Wednesday, May 25, 2011

'Incurably APA Insane' Physicians STILL A Big Problem: New Study

Fierce Healthcare has;

Disruptive Physicians Continue To Be A Big Problem, Study Finds

May 25, 2011 — 10:14am ET | By Alicia Caramenico

Instances of doctors using profanity, refusing to follow protocol or even engaging in outright physical assault continue to plague healthcare organizations. In fact, more than 70 percent of physicians say disruptive physician behavior occurs at least once a month at their facilities, according to a new study of more than 840 physicians and physician leaders from QuantiaMD and the American College of Physician Executives. More than 10 percent say that such unprofessional incidents happen daily. This issue is something healthcare organizations cannot take lightly, as nearly all physicians--99 percent--believe that disruptive behavior ultimately affects patient care. Study

Thank You Fierce Healthcare and Ms. Caramenico

These Physician Diversion Program Protected, ...... Physicians, are Exempt from having to WEAR their Own 'Mental Health' Stench. Everybody Else that they can BILL Medicare, Medicaid, & Private Insurers for, is Incurably Mentally Ill, ...... but not themselves, .....

They're 'Caregivers'.

And Congress is Borrowing $188 Million per hour, every hour, in part to make sure that everybody who Hasn't Bought a medical work license can be compassionately, Psychiatrically disabled, drug maimed, & drug murdered by them.

Don't you just love it?

Congress "Deeply Troubled" With FDA/J&J

Bloomberg has;

J&J Puerto Rico Plant Has Deeply Troubling Lack Of Oversight

By Catherine Larkin - May 20, 2011 3:05 PM ET

"Johnson & Johnson (JNJ)’s plans to clean up a Puerto Rico factory haven’t been checked by U.S. regulators in what a Republican chairman of a House committee called a “deeply troubling” lack of oversight.

Food and Drug Administration officials haven’t visited the San Juan plant operated by J&J’s McNeil Consumer Healthcare unit since September, Representative Darrell Issa said today in a letter to Margaret Hamburg, the agency’s commissioner. Regulators stationed in Puerto Rico also told Issa that they haven’t reviewed corrective actions taken by McNeil as part of a consent decree the division signed with the FDA in March.

McNeil has pulled more than 40 brands of over-the-counter medicines since April 2010 because of contamination, musty odors, incorrect labeling and insufficiencies in manufacturing. The House Oversight committee that Issa chairs urged the FDA to follow up hearings held last year about manufacturing deficiencies at McNeil’s plants in Puerto Rico and Pennsylvania. Officials there say they don’t have enough resources, Issa said.

“I find this excuse deeply troubling and inconsistent with the resources made available to the FDA in the legal consent decree,” Issa, of California, wrote in his letter. This raises “several questions about the mismanagement of safety concerns at FDA’s San Juan office and the direction of the FDA’s oversight efforts in Puerto Rico.”

The FDA doesn’t comment publicly about letters from Congress as a matter of policy, Shelly Burgess, an agency spokeswoman, said today in an e-mail. The FDA will reply directly to Issa, she said."

Thank You Bloomberg & Ms Larkin

And this is Worse even than it appears Why?

Because even With Congressman Issa's putting the FDA on Notice that the situation is Deeply Troubling, the FDA has Already Flunked J&J on 48% of 161 Inspections that it Has conducted.

Johnson & Johnson Recalls Continue

You gotta wonder how many More Inspections J&J would Flunk if the FDA were Really on the ball. At least now FDA Knows, and they'll get Right On It, or maybe not.

Prescription Drug User Fee Act (PDUFA) > PDUFA User Fee Rates Archive

The Same way they're holding Pharma Execs responsible for Knowing what their subordinates are doing.

The Park Doctrine: FDA Issues Their Position: "Like, Oh Well, Whatever"

PS: When we link to folks like Bloomberg, BNET, FierceHealthcare/Pharma, Pharmalot, et Al, Please click on through to them and visit their Advertisers. Help them pay the rent, OK?

Dystonia, It's 'Mentally Healthy' For You

Dystonia is just One More 'FACE' of 'Mental Health', & if you think that any of the Ideates poisoning You or your Child into a state of Their Medicare & Medicaid/MediCal Raiding Illuminati Ideations of what's good for You, Or Society, are going to get within 90 Miles of actually disclosing This Direct Effect of their 'Treatment', ..... of You, ..... Bwahahaha.

Nobody, but Nobody, would get within 90 miles of Them, if they knew What 'Mental Health' actually is, going in.

Wiki has;


Dystonia is a neurological movement disorder, in which sustained muscle contractions cause twisting and repetitive movements or abnormal postures. The disorder may be hereditary or caused by other factors such as birth-relatedor other physical trauma, infection, poisoning (e.g., lead poisoning) or reaction to pharmaceutical drugs, particularly neuroleptics.[1] Treatment is difficult and has been limited to minimizing the symptoms of the disorder, since there is no cure available.

A person with medication induced dystonia.


Types of dystonia

Generalized dystonias

  • Normal birth history and milestones
  • Autosomal dominant
  • Childhood onset
  • Starts in lower limbs and spreads upwards
  • Also known as "idiopathic torsion dystonia" (old terminology "dystonia musculrum deformans")

Focal dystonias

These are the most common dystonias and tend to be classified as follows:

Anismusmuscles of the rectumCauses painful defecation, constipation; may be complicated by encopresis.
Cervical dystonia (spasmodic torticollis)muscles of the neckCauses the head to rotate to one side, to pull down towards the chest, or back, or a combination of these postures.
Blepharospasmmuscles around theeyesThe sufferer experiences rapid blinking of the eyes or even their forced closure causing effective blindness.
Oculogyric crisismuscles of eye and headAn extreme and sustained (usually) upward deviation of the eyes often with convergence causing diplopia. It is frequently associated with backwards and lateral flexion of the neck and either widely opened mouth or jaw clenching. Frequently a result of antiemetics such as the neuroleptics (e.g., prochlorperazine) or metoclopramide. Also can be caused byChlorpromazine
Oromandibular dystoniamuscles of the jaw andmuscles of tongueCauses distortions of the mouth and tongue.
Spasmodic dysphonia/Laryngeal dystoniamuscles of larynxCauses the voice to sound broken or reducing it to a whisper.
Focal hand dystonia (also known as musician's orwriter's cramp).single muscle or small group of muscles in the handIt interferes with activities such as writing or playing a musical instrument by causing involuntary muscular contractions. The condition is sometimes "task-specific," meaning that it is generally only apparent during certain activities. Focal hand dystonia is neurological in origin, and is not due to normal fatigue. The loss of precise muscle control and continuous unintentional movement results in painful cramping and abnormal positioning that makes continued use of the affected body parts impossible.

The combination of blepharospasmodic contractions and oromandibular dystonia is called cranial dystonia or Meige's syndrome.

Segmental dystonias

Segmental dystonias affect two adjoining parts of the body:

  • Hemidystonia affects an arm and a leg on one side of the body.
  • Multifocal dystonia affects many different parts of the body.
  • Generalized dystonia affects most of the body, frequently involving the legs and back.

Genetic / primary

NameOMIMGeneLocusAlt Name
DYT1 (or EOTD)128100DYT19q34early-onset torsion dystonia
DYT2224500unknownunknownautosomal recessive torsion dystonia
DYT3314250TAF1Xq13X-linked torsion dystonia
DYT4128101unknownunknownautosomal dominant torsion dystonia
DYT5 (or DRD)128230GCH114q22.1-q22.2Dopamine-responsive dystonia
DYT7602124unknown18pPrimary cervical dystonia
DYT8 (or PNKD1)118800MR12q35paroxysmal nonkinesigenic dyskinesia 1
DYT9601042possibly KCNA3[3]1pepisodic choreoathetosis/spasticity
DYT10 (or EKD1)128200unknown16p11.2-q12.1episodic kinesigenic dyskinesia 1
DYT11159900SGCE7q21Myoclonic dystonia
DYT13607671unknown, near D1S2667[4]1p36.32-p36.13
DYT15607488unknown18p11[5]Myoclonic dystonia
DYT17612406unknown, near D20S107[6]20p11.2-q13.12
DYT19 (or EKD2)611031unknown16q13-q22.1episodic kinesigenic dyskinesia 2
DYT20 (or PNKD2)611147unknown2q31paroxysmal nonkinesigenic dyskinesia 2

There is a group called myoclonus dystonia or myoclonic dystonia, where some cases are hereditary and have been associated with a missense mutation in thedopamine-D2 receptor. Some of these cases have responded remarkably to alcohol.[7][8]

Signs and symptoms

Hemichorea and dystonia.ogv
Hyperglycemia-induced involuntary movements which, in this case, did not consist of typical hemiballismus, but rather of hemichorea (dance-like movements of one side of the body; initial movements of the right arm in the video) and bilateraldystonia (slow muscle contraction in legs, chest and right arm) in a 62-year-old Japanese woman with type 1 diabetes.

Symptoms vary according to the kind of dystonia involved. In most cases, dystonia tends to lead to abnormal posturing, particularly on movement. Many sufferers have continuous pain, cramping and relentless muscle spasms due to involuntary muscle movements. Other motor symptoms are possible including lip smacking.[9]

Early symptoms may include loss of precision muscle coordination (sometimes first manifested in declining penmanship, frequent small injuries to the hands, and dropped items), cramping pain with sustained use and trembling. Significant muscle pain and cramping may result from very minor exertions like holding a book and turning pages. It may become difficult to find a comfortable position for arms and legs with even the minor exertions associated with holding arms crossed causing significant pain similar to restless leg syndrome. Affected persons may notice trembling in the diaphragm while breathing, or the need to place hands in pockets, under legs while sitting or under pillows while sleeping to keep them still and to reduce pain. Trembling in the jaw may be felt and heard while lying down, and the constant movement to avoid pain may result in the grinding and wearing down of teeth, or symptoms similar to TMD. The voice may crack frequently or become harsh, triggering frequent throat clearing. Swallowing can become difficult and accompanied by painful cramping.

Electrical sensors (EMG) inserted into affected muscle groups, while painful, can provide a definitive diagnosis by showing pulsating nerve signals being transmitted to the muscles even when they are at rest. The brain appears to signal portions of fibers within the affected muscle groups at a firing speed of about 10 Hz causing them to pulsate, tremble and contort. When called upon to perform an intentional activity, the muscles fatigue very quickly and some portions of the muscle groups do not respond (causing weakness) while other portions over-respond or become rigid (causing micro-tears under load). The symptoms worsen significantly with use, especially in the case of focal dystonia, and a "mirror effect" is often observed in other body parts: use of the right hand may cause pain and cramping in that hand as well as in the other hand and legs that were not being used. Stress, anxiety, lack of sleep, sustained use and cold temperatures can worsen symptoms.

Direct symptoms may be accompanied by secondary effects of the continuous muscle and brain activity, including disturbed sleep patterns, exhaustion, mood swings, mental stress, difficulty concentrating, blurred vision, digestive problems and short temper. People with dystonia may also become depressed and find great difficulty adapting their activities and livelihood to a progressing disability. Side effects from treatment and medications can also present challenges in normal activities.

In some cases, symptoms may progress and then plateau for years, or stop progressing entirely. The progression may be delayed by treatment or adaptive lifestyle changes, while forced continued use may make symptoms progress more rapidly. In others, the symptoms may progress to total disability, making some of the more risky forms of treatment worth considering. In some cases with patients who already have dystonia, a subsequent tramatic injury or the effects of general anethesia during an unrelated surgery can cause the symptoms to progress rapidly.

An accurate diagnosis may be difficult because of the way the disorder manifests itself. Sufferers may be diagnosed as having similar and perhaps related disorders including Parkinson's disease, essential tremor, carpal tunnel syndrome, TMD, Tourette's syndrome, or other neuromuscular movement disorders. It has been found that the prevalence of dystonia is high in individuals with Huntington’s disease, where the most common clinical presentations are internal shoulder rotation, sustained fist clenching, knee flexion, and foot inversion.[10] Risk factors for increased dystonia in patients with Huntington’s disease include long disease duration and use of antidopaminergic medication.[10]


The causes of dystonia are not yet known or understood; however, they are categorized as follows on a theoretical basis:

Primary dystonia is suspected to be caused by a pathology of the central nervous system, likely originating in those parts of the brain concerned with motor function, such as the basal ganglia, and the GABA (gamma-aminobutyric acid) producing Purkinje neurons. The precise cause of primary dystonia is unknown. In many cases it may involve some genetic predisposition towards the disorder combined with environmental conditions.

Secondary dystonia refers to dystonia brought on by some identified cause, usually involving brain damage, or by some unidentified cause such as chemical imbalance. Some cases of (particularly focal) dystonia are brought on after trauma, are induced by certain drugs (tardive dystonia), or may be the result of diseases of the nervous system such as Wilson's disease.

Environmental and task-related factors are suspected to trigger the development of focal dystonias because they appear disproportionately in individuals who perform high precision hand movements such as musicians, engineers, architects and artists. Chlorpromazine can also cause dystonia, which can be often misjudged as a seizure.


Treatment has been limited to minimizing the symptoms of the disorder as there is yet no successful treatment for its cause. Reducing the types of movements that trigger or worsen dystonic symptoms provides some relief, as does reducing stress, getting plenty of rest, moderate exercise, and relaxation techniques. Various treatments focus on sedating brain functions or blocking nerve communications with the muscles via drugs, neuro-suppression or denervation. All current treatments have negative side effects and risks.

Physical intervention

Although physical therapy cannot directly treat dystonia, it can be utilized to manage changes in balance, mobility and overall function that occur as a result of the disorder.[11] A variety of treatment strategies can be employed to address the unique needs of each individual. Potential treatment interventions include splinting[12], therapeutic exercise, manual stretching, soft tissue and joint mobilization, postural training, neuromuscular electrical stimulation, constraint-induced movement therapy, activity and environmental modification, and gait training.[11] Due to the rare and variable nature of dystonia, research investigating the effectiveness of these treatments is limited. To date, focal cervical dystonia has received the most research attention[11]; however, study designs are poorly controlled and limited to small sample sizes.[13]

Some focal dystonias have been proven treatable through movement retraining in the Taubman approach, particularly in the case of musicians. However other focal dystonias may not respond and may even be made worse by this treatment.


Different medications are tried in an effort to find a combination that is effective for a specific person. Not all people will respond well to the same medications. Medications that have had positive results in some include: diphenhydramine, benzatropine, anti-Parkinsons agents ( such as trihexyphenidyl), and muscle relaxers (such as diazepam).

Cannabidiol, one of the non-psychoactive cannabinoids found in cannabis sativa, was shown in a 6-week study to have reduced dystonic symptoms in all participants by up to 20-50%.[14][15]


Medications such as anticholinergics (benztropine), which act as inhibitors of the neurotransmitter acetylcholine, may provide some relief. In the case of a acute dystonic reaction, diphenhydramine is sometimes used (though this drug is well known as an antihistamine, in this context it is being used primarily for its anticholinergic role).[2] In the case of Oculogyric crisis, diphenhydramine may be administered with excellent results with symptoms subsiding in a matter of minutes.[citation needed]

Muscle relaxants

Clonazepam, an anti-seizure medicine, is also sometimes prescribed. However, for most their effects are limited and side effects like mental confusion, sedation, mood swings and short-term memory loss occur.

Botulinum toxin injections into affected muscles have proved quite successful in providing some relief for around 3–6 months, depending on the kind of dystonia.Botox injections have the advantage of ready availability (the same form is used for cosmetic surgery) and the effects are not permanent. There is a risk of temporary paralysis of the muscles being injected or the leaking of the toxin into adjacent muscle groups causing weakness or paralysis in them. The injections have to be repeated as the effects wear off and around 15% of recipients will develop immunity to the toxin. There is a Type A and Type B toxin approved for treatment of dystonia; often those that develop resistance to Type A may be able to use Type B.[16]

Noting that botulinum toxin has been shown to have an effect on inhibiting neurogenic inflammation, and evidence suggesting the role of neurogenic inflammation in the pathogenesis of psoriasis, the University of Minnesota has begun a clinical trial to follow up on the observation that patients treated with botulinum toxin for dystonia had dramatic improvement in psoriasis. See: Use of Botulinum Toxin to Treat Psoriasis.

Parkinsonian drugs

Dopamine agonists: One type of dystonia, dopamine-responsive dystonia, can be completely treated with regular doses of L-DOPA in a form such as Sinemet (carbidopa/levodopa). Although this doesn't remove the condition, it does alleviate the symptoms most of the time. (In contrast, dopamine antagonists can sometimes cause dystonia.)


A baclofen pump has been used to treat patients of all ages exhibiting muscle spasticity along with dystonia. The pump delivers baclofen via a catheter to the thecal space surrounding the spinal cord. The pump itself is placed in the abdomen. It can be refilled periodically by access through the skin.[17]


Surgery, such as the denervation of selected muscles, may also provide some relief; however, the destruction of nerves in the limbs or brain is not reversible and should only be considered in the most extreme cases. Recently, the procedure of deep brain stimulation (DBS) has proven successful in a number of cases of severe generalised dystonia.[18] DBS as treatment for medication-refractory dystonia, on the other hand, may increase the risk of suicide in patients. Unfortunately, reference data of patients without DBS therapy are lacking.[19]

See also


  1. ^ a b Dystonia fact sheet: National Institute of Neurological Disorders and Stroke
  2. ^ a b
  3. ^ Auburger G, Ratzlaff T, Lunkes A, et al. (January 1996). "A gene for autosomal dominant paroxysmal choreoathetosis/spasticity (CSE) maps to the vicinity of a potassium channel gene cluster on chromosome 1p, probably within 2 cM between D1S443 and D1S197". Genomics 31 (1): 90–4.doi:10.1006/geno.1996.0013. PMID 8808284.
  4. ^ Valente EM, Bentivoglio AR, Cassetta E, et al. (March 2001). "DYT13, a novel primary torsion dystonia locus, maps to chromosome 1p36.13--36.32 in an Italian family with cranial-cervical or upper limb onset". Ann. Neurol. 49 (3): 362–6. doi:10.1002/ana.73. PMID 11261511.
  5. ^ Grimes DA, Han F, Lang AE, St George-Hyssop P, Racacho L, Bulman DE (October 2002). "A novel locus for inherited myoclonus-dystonia on 18p11".Neurology 59 (8): 1183–6. PMID 12391345.
  6. ^ Chouery E, Kfoury J, Delague V, et al. (October 2008). "A novel locus for autosomal recessive primary torsion dystonia (DYT17) maps to 20p11.22-q13.12". Neurogenetics 9 (4): 287–93. doi:10.1007/s10048-008-0142-4.ISBN 1004800801424. PMID 18688663.
  7. ^ Cassim F (Oct 2003). "[Myoclonic dystonia [Myoclonic dystonia]"] (in French). Rev Neurol. (Paris) 159 (10 Pt 1): 892–9. PMID 14615678.
  8. ^ Vidailhet M, Tassin J, Durif F, et al. (May 2001). "A major locus for several phenotypes of myoclonus—dystonia on chromosome 7q". Neurology 56 (9): 1213–6. PMID 11342690.
  9. ^ Burda A, Webster K, Leikin JB, Chan SB, Stokes KA (October 1999). "Nefazadone-induced acute dystonic reaction". Vet Hum Toxicol 41 (5): 321–2.PMID 10509438.
  10. ^ a b Louis, E.D., Lee, P., Quinn, L., & Marder, K. (1999). Dystonia in Huntington’s disease: Prevalence and clinical characteristics. Movement Disorders, 14(1), 95-101. doi:10.1002/1531-8257(199901)14:1<95::AID-MDS1016>3.0.CO;2-8
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  11. ^ a b c Myers, K. J., & Bour, B. (2009). The Role of Physical Therapy in the Management of Dystonia. In M. S. Okun,The Dystonia Patient: A Guide to Practical Management(pp. 117-148). New York, NY: Demos Medical Publishing.
  12. ^ Priori, A., Pesenti, A., Cappellari, A., Scarlato, G., & Barbieri, S. (2001). Limb immobilization for the treatment of focal occupational dystonia.Neurology , 57(3), 405-409.
  13. ^ Crowner, Beth (November 2007). "Cervical Dystonia: Disease Profile and Clinical Management". Physical Therapy 87 (11): 1511-1526. doi:10.2522/​ptj.20060272. Retrieved 14 May 2011.
  14. ^
  15. ^
  16. ^ Brin MF, Lew MF, Adler CH, Comella CL, Factor SA, Jankovic J, O'Brien C, Murray JJ, Wallace JD, Willmer-Hulme A, Koller M (1999). "Safety and efficacy of NeuroBloc (botulinum toxin type B) in type A-resistant cervical dystonia".Neurology 53 (7): 1431–8. PMID 10534247.
  17. ^ Jankovic, Dr. Joseph; Dr. Eduardo Tolosa (2007). Parkinson's Disease & Movement Disorders (5th ed.). Philadelphia, Penn.: Lippincott Williams & Wilkins. pp. 349–350. ISBN 0-7817-7881-6.
  18. ^ Bittar RG, Yianni J, Wang S, Liu X, Nandi D, Joint C, Scott R, Bain PG, Gregory R, Stein J, Aziz TZ (2005). "Deep brain stimulation for generalised dystonia and spasmodic torticollis". J Clin Neurosci 12 (1): 12–6.doi:10.1016/j.jocn.2004.03.025. PMID 15639404.
  19. ^ Foncke EMJ, Schuurman PR, Speelman JD (2006). "Suicide after deep brain stimulation of the internal globus pallidus for dystonia". Neurology 22 (1): 142–143.

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