Re: Re: : Philadelphia Inquirer article on meds : Tarnished Vie...

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In a message dated 2/18/2008 2:36:49 P.M. Central Standard Time,

ludwig33@... writes:

I'm curious if a lot of our children are or have been on anti-

psychotics. Has anybody's child ever developed a side effect from it?

Hello, ,

My son was prescribed Risperdal when he was 18, but it did not alleviate his

SIB, aggression or anxiety. We tried it low dose, then increased to high

dose. It can stimulate prolactin (hormone that produces milk in breasts),

and we discontinued use after 8 months when my son's breasts became enlarged

and swollen (he did not produce milk, but this can occur). My son has a

history of poor response (with severe side effects) to psychiatric medications

since he was 6 years old. It seems to me that many (if not most) ASD folks end

up with psychiatrists and meds. I am nearly done withdrawing my 24 year old

from the last of his psychiatric medications, and I am absolutely DONE with

psychiatry. This last group of drugs induced metabolic syndrome, screwed up

his hormones, and precipitated 160 lb. weight gain. And we still try to manage

the head pounding and anxiety.

Choosing drugs as treatment is a contentious issue, just as biomedical and

nutritional treatments are controversial for some. Tough decisions for us

Moms. As you are just beginning this journey, I would encourage you to trust

your intuition. Your own instincts will always prove true, and you won't end

up years later wishing you had followed your gut way back when.

Here's an interesting study from the U.K. for those interested:

Withers

The Lancet, Volume 371, Number 9606, _5 January 2008_

(http://www.thelancet.com/journals/lancet/issue?issue_key=S0140-6736(08)X6002-7)

_Contents in

Full_

(http://www.thelancet.com/journals/lancet/full?issue_key=S0140-6736(08)X6002-7)

_Editorial_

(http://www.thelancet.com/journals/lancet/section?issue_key=S0140-6736(08)X6002-\

7 & section=Editorial)

_Comment_

(http://www.thelancet.com/journals/lancet/section?issue_key=S0140-6736(08)X6002-\

7 & section=Comment)

_World Report_

(http://www.thelancet.com/journals/lancet/section?issue_key=S0140-6736(08)X6002-\

7 & section=World+Report)

_Perspectives_

(http://www.thelancet.com/journals/lancet/section?issue_key=S0140-6736(08)X6002-\

7 & section=Perspectives)

_Obituary_

(http://www.thelancet.com/journals/lancet/section?issue_key=S0140-6736(08)X6002-\

7 & section=Obituary)

_Correspondence_

(http://www.thelancet.com/journals/lancet/section?issue_key=S0140-6736(08)X6002-\

7 & section=Correspondence)

_Department of Error_

(http://www.thelancet.com/journals/lancet/section?issue_key=S0140-6736(08)X6002-\

7 & section=Department+of+Error)

_Articles_

(http://www.thelancet.com/journals/lancet/section?issue_key=S0140-6736(08)X6002-\

7 & section=Articles)

_Seminar_

(http://www.thelancet.com/journals/lancet/section?issue_key=S0140-6736(08)X6002-\

7 & section=Seminar)

_Series_

(http://www.thelancet.com/journals/lancet/section?issue_key=S0140-6736(08)X6002-\

7 & section=Series)

_Department of Ethics_

(http://www.thelancet.com/journals/lancet/section?issue_key=S0140-6736(08)X6002-\

7 & section=Department+of+Ethics)

_Case Report_

(http://www.thelancet.com/journals/lancet/section?issue_key=S0140-6736(08)X6002-\

7 & section=Case+Report)

(http://www.thelancet.com/journals/lancet/article/PIIS0140673608600719/abstract)

(http://www.thelancet.com/journals/lancet/article/PIIS0140673608600732/abstract)

The Lancet 2008; 371:57-63

DOI:10.1016/S0140-6736(08)60072-0

Articles

Risperidone, haloperidol, and placebo in the treatment of aggressive

challenging behaviour in patients with intellectual disability: a randomised

controlled trial

Prof_ Tyrer_

(http://www.thelancet.com/search/results?search_mode=cluster & search_area=cluster\

& search_cluster=thelancet & search_sort=date & restrictname_a

uthor=author & restricttype_author=author & restrictterm_author=tyrer0p & restrictde

sc_author= Tyrer) FMedSci (mailto:p.tyrer@...) _a_

(http://www.thelancet.com/journals/lancet/article/PIIS0140673608600720/abstract#\

aff1)

(http://www.thelancet.com/journals/lancet/article/PIIS0140673608600720/abstract#\

cor1) , _ C Oliver-Africano_

(http://www.thelancet.com/search/results?search_mode=cluster & search_area=cluster\

& search_cluster=thelancet & search_

sort=date & restrictname_author=author & restricttype_author=author & restrictterm_a

uthor=oliverafricano0pc & restrictdesc_author= C Oliver-Africano) PhD

_a_

(http://www.thelancet.com/journals/lancet/article/PIIS0140673608600720/abstract#\

aff1) , _Zed Ahmed_

(http://www.thelancet.com/search/results?search_mode=cluster & search_area=cluster\

& search_cluster=thelancet & search_sort=date & restr

ictname_author=author & restricttype_author=author & restrictterm_author=ahmed0z & r

estrictdesc_author=Zed Ahmed) FRCPsych _b_

(http://www.thelancet.com/journals/lancet/article/PIIS0140673608600720/abstract#\

aff2) , Prof_ Nick Bouras_

(http://www.thelancet.com/search/results?search_mode=cluster & search_area=cluster\

&

search_cluster=thelancet & search_sort=date & restrictname_author=author & restrictt

ype_author=author & restrictterm_author=bouras0n & restrictdesc_author=Nick

Bouras) FRCPsych _c_

(http://www.thelancet.com/journals/lancet/article/PIIS0140673608600720/abstract#\

aff3) , _Sherva Cooray_

(http://www.thelancet.com/search/results?search_mode=cluster & search_area=cluster\

& search_cluster=thelancet & search

_sort=date & restrictname_author=author & restricttype_author=author & restrictterm_

author=cooray0s & restrictdesc_author=Sherva Cooray) FRCPsych _d_

(http://www.thelancet.com/journals/lancet/article/PIIS0140673608600720/abstract#\

aff4) ,

Prof_ Shoumitro Deb_

(http://www.thelancet.com/search/results?search_mode=cluster & search_area=cluster\

& search_cluster=thelancet & search_sort=date & restrictname_

author=author & restricttype_author=author & restrictterm_author=deb0s & restrictdes

c_author=Shoumitro Deb) FRCPsych _e_

(http://www.thelancet.com/journals/lancet/article/PIIS0140673608600720/abstract#\

aff5) , Prof_ _

(http://www.thelancet.com/search/results?search_mode=cluster & search_area=cluster\

& sear

ch_cluster=thelancet & search_sort=date & restrictname_author=author & restricttype_

author=author & restrictterm_author=murphy0d & restrictdesc_author= )

FRCPsych _f_

(http://www.thelancet.com/journals/lancet/article/PIIS0140673608600720/abstract#\

aff6) , _ Hare_

(http://www.thelancet.com/search/results?search_mode=cluster & search_area=cluster\

& search_cluster=thelancet & search_sor

t=date & restrictname_author=author & restricttype_author=author & restrictterm_auth

or=hare0m & restrictdesc_author= Hare) MPhil _b_

(http://www.thelancet.com/journals/lancet/article/PIIS0140673608600720/abstract#\

aff2) , _

Meade_

(http://www.thelancet.com/search/results?search_mode=cluster & search_area=cluster\

& search_cluster=thelancet & search_sort=date & restrictname_author=author & re

stricttype_author=author & restrictterm_author=meade0m & restrictdesc_author=Micha

el Meade) BSc _a_

(http://www.thelancet.com/journals/lancet/article/PIIS0140673608600720/abstract#\

aff1) , _Ben Reece_

(http://www.thelancet.com/search/results?search_mode=cluster & search_area=cluster\

& search_cluster=thelancet & search_

sort=date & restrictname_author=author & restricttype_author=author & restrictterm_a

uthor=reece0b & restrictdesc_author=Ben Reece) BSc _a_

(http://www.thelancet.com/journals/lancet/article/PIIS0140673608600720/abstract#\

aff1) , _Kofi Kra

mo_

(http://www.thelancet.com/search/results?search_mode=cluster & search_area=cluster\

& search_cluster=thelancet & search_sort=date & restrictname_author=author & restr

icttype_author=author & restrictterm_author=kramo0k & restrictdesc_author=Kofi

Kramo) MSc _a_

(http://www.thelancet.com/journals/lancet/article/PIIS0140673608600720/abstract#\

aff1) , _Sabyasachi Bhaumik_

(http://www.thelancet.com/search/results?search_mode=cluster & search_area=cluster\

& search_cluster=thelancet & sear

ch_sort=date & restrictname_author=author & restricttype_author=author & restrictter

m_author=bhaumik0s & restrictdesc_author=Sabyasachi Bhaumik) FRCPsych _g_

(http://www.thelancet.com/journals/lancet/article/PIIS0140673608600720/abstract#\

aff

7) , _ Harley_

(http://www.thelancet.com/search/results?search_mode=cluster & search_area=cluster\

& search_cluster=thelancet & search_sort=date & restrictnam

e_author=author & restricttype_author=author & restrictterm_author=harley0d & restri

ctdesc_author= Harley) PhD _h_

(http://www.thelancet.com/journals/lancet/article/PIIS0140673608600720/abstract#\

aff8) , _Adrienne Regan_

(http://www.thelancet.com/search/results?search_mode=cluster & search_area=cluster\

& search_cl

uster=thelancet & search_sort=date & restrictname_author=author & restricttype_autho

r=author & restrictterm_author=regan0a & restrictdesc_author=Adrienne Regan)

FRCPsych _i_

(http://www.thelancet.com/journals/lancet/article/PIIS0140673608600720/abstract#\

aff9) , _ _

(http://www.thelancet.com/search/results?search_mode=cluster & search_area=cluster\

& search_cluster=thelancet & search_sort=da

te & restrictname_author=author & restricttype_author=author & restrictterm_author=t

homas0d & restrictdesc_author= ) DPM _j_

(http://www.thelancet.com/journals/lancet/article/PIIS0140673608600720/abstract#\

aff10) , _Bharti Rao_

(http://www.thelancet.com/search/results?search_mode=cluster & search_area=cluste

r & search_cluster=thelancet & search_sort=date & restrictname_author=author & restric

ttype_author=author & restrictterm_author=rao0b & restrictdesc_author=Bharti Rao)

MSc _a_

(http://www.thelancet.com/journals/lancet/article/PIIS0140673608600720/abstract#\

aff1) , _Bernard North_

(http://www.thelancet.com/search/results?search_mode=cluster & search_area=cluster\

& search_cluster=thelancet & search_sort=d

ate & restrictname_author=author & restricttype_author=author & restrictterm_author=

north0b & restrictdesc_author=Bernard North) PhD _k_

(http://www.thelancet.com/journals/lancet/article/PIIS0140673608600720/abstract#\

aff11) , _ph

Eliahoo_

(http://www.thelancet.com/search/results?search_mode=cluster & search_area=cluster\

& search_cluster=thelancet & search_sort=date & restrictname_author=author & re

stricttype_author=author & restrictterm_author=eliahoo0j & restrictdesc_author=Jos

eph Eliahoo) PhD _k_

(http://www.thelancet.com/journals/lancet/article/PIIS0140673608600720/abstract#\

aff11) , _Shamshad Karatela_

(http://www.thelancet.com/search/results?search_mode=cluster & search_area=cluster\

& search_cluster=thela

ncet & search_sort=date & restrictname_author=author & restricttype_author=author & re

strictterm_author=karatela0s & restrictdesc_author=Shamshad Karatela) MPH _h_

(http://www.thelancet.com/journals/lancet/article/PIIS0140673608600720/abstract

#aff8) , _Anju Soni_

(http://www.thelancet.com/search/results?search_mode=cluster & search_area=cluster\

& search_cluster=thelancet & search_sort=date & restrictna

me_author=author & restricttype_author=author & restrictterm_author=soni0a & restric

tdesc_author=Anju Soni) MRCPsych _l_

(http://www.thelancet.com/journals/lancet/article/PIIS0140673608600720/abstract#\

aff12) and _Mike Crawford_

(http://www.thelancet.com/search/results?search_mode=cluster & search_area=cluster\

& sea

rch_cluster=thelancet & search_sort=date & restrictname_author=author & restricttype

_author=author & restrictterm_author=crawford0m & restrictdesc_author=Mike

Crawford) MD _a_

(http://www.thelancet.com/journals/lancet/article/PIIS0140673608600720/abstract#\

aff1)

Summary

Background

Aggressive challenging behaviour is frequently reported in adults with

intellectual disability and it is often treated with antipsychotic drugs.

However, no adequate evidence base for this practice exists. We compared

flexible

doses of haloperidol (a typical, first-generation antipsychotic drug),

risperidone (an atypical, second-generation antipsychotic), and placebo, in

the

treatment of this behaviour.

Methods

86 non-psychotic patients presenting with aggressive challenging behaviour

from ten centres in England and Wales, and one in Queensland, Australia, were

randomly assigned to haloperidol (n=28), risperidone (n=29), or placebo

(n=29). Clinical assessments of aggression, aberrant behaviour, quality of

life,

adverse drug effects, and carer uplift (positive feelings about the care of

the disabled person) and burden, together with total costs, were recorded at

4, 12, and 26 weeks. The primary outcome was change in aggression after 4

weeks' treatment, which was recorded with the modified overt aggression scale

(MOAS). Analysis was by intention to treat. This study is registered as ISRCTN

11736448.

Findings

80 patients had adherence of 80% or more to prescribed drug. Aggression

decreased substantially with all three treatments by 4 weeks, with the placebo

group showing the greatest change (median decrease in MOAS score after 4

weeks=9 [95% CI 5–14] for placebo, 79% from baseline; 7 [4–14] for

risperidone,

58% from baseline; 6·5 [5–14] for haloperidol, 65% from baseline; p=0·06).

Furthermore, although no important differences between the treatments were

recorded, including adverse effects, patients given placebo showed no evidence

at

any time points of worse response than did patients assigned to either of

the antipsychotic drugs.

Interpretation

Antipsychotic drugs should no longer be regarded as an acceptable routine

treatment for aggressive challenging behaviour in people with intellectual

disability.

Affiliations

a. Department of Psychological Medicine, Imperial College, London, UK

b. Welsh Centre for Learning Disabilities Clinical Studies, University of

Wales College of Medicine, Cardiff, UK

c. Mental Health in Learning Disabilities Centre, King's College London,

Institute of Psychiatry, Estia Centre, Guy's Hospital, London, UK

d. Central North West London Foundation NHS Trust, Kingsbury Community Unit,

Brent, London, UK

e. Department of Psychiatry, University of Birmingham, Queen

Psychiatric Hospital, Birmingham, UK

f. Section of Brain Maturation, Institute of Psychiatry, London, UK

g. Leicestershire Partnership NHS Trust, Leicester Frith Hospital,

Leicester, UK

h. Queensland Centre for Intellectual and Developmental Disability (QCIDD),

School of Population Health, University of Queensland, Brisbane, Australia

i. Harrow Primary Care NHS Trust, Orme Lodge, Stanmore, Middlesex, UK

j. North East London Mental Health NHS Trust, Redbridge Learning Disability

Service, Barkingside, Essex, UK

k. Statistical Advisory Service, Imperial College, London, UK

l. West London Mental Health NHS Trust, Hammersmith and Fulham Mental

Health Unit, London, UK

(http://www.thelancet.com/journals/lancet/article/PIIS0140673608600720/abstract#\

back-cor1) Correspondence to: Prof Tyrer, Department of

Psychological Medicine, Imperial College, St 's Road, London W6 8RP, UK

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