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> The most bizarre aspect of mental illness is a few of them can actually be treated by drugs which are a huge blunt instrument It’s never seemed bizarre to me

> The most bizarre aspect of mental illness is a few of them can actually be treated by drugs which are a huge blunt instrument It’s never seemed bizarre to me. You could treat a broken leg using only morphine if you wanted to. The pain will probably go away, but the leg won’t get less broken.

mlyle 7y ago
Pharmaceuticals to treat mental illness are limited, but they're better than just palliative (morphine for a broken leg).
- AmericanChopper 7y ago
  Morphine for a broken leg would be a symptomatic treatment in most cases (unless you were expected to die without recovering from it, then it would be palliative). As far as I can tell most medications for mental illnesses are also symptomatic. If somebody had general anxiety issues, and they started taking benzodiazepines, their anxiety issues would be expected to return if they stopped taking them. Unless they had also undertaken other non-pharmaceutical treatments during that time.
  - mlyle 7y ago
    > unless you were expected to die without recovering from it, then it would be palliative). I understand that palliative care has developed a connotation of "this is what we do for you when you're dying..." but the definition is e.g. palliate verb (used with object), pal·li·at·ed, pal·li·at·ing. to relieve or lessen without curing; mitigate; alleviate.
    - AmericanChopper 7y ago
      Strictly speaking that’s what palliate means, but palliative care almost always refers to symptomatic care for people with life threatening conditions (see the WHO definition[0]). If you look at the way the phrase is most often used in medical literature, you can see it’s qualitatively different from general symptomatic treatment, as the potential side effects are assessed differently. You’d be much less concerned about a patient developing an opioid dependence if they’re terminally ill. For instance the standard[1] from BC describing guidelines for opiate prescriptions states: > This standard does not apply to active cancer care, palliative care, and management of substance use disorders. Physicians are expected to follow relevant clinical guidelines and established best practices in managing patients with these conditions. Nothing in this standard interferes with a physician’s obligation to provide aggressive symptom management to patients with active cancer, or nearing the end of their lives. [0] https://www.who.int/cancer/palliative/definition/en/ https://www.who.int/cancer/palliative/definition/en/ [1] https://www.cpsbc.ca/files/pdf/PSG-Safe-Prescribing.pdf https://www.cpsbc.ca/files/pdf/PSG-Safe-Prescribing.pdf
      - mlyle 7y ago
        Ugh. Semantic arguments. From your link: > is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications. ... https://medlineplus.gov/ency/patientinstructions/000536.htm https://medlineplus.gov/ency/patientinstructions/000536.htm > Palliative care can be given at the same time as treatments meant to cure or treat the disease. Palliative care may be given when the illness is diagnosed, throughout treatment, during follow-up, and at the end of life. https://www.nia.nih.gov/health/what-are-palliative-care-and-hospice-care https://www.nia.nih.gov/health/what-are-palliative-care-and-... > Doctors can provide treatment to seriously ill patients in the hopes of a cure for as long as possible. These patients may also receive medical care for their symptoms, or palliative care, along with curative treatment. But, this is an aside. When we're talking about any given treatment medication / treatment-- it can be a likely cure; it can halt or slow the progression of the disease itself; it can merely provide symptom relief. The latter is often called a palliative.
        AmericanChopper 7y ago
        > it can merely provide symptom relief. The latter is often called a palliative. Because some times it is, but sometimes it isn’t. Which is why the document I linked detailing prescription guidelines for opioids (medicines which exclusively treat symptoms), specifically states that the guidelines do not apply to palliative care. If all treatment of symptoms was palliative treatment, then that standard would never apply in any situation.
- shkkmo 7y ago
  If you have to keep taking something, the treatment is palliative and not curative. If treatments are applied based on symptoms rather than an understanding of the cause, they also tend to be palliative.
  - mannykannot 7y ago
    Palliative's primary meaning is to treat or mask symptoms rather than the disease itself, and it has nothing to do with duration. Current antiretroviral therapy for HIV is for life, as far as we know, but this does actually treat the disease itself by controlling the virus. Painkillers for a broken leg are generally only needed until it heals, but they are not causal in that healing, and are properly called palliative. One cannot make a case that any given treatment for mental illness is merely palliative on the basis of duration. Lifelong treatments are indeed not curative, but they are better than palliative care, which is better than nothing.

mlyle 7y ago

Pharmaceuticals to treat mental illness are limited, but they're better than just palliative (morphine for a broken leg).

AmericanChopper 7y ago
Morphine for a broken leg would be a symptomatic treatment in most cases (unless you were expected to die without recovering from it, then it would be palliative). As far as I can tell most medications for mental illnesses are also symptomatic. If somebody had general anxiety issues, and they started taking benzodiazepines, their anxiety issues would be expected to return if they stopped taking them. Unless they had also undertaken other non-pharmaceutical treatments during that time.
- mlyle 7y ago
  > unless you were expected to die without recovering from it, then it would be palliative). I understand that palliative care has developed a connotation of "this is what we do for you when you're dying..." but the definition is e.g. palliate verb (used with object), pal·li·at·ed, pal·li·at·ing. to relieve or lessen without curing; mitigate; alleviate.
  - AmericanChopper 7y ago
    Strictly speaking that’s what palliate means, but palliative care almost always refers to symptomatic care for people with life threatening conditions (see the WHO definition[0]). If you look at the way the phrase is most often used in medical literature, you can see it’s qualitatively different from general symptomatic treatment, as the potential side effects are assessed differently. You’d be much less concerned about a patient developing an opioid dependence if they’re terminally ill. For instance the standard[1] from BC describing guidelines for opiate prescriptions states: > This standard does not apply to active cancer care, palliative care, and management of substance use disorders. Physicians are expected to follow relevant clinical guidelines and established best practices in managing patients with these conditions. Nothing in this standard interferes with a physician’s obligation to provide aggressive symptom management to patients with active cancer, or nearing the end of their lives. [0] https://www.who.int/cancer/palliative/definition/en/ https://www.who.int/cancer/palliative/definition/en/ [1] https://www.cpsbc.ca/files/pdf/PSG-Safe-Prescribing.pdf https://www.cpsbc.ca/files/pdf/PSG-Safe-Prescribing.pdf
    - mlyle 7y ago
      Ugh. Semantic arguments. From your link: > is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications. ... https://medlineplus.gov/ency/patientinstructions/000536.htm https://medlineplus.gov/ency/patientinstructions/000536.htm > Palliative care can be given at the same time as treatments meant to cure or treat the disease. Palliative care may be given when the illness is diagnosed, throughout treatment, during follow-up, and at the end of life. https://www.nia.nih.gov/health/what-are-palliative-care-and-hospice-care https://www.nia.nih.gov/health/what-are-palliative-care-and-... > Doctors can provide treatment to seriously ill patients in the hopes of a cure for as long as possible. These patients may also receive medical care for their symptoms, or palliative care, along with curative treatment. But, this is an aside. When we're talking about any given treatment medication / treatment-- it can be a likely cure; it can halt or slow the progression of the disease itself; it can merely provide symptom relief. The latter is often called a palliative.
      - AmericanChopper 7y ago
        > it can merely provide symptom relief. The latter is often called a palliative. Because some times it is, but sometimes it isn’t. Which is why the document I linked detailing prescription guidelines for opioids (medicines which exclusively treat symptoms), specifically states that the guidelines do not apply to palliative care. If all treatment of symptoms was palliative treatment, then that standard would never apply in any situation.
shkkmo 7y ago
If you have to keep taking something, the treatment is palliative and not curative. If treatments are applied based on symptoms rather than an understanding of the cause, they also tend to be palliative.
- mannykannot 7y ago
  Palliative's primary meaning is to treat or mask symptoms rather than the disease itself, and it has nothing to do with duration. Current antiretroviral therapy for HIV is for life, as far as we know, but this does actually treat the disease itself by controlling the virus. Painkillers for a broken leg are generally only needed until it heals, but they are not causal in that healing, and are properly called palliative. One cannot make a case that any given treatment for mental illness is merely palliative on the basis of duration. Lifelong treatments are indeed not curative, but they are better than palliative care, which is better than nothing.