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Phony diagnoses hide high rates of drugging at nursing homes

nytimes.com

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Re: Phony diagnoses hide high rates of drugging at nursing homes

#281

Post by EMM_386 »

lotsofpulp wrote: post #96
matheusmoreira wrote: post #86

Earlier quoted context omitted.

Yeah, I've read some incredible stories. Locking the doors behind the patient. Using some tiny remark as cause for involuntary institutionalization. It made me think american psychiatry was like american prisons where they get paid per person and are therefore incentivized to stuff as many people in the building as possible.

All the while I can drive 15 min and find thousands of obviously mentally ill people in need of involuntary mental health treatment (the type perhaps not even available at this point in the US) wandering around and the police cannot do anything about it because their only avenue for detaining them is to wait until they catch them committing a crime. And even then they are shortly released onto their own recognizance…

> All the while I can drive 15 min and find thousands of obviously mentally ill people in need of involuntary mental health treatment. because their only avenue for detaining them is to wait until they catch them committing a crime.

Let's say you were wandering the streets of a major city, looking very odd to everyone else and muttering to yourself (likely someone you'd see on a drive who is "obviously mentally ill"), but otherwise very happy and not breaking any laws, would you want the police to be able to snatch you off the street and involuntarily lock you away?

Likely not, and this is why the laws in some countries like the US are the way they are.

Re: Phony diagnoses hide high rates of drugging at nursing homes

#282

Post by EMM_386 »

> “People don’t just wake up with schizophrenia when they are elderly,” said Dr. Michael Wasserman, a geriatrician and former nursing home executive who has become a critic of the industry. “It’s used to skirt the rules.”

What will likely happen is that they will simply approve Haldol for additional uses, such as the cases where elderly are hallucinating and highly agitated due to the effects of Alzheimers. Then doctors won't be use the schizophrenia diagnosis, they will diagnose "Alzheimers-induced psychosis" instead.

The effects can be remarkably similar, which is one reason this may be occurring and not just staff shortages or cost cutting.

I am not taking sides on this, but there would be no uproar if Haldol was on-label for late-stage symptoms of Alzheimers. It would just be another medication used to help ease symptoms. I'd be curious if manufacturers are trying this route.

If I was in this terrible situation I'd probably want the Haldol but that's just me.

Re: Phony diagnoses hide high rates of drugging at nursing homes

#283

Post by rejectfinite »

hnuser123456 wrote: post #151
kbenson wrote: post #142

Earlier quoted context omitted.

> it's an open secret in that industry that Ritalin and other behavioural drugs are administered for the benefit of the teacher and other students in the class - not necessarily for the child receiving it. Not necessarily does not mean never, so be careful of a claim like that, and maybe back it up. I have a daughter, now an adult, which Ritalin and/or Adderall provided real benefit. The only thing in question was ho…

In my case, it "worked" by making me far more anxious of failure and the judgement of others. For 8 years. I had never previously had suicidal thoughts but I did less than a year after starting the "meds." Then I got in trouble for discussing suicide with another student. The whole situation is more hellishly dystopian than a grimdark fiction writer could imagine. It's no mystery why gen Z are often aggressive doomer…

>The whole situation is more hellishly dystopian than a grimdark fiction writer could imagine. It's no mystery why gen Z are often aggressive doomers.

Ah yes gen z are the only ones... the only ones to be sad and mad. Never mind the generation having to be drafted and die in Vietnam. Never mind the generation having to fight in WW2. Never mind the generation having to take care of your ass.

I had breakdowns from social anxiety everyday in 7th grade in 2003. I got nothing. I would have rather have drugs.

the zoom zoom is showing. Go to bed please its past your bedtime.

Re: Phony diagnoses hide high rates of drugging at nursing homes

#284

Post by adamcharnock »

glangdale wrote: post #213
crunchytartar wrote: post #201

Earlier quoted context omitted.

> That's 24 hour home care - and it's not cheap Why don't they just eat cake? This is the good end of the spectrum. The other end is that the patient lives alone, soils his clothes and doesn't change them for months/ gets lost and becomes homeless, gets infected and dies an animals death. Most of the patients live closer to the bad end.

Two points. First of all, a lot of the grandiose claims here about how "if I was demented I would just get myself put down" are coming from tech people who could afford this end of the spectrum. Second, 24 hour home care - or 'family care plus a certain amount of professional relief' is, while expensive, not much more expensive than medicalized fulltime care in a lot of facilities. You're not paying the overheads of…

You’re mention of HN(/tech) people got me thinking about the difference between the experiencing self and the remembering self.

I can illustrate it as follows: You can go on a wonderful free holiday for two weeks, but the deal is you will not be able to remember it. Do you want to go?

Some people will say no. After all, if they cannot remember it then it is just loosing two weeks. These people prioritise the remembering self.

But some people will say yes, because woohoo it’s a holiday! It’ll be fun in the moment. These people prioritise the experiencing self.

I think this is a really interesting concept by itself.

In the case of tech people, I suspect they are mostly in the first category. So they are more in the ‘if I cannot remember anything then put me out of my misery. I essentially don’t have a self anymore.’

But I wonder if people in the second category will be of the mindset, ‘well, I’ll still have good days, which I guess I’ll enjoy at the time’

Re: Phony diagnoses hide high rates of drugging at nursing homes

#285

Post by fires10 »

pottertheotter wrote: post #223
BingoAhoy wrote: post #32

Phony Diagnoses not just at nursing homes, also in mental facilities. Was really surprised (better word-traumatized) that one flippant casual mention of not valuing my life in a private text message was enough to to get me detained by police in a facility for a night. "Doctor" threatened me with drugging just because I refused to answer some of their questions and instead insisted on a lawyer. Funny how freedoms can…

I picked up my wife yesterday after a 72 hour hold at an in-patient center. I’m so glad that she legally had to be there. She tried to commit suicide Sunday night and spent Monday and Tuesday in the ER. It’s been a horrible week for all of us. The behavioral health place she was at was not perfect, but she would not be where she is right now if it weren’t for her having to be there. For years I have told myself that…

There are times when getting someone on a 72 hour hold has been too difficult. I have been in situations where getting a 72 hour hold was necessary but was not possible. I'm glad it worked out for you. I can see both sides of it. I wish I knew a good solution.

Re: Phony diagnoses hide high rates of drugging at nursing homes

#286

Post by Ekaros »

jgeada wrote: post #167
AussieWog93 wrote: post #113

Earlier quoted context omitted.

>Phony Diagnoses not just at nursing homes, also in mental facilities. Schools too. My mum spent two decades as a primary schol teacher, and it's an open secret in that industry that Ritalin and other behavioural drugs are, at least in some cases, administered for the benefit of the teacher and other students in the class - not necessarily for the child receiving it.

Because that child with behavioral issues is sharing a classroom with 10 to 20 other children. It has never been fair to everyone else to put up with the issues on the one. In more brutal prior days, they'd be expelled and become the parent's problem. Now, they get medicated into compliance. It isn't fair to anyone, neither that child nor the others, that they get streamed in with everyone and everyone has to figure…

Maybe that is one place were we could spend more resources. Even if separating them from other kinds might sound wrong. It might be for best. That is move them to smaller groups with specialised teachers who have adequate support in place.

It is harsh, but clearly trying to integrate all of them to general population is not working for anyone, but administrators...

Re: Phony diagnoses hide high rates of drugging at nursing homes

#287

Post by matheusmoreira »

SkyPuncher wrote: post #99
matheusmoreira wrote: post #86

Earlier quoted context omitted.

Yeah, I've read some incredible stories. Locking the doors behind the patient. Using some tiny remark as cause for involuntary institutionalization. It made me think american psychiatry was like american prisons where they get paid per person and are therefore incentivized to stuff as many people in the building as possible.

It's less about pay and more about liability. Mental health is terrified that someone will do something to harm themselves. The incentive systems have yet to realize that there needs to be some balance in bad outcomes to support the good ones. It results in a system where any mention of self-harm is taken extremely seriously, even at the cost of a larger treatment plan.

> Mental health is terrified that someone will do something to harm themselves.

I can understand that but involuntary institutionalization should be implemented only if there's an immediate danger to someone's life.

A currently euthymic person mentioning casually there were times they wished they were dead is not cause for institutionalization.

A depressed person who not only thinks about taking their own life but has made plans for it and has the means to execute that plan is in great danger and in need of immediate help.

Re: Phony diagnoses hide high rates of drugging at nursing homes

#288

Post by fit2rule »

BingoAhoy wrote: post #32

Phony Diagnoses not just at nursing homes, also in mental facilities. Was really surprised (better word-traumatized) that one flippant casual mention of not valuing my life in a private text message was enough to to get me detained by police in a facility for a night. "Doctor" threatened me with drugging just because I refused to answer some of their questions and instead insisted on a lawyer. Funny how freedoms can…

Psychiatric institutions are the Wests' gulags.

Re: Phony diagnoses hide high rates of drugging at nursing homes

#289

Post by MertsA »

thaumasiotes wrote: post #240
tornato7 wrote: post #93

Earlier quoted context omitted.

Something similar happened to a friend of mine and you can find plenty of stories on the internet - the way suicidal people are treated by the police is actually cruel and I can't imagine it helps anyone who is really feeling suicidal. My buddy got arrested, restrained to a hospital bed against his will, was given a cocktail of drugs, and had to stay there multiple days while getting a 'wellness check' every fifteen…

> while getting a 'wellness check' every fifteen minutes where a nurse shakes you awake. Actually, speaking of practices that are implemented for the convenience of administrators rather than the benefit of the patient... There is a popular belief that, if you have a head injury, you must stay awake because losing consciousness is dangerous. This is completely false. Your urge to sleep reflects the fact that that is…

If the patient is conscious and starts exhibiting symptoms indicative of a medical emergency then there's the possibility of treating it. If they're unconscious you might not know about it until you start seeing cardiac or respiratory symptoms, at which point you've already waited too late and they could die, be left in a comatose state, or suffer from brain damage. How is improving the odds of preventing that not "for the benefit of the patient"?

Re: Phony diagnoses hide high rates of drugging at nursing homes

#290

Post by yosame »

winocm wrote: post #91
heavyset_go wrote: post #2

Antipsychotics are not something to be handed out like candy. They have serious, sometimes permanent and sometimes fatal, side effects in anyone of any age. The article notes how that class of medication increases mortality in elderly people in particular. The fact that some people were prescribed haloperidol as the first line of treatment instead of a newer, safer antipsychotics also blows my mind. I'm terrified of…

Heh, yes. I developed tardive dyskinesia from use of antipsychotics over a period of 8 months. It's been over 6 years since I've taken them, but it still has not gotten any better... You can still develop TD regardless of the drug, given that pretty much any dopamine antagonist can cause it in the long term.

I'm not sure of you're aware, but there's actually drug treatments for TD now, such as Valbenazine. From what I can tell, they have pretty good efficacy/safety [1].

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5958944/

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