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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Deneb on July 25, 2005, at 20:57:38
I saw a woman maybe in her 60's who kept sticking her tongue in and out...it looked strange and it was really obvious. She seem like a normal person otherwise.
Is this what TD looks like?
Deneb
Posted by Phillipa on July 25, 2005, at 21:54:33
In reply to Did I see someone with tardive dyskinesia?, posted by Deneb on July 25, 2005, at 20:57:38
Could be but there are other signs also. The experts will tell you I'm sure. Fondly, Phillipa
Posted by sleepygirl on July 25, 2005, at 22:21:55
In reply to Did I see someone with tardive dyskinesia?, posted by Deneb on July 25, 2005, at 20:57:38
maybe, strange movements especially around the mouth are characteristic of tardive dyskinesia
Posted by med_empowered on July 26, 2005, at 1:33:26
In reply to Re: Did I see someone with tardive dyskinesia?, posted by sleepygirl on July 25, 2005, at 22:21:55
I knew a guy with schizophrenia..he was actually kind of young, late 20s, early 30s maybe...who had already developed what I guess would be termed "mild" to "moderate" tardive dyskinesia. He had the same odd, uncontrollable facial movements you described seeing in an older woman. The tongue darting is one of the first signs; in very, very severe cases, tardive dyskinesia can cause abnormal movements around the trunk area and can be disabling. In addition, there is tardive dystonia, which causes uncontrollable muscle contractions. Lots of people on antipsychotics experience tremor, muscle stiffness, that kind of thing, but tardive dystonia can be intensely painful and utterly debilitating; in some cases, people who develop it end up in wheel chairs. Tardive dyskinesia will sometimes disappear on its own after a while...in many cases, though, it is permanent. When it develops, there are almost no ways to treat the disorder; all one can really do is suppress the disorder. The traditional way to do this is to use the neuroleptic the individual was taking when they developed the disorder and increase the dose until the TD is no longer noticeable. The problem is that increasing the dose can cause worsening of the TD; when this becomes apparent, the dose may have to be raised again. The likelihood of developing TD is almost impossible to predict for an individual patient..with old antipsychotics, the given rate is 3% a year baseline risk, with 20% developing the disorder at a moderate or severe level after 5 years of treatment. Other sources put the number around 30-40%. At "end-point" (several decades of antipsychotic treatment), more than 50% of patients will develop TD to some extent. With new, atypical antipsychotics, the risk is even harder to pin down; the best data I've seen puts it at about 1% a year. Women, children, and the elderly are at a higher risk of developing the condition; elderly women are considered the highest risk group. Those with "affective disorders" (bipolar, for example, instead of schizophrenia) are believed to be at a substantially higher risk of developing TD than those with schizophrenia. In addition, those with "moody schizophrenia" or schizoaffective disorder may be at a higher risk than those who have "classic" schizophrenia. Those with mood disorders/affective disorders are also at a higher risk of developing EPS, including akathisia; there may be some connection between the two. What exactly causes TD is unkown; one study I read pointed to "oxidative stress" caused in the brain by neuroleptics. Apparently, old antipsychotics, such as haldol, cause the formation of "free radicals" within the brain...this results in damage to the structure of the brain, changes in brain structure, and, possibly, tardive dyskinesia. Some authors also believe that tardive dyskinesia is not *just* a movement disorder, but a sign of deeper underlying damage to the brain. Some research has shown that those with TD suffer significantly more cognitive impairment and overall cognitive decline than those who are treated with neuroleptics but don't have TD and/or those who have never been treated with neuroleptics. Although cognitive impairment is common in those with schizophrenia, it is apparently much more pronounced among those who develop TD.
Posted by ed_uk on July 26, 2005, at 14:37:05
In reply to Did I see someone with tardive dyskinesia?, posted by Deneb on July 25, 2005, at 20:57:38
Hi,
>Is this what TD looks like?
It's a common symptom of TD. Some people call it 'fly catching' - not very nice I know.
~Ed
Posted by alexandra_k on July 26, 2005, at 22:07:36
In reply to yup, posted by med_empowered on July 26, 2005, at 1:33:26
Though Frith in "The Cognitive Neuropsychology of Schizophrenia" maintains that we don't really know whether TD is something that happens due to progressive brain deterioration over the course of the illness or whether TD is something that happens in response to brain deterioration that is caused by anti-psychotics.
I don't know if he is 'very radical' in suggesting this.
He just says that there isn't much of a way to tell at present. We only get a good look at the brain on autopsy and it is unethical to withold anti-psychotics so we can see whether rates of TD go down.
Apparantly TD symptoms have been reported BEFORE the development of AP's. But maybe they make the liklihood of developing TD a bit higher...
Posted by med_empowered on July 27, 2005, at 3:44:25
In reply to Re: yup » med_empowered, posted by alexandra_k on July 26, 2005, at 22:07:36
hey! Yeah, there is some indication that pre-neuroleptic era asylums reported TD-like movements in those who were admitted. There are some problems with this however. First of all, TD type movements (and schizophrenia-type symptoms) often occur during or after a bout of encephalitis lethargica, which apparently was something of a problem around the same time the very term "schizophrenia" was coined and described in the literature. Secondly, its important to keep in mind that antipsychotics have never been used only for psychosis. Thorazine was originally developed as a pre-operative sedtive; it worked so well, and resulted in "sedation without necrosis," so the decision was made to give Thorazine (and later resperine) to inmates in asylums...not so much to cure them per se as to calm them down. Keep in mind that Deniker, et. al, the early pioneers in neuroleptic research, compared the effects of Thorazine to "a chemical lobotomy". Until about 1964, Thorazine truly was used as a "tranquilizer," not an "antipsychotic". Its "antipsychotic" effects were attributed to its unusual sedative powers. As such, Thorazine was used in all kinds of disorders. It was used in lower doses for depression, anxiety, "senile agitation", control of the behavior of the mentally handicapped, in prisons and orphanages...so on and so forth. It also was used, and is used, as an anti-emetic and in part of anaesthesia mixes (ex: DPT--Demerol, Promethazine, Thorazine; this is used alot in children, apparently). The problem with claiming that neuroleptics only slightly raise the TD risk is that no one ever recorded how often TD-like movements presented themselves in those with schizophrenia who did not take neuroleptics, and no one ever did such a study that controlled for other conditions, such as encephalitis lethargica. The numbers I quoted--20% over 5 years--come from the 1980 American Psychiatric Association Tardive Dyskinesia Taskforce. At the time, shrinks were getting sued left and write, especially in the US (apparently, US shrinks tended to use larger doses of neuroleptics and use them for longer periods...European docs tended to use lower doses, sometimes did drug-holidays, and were more willing to terminate neuroleptic treatment when a patient stabilized). A lot of experts think the APA numbers are actually pretty low, since they exclude more minor cases of TD (and since docs kind of ignored TD, especially in the US, until around 1980, even though reports first appeared in the literature around 1957 and the "Thorazine shuffle" was a well-known phenomenom only a short while after the widespread introduction of Thorazine into the mental health system). One thing I personally find offensive is doctors who find it unethical to "withhold" neuroleptics. Patient non-compliance with neuroleptic treatment is much, much more frequent than patients banging down doctors doors begging for more Haldol...this is why we have fast acting injections and depot injections, and why an implant was recently developed to deliver Haldol over a long period. The questions here revolve around POWER and TRUTH. Whose decision is it to decide whether TD or untreated schizophrenia is a worse fate? Whose decision is it to decide whether or not a certain individual continues to consume chemicals that fundamentally alter their thought processes and carry definite risks? To me, forcing someone to take a neuroleptic--and deciding that doing so is OK, and worth the risk of TD and other problems--basically sends the message that if you venture too far astray from what is "normal," you can and will have "normality" forced upon you, whether you like it or not. Considering the side effects--not just TD, but NMS, akathisia, "neuroleptic induced dysphoria," the "neuroleptic induced deficit syndrome," EPS, etc., it seems to me that forcing neuroleptics on people, or coaxing them against their own feelings that they *must* take them is more like PUNISHMENT than treatment. Having taken newer neuroleptics, and met those who have taken neuroleptics more long term and/or taken older ones, I can honestly say that I DO NOT think the risks of neuroleptic use are justified by "benefits". As for the TRUTH part of the equation...the truth is that, for all the "wonder drugs" (Thorazine, Haldol, down to Zyprexa and Abilify), Schizophrenia remains an incredibly disabling illness, and drugs dont seem to have made a huge dent in the problem. Those with Schizophrenia still have a freakishly high suicide rate (15% WITH treatment), they still experience severe cognitive and social impairment, and they still seem to largely lead isolated, unfulfilled lives on the margins of society. It seems that those with schizophrenia in less developed nations with stronger family and community systems recover more often and lead much better lives than those in the US...keep in mind that many of those in less developed countries are either NEVER treated with neuroleptics or they are only periodically treated while floridly psychotic. To be truly honest about neuroleptics, I think we must admit that although they have helped some people, and medications may well play a huge part in handling all the problems associated with schizophrenia, there are still many, many unanswered questions and neuroleptic treatment causes significant problems with few clear benefits.
Posted by xbunny on July 27, 2005, at 6:43:10
In reply to Re: yup, posted by med_empowered on July 27, 2005, at 3:44:25
>I can honestly say that I DO NOT think the risks of neuroleptic use are justified by "benefits".
I can honestly say that I am glad your opinion is not the widely held viewpoint. Antipsychotics (old ones to boot) have radically improved my life. If you want to talk about undeserved punishment I suggest you let your schizophrenia go untreated. Maybe you have and thats your choice but I think a larger majority of people would prefer not to or at least have a state of mind to able to make an informed decision. The risk of serious side effects is ever present however despite these I prefer to be able to have a fighting chance of acheiving my lifes goals. Even having some and realizing the possibility is there is in itself a victory. I think if I were to die tomorrow from a complication from taking antipsychotics no-one who has known me would begrudge those drugs. They would rejoice that, even if for a short while, I was able to live closer to the resemblance of the life I want to have.
Best regards Bunny
Posted by xbunny on July 27, 2005, at 7:06:04
In reply to Re: yup, posted by xbunny on July 27, 2005, at 6:43:10
Note to self: you better read that when you are 35 and virtually crippled with akathasia and TD like poor John :-( then you'll be talking out the other side of your face.
Posted by xbunny on July 27, 2005, at 7:23:28
In reply to Re: yup » xbunny, posted by xbunny on July 27, 2005, at 7:06:04
> Note to self: you better read that when you are 35 and virtually crippled with akathasia and TD like poor John :-( then you'll be talking out the other side of your face.
>that post was to me, from me, just so theres no confusion :-(
I'll never forget John. He was the sweetest guy in the world but couldnt keep still and could hardly walk or talk because of involuntary movements. All day and all night he shuffled around finding old ciggie butts to build rollies out of, but always tried to say thank you and was polite as can be if you offered him a ciggie, a biscuit or a cup of tea. Of all my memories from hospital he remains the clearest and the saddest. I hope he is well somewhere. I hope all people I met n hospital are well somwehere and have found the peace they so deserve.
Buns :-( (crying now, sorry for the multiple posts)
You know the first time I met john I wasnt even sure if he existed or was a projection of my deepest fears about treatment for schizophrenia I feel like such a rat for not even in beleiving in him when we first met.
Posted by xbunny on July 27, 2005, at 7:39:35
In reply to Re: yup, posted by xbunny on July 27, 2005, at 7:23:28
>I hope all people I met n hospital are well somwehere and have found the peace they so deserve.
The guy who would only talk about being a spy for osama bin laden.
The angry guy who had a 'nervous disorder' and needed 20mg of stelazine to calm down.
The old guys who always used to draw pictures of spitfires.
The young kid who smashed his room up and got sectioned.
The big guy who was always trying to round people up for therapy.
The girl who used to shout at me from her room across the atrium.
The guy who used to collect used paper towels and store them in his knapsack.
The guy who prized his bible so fervently and was always talking with the nun.
All the lost souls who would shuffle around the ward at night, like some demented conga line.Hope you have peace guys.
Buns
sorry I had to write this, dr bob feel free to delete this message if you like...
Posted by ed_uk on July 27, 2005, at 17:08:34
In reply to Re: yup, posted by xbunny on July 27, 2005, at 7:39:35
>sorry I had to write this, dr bob feel free to delete this message if you like...
He won't delete it Buns. It's good to express your thoughts, and your emotions.
Kind regards
~Ed
Posted by alexandra_k on July 28, 2005, at 1:02:57
In reply to Re: yup, posted by med_empowered on July 27, 2005, at 3:44:25
hey. thanks for an interesting post :-)
i think...
that anti-psychotics are actually fairly effective with respect to reducing the positive symptoms of schizophrenia: the delusions, the hallucinations, the formal thought disorder.
it is the negative symptoms, however, that are more debiliating: the social withdrawal etc.
there isn't a lot that seems to help with the negative symptoms (social support is great there as would be social skills training IMO though i guess lack of motivation / interest is hard).
but with respect to positive symptoms... we probably consider the negative symptoms to be more debilitating because of the relative success of bringing those positive symptoms under control...
via anti-psychotics
imo some doctors have a tendancy to over-prescribe in general. i remember (not very well admittedly) being on huge dosages of chlorpromazine basically with the intent of turning me into a vegetable.though, to try and be fair... an ALIVE vegetable. i suppose that was the point...
its hard because it depends a lot on how those positive symptoms actually do interfeare with ones quality of life.
one of my friends, for instance, used to be OUTRAGED when he was made to have his injection. but without his injection he had a tendancy to gather implements such as long steel poles and go stand outside the cop station fully intent on wacking them around.
it depends...
it depends on those positive symptoms...
but there has been an unfortunate tendancy in the history of psychiatry to use it as an 'excuse' to opress certain groups of people who deviated from that norm. that is true. In Russia people who opposed the political regeime were considered to be mentally ill and in some instances institutionalised. there was a special kind of disorder in which slaves ran away from their owners. and of course homosexuality... and lots of clinicians attitudes towards people in general and towards people with mental illness in particular leave a lot to be desired. that is true as well.but... there are some people out there really trying to help...
and... they can help sometimes. some of the meds do provide some relief...but treatment orders are hard, yes.
:-(
This is the end of the thread.
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