Monday, November 29, 2010

Akathisia: Risperdal v Haldol In Antipsychotic 1st Timers: Risperdal LOSES

"Robert Whitaker wrote about “the Madman of our Nightmares” who was not a schizophrenic but an akathisiac, having just taken, or taken himself off, prescribed medication."
Whitaker Robert: Mad In America. Perseus
Publishing. 2002.

Patricia L Rosebush, MD, FRCP(C); and Michael F. Mazurek, MD, FRCP(C)
Article abstract-Objective: To compare the side effect profile of risperidone with that of oral haloperidol in patients with no previous exposure to antipsychotic drugs (APDs). Background: Early studies suggested that the APD risperidone may have a side effect profile comparable with that of placebo. These early studies involved patients with chronic schizophrenia and a long history of APD use. Very little information is available regarding the neurologic side effects of risperidone patients without previous APD exposure-
Methods: The authors prospectively studied 350 consecutive neuroleptic naive patients admitted to their acute-care psychiatry service; 34 of these were treated with risperidone (mean dose, 3.2 mg/d) and 212 were treated with low-dose haloperidol (mean dose 3.7 mg/d). All patients were assessed on admission and twice weekly thereafter using rating scales for dystonia, parkinsonism, akathisia, and dyskinesia.
Results: The incidence and severity of dystonic reactions, akathisia, parkinsonism, and dyskinesia were comparable in the risperidone- and haloperidol-treated groups.
Conclusions: The neurologic side effect profile of low-dose risperidone is comparable with that of haloperidol in patients receiving APDS for the first time. Risperidone may not be a useful alternative to typical APDs for patients with PD and psychosis.
Received June 30th 1998. Accepted in final form Nov 20th, 1998.
There Were other variables in this study such as SSRIs, TCAs, Benzos et al. but generally speaking they’re close enough to fulfill the non-significance the authors write of when set against the similarly “non-significant” portion of Extremely Significant Akathisia which erupts in Suicide/Homicide.
pg 3 has this quick reference table. The numbers in parentheses are the affected Percentages of the two patient groups.
Not present_____17_(50)________126_(61)
Severe_________ 4_(12)_________11__(5)
Not Present_____14_(41)________95_(48)
Mild__________13_(38)________ 57_(28)
While a test of only 34 patients on Risperdal may seem too small to draw definites from, the eye catcher –After the much larger Haldol group exhibited 22% Less Akathisia – is in the Moderate & Severe categories. Risperdal showed vastly increased percentiles of Moderate Akathisia: 24% to Haldol’s 14% and the Severe Akathisiac response was 12% to Haldol’s 5%.
Moderate Akathisia_____ 58.3% More from Risperdal than Haldol
Severe Akathisia_______ 120% More from Risperdal than Haldol
With numbers like that it’s no wonder Risperdal’s Severe Parkinsonism read 0%. Akathisia’s fevered motions could distract Scorers looking for the tinier tremors of Parkinsons into searching the Haystack – while it’s on a Pogo Stick - for the Needle. And as for the 50% who Didn’t score Akathisia, ….. just because they weren’t doing jumping jacks doesn’t mean they weren’t thinking about it.
Haldol, $15 a month.
Risperdal, $475 an month.
31.67 Times more money, for, ….. ?
This study was not only Low Dose, but it was with Neuroleptic Naïve subjects, so what you see is what you get. The raters were not being misled by the effects of previous neuroleptic Brain Damage or any residuum of Behavioral Toxicity which is the hallmark of Detoxifying from previous neuroleptics: as non-attested on numerous FDA label end runs:
Suicide attempt was associated with discontinuation in 1.2% of RISPERDAL®-treated patients compared to 0.6% of placebo patients, but, given the almost 40-fold greater exposure time in RISPERDAL® compared to placebo patients, it is unlikely that suicide attempt is a RISPERDAL®-related adverse event, ….. “
(Excuse Us but in Which pig’s ear is it 'Unlikely'?)
We’d be tempted to have wished for a larger Risperdal patient population to cement the percentages, but only a ghoul would wish Akathisia on anyone.
And should you need further reproach of Atypicals we refer you to the celebrated Geddes (2000) overview which also concluded that the atypicals proved no better than the 1st generation people eaters.
The Rosebush/Mazurek study per se is not one we want repeated, but since we’re already drowning under these damnable neurotoxins and their ‘Investigators’ anyway, we must see at least Rosebush/Mazurek’s Focus made a Priority if we’re ever to even Start cleaning this mess up.

So what does Akathisia actually Feel like?
Robert Whitaker knows.
Buy his book, & Please Notice that on Amazon where the Price is determined by Consumer demand, the Price remains the Same for either New OR Used copies, Unlike Psychiatric Junk Science like Dr. Nancy Andreasen's "Broken Brain" which had at one point plummeted to 1 cent. Because, as Thomas Jefferson observed, "It is Error alone which needs the support of Government. The Truth can Stand by itself."
The Madman of our Nightmares
Supersensitive psychosis was evidence that dampening down the dopamine system could produce paradoxical effects. Neuroleptics temporarily dimmed psychosis but over the long run made patients more biologically prone to it. A second paradoxical effect, one that cropped up with the more potent neuroleptics, particularly Prolixin and Haldol, was a side effect called akathisia. Neuroleptics were supposed to tranquilize patients, but the more powerful drugs often triggered extreme inner anxiety and restlessness. Patients would endlessly pace, fidget in their chairs, and wring their hands – actions that reflected an inner torment. This side effect was linked to assaultive, violent behavior.
Although the public may think that “crazy” people are likely to behave in violent ways, this was not true of mental patients prior to the introduction of neuroleptics. Before 1955, four studies found that patients discharged from mental hospitals committed crimes at either the same or a lower rate than the general population. However, eight studies conducted from 1965 to 1979 determined that discharged patients were being arrested at rates that exceeded the general population. And while there may have been many social causes for this change in relative arrest rates (homelessness among the mentally ill is an obvious cause), akathisia was also clearly a contributing factor.
In his book In The Belly Of The Beast, Jack Henry Abbot described how akathisia could turn one inside out:

These drugs, in this family, do not calm or sedate the nerves. They attack. They attack from so deep inside you, you cannot locate the source of the pain … The muscles of your jawbone go berserk, so that you bite the inside of your mouth and your jaw locks and the pain throbs. For hours every day this will occur. Your spinal column stiffens so that you can hardly move your head or your neck and sometimes your back bends like a bow and you cannot stand up. The pain grinds into you fiber … you ache with restlessness, so you feel you have to walk, to pace. And then as soon as you start pacing, the opposite occurs to you; you must sit and rest. Back and forth, up and down you go in pain and you cannot locate, in such wretched anxiety you are overwhelmed, because you cannot get relief even in breathing.

Akathisia was given little attention by psychiatric researchers for nearly twenty years. Patients usually perceived the restless behavior as a sign that the patient was about to relapse and would increase the dosage of the offending drug. But when investigators finally studied it, patients gave them an earful. They told of pain so great they wanted to “jump out of their skins,” of “anxiety of annihilating proportions.” One woman banged her head against the wall and cried, “I just want to get rid of this whole body!” Case studies detailed how patients, seeking to escape from this misery, had jumped from buildings, hung themselves, and stabbed themselves. In one study, 79 percent of mentally ill patients who had tried to kill themselves suffered from akathisia. Another study documented thirty cases of akathisia-linked suicides. “They made many requests or demands that something be done to relieve their tensions,” the researchers said. “They appeared driven to find some kind of relief.” One who killed himself for this reason was a thirty-six year old Hispanic man who’d come to a hospital because he couldn’t sleep and was overly nervous. He was given an injection of long-acting fluphenazine, and then, over the next several weeks he repeatedly returned to hospital emergency rooms in an extremely agitated state and “begged for help.” Something had to be done about the extreme physical misery he was in, but nothing was, and finally, “he killed himself without warning by jumping in front of a subway train.” UCLA Psychiatrist Theodore Van Putten determined that 75 percent of patients treated with a Haldol injection experienced akathisia.
Various investigators found that this side effect regularly made patients more prone to violence. A 1990 study determined that 50 percent of all fights on a psychiatric ward could be tied to akathisia. Yet another concluded that moderate-to-high doses of haloperidol made half of the patients markedly more aggressive. Patients described “violent urges to assault anyone near” and wanting to kill “the motherf**kers” tormenting them in this way. A few case reports linked akathisia to bizarre murders. One thirty-nine-year-old white man, after a haloperidol injection made him feel like he was “falling apart, … that all the bones in his body were broken – bludgeoned his mother with a hammer, an act he later found incomprehensible. Another thirty-five year old man, asked why he had stabbed a grocer he had known for some time, said he did it to get the drug induced pain out of his head: “The only reason I knifed the guy was Haldol messed me up. Prolixin makes me want to kill, too.” The murderous explosion of a twenty-three-year-old man, detailed in the Journal Of Forensic Psychiatry, was perhaps the most chilling example of all. After his wife left him, he became distraught and was brought to an Emergency Room by the police. He had been briefly hospitalized before, and he warned the staff that he reacted badly to haloperidol. In spite of his protest, he was injected with the drug, and he quickly exploded in rage. He ran from the emergency room, tore off his clothes in a nearby park, and started attacking everyone he saw. Over the course of forty-five minutes, he tried to rape a woman walking in the park, broke into a house and beat an eighty-one-year-old woman to a pulp, fought with a policeman and then escaped, stabbed two more women, and was then at last subdued by a gang of eight cops.
Such case reports led researchers to conclude that haloperidol could produce a “marked increase in violent behavior,” even among those without any history of assault. They dubbed this side effect of neuroleptics a “behavioral toxicity.” Little could the public have suspected that the madman of its nightmares, who kills without warning and for no apparent reason, was not always driven by an evil within but by a popular medication.

50% Akathisia is one Hell of an Interesting Definition of "Safe and Effective".
But then we Are talking about Psychiatry here.

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