4 ms·

The claims you are making are stronger than the claims made by that paper (http://www.sciencedirect.com/science/article/pii/S0149763416300549 http://www.science

The claims you are making are stronger than the claims made by that paper (http://www.sciencedirect.com/science/article/pii/S0149763416300549 http://www.sciencedirect.com/science/article/pii/S0149763416...). First, the paper does not claim that cortisol production is related to psychosis. Instead, it measures the degree to which cortisol levels increase immediately upon awakening (cortisol awakening response or CAR), and specifically notes that CAR necessarily related to overall cortisol levels, but suggests that it may be related to hypothalamic-pituitary-adrenal axis function. It finds that CAR is blunted in patients with schizophrenia and first episode psychosis. However, it is not clear whether the changes in CAR are causal or symptomatic. For example, psychosis might lead to a disrupted wake-sleep cycle, which could then lead to blunted CAR. To determine whether there is a causal effect, you'd need to perform a longitudinal study, measuring CAR in patients who are at first normal but some of whom later go on to develop a psychosis, and show that the CAR differences predate the development of psychotic symptoms, instead of developing later. The paper notes that such longitudinal studies are "clearly needed." Mental illness is complicated. While it can clearly be explained scientifically, if the answer were easy, we would have found it by now. With that said, existing treatments have been shown to improve outcomes in double-blind placebo-controlled studies, even if we can't fully explain why, and that is why they are used. There are certainly problems with these treatments: They don't work for many patients and they often have undesirable side effects. But overall, we know that they help people, which is why we use them. There are undoubtedly better treatments out there, but either they haven't been discovered yet or they haven't been proven to help. There is no nefarious motive behind sticking to the status quo. Researchers know that, if they were to publish a paper showing spectacular results from a treatment with few side effects, it would be great for the people they're trying to help, and also for them and their career. Instead, people stick to the status quo because, historically, alternative treatments have not been as effective.

tcj_phx 10y ago
What is your motivation for defending the status quo? My goal for posting was to point out that existing mental health treatments don't work, and that there are promising developments that point to a better model. I didn't share all my references. > There are undoubtedly better treatments out there, but either they haven't been discovered yet or they haven't been proven to help. Antipsychotics have been shown again and again to be ineffective over the long term: http://www.madinamerica.com/wp-content/uploads/2016/07/The-Case-Against-Antipsychotics.pdf http://www.madinamerica.com/wp-content/uploads/2016/07/The-C... > There is no nefarious motive behind sticking to the status quo. Just inertia and institutional retardation.
- simonster 10y ago
  > What is your motivation for defending the status quo? My goal for posting was to point out that existing mental health treatments don't work, and that there are promising developments that point to a better model. I didn't share all my references. My goal is to provide an opinion that balances yours, because there are likely many people in your situation, and I don't think they should give up on existing treatments quite so quickly. I know how it feels to see someone you know and love afflicted by mental illness, and I also know how, if treatment as usual doesn't work, it feels like there must be something out there that can help them if you can only find it. But I'm also a neuroscientist (albeit in a subfield without any connection to the study of mental illness) and I know that scientists really do the best they can, and are generally willing to pursue any route if they think it might lead to a better understanding of their subject of study, or, in the case of mental illness, a treatment that can work better than what's out there today. > Antipsychotics have been shown again and again to be ineffective over the long term: I am not qualified to assess this evidence, since I don't have an extensive knowledge of this field nor the time to acquire that knowledge, but here is a Cochrane review incorporating 65 RCTs that shows antipsychotics are effective for maintenance: http://www.cochrane.org/CD008016/SCHIZ_maintenance-treatment-with-antipsychotic-drugs-for-schizophrenia http://www.cochrane.org/CD008016/SCHIZ_maintenance-treatment... It is true that the reduction in the risk of relapse appears to decrease with the duration of the study, which is definitely a disquieting finding and deserves further study, but there was still a reduction in risk in the longest study included (3 years).
  - tcj_phx 10y ago
    I know scientists mean well, but there is something rotten at the core of conventional psychiatric practice. Sometimes people are helped, but there's a lot of "if at first you don't succeed, try, try again," where the psychiatrists try pill after pill on their patients, trying to find something that works, or helps a little. W.C. Fields' advice was "... try, try again. Then quit. There's no point in being a damn fool about it." [1] [1] http://www.quotecounterquote.com/2014/04/if-at-first-you-dont-succeed.html http://www.quotecounterquote.com/2014/04/if-at-first-you-don... What my girlfriend needed was sobriety, but none of her psychiatrists has been willing to give her time. They're just being 'damned fools'. "The Case Against Antipsychotics" (linked in my earlier comment) tells of an approach called "Open Dialogue Therapy", which was developed in Finland in the 1990's (pg 33). They avoid jumping straight to medications. Most "psychotic" patients do just fine when given a supportive environment and adequate time. I'm going back to the courts soon to ask them to protect my friend from her court-ordered medical practitioners. One of my points is that they never gave her a chance to demonstrate that the drugs were unnecessary. She escaped from her court-ordered sedation, briefly, and started to do better... She couldn't handle the stress of her new job, did NOT take a good lunch on her second day, and resumed drinking. There are some good drugs that would have been helpful for keeping her off alcohol (naltrexone, etc), but at her next appointment all she got was the SSRI she asked for. She thought this "anti-depressant" had helped years before, but really it just helped her relapse (then). This time the SSRI and the benzodiazepine caused her to 'fall apart', relapse, get arrested...

tcj_phx 10y ago

What is your motivation for defending the status quo? My goal for posting was to point out that existing mental health treatments don't work, and that there are promising developments that point to a better model. I didn't share all my references. > There are undoubtedly better treatments out there, but either they haven't been discovered yet or they haven't been proven to help. Antipsychotics have been shown again and again to be ineffective over the long term: http://www.madinamerica.com/wp-content/uploads/2016/07/The-Case-Against-Antipsychotics.pdf http://www.madinamerica.com/wp-content/uploads/2016/07/The-C... > There is no nefarious motive behind sticking to the status quo. Just inertia and institutional retardation.

simonster 10y ago
> What is your motivation for defending the status quo? My goal for posting was to point out that existing mental health treatments don't work, and that there are promising developments that point to a better model. I didn't share all my references. My goal is to provide an opinion that balances yours, because there are likely many people in your situation, and I don't think they should give up on existing treatments quite so quickly. I know how it feels to see someone you know and love afflicted by mental illness, and I also know how, if treatment as usual doesn't work, it feels like there must be something out there that can help them if you can only find it. But I'm also a neuroscientist (albeit in a subfield without any connection to the study of mental illness) and I know that scientists really do the best they can, and are generally willing to pursue any route if they think it might lead to a better understanding of their subject of study, or, in the case of mental illness, a treatment that can work better than what's out there today. > Antipsychotics have been shown again and again to be ineffective over the long term: I am not qualified to assess this evidence, since I don't have an extensive knowledge of this field nor the time to acquire that knowledge, but here is a Cochrane review incorporating 65 RCTs that shows antipsychotics are effective for maintenance: http://www.cochrane.org/CD008016/SCHIZ_maintenance-treatment-with-antipsychotic-drugs-for-schizophrenia http://www.cochrane.org/CD008016/SCHIZ_maintenance-treatment... It is true that the reduction in the risk of relapse appears to decrease with the duration of the study, which is definitely a disquieting finding and deserves further study, but there was still a reduction in risk in the longest study included (3 years).
- tcj_phx 10y ago
  I know scientists mean well, but there is something rotten at the core of conventional psychiatric practice. Sometimes people are helped, but there's a lot of "if at first you don't succeed, try, try again," where the psychiatrists try pill after pill on their patients, trying to find something that works, or helps a little. W.C. Fields' advice was "... try, try again. Then quit. There's no point in being a damn fool about it." [1] [1] http://www.quotecounterquote.com/2014/04/if-at-first-you-dont-succeed.html http://www.quotecounterquote.com/2014/04/if-at-first-you-don... What my girlfriend needed was sobriety, but none of her psychiatrists has been willing to give her time. They're just being 'damned fools'. "The Case Against Antipsychotics" (linked in my earlier comment) tells of an approach called "Open Dialogue Therapy", which was developed in Finland in the 1990's (pg 33). They avoid jumping straight to medications. Most "psychotic" patients do just fine when given a supportive environment and adequate time. I'm going back to the courts soon to ask them to protect my friend from her court-ordered medical practitioners. One of my points is that they never gave her a chance to demonstrate that the drugs were unnecessary. She escaped from her court-ordered sedation, briefly, and started to do better... She couldn't handle the stress of her new job, did NOT take a good lunch on her second day, and resumed drinking. There are some good drugs that would have been helpful for keeping her off alcohol (naltrexone, etc), but at her next appointment all she got was the SSRI she asked for. She thought this "anti-depressant" had helped years before, but really it just helped her relapse (then). This time the SSRI and the benzodiazepine caused her to 'fall apart', relapse, get arrested...