Posts tagged psychotic
Posts tagged psychotic
These dangerous medications are prescribed at an alarming rate without the patient’s consent
When Patricia Thomas, 79, went into a Ventura, Calif.,nursing home with a broken pelvis, the only prescriptions she used were for blood pressure and cholesterol, and an inhaler for her pulmonary disease. By the time she was discharged 18 days later, she “wasn’t my mother anymore,” says Kathi Levine, 57, of Carpinteria, Calif. “She was withdrawn, slumped in a wheelchair with her head down, chewing on her hand, her speech garbled.” Within weeks, she was dead.
Thomas, a former executive assistant, had been given so many heavy-duty medications, including illegally administered antipsychotics, by the Ventura Convalescent Hospital in November of 2010 that she could no longer function. If one drug caused sleeplessness and anxiety, she was given a different medication to counteract those side effects. If yet another drug induced agitation or the urge to constantly move, she was medicated again for that.
"Yes, my mom had Alzheimer’s, but she wasn’t out of it when she went into the nursing home. She could dress and feed herself, walk on her own. You could have a conversation with her,” says Levine. “My mother went into Ventura for physical therapy. Instead, she was drugged up to make her submissive. I believe that my mother died because profit and greed were more important than people.”
A Ventura County Superior Court judge agreed that Levine had a legitimate complaint against the nursing home. In May, attorneys from the law firm Johnson Moore in Thousand Oaks, Calif., joined by lawyers from AARP Foundation, agreed to a settlement in an unprecedented class-action suit against the facility for using powerful and dangerous drugs without the informed consent of residents or family members. “It is the first case of its kind in the country, and hopefully we can replicate this nationwide,” says attorney Kelly Bagby, senior counsel for AARP Foundation Litigation.
A national problem
Tragically, what happened to Patricia Thomas is not an isolated incident. According to Charlene Harrington, professor of nursing and sociology at the University of California, San Francisco, as many as 1 in 5 patients in the nation’s 15,500 nursing homes are given antipsychotic drugs that are not only unnecessary, but also extremely dangerous for older patients. The problem, experts say, stems from inadequate training and chronic understaffing, as well as an aggressive push by pharmaceutical companies to market their products.
"The misuse of antipsychotic drugs as chemical restraints is one of the most common and long-standing, but preventable, practices causing serious harm to nursing home residents today," says Toby Edelman, an attorney at the Center for Medicare Advocacy in Washington, D.C. "When nursing facilities divert funds from the care of residents to corporate overhead and profits, the human toll is enormous."
Kickbacks to doctors
Last November, in what the U.S. Department of Justice called “one of the largest health care fraud settlements in U.S. history,” Johnson & Johnson and its subsidiaries were fined more than $2.2 billion to resolve criminal and civil charges because of their aggressive marketing of drugs, including antipsychotics, to nursing homes, when they knew the drugs had not been approved by the U.S. Food and Drug Administration (FDA) as safe and effective for a general elderly population. The corporation also allegedly paid kickbacks to physicians, as well as to Omnicare, the nation’s largest long-term-care pharmacy provider. Omnicare pharmacists were recommending Johnson & Johnson’s drugs, including the antipsychotic Risperdal, for use by nursing home residents.
Back in 2009, Eli Lilly did the same thing with its antipsychotic Zyprexa, marketing to older people in nursing homes and assisted living facilities, federal prosecutors charged. In a settlement, the company agreed to pay $1.4 billion. “This case should serve as still another warning to all those who break the law in order to improve their profits,” Patrick Doyle, special agent in charge of the Office of Inspector General for the U.S. Department of Health and Human Services in Philadelphia, said at the time.A report released in March by the inspector general of Health and Human Services charged that one-third of Medicare patients in nursing homes suffered harm, much of which was preventable. “Too many nursing homes fail to comply with federal regulations designed to prevent overmedication, giving patients antipsychotic drugs in ways that violate federal standards for unnecessary drug use,” Inspector General Daniel Levinson said. “Government, taxpayers, nursing home residents, as well as their families and caregivers, should be outraged — and seek solutions.”Antipsychotic drugs are intended for people with severe mental illness, such as patients with schizophrenia or bipolar disorder. As such, they carry the FDA’s black-box warning that they are not intended for frail older people or patients with Alzheimer’s or dementia. In those populations, these drugs can trigger agitation, anxiety, confusion, disorientation and even death. “They can dull a patient’s memory, sap their personalities and crush their spirits,” according to a report from the California Advocates for Nursing Home Reform.
Kept in the dark
What’s more, the law requires “informed consent” by a patient or, if that is no longer possible, by his or her family before such drugs are administered. Yet advocates say that, all too frequently, this doesn’t happen. Levine, for example, says she didn’t know about all her mother’s medications until she transferred her mom to another facility. “When I saw the list of what she’d been given, I freaked out. I was upset and angry, in tears,” she recalls.
How can such things happen? One explanation is that many facilities don’t have enough properly trained staff: Most of the patient care in nursing homes falls to certified nursing assistants (CNAs) who need as little as 75 hours of on-the-job training to get certified. “Yet if you want a license to be a hairdresser, you need 1,500 hours of training,” Harrington points out.What’s more, CNAs are paid low wages so many of them work long hours. “They are totally exhausted, with extremely heavy workloads,” she says. That leads to high employee turnover and caregivers who don’t know their patients well enough to recognize their needs.Compounding the problem, many nursing home patients require a high level of care. Some are incontinent, and an estimated 60 to 70 percent have some form of dementia. There should be one CNA for every seven patients, but in some cases, the ratio is 1 to 15 — or even more, Harrington says. There also tend to be too few physicians actually present in nursing homes. “These facilities are highly medicalized, but doctors are rarely there,” says Tony Chicotel, staff attorney for California Advocates for Nursing Home Reform. He says that because of their low rate of reimbursement from Medicare, nursing homes are too often seen as a place where few top doctors practice.The result of all this can be so-called behavior problems among patients — which is the explanation nursing homes cite for giving patients unnecessary antipsychotic drugs, according to the U.S. Centers for Medicare and Medicaid Services (CMS). And pharmaceutical companies have been aggressively marketing their products as an easy and effective way to control these issues.
"There was a push by drug manufacturers, claiming these medications work for seniors when they knew, in fact, that it doubled their risk of death," Chicotel says.
CMS, which oversees the nursing homes that receive funding from federal programs, says it has been working to correct deficiencies in nursing facilities, including the inappropriate use of medications. The agency achieved the goal of reducing the inappropriate use of antipsychotic drugs by 15 percent over a recent two-year period, and hopes to get to a 30 percent reduction in the next few years, according to spokesman Thomas Hamilton. But Edelman points out that initial goal was reached more than a year late, and some 300,000 patients are still receiving the drugs inappropriately. Hamilton acknowledges that more needs to be done, but lack of funding from Congress is making even the most preliminary work difficult.
A better way
Fortunately, a growing number of nursing homes have begun to look for more effective — and more humane — ways to care for patients. Better training for caregivers is key: According to Cheryl Phillips, M.D., a geriatrician at LeadingAge, an organization representing nonprofit services for older people, nursing home staff can be trained to deal with behavior issues thoughtfully and creatively, without resorting to drugs.
She cites an example of a male patient who was spending his days in a noisy nursing home activity room. One day, he grew more and more agitated and tripped an aide with his cane. To calm him down, the staff took him to his private quarters. Over the following days, his behavior in the activity room became increasingly aggressive; he began randomly hitting caregivers and fellow patients. Each time, he was taken away to spend time in his room.
"The staff initially thought he had become violent and needed an antipsychotic," Phillips recalls. "But they ultimately realized that the cacophony in the activity room was stressing him out. Caregivers inadvertently rewarded him by giving him quiet time in his room, which is what he wanted. When they did it repetitively, they reinforced his aggressive behavior." Once the staff discussed the problem and began finding peaceful activities for the patient, the problem was solved — no drugs needed.
Putting patients first
Another success story is the Beatitudes facility in Phoenix, which dramatically changed its way of handling patients with dementia based on Tom Kitwood’s book Dementia Care Reconsidered: The Person Comes First. “What happens here is not for our systems, our convenience, but for the people we care for,” says Tena Alonzo, the director of education and research at Beatitudes. “People with dementia have disturbances in their sleep/wake cycle, so we let them be comfortable and decide when they want to sleep or eat, or not. Or how they want to spend their time,” she says. As a result, patients stop resisting care, and the facility runs more smoothly.
The Beatitudes’ philosophy is now being taught to a growing number of nursing homes around the country. “We’ve created a softer, gentler approach, acknowledging that we are not in charge of a person’s life — they are. In allowing them to retain their dignity, and adopt a comfort level of care, we’ve had better outcomes,” says Alonzo. That paradigm shift has not increased operating expenses, or required a higher staff-to-resident ratio. “We discovered that better care was better business,” Alonzo says.
For Kathi Levine and her mother, these encouraging developments are coming too late. “I want our lawsuits to impact nursing homes all over the country,” Levine says. “We need to protect our family members. They don’t have a voice, they can’t speak for themselves. So we need to speak out for them and help other people know what to look for. I want to make sure that what happened to my family doesn’t happen to anyone else.”
Jan Goodwin is an award-winning author and investigative journalist for national publications.
A damning report has highlighted the sub-standard care provided for schizophrenics.
Treatment delays, a lack of information, poor life expectancy and patchy GP support were condemned in research by mental health charity Sane.
It found that 63 per cent of schizophrenia patients needed five visits to doctors before getting a diagnosis and 58 per cent said they received no information about the illness and how to deal with it.
Marjorie Wallace, Sane’s chief executive, said: “It is still a condition that is feared by everyone from patients to professionals and it is a national shame that we have not improved treatment for people with schizophrenia.
“I feel very sad that I am still hearing the same stories from patients and families that made me set up Sane 25 years ago.” Schizophrenia affects about one in 100 and costs the UK £11.8 billion a year in care and lost production. Life expectancy is 15 to 20 years less than the general population.
The Living with Schizophrenia report, compiled from interviews, accepted that doctors often delayed diagnosis for fear of giving patients a stigma but it added that delays and confusion in treatment strategies caused mistrust among patients and heightened the risk of relapse with lengthy hospital stays.
“Inappropriate treatment has the potential to destabilize a person’s condition further,” the report said. “However, GPs and psychiatrists also have to be cautious when making a diagnosis of schizophrenia.
“Such a diagnosis can often be a very traumatic experience for many and has the potential to generate stigma as well as unwarranted pessimism.
“Our research suggests that more needs to be done to ensure appropriate services are available and people are being referred as early as possible.”
The report called for better and swifter access to psychological services to avoid hospital stays and more support for physical health to correct the life expectancy imbalance.
A controversial peer-reviewed paper published by Springer claims the mental disorder is caused by evil spirits and can be cured by faith healers
Ignoring the long-established biological and environmental causes of schizophrenia, one researcher claims that hallucinations associated with the disorder are actually the result of demonic possession.
Published in the Journal of Religion and Health, Turkish researcher M. Kemal Irmak’s paper “Schizophrenia or Possession?” argues that demons “have the power to possess humans and control their body” and that schizophrenic hallucinations are “a false interpretation of a real sensory image formed by demons.” Based on anecdotal evidence from one man who claims to have expelled “evil demons from many psychiatric patients with the help of good ones,” Irmak concludes that mental health professionals should work together with faith healers to form more holistic treatment options.
The paper has caused ripples within the scientific community and threatens to further tarnish the reputation of the journal’s German publisher, Springer. The company came under fire in February when a researcher discovered that Springer had inadvertently published 18 fake papers that were computer-generated—raising concerns over quality control in their journals.
The following excerpts from Irmak’s paper are equally dubious:
The science site Real Clear Science spoke with Irmack, who admitted that while there is no evidence to support his spurious claims, he believes that our world is indeed inhabited by nefarious spirits. “This is like the argument of creation or evolution. It is a matter of belief and I think the existence of demons cannot be proved by scientific methods,” he said. Irmack added that schizophrenic mathematician John Nash—whose life was chronicled in A Beautiful Mind—is under siege from the spiritual world. “I think the creatures who disturb John Nash are demons.”
Curtis Hart, editor-in-chief of the Journal of Religion and Health and lecturer in public health at Weill Cornell Medical College, told Real Clear Science that he stands behind Irmak’s paper and has no plans to retract it. “The article was published in hopes that it would provoke discussion,” he said. “The journal does not agree that demons are a real entity.”
Hart might see the paper’s inclusion as an interesting way to ignite debate, but his peers in the medical community question if it’s a useful one. Dr. Joshua Kantrowitz, director of Columbia University’s Lieber Schizophrenia Research Clinic, dismisses Irmack’s argument as “pretty unfortunate.”
“With respect, this is a way to attract eyes to their journal and not necessarily a legitimate scientific debate,” he says. “People with schizophrenia are prescribed antipsychotics, and they work for most. As the article correctly cites, they don’t work for everybody, but I think it’s a pretty big leap to jump to the explanation offered. There didn’t seem to be much actual evidence or science behind what the author was saying.”
Moving during childhood linked to increased schizophrenia risk
By Laura Cowen, MedWire
Childhood residential mobility is associated with an increased risk of psychotic disorders, particularly schizophrenia, during adulthood, according to results of a study conducted in Denmark.
Children who move several times and those who move during adolescence may be particularly vulnerable, report Diana Paksarian (National Institute of Mental Health, Bethesda, Maryland, USA) and colleagues in Schizophrenia Bulletin.
The researchers explain that residential mobility during childhood is a potential form of adversity that could impact psychosis risk by disrupting “the continuity of children’s psychosocial contexts, challenging them to navigate new and unfamiliar neighborhoods, schools, and peer groups.”
Using data from the Danish Civil Registration System, the team calculated the number of moves between any of the 276 Danish municipalities during each year from birth to age 15 years for approximately 1.1 million individuals born between 1971 and 1991. The individuals were then followed up from age 15 to development of a psychotic disorder, death, emigration from Denmark, or until December 2010 when they were between 19 and 39 years old.
During the follow-up period there were 7277 cases of narrowly defined schizophrenia, 12,970 of broadly defined schizophrenia and 2841 cases of bipolar disorder. Mobility was highest in the year of birth and declined across childhood.
Paksarian et al found that mobility at all ages except the year of birth was significantly associated with development of narrowly defined schizophrenia. The likelihood of narrowly defined schizophrenia increased with increasing age and number of moves per year, with the highest risk observed among children who moved three or more times when they were aged 14 years (relative risk=3.72 vs those who did not move).
Similar results were observed for broadly defined schizophrenia, but there were fewer associations with bipolar disorder, and these showed less of an increase with age and number of moves.
The researchers note that their findings were not modified by gender, having siblings or distance moved but that there was modest evidence of an interaction with family history of psychiatric diagnosis.
The fact that distance moved did not alter the risk suggests that “both municipality and region changes are proxies for changes of school”, they remark.
Indeed, “[t]he potential importance of school change is consistent with the lower magnitude of associations of mobility in early childhood, before children enter school, and the higher magnitude of associations during adolescence, when peer relationships are especially salient.”
The authors add that it is currently unknown whether their findings reflect causal effects of mobility on the development of psychotic disorders or whether mobility is a marker for other childhood adversities such as parental discord.
HAVE YOU CREATED ART IN OR ABOUT AN EXTREME STATE?
The creators of the Serious Mental Illness blog invite you to submit your visual art, photography, video work, poetry, collage, or short fiction to Art from the Edge. All of the art shown on this flyer has been featured on the blog.
Art from the Edge, a virtual gallery and resource center, is dedicated to art created in and about extreme mental states. It is an open and public world wide forum for artists to share their visual and written works and their personal stories with all those interested in the connection between creativity and “edge” states.
Much like art, which exists in a multitude of mediums and forms of expression, there are a plurality of “edge” states that inspire the artists who harbor them. For this reason, we leave the term completely open to our community’s interpretation, knowing from research and experience that this state could be driven by psychosis or trauma, or an altered state induced by drugs. It could be the offshoot of extreme depression or grief, or the aftermath of a spiritual or mystical state of consciousness.
Ultimately, we are interested in the artist’s individual experience and in his or her sense of what it is that drove the creative act.