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Schizophrenia drugs may have been off target for decades, study finds

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Re: Schizophrenia drugs may have been off target for decades, study finds

#121

Post by wheelerof4te »

cwsx wrote: post #114
wheelerof4te wrote: post #59

Earlier quoted context omitted.

"Or is schizophrenia a spectrum very much alike as autism?" It is exactly that. There are a lot of people with pcychosis-related symptoms who go about their lives without treatment. They experience attacks once in a blue moon, but that is just about it. A few calming words or moments alone help.

Adding to this, I've experienced a few psychotic episodes but am not (for now) diagnosed schizophrenic. Even during my first episode, which was by far my worst while having the least experience, I was aware that what I was experiencing (hearing voices/feeling watched) was likely me experiencing psychosis. While I still 'went along' with the episode, I was doing everything in a way that minimised harm to myself and ot…

Thanks for sharing your experience.

I remmember hearing voices a few times, but they would not last more than a day.

They were telling me to reach out to one person (that would be awkward at the time) or to harm someone close. I've felt fear but knew those voices weren't real.

The voice sounded like me talking to myself.

Re: Schizophrenia drugs may have been off target for decades, study finds

#122

Post by Lutger »

whats_a_quasar wrote: post #5

The brain is really complicated, and all psychiatric medications affect multiple receptors and subsystems. Framing this study as "antipsychotics were off target" is an editorial choice. The title could just as easily have been "Improved understanding of antipsychotic action means we may be able to design better antipsychotics." Edit: It also ought to be noted that the study was on mice that had been given amphetamine…

This media story isn't 'in the tradition' of vocally disliking psychiatric medication. You could twist the headline to be, possibly. Have you read the article itself? Its the complete opposite.

The headline is a bit attention grabby perhaps (and of course, that is what a headline must do), but I wouldn't even call it clickbait. It is even fairly accurate. Yes, they were likely off target with the specific neuroreceptors, no that doesn't mean the medication didn't work and of course, this is a positive development for designing better medication. This is classic storytelling, draw the reader in with some conflict and save the resolution for the end.

We need to be able to discuss negatives and limitations associated with psychiatric medication in an honest and nuanced way. They often don't work well enough, there are costs associated and just giving somebody a pill and be done with it is hopelessly inadequate to the point of negligence.

As someone who did experience uncontrolled psychosis myself, let me tell you the absolute taboo of discussing these matters made me way more uncomfortable than the side effects. Furthermore, psychiatry made me feel like a diseased animal at times, not to be taken very seriously and just put on drugs for life to be on the safe side. In hindsight I do appreciate how difficult that line of work is, doesn't change my experience.

I am not against medication really, actually I think they are a must-have. I just think most anti-medication people are not really rallying against the side effects or at least not initially, but grew opposition out of bad experiences with treatment that focuses only on medication and was just very inadequate. Medication is what represents that. Additionally, medication can come to represent your loss of sanity and with that, you fundamental not-belonging to the group of 'normal people'. Thus the desire to not be on meds 'for life'. Haven't spoken to a single therapist or psychiatrist who made me feel that was a legitimate desire and who understood that. Maybe things have changed, this was a long time ago.

To deal with the resentment against meds, I think it is way more effective to address those concerns directly and without fear, rather than putting down everything that might be interpreted as negative about medication.

Like you say, without experience yourself, you have no idea how bad psychosis can get. It is a really complex thing and you will need much, much more than pills. And not only for the psychotic episodes, because these experiences tear at your identity as a human being. It isn't over when the psychosis is over.

Re: Schizophrenia drugs may have been off target for decades, study finds

#123

Post by MichaelZuo »

aatd86 wrote: post #119
MichaelZuo wrote: post #118

Earlier quoted context omitted.

> Maybe it's my fault for not being specific but in context, I was talking about long-term, possibly irreversible complications. How is significantly increased rate of dementia among the affected population not long-term? It seems irreversible too?

It clearly says that the link has not been established and that it is a risk. Not only that, it's more of a risk in older patients. There is no formal causality link here. Unless you can find other studies. And even then, methodology matters. There is a realm of difference between that and the type of side-effects that were the subject of the initial conversation, to the point that I'd be tempted to say it is a red-h…

I'm fairly certain it's possible to discuss the possibility and likelihood of things in the medial context without there being a 'formal causality link'.

From a random sample of HN user's comments in the last year in some context or another this is a well established usage in a supermajority of them. So if you must insist on it, you likely will always be outvoted, at least with other HN users.

Re: Schizophrenia drugs may have been off target for decades, study finds

#124

Post by cwsx »

wheelerof4te wrote: post #121
cwsx wrote: post #114

Earlier quoted context omitted.

Adding to this, I've experienced a few psychotic episodes but am not (for now) diagnosed schizophrenic. Even during my first episode, which was by far my worst while having the least experience, I was aware that what I was experiencing (hearing voices/feeling watched) was likely me experiencing psychosis. While I still 'went along' with the episode, I was doing everything in a way that minimised harm to myself and ot…

Thanks for sharing your experience. I remmember hearing voices a few times, but they would not last more than a day. They were telling me to reach out to one person (that would be awkward at the time) or to harm someone close. I've felt fear but knew those voices weren't real. The voice sounded like me talking to myself.

Normally mine last 2 - 3 days, with maybe a couple days of ramp up. These ones sound very real, exactly like the voice of a friend or relative etc. The thing that makes them especially feel real, the voices always have some 'spatial' element to them, like I'm overhearing a conversation from the other room. They also get quieter (or disappear entirely) if I walk away from the source.

The other form of voices I get, which are much more frequent + longer lasting, sound like my internal monologue. They can be different voices, but always sound like I'm 'thinking' them (rather than overhearing). These tend to last 2~ weeks after an episode, and come back when my anxiety or insomnia gets worse. Luckily these are pretty ignorable, if not a helpful sign that I'm nearing an episode. I'd compare them to anxious/intrusive thoughts (though a bit more intense).

I haven't had an episode in almost a year and have learnt to easily manage the intrusive thoughts (/possible start of an episode). This hasn't even impacted my lifestyle all that much, if anything it's taught me to manage my work/life balance.

Re: Schizophrenia drugs may have been off target for decades, study finds

#125

Post by Lutger »

Broken_Hippo wrote: post #9
whats_a_quasar wrote: post #5

The brain is really complicated, and all psychiatric medications affect multiple receptors and subsystems. Framing this study as "antipsychotics were off target" is an editorial choice. The title could just as easily have been "Improved understanding of antipsychotic action means we may be able to design better antipsychotics." Edit: It also ought to be noted that the study was on mice that had been given amphetamine…

The story could just as easily be "Improved understanding of antipsychotic action means we may be able to design better antipsychotics" And that would be a more accurate understanding of it - and I hope its true. Current antipsychotics are helpful but imperfect.

You'll be positively surprised to read the conclusion of the article then:

"The findings also offer a glimmer of hope that researchers can correct course and use these new insights to design much-improved treatments for schizophrenia. Treatments that can't come soon enough."

Close enough, right?

Journalists know how to write headlines that make people read the article, or at least some people. They are little dramas, and if you start by giving the plot away like that, as if you just simplified a scientific paper a bit, your analytics will tell you to look for a different job soon. It is what it is. So no, it couldn't 'just as easily' be this alternative thing if it wants to get attention.

And I don't think this is always a bad thing. It only gets bad if the headline is overly editorializing, clickbait or just plain false. I don't think it is in this case.

Re: Schizophrenia drugs may have been off target for decades, study finds

#126

Post by throwaway60707 »

atchoo wrote: post #89
throwaway60707 wrote: post #17

Earlier quoted context omitted.

You sure? Schizophrenia is directly linked to dopamine. So is ADHD, but in the opposite way (not enough dopamine). Both were demonstrated on fMRI. Psychosis is a physical issue in the brain (too much dopamine making the brain fire when it shouldn't) that's solved by administering dopamine antagonists (= antipsychotics).

There is little surprise that if a brain is behaving differently, that we can see differences in neurotransmitters. Like the Serotonin Hypothesis, that doesn't mean the neurotransmitters themselves are part of the physical cause and not just a consequence. It's like trying to diagnose and treat a political crisis by observing telephone connections. We see stark changes in telephone use in a crisis. If we meddle with…

Well, sure. I guess nobody thinks that the dopamine just appears/disappears by itself. Of course there is an underlying structural cause.

But currently we're unable to image live people at that resolution, not even dead people yet.

Re: Schizophrenia drugs may have been off target for decades, study finds

#127

Post by aatd86 »

MichaelZuo wrote: post #123
aatd86 wrote: post #119

Earlier quoted context omitted.

It clearly says that the link has not been established and that it is a risk. Not only that, it's more of a risk in older patients. There is no formal causality link here. Unless you can find other studies. And even then, methodology matters. There is a realm of difference between that and the type of side-effects that were the subject of the initial conversation, to the point that I'd be tempted to say it is a red-h…

I'm fairly certain it's possible to discuss the possibility and likelihood of things in the medial context without there being a 'formal causality link'. From a random sample of HN user's comments in the last year in some context or another this is a well established usage in a supermajority of them. So if you must insist on it, you likely will always be outvoted, at least with other HN users.

I don't understand what you mean respectfully.

If it's about statistics and sampling methodology, I am afraid we are veering toward being quite off-topic.

I'll say that my comment was toward paying attention to the different kind of study methodologies, such as metanalysis vs randomized controlled trials and even within the latter, there are differences in qualities depending on how the control group is ensured. As opposed to experimental groups as well.

Then of course sample size.

All that because cross-correlations are possible and correlation is not causation in general.

So yeah, in the end one can ask on hackernews but that will not be statistically relevant. Worse there is the bias that people who have undergone such procedures without issue won't report most likely. So really that's not a way to collect scientific evidence.

Re: Schizophrenia drugs may have been off target for decades, study finds

#128

Post by FollowingTheDao »

Dylan16807 wrote: post #120
FollowingTheDao wrote: post #113

Earlier quoted context omitted.

Seriously? https://www.nature.com/articles/s41398-023-02445-y Here are the plurals…. https://scholar.google.com/scholar?as_ylo=2019&q=immune+syst...

"The role of immune dysfunction in BD is currently unclear, with low-grade chronic inflammation (increased plasma cytokines, soluble cytokine receptors, chemokines, acute phase reactants) and T-cell activation features that may be associated with BD, but the results are controversial" If this is your best citation, then I don't know why you expect everyone to know about and be confident in this theory. And that's wit…

Sorry, wrong link.

https://www.cell.com/neuron/pdf/S0896-6273(20)30431-1.pdf

“It is now well established that dysregu- lation of both the innate and adaptive immune systems occur in depressed patients and hinder favorable prognosis, including antidepressant responses.”

Re: Schizophrenia drugs may have been off target for decades, study finds

#129

Post by P_I_Staker »

strken wrote: post #108
P_I_Staker wrote: post #87

Earlier quoted context omitted.

I don't think you read my comment. This issue is actually highly contentious. If a remedy consistently has poor results, it's a bad remedy. Simply saying "it works for the ones that are righteous" is absurd. If you break it down that's generally what people are saying, but usually use words like lazy, stupid, crazy, addict, etc. If most patients can't or won't follow a treatment maybe it doesn't work so well. > Might…

The issue of entire treatment plans not working when the patient is unable to follow them might be contentious, but whether the medication works when taken isn't, and that was the topic being discussed. Convincing people to agree to treatment that's in their own interests is fascinating and raises moral questions, but is also completely irrelevant.

> but whether the medication works when taken isn't

But this is irrelevant, arguably. It doesn't work if you don't take it. People don't take it if it's a bad medicine. In which case, I think it's fair to say "this is a bad medicine that doesn't work"

I know many people feel otherwise, but I'm baffled as to why... btw, many doctors agree with me. IMO they're ahead of the curve on this issue.

> and that was the topic being discussed.

No, that's not the topic being discussed. I'm talking about whether this entire way of thinking makes any sense (it doesn't).

That's especially true when there's real reasons these treatments fail. That makes them bad. That makes them "not work".

It's totally reasonable to question the entire way of thinking. This is happening with obesity and drug abuse, also. Is there any point we'll put our biases down and stop blaming the patient for our failings.

Also, I'm a little shocked that you think you can dictate what we're talking about. In any discussion these topics are always negotiable. Things that you feel are irrelevant, may not be.

It's fair to argue against the entire way of thinking, and how we should be interpreting a concept like "a medicine working". You can try to reframe, but I'm always going to take issue with this assumption that patient behavior is irrelevant to the concept of a medicine working.

This is also an issue because this whole "they were fine until they decided to be stupid and stop taking their meds for no reason" stereotype hurts people, especially when you pretend that their negative experiences are "irrelevant"

> Convincing people to agree to treatment that's in their own interests is fascinating and raises moral questions, but is also completely irrelevant.

I never mentioned this, it's a total strawman. I also question your assumption that it's in their own interest, which you are very ill equipped to judge. Please remember all the times in history we did horrible things because we thought we knew someone's best interests better than them.

I think I'm being more reasonable than you're giving me credit for, and you should consider these ideas further, instead of being so dismissive.

Re: Schizophrenia drugs may have been off target for decades, study finds

#130

Post by Dylan16807 »

FollowingTheDao wrote: post #128
Dylan16807 wrote: post #120

Earlier quoted context omitted.

"The role of immune dysfunction in BD is currently unclear, with low-grade chronic inflammation (increased plasma cytokines, soluble cytokine receptors, chemokines, acute phase reactants) and T-cell activation features that may be associated with BD, but the results are controversial" If this is your best citation, then I don't know why you expect everyone to know about and be confident in this theory. And that's wit…

Sorry, wrong link. https://www.cell.com/neuron/pdf/S0896-6273(20)30431-1.pdf “It is now well established that dysregu- lation of both the innate and adaptive immune systems occur in depressed patients and hinder favorable prognosis, including antidepressant responses.”

That sounds like evidence it's an important factor in treatment, but it doesn't mean we can be confident it's the cause.
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