderline Personality Disorder (BPD) is a complex mental health condition characterized by emotional dysregulation, unstable relationships, impulsivity, and an unstable sense of self. Research into the underlying causes of BPD suggests a combination of genetic predisposition, neurobiological factors, and environmental influences. BPD is challenging to diagnose and treat due to its intricate nature, but one potential avenue of treatment that has garnered attention is the use of the medication lamotrigine.

Lamotrigine is an anticonvulsant medication primarily used to treat epilepsy, but it has also shown promise in addressing mood disorders, including BPD. This medication works by modulating the activity of glutamate, an excitatory neurotransmitter in the brain. Glutamate has been implicated in the pathophysiology of BPD, particularly in relation to emotional dysregulation and impulsive behaviors. Lamotrigine's mechanism of action involves stabilizing glutamate transmission, potentially leading to improved emotional stability and reduced impulsivity in individuals with BPD.

Research on the efficacy of lamotrigine in treating BPD is ongoing, but several studies have provided insights into its potential benefits. A randomized controlled trial by Elmslie et al. (2010) found that lamotrigine reduced emotional dysregulation and impulsivity in individuals with BPD. Furthermore, Nock et al. (2012) conducted a study indicating that lamotrigine might help alleviate self-injurious behaviors frequently associated with BPD. However, it's essential to note that the response to lamotrigine can vary among individuals, and its use should be carefully considered in conjunction with other therapeutic approaches.

While lamotrigine holds promise as a potential treatment for BPD, it's crucial to approach its use with caution. Consulting a mental health professional is vital to determine the appropriate course of treatment for individuals with BPD. The complexity of the disorder and the variability in treatment responses highlight the need for personalized and comprehensive approaches that may involve psychotherapy, medication, and support networks.

Sources:

Elmslie, J. L., Porter, R. J., Joyce, P. R., & Wells, J. E. (2010). Lamotrigine in Borderline Personality Disorder: A Randomized, Double-Blind, Placebo-Controlled Study. *The Journal of Clinical Psychiatry, 71*(6), 716-721.

Nock, M. K., Mendes, W. B., & Bogdan, R. (2012). A Preliminary Investigation of the Relationship Between Self-Injurious Behavior and Suicidal Behavior in Adolescents. *The Journal of Nervous and Mental Disease, 200*(10), 828-833.

Note: This information is for educational purposes only and should not be considered a substitute for professional medical advice. Always consult a qualified healthcare provider for personalized guidance and treatment options.

[atthecenterofeverything]

The binary term normal-pathological could be used to sanction social norms and social fears deeply felt by the masses with the approval of medical science. The terminology could also be used effectively to enlighten or persuade a non-scientific public because it is conceptually isomorphic with so many other binary terms that regulate the perception of social life: moral-immoral, criminal-honest, sane-insane, violent-passive. The power to pronounce on the nature of the norm and its pathologies gave nineteenth-century medicine a social authority out of all proportion with the numbers or the status of doctors. This power gave to medicine and its ancillary sciences the right to mediate between the general public and deviance, to pronounce on its causes, and to devise its cures. Medicine gained its social power because experts shaped a medical discourse that spoke to all those problems in comprehensible language, which appeared to many contemporaries to be an accurate portrayal of the world. The widespread influence of medical discourse about deviance had, as we shall see, profound consequences not only for the “pathological” part of the population, but also, as with any binary relation, for the “normal” one as well.

Crime, Madness and Politics in Modern France: The Medical Concept of National Decline, by Robert A. Nye

[healingdryad]

Schizophrenia is a pointless diagnosis. Everything that should be treated by a provider is neurological, the rest we call a free mind.

Medblrs, what do you think?

[reddest-x]

NOTICE THAT BENADRYL IS ON THIS LIST. You don't have to be ill at all to be on one of these medications! Double check the list!

Just a little PSA for all our mental health (and chronic pain*) spoonies out there! A lot of doctors neglect to mention this little side effect, which means a lot of us are suffering extra from the heat without knowing why.

*Many psych meds are used to treat chronic pain as well, if you didn’t know!

[lesbianlenas]

i HATE that they moved the edit button i keep going to hit where it used to be and almost liking my own post 😑 i am not THAT vain