Diabetes + Mental disorder

[grayfalcon89]

Before going to discuss my question, read this article:

 

http://www.nytimes.com/2006/06/12/health/12diabetes.html

 

Here comes my question:

 

What do you think we should do with these people then? Without medicines for mental illness, they won't survive normally. But giving medicines for mental illness can cause diabetes, which, in some case, are even more hazardous than diabetes.

 

Any intelligent idea? I just wanted to know about other people's opinions.

[Glider]

But giving medicines for mental illness can cause diabetes, which, in some case, are even more hazardous than diabetes.

What?

[scicop]

Yeah, its well known that some drugs for the "mentally" are linked to higher incidents for what's know as "metabolic disease" (altered glucose, triglycerides levels in the blood), which is associated with higher propensites for weight gain.

 

Usually these effects are associated with atypical antipsychotics (used for the treatment of schizophrenia, bipolar disorder, obsessive compulsive disorder).

 

The reason is that these drugs not only act at targets that reduced "mental illness" (such as blockade of dopamine d2, and serotonin-5HT1A) but at other targets in a non-specific manner, such as H1-histamine receptors. Studies have shown that the increased affinity of these drugs to H1-histamine receptors are associated with weight gain. In addition, blockade of D2 receptors can precipitate other metabolic disorders such as hyperprolactemia.

 

There are newer drugs (partial agonists) being put out now, that have reduced affinity for H1 (thus lower propensity for weight-gain/metabolic disorder) and that are senstive to neurotransmitter level. As these drugs can help reduce the propensity for the "mentally ill" to gain weight, and show good effectiveness.

S

o the problem is being addressed in the industry. Also, physcians now have options now to individualize therapy options for patients who may be predisposed for diabetes (i.e. overweight etc.)

[Peels]

Diabetes is only a part of the prices that they are paying. Antipsychotic drugs may produce much more serious side effects, such as parkinsonism, akathisia, dystonia, and tardive dyskinesia, tachycardia, hypotension, impotence, lethargy, seizures and hyperprolactinaemia.

[scicop]

Diabetes is only a part of the prices that they are paying. Antipsychotic drugs may produce much more serious side effects, such as parkinsonism, akathisia, dystonia, and tardive dyskinesia, tachycardia, hypotension, impotence, lethargy, seizures and hyperprolactinaemia.

 

Yes and no, certain effects, such as parkinsonium, akathisia, tardive dyskiesis, siezure can occur if switching or therapy cessation is not titrated properly. Thus these effects can be controlled for by a well-educated/practiced physician. Others, such hyperprolactermia (a function of D2 receptor occupancy by pure d2/5ht antagonists) may not be important in certain populations like the elderly or pre-adolescent/adolescent. Although hyperprolacemia may cause sexual dysfuntion, and H1 affinity may predict weight gain, as stated before, there are the newer partial agonist drugs that have more favorable adverse event profile, and are more effective for achieving remission and preventing relapse to psychosis.

[Peels]

When the CPU of my old computer stopped functioning, I decided to try to fix it myself although I don't know too much about computer. Even though I knew I would be ended in a failure, I still did it. What a big deal, as I wanted to buy a new one anyway.

 

This is a different story to fix a human brain. We can not just simply do it by trial and error. How much do we understand about these neurotransmitters when we decide to change them by these neuroleptic drugs? We should keep this in mind that all neuroleptics are neurotoxin!

 

Please read this article: "Should the use of neuroleptics be severely limited?"

by Peter R. Breggin, M.D.

http://www.breggin.com/neuroleptics.html

[scicop]

Um, I'm not arguing for the use of neuroleptics, I'm just stating that therapy regimens that are individualized have the propensity to limit adverse events. This is possible given the arsonal of agents available to the physcian, and there are so many agents because pateints are heterogenous in their responses to a given compound (i.e. divers aetiology)

 

As for neuroleptics or another psychiatric drug, they are already compensating for an already existant imbalance (presumably excess cortical dopamine/serotonin) , hense the cause of pyschosis affiliated by bipolar and schizo and so on. This is why these drugs, despite side effects, are effective for reducing psychosis. As I said, new drugs are coming out with less propensity for adverse events, thus the physcians have new tools.

 

In addition, physicians would rather prevent a complete psychotic episode and prescribe atypicals as a preventative step. Among the well known barriers to achieving remission or treating these patients is misdiagonisis and failure to identify the prodromal symptoms (sub symptom) signs of pyschosis and alot of education initiatives (CME..paid for by big pharma) are out there to increase physician awareness of prodromal symptoms and misdiagnosis of psychotic disorders.

 

Such, they're not the best, but its what we've got and scientific research is putting alot more efficacious and tolerable drugs out there (like aripiprazole), just look at some of the pharma pipe lines.

[grayfalcon89]

There are newer drugs (partial agonists) being put out now' date=' that have reduced affinity for H1 (thus lower propensity for weight-gain/metabolic disorder) and that are senstive to neurotransmitter level. As these drugs can help reduce the propensity for the "mentally ill" to gain weight, and show good effectiveness.

S

o the problem is being addressed in the industry. Also, physcians now have options now to individualize therapy options for patients who may be predisposed for diabetes (i.e. overweight etc.)[/quote']

 

Shouldn't the newer drugs cost more money (and therefore, out of reach for most people ---> which would be main problem for introducing a new drug)?

[scicop]

yeah, sadly. The higher costs for new drugs may mean that the safer drug drugs may remain out of reach, usually being precribed when patients have failed to respond to a drug or experienced health compromising adverse effects. Usually alot of the newer drugs are placed in tiered, or stratified formularies so physicians as well as consumers (thats the patient!) have to been prescibed other medications before "being covered" by insurance. Doesn't mean it can't be prescribed, you can still get it providing your willing to pay out of pocket.

 

Big pharma is on your side on this one (however for their benefit) they try convinice the MCOs and thier formulary committes that thier new drug is effective and safe, as well as cost-effective. Big pharma knows..as so do we that MCOs would rather cover more costly yet effective and tolerable drug, rather than less costly and less effective and tolerable, drugs. So if the pharma can convince providers that their newer drugs are more cost-effective in the long run (less money expended to treat side-effects or co-morbid conditions) then there can be accessibility for the consumers.

 

Ah....the world of MCO's and formulary management.

 

Sorry for the managed-care pharmcist language.

[scicop]

When the CPU of my old computer stopped functioning' date=' I decided to try to fix it myself although I don't know too much about computer. Even though I knew I would be ended in a failure, I still did it. What a big deal, as I wanted to buy a new one anyway.

 

This is a different story to fix a human brain. We can not just simply do it by trial and error. How much do we understand about these neurotransmitters when we decide to change them by these neuroleptic drugs? We should keep this in mind that all neuroleptics are neurotoxin!

 

Please read this article: "Should the use of neuroleptics be severely limited?"

by Peter R. Breggin, M.D.

http://www.breggin.com/neuroleptics.html[/quote']

 

As far as Peter R Breggin is concerned, he's a quack physcian. Most of is "publications" are commentries and letters, very little of what he's written if any is substantiated by his own work, he just complains. He's what we like to call in the industry, a Troll; a neysayer..a s**t stirrer, kinda like me.

[Peels]

"The case against antipsychotic drugs: a 50-year record of doing more harm than good"

http://psychrights.org/Research/Digest/Chronicity/50yearecord.pdf

 

Is newer atypical antipsychotic drugs more effective than the old typical antipsychotic?

Please read this article: "Schizophrenia Drugs About The Same"

http://www.cbsnews.com/stories/2005/09/19/health/main858922.shtml

or this article: "NIMH Study to Guide Treatment Choices for Schizophrenia"

http://www.nih.gov/news/pr/sep2005/nimh-19.htm

[badchad]

I must admit, I didn't have a lot of time to pick through the references so I'll keep my comments brief.

 

"The case against antipsychotic drugs: a 50-year record of doing more harm than good"

http://psychrights.org/Research/Digest/Chronicity/50yearecord.pdf

 

Unfortunately' date=' there seems little alternative. There are obvious exceptions, but many schizophrenics lack the resources and abilityto lead functional lives without extensive care. There are obvious problems with the drugs, but are side effects much worse than being institutionalized indefinetly?

 

"Is newer atypical antipsychotic drugs more effective than the old typical antipsychotic?

Please read this article: "Schizophrenia Drugs About The Same"

http://www.cbsnews.com/stories/2005/09/19/health/main858922.shtml

or this article: "NIMH Study to Guide Treatment Choices for Schizophrenia"

http://www.nih.gov/news/pr/sep2005/nimh-19.htm

 

I would urge you to read the published report. There has been a relatively large backlash and criticism of the study since publication, pointing out methodological flaws. One that comes to mind: There was only one typical antipsychoitc used for the comparison.

 

Then you have the usual issues of outcomes measures, dose etc. Go to pubmed and search with the key word CATIE and they will all pop up. There are valid arguments against, and supporting the results of the trial. All I'm saying is that those results are debateable and far from concrete.

[scicop]

"The case against antipsychotic drugs: a 50-year record of doing more harm than good"

http://psychrights.org/Research/Digest/Chronicity/50yearecord.pdf

 

Is newer atypical antipsychotic drugs more effective than the old typical antipsychotic?

Please read this article: "Schizophrenia Drugs About The Same"

http://www.cbsnews.com/stories/2005/09/19/health/main858922.shtml

or this article: "NIMH Study to Guide Treatment Choices for Schizophrenia"

http://www.nih.gov/news/pr/sep2005/nimh-19.htm

 

Ok, just to clarify, I'm not advocating for the use of neuroleptics, but they are better than no treatment at all. The cititation you provided was interesting though I have issues with papers published in a journal called "medical hypothesis". Even my most crappist PhD and postdoctoral papers and reviews were published journals with very high citation indexes..I wouldn't publish in "medical hypothesis" if it were the last journal to publish in.

 

As far as your second links are concern....Ahh..my old friend CATIE!!! Great study!!

but they didn't include the newer partial agonist!

[Peels]

First, I would like to say that this is a science debate forums, therefore, any articles that I referred are only for the purpose of food for thoughts. I am neither anti-psychiatry nor pro-psychiatry.

 

Unfortunately' date=' there seems little alternative. There are obvious exceptions, but many schizophrenics lack the resources and abilityto lead functional lives without extensive care. There are obvious problems with the drugs, but are side effects much worse than being institutionalized indefinetly?[/quote']

 

 

It is obvious that side effects can never be much worse than "being institutionalized indefinitely". But the question is: do all schizophrenics have to be "institutionalized indefinitely" if without antipsychotic drugs? Are these antipsychotic drugs the only choice for schizophrenics? What happened for so many schizophrenics (John Nash, for instance) who recovered without antipsychotic drugs?

 

 

I would urge you to read the published report. There has been a relatively large backlash and criticism of the study since publication' date=' pointing out methodological flaws. One that comes to mind: There was only one typical antipsychoitc used for the comparison.[/quote']

 

To your comment, I'll just quote some part of recent interviews from SRF with Dr. Robin Murray, a leader in European schizophrenia research:

 

SRF: "…What are the biggest differences in how prescribing physicians approach schizophrenia in Europe and the U.S. at the clinical level?"

 

RM: "…In terms of daily practice, the biggest difference is the extent to which the drug companies dominate the thoughts of the practitioners. My own view is that the academic establishment in North America has been unduly influenced by the pharmaceutical industry."

 

SRF: "Leading to overprescription?"

 

RM: "Not necessarily overprescription but, for example, leading to a mindless acceptance that atypical antipsychotics are hugely better than typical antipsychotics. To my knowledge, around 90 percent of the antipsychotics prescribed in the United States are now atypicals, as compared to 50 percent in Britain. American psychiatrists have been convinced for a long time that the atypicals were superior. Many European psychiatrists agree that clozapine is superior, but are less convinced that the novel atypicals are superior. In fact, a big American study called the CATIE study just demonstrated that there isn't much difference in efficacy. I look forward to many American academics eating their words."

 

http://www.schizophreniaforum.org/for/int//Murray/murray.asp

[Peels]

...The cititation you provided was interesting though I have issues with papers published in a journal called "medical hypothesis". Even my most crappist PhD and postdoctoral papers and reviews were published journals with very high citation indexes..I wouldn't publish in "medical hypothesis" if it were the last journal to publish in...

 

The only comment to your post is: not all papers that published in a high citation index journal are jewels, and not all papers "published in a journal called 'medical hypothesis'" are crappy one. As a scientist, you should judge a paper by its scientific value not the name of the journal, especially, when its view against the main stream's.

[scicop]

I pressed the submitte button twice. so, anyway with repect to BADCHADs comment on the CATIE trial...yes you are correct, there was alot of criticism about CATIE and their metrix as well as drugs used. In addition CATIE did not include the newer atypicals that are associated with more tolerability (these drugs were not available). CATIE did a great job of showing that atypicals they used were associated with high incidents for Adverse events, therefore companies like BMS and Otsuka jumped on that and actually used the results of CATIE to market aripiprazole to their consumers (not patients!! but rather physcians) through alot of industry sponsered physician training programs like CME.

 

As for PEELS, good research regarding Murray's comment. The reality is that he is correct in terms that pharma does control the minds of physcians, especially in psychiatry. They (pharma) use established clinicians/scientist in thier promotional efforts and pay high money. These clinicians get paid alot of money to make their that pharma industry messaging is incoropated into their seminars even in activities that are suppose to be fair and balanced. The clincians in a sense are selling their souls to the pharma industry, for each talk they give they receive about 3 to 4,000 US Dollars. A few handful of these "whores of the industry" are dictating pyschiatry in the US. By the way for anyone that gets offended by the term "whores of the industry" this is a term used by pharma and understood in the competitive marketing world. It would be understood if you were to use in the industry.

 

It doesn't stop there though. You raised a point about juding a paper on scientific value which I address in the next post, but something I forgot to say is that alot of these journals publish articles that are paid for by pharmaceutical companies (indirectly). The authors of some of these papers are PAID by pharma to include messaging. Some of these journals include Journal of Clinical Psychiatry. Also clinical trials! Did you know that pharmaceutical companies pay other companies to write these papers in a positive marketing light? You know where they publish? JAMA, NEJM!! yup..these journals publish clinical trials papers that are written by a medical communications company with the intent to put the data is a positive light.

 

HOWEVER, the data (graphs and tables) can't really be manipulated. The data is realitively raw (OIG will not allow data manipulation for marketing purposes), so its up to the reader to read between the lines.

 

When you do, you find that at least the case for atypicals..they are better than typicals in terms of propensity for adverse events. albiet they DO share the same effectiveness as the typicals (noticed I didn't say efficasy..that's a different word that relates to drug dosing).

 

Now read below regarding my judgement of "crappy" papers.

[scicop]

The only comment to your post is: not all papers that published in a high citation index journal are jewels, and not all papers "published in a journal called 'medical hypothesis'" are crappy one. As a scientist, you should judge a paper by its scientific value not the name of the journal, especially, when its view against the main stream's.

 

And you're absolutely correct! And I do judge papers by their scientific value, however it would be completely "dumb" in not accept that 1. certain journals are below scientific stardard, even for non high caliber work 2. authors publish in certain journals because perhaps the can't get in elsewhere, thus one begins to question their scientific capabilities/knowledge/integrity.

 

With exception of the CATIE trial, which I think was a great study (but since the newer drugs were not available at the time study,they were not incorporated..it would have been interesting to see what would happen if they did include, lets say..abilify) The authors you have cited in your postings are NOT experts, and as a scientist you HAVE to consider where these authors are comming from, who they are, and who their target audience is! For example, "medical hypothesis", who's their target audience? who subscribes to that journal? Would you find a lead author of a clinical trial publishing there?

 

I had the pleasure of being a scientific director (a while back) for a grant review board for a very endowed (lots of $$) non-profit neurodegenrative disease funding agency and I HAD FINAL say in deciding which grants got funded. My review board that "I" selected were among the top scientist in the field for that neurodegenerative disease. When we have 200 grants to go through in one day, You know what's one of the first things we looked at? Publications! Where are the applicants published? Are they in the "Journal of Biological Chemistry", or are they in the "Southwestern Iowa Journal of Biochemistry". Right away that tells us if their grant is even worth our time to read! It gives us insight into whether the research was worth us giving money too!! Chances are if they're in a "someplace journal of something", the peer-review (these are scientist) caliber are no where near the scientist you would have for peer-review in a more reputable journal. Thus most-likely, if not always the case, papers that are REJECTED from the higher caliber journals get accepted into the lower journals. The SAME is true for REVIEWS!! Therefore we did not WASTE our time with that grant, and yes..we are scientist and we do have that point of view..welcome the the world of the science. You think we want to fund low quality science and low quality investigators? If you think my board was bad, wait till you apply for a grant at the NIH, their peer-review process a grant is perhaps 100 worse than what I was directing. I've heard the career of scientist can be destroyed in those meetings. The way science is set up on PLANET EARTH is that if you want to get funding, then YOU HAD better publish in journals with high citation indexes and reputable scientist on their review panel (i.e. their peer review is of high caliber).

 

 

As I said before, welcome to the world of science, it is not easy and good scientist leave research because of this process. Its even worse now that funding at NIH is top 9% whereas 8 years ago it was 50%. There is a reason young investigators today are scared and leave science (like me). Its so bad today that even good publications can ensure funding...so....you want to trust a guy published in medical hypothesis, or cite a guy whose publication record are letters and commentaries? be my guest, just realize that if you have that point of view, YOU WILL NOT MAKE IT IN SCIENCE!!!!!!

[Peels]

Scicop, I fully understand and agree with your reply.

 

The first thing that I realized when I read articles from psychiatry journals was that psychiatry field is totally different with the engineering filed. When doing study in engineering field, yes, one should start from more reputable journals, because that is where the most valuable papers are published. But when doing study in psychiatry related field, one has to be open-minded, because many researchers and scientists in this field are controlled by the drug company ("whores of the industry" as you termed), and so these high citation indexes journals. As a result, many articles published on these journals are not that valuable, and even sometimes misleading. I have no doubt that the papers I referred above will never be accepted by these journals because of their views. However, in my opinion, to better understand psychiatry, one really needs to study views from both anti-psychiatry and pro-psychiatry.

[scicop]

However, in my opinion, to better understand psychiatry, one really needs to study views from both anti-psychiatry and pro-psychiatry.

 

Glad its an opinion, but I would say NO to that opinion. You do not NEED to study the views from anti-psychiatry and pro-psychiatry.

 

Whats important is the DATA.

 

Even though a pharma sponsored KOL may present the data in a promotional /anti-promotional fashion, it is essential to be objective an READ THE DATA!

I.e. controls, arms, population, outcomes metrix, definitions, limits etc.

 

I actually get more out of META-ANALYSIS studies (and studies like CATIE providing they account for newer availble agents..STAR-D is one i'm paying attention too) Now, you don't have to tell me the problems associated by comparison across clinical trials, certainly one must be careful, but they are truly a way to statistically analyse to VERY BIG POPULATION and get more clinically meaningful results, that are not limited to the protocols set in just one Phase III clinical trial.

 

DATA. Its where its at.

[cpwmatthews]

I suffer from schizophrenia, manic depression and have just found out that my glucous level is high. All your articles have been really interesting to read and i can agree with many of the points raised. I take Olanzapine as my antipsychotic drug and as a result have unfortunately put on a lot of weight, yet to not take it would result in paranoid schizophrenia, I confess that I still do not know the difference of atypical and typical, it's all a bit of a muchness. People find, sometimes by trial of many different types, which tablet calms the troubled mind. I do think the drug companies even here in the U.K. influence the doctors decisions. I would not know how I would fair if I was to live in America with the paid for medical system that they have. To not receive the latest drugs because they are not affordable means that some people are getting an out of date service and are essencially second class citizens to those who cannot afford modern care. Back to the first point, It could be coincidental that I fullfill the prophesy of Diabetes linked to mental illness, I think it's hireditary, finaly though, I say sod it if it's going to get me down.

[scicop]

Dude, you need to talk to your physcian. Olanzapine has a high affinity for H1 which has been associated with weight gain..not a good thing for diabetes. You should be asked to switch another atypical with a pharmacological profile that would match your characteristics.

 

As far as EU goes, they are even worse than the US with company influence over physicians. The EU rules are laxed compared to US and gift-giving is often practiced in EU, where as not allowed in US. For example, Global parts of Pharma can fly EU physicians to conferences all expenses paid. American based pharma can't. Only for like KOLs can they do that...and even so its through a third party and they have to be presenting.

 

As far as the differences goes, Typical as are only D2 selective, and atypicals are D2/and 5HT (serotonin) selective, the side effects tend to be less with the atypicals than conventional, especially in maintanance setting.

 

You may have access to those other meds, but depending on how your provider has their formulary tiered, you may have to either have not responded to or have an adverse event that necessitates switching. You have diabetes, olanzapine is not a good drug to use, you may be able to switch..talk to your physcian, because you're not gonna get the best advice here on this board..I only know of this stuff cause it was my therapeutic area when I worked for a Big Pharma in New Jersey (very short time), my PhD does not make me an MD!!!!