Saturday, 8 March 2014

Brief Psychotic Disorder - a common condition, virtually unknown


In a city of a million people, about three cases per day - or in a large psychiatric hospitals acute admissions ward, a new case arriving every week or two.

That's about how common is a condition variously termed Brief Psychotic Disorder, or Psychogenic Psychosis, or Schizophreniform Disorder.

In other words it happens quite a lot - it will probably happen to someone you know.


A person is brought into hospital (usually against their wishes, brought in by their terrified family, or the police) with some kind of acute, excited, aggressive psychotic breakdown following several days or weeks of escalating disturbance - usually associated with a period of unusual stress or hard work, many late nights - perhaps skipping sleep.

They may be typically manic (happy or angry, over-active, grandiose, talking too much and too loud, impulsive, over-bearing); or a more typically schizophrenic picture (puzzled, suspicious, hearing voices, believing they are being observed, victim of some conspiracy, jumbled nonsensical speech); or there may be catatonic posturing and strange movements...

Very abnormal, very severe, very scary.

Yet after just a few days of admission, with sedation or tranquillization, a few nights of sleep - the patient completely recovers back to normal and may leave hospital within a week - and never suffer any further problems.

And that is that.

Or that is how it used to be... 


Except that nowadays, in the developed world, they will likely be given antipsychotic (aka neroleptic, 'mood stabilizer') drugs, and kept on them after discharge - supposedly to 'prevent' future problems.

And will therefore suffer the inevitable and severe Parkinsonian effects of antipsychotics; including demotivation, inability to experience pleasure, lack of drive -the drugs will probably make them constantly sleepy and obese...

And after a few months of 'preventive' treatment ('to be on the safe side') inevitably they will become dependent on the antipsychotics; so that if or when the drugs are stopped, they have a high chance of suffering a withdrawal-triggered psychotic breakdown - which will then be taken as proof that they 'need' the drug, and indeed need the drugs for the rest of their lives...


In psychiatry, all the drugs, without any exceptions, cause greater or lesser dependence when taken in significant doses for a few months - but the fact is not acknowledged; so long term covert (un-acknowledged) drug dependence is relabelled as disease.


So quite likely, nowadays, thanks to covert drug dependence, the patient with brief psychotic disorder will never recover from their breakdown; will never return to their former level of functioning - they will instead become a chronic psychiatric patient (and prescribed drug consumer) for the rest of their days (which may not be very long, considering that antipsychotics substantially elevate all-cause mortality rates). 


In this brave new world where an on-patent and useless antipyschotic (Ablify) is the biggest selling drug of all drugs in the world; the person with a brief psychotic episode will not be allowed to recover and walk away; but will very likely be made into a fake diagnosis of 'bipolar disorder' or 'schizophrenia' or whatever is being promoted - and will spend the rest of their lives as impaired and dependent.


Why am I telling you this?

Because it may well affect you or your loved ones.

Antipsychotic prescriptions are sky high - when described as 'mood stabilizers' they are being given to people with mild, temporary and imaginary illnesses; they are being given to teenagers, young children and toddlers; the drugs are being given supposedly to prevent the 'risk' of future illness without any awareness that long-term antipsychotic drugs always cause present and future impairment and illness.

In sum antipsychotics (including labelled as 'mood stabilizers') are being grossly, hideously, evilly over-prescribed - millions of lives have been, are being, ruined for faked reasons on false grounds.


Why am I telling you this?

Because you may not have known that people can and do suffer severe psychotic breakdowns, yet these people would be expected to get better very quickly and (if left alone) will probably never experience any further trouble.

This is fairly common.


Why am I telling you this? 

So you know to resist 'medical advice' which would - instead of letting the patient (which may be you) get better and stay well - will instead lead to them getting permanently-hooked on dangerous, brain impairing and dependence-producing drugs.


Antipsychotics are very nasty drugs - they should be used seldom, in as low as dose  as possible and for as briefly as possible; and only as a last resort.

Avoid - if at all possible - the risk of getting dependent on them.

Addiction to a drug that makes you high or happy is a bad thing; but to become dependent on a drug that makes you look, act and feel like a dull, demotivated zombie, and probably prevents you ever holding a responsible job, is much, much worse.



leftist conservative said...

great post. I don't really have any experience with psych drugs myself, but my wife had some psych issues and I considered have her looked at, but never did, mainly because my research led me to believe that mental health industry was a bit of a scam. Here is america, all our institutions are corrupt, and the medical field is right there at the top.

George Goerlich said...

They had out anti-depressants out like candy in the US. My wife was prescribed some at 13 because she was unhappy while her parents went through a divorce.

No mental evaluation necessary, just any vague complaint about being lethargic or unhappy. There's been news that many of the school-shooters here in the US were on SSRI's.

Bruce Charlton said...

@GG - Yes indeed:

Jeremy said...

There is a parasitical bureaucracy of social workers and their ilk who need to to be kept in employment, which is one of the reasons that the first thing they do when a patient comes into their domain with a minor complaint is dope them up to the eyeballs on major tranquilisers to keep them docile, and dependent. Thus, a minor illness, which could usually be cured quickly with a push in the right direction, becomes a major debilitating long-term illness, often rendering the subject unemployable. Several years later, many of the unfortunates who end up under the auspices of the mental-health profession, end up dead. At least, that's my experience of ten years of these people. Social workers are largely characterised by their apathy and incompetence. Oh, and, of course, by their 'progressive' attitudes!

Jasper said...

I have a close relative in this situation. I wonder what you'd advise at this point. He had a serious psychosis, and was put on drugs for a period of a whole year -- a condition for his being able to hold on to his job, in effect, supported by the doctors. After then being _off_ the drugs for about six months he had another more severe psychosis. This time it was much harder to get him back to reality, but with the drugs and a few weeks in hospital he was pretty much back to normal. Now it seems the expectation is he'll be on the drug indefinitely. What can be done _at this point_ to help him off the drug? Is there anything? I don't think we can risk another episode. The damage would probably be very serious a third time round.

Bruce Charlton said...

@Jasper - I can't give clinical advice remote-control. I could just state that in general there are some situations when all options have problems. Two breakdowns may mean more to come - or it may not; but lifelong antipsychotic use has many problems (it means lifelong Parkonsonism - causing one disease to try and prevent another) ; and very often does not work (because the brain adapts to the drug in various ways).

The other alternatives are to use as-required sedation as the main preventive therapy, with ECT/ electroshock if/ when the psychosis breaks through.

That would be what I wanted for myself in a similar situation. If I felt as if a psychosis was coming - for example, if I was having trouble sleeping, or had the idea I 'didn't need' sleep; then I would take immediate sedation to ensure I did sleep.

Such a person would need constant access to sedation, because hours might be important.

What kind of sedation? Maybe one of the old antihistamines like promethazine, or something like diazepam/ valium.

Of course all this depends on insight, which may be lacking - or having someone close at hand to keep an eye on things. But in principle sedation-when-needed could be used as a preventive; and sedation and ECT as the main, most effective and only truly 'antipsychotic' treatment - would enable neuroleptic/ antipsychotic drugs to be avoided in most people.

Jasper said...

Thank you.

Obviously I didn't want "clinical advice remote control" but only some general thoughts from an expert.

What would you suggest for my relative if he is now _on_ these drugs and has been for a while but would like to someday be free of them? Might that be safe for people in this situation, if they have insight and/or monitoring to ensure sleep, etc?