Sunday, November 30, 2008

Bipolar and ADHD: Boys and Breasts

It has always been the worst nightmare for any Child Psychiatrist to be faced with a schizophrenic boy. It is such a serious condition that there is no choice but to treat with an antipsychotic. However, the risk of breast enlargement (gynaecomastia) is extremely high and for boys, this is particularly unpleasant.

Fortunately incidence of true schizophrenia in early adolescent boys is rare and it is this group that are most vulnerable to this particular side effect: gynaecomastia secondary to raised prolactin (a hormone for milk production) level.

As newer antipsychotics came on to the market, claims were made that traditional side effects such as Parkinsonic symptoms and breast enlargement were rarer or non existent. Unfortunately they were only claims.

Then the situation became more serious when antipsychotics began to be liberally used for other fashionable child psychiatric conditions.

First came ADHD. The use of stimulants benefits mainly teachers during school hours. Parents and doctors soon find a quick fix in antipsychotics, and for good measure the newer ones, believing that they have fewer side effects.

This was soon followed by Bipolar Disorder. Many believe that Dr Biederman, Child Psychiatrist from Harvard, single-handedly led the movement to diagnose Bipolar Disorder in children, many as young as 2 or 3 years old. This recent trend meant that suddenly there is justification for the use of antipsychotics in very young children.

Biederman, as I reported in a previous
blog, is being paid by pharmaceutical companies that manufacture the very same antipsychotics that are now causing concern, major concern.

New York Times headline:

Use of Antipsychotics in Children Is Criticized
New York Times: November 18, 2008
“Powerful antipsychotic medicines are being used far too cavalierly in children, and federal drug regulators must do more to warn doctors of their substantial risks, a panel of federal drug experts said Tuesday.

"The meeting on Tuesday was scheduled to be a routine review of the pediatric safety of Risperdal and Zyprexa(Olanzapine), popular antipsychotic medicines made, respectively, by Johnson & Johnson and Eli Lilly & Company. Food and Drug Administration officials proposed that the committee endorse the agency’s routine monitoring of the safety of the medicines in children and support its previous efforts to highlight the drugs’ risks.

“More than 389,000 children and teenagers were treated last year with Risperdal (Risperidone), one of five popular medicines known as atypical antipsychotics. Of those patients, 240,000 were 12 or younger, according to data presented to the committee. In many cases, the drug was prescribed to treat attention deficit disorders.

“But Risperdal is not approved for attention deficit problems, and its risks — which include substantial weight gain, metabolic disorders and muscular tics that can be permanent — are too profound to justify its use in treating such disorders, panel members said.”

“Prescription rates for the drugs have increased more than fivefold for children in the past decade and a half, and doctors now use the drugs to settle outbursts and aggression in children with a wide variety of diagnoses, even though children are especially susceptible to their side effects.” The New York Times article continued and surprise surprise, the panel in the end rejected the FDA’s proposal.
The panel members spoke at length about Risperdal, but their concerns applied to the other medicines in its class, including Zyprexa, Seroquel, Abilify and Geodon.

The Problems:
In the United States:
“From 1993 through the first three months of 2008, 1,207 children given Risperdal suffered serious problems, including 31 who died. Among the deaths was a 9-year-old with attention deficit problems who suffered a fatal stroke 12 days after starting therapy with Risperdal.”

Boys and Breasts: The WSJ detailed concerns by doctors on breast enlargements in children especially boys at the same FDA meeting and reported that six teenage boys are seeking compensation from Johnson and Johnson. Two of the boys required mastectomies (surgical removal of the enlarged breasts).

Many great poets, musicians, writers and artists are believed to have suffered from Bipolar Disorder but were unrecognised. Imagine them being diagnosed as such in their formative years and treated with antipsychotics. Would they still have become great poets, musicians, writers and artists?
The question to ponder is: do children diagnosed with ADHD and Bipolar fare better with antipsychotics? What if the diagnosis is suspect in the first place?

When you look closer, many children present with behaviour problems. Parents find it easier to accept the diagnosis shared with famous people: Bipolar Disorder. Instead of using a mood stabiliser, an antipsychotic is used as a behaviour controlling drug. For good measure the drug is recommended by a famous Child Psychiatrist. That he is paid by the drug company is really neither here nor there.

So perhaps there really is no epidemic in Bipolar Disorder in children, nor indeed ADHD.

Related Posts:

Lithium Bipolar and Nanking
Bipolar Disorder in Children
Bipolar and ADHD: Boys and Breasts
Bipolar Disorder: Biederman Einstein God.
Antipsychotics: Really?
Grand Round: Medicine and War
Bipolar Disorder: Lithium-The Aspirin of Psychiatry?

Saturday, November 15, 2008

Doctor Atomic

Batter my heart, three-person'd God ; for you
As yet but knock ; breathe, shine, and seek to mend ;
That I may rise, and stand, o'erthrow me, and bend
Your force, to break, blow, burn, and make me new.
I, like an usurp'd town, to another due,
Labour to admit you, but O, to no end.
Reason, your viceroy in me, me should defend,
But is captived, and proves weak or untrue.
Yet dearly I love you, and would be loved fain,
But am betroth'd unto your enemy ;
Divorce me, untie, or break that knot again,
Take me to you, imprison me, for I,
Except you enthrall me, never shall be free,
Nor ever chaste, except you ravish me.

HOLY SONNETS. XIV John Donne (1572-1631)

Doctor Atomic Metropolitan Opera House

At the end of Act 1 of Dr Atomic (premiere at the Metropolitan Opera House, New York this season - composer: John Adams), Oppenheimer, the father of the Atomic bomb, faces his own personal crisis alone in the desert, recalling this sonnet by John Donne.

Gerald Finley as J. Robert Oppenheimer in "Doctor Atomic." Terrence McCarthy
This opera was first performed in San Francisco in 2005. You can read about that here.

The Cockroach Catcher and his wife were at the Met’s performance on the 13th of November 2008, a review of which you can read

I am not here to discuss the rights and wrongs of the Atomic bomb and its derivatives. There are now 50,000 such weapons worldwide. What is clear is that it has always been humans who hold the key to mass destruction. In
Nanking. the Japanese grew bamboo through living Chinese as a means of destruction. It did not take an Einstein to work that one out nor an Oppenheimer to execute it.

In Dr Atomic, at the high point of the final countdown to the test firing of the bomb, there was a tape recorded voice of a Japanese woman repeatedly asking for a glass of water.

5:29:45 am Mountain War Time on July 16, 1945 Los Alamos National Laboratory
What would the effect have been if images of Japanese atrocities in Nanking or in Hong Kong were projected on stage at the same time? Or perhaps Pearl Harbour, for an American audience?
After all there have been recent attempts by Japan to change their history textbooks. Guilt must in the end find its proper home.

That I may rise, and stand, o'erthrow me, and bend
Your force, to break, blow, burn, and make me new.

Other Opera Posts:

Thursday, November 13, 2008

The Dark Side

Another child died: Baby P. And the Social Services Department involved? The same one which oversaw Victoria Climbie’s death eight years ago.

The Cockroach Catcher:

“As we move into the new century child psychiatrists are faced with more and more guidelines and protocols.
Since Maria Colwell, Social Services have been working under revised Guidelines and Child Protection Procedures. The sad truth is that more children continue to be abused and killed despite these tighter guidelines and procedures.

My hunch is that despite media coverage many of us still fail to grasp the dark side – the dark side of human nature. Until we do, we shall continue to read about child abuse, abductions and murders of the worst kind.” Chapter 31 Adapting To Guidelines

A post on NHS Blog Doctor said “Time to crucify the social workers”. Your can read it

“Social workers are professional ‘do-gooders’. What is wrong with that? Some of them are vegetarians and I dare say that some of them have geography degrees. A few may even, Heaven forefend, read the Guardian. So what? They also happen to be a group of highly trained, intelligent, caring professionals.”One thing is certain; they are not in it for the money.”

They need to see “The Dark Side” of human nature.

Peter Paul and Mary? “When will we ever learn? When will we ever learn?”
You can also read about Climbie
here and here.


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