Thursday, April 24, 2025

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
Statins-Harvard-Roosevelt
Bipolar Disorder: Biederman Einstein God.
Antipsychotics: Really?
Grand Round: Medicine and War
Bipolar Disorder: Lithium-The Aspirin of Psychiatry?







Thursday, April 10, 2025

Cockroach Catcher II: Attempted Living---- Review from Hong Kong.

 Pleasurable Challenge


To me, it is an honour as well as a challenge to be requested by Am Ang to write a review for his new book - - The Cockroach Catcher II Attempted Living. I found it an honour because even as a layman to the medical field I was assigned with this grand job of commenting on the masterpiece of a renowned and accomplished medical practitioner! It is a challenge as I wonder whether my career as a teacher and later a principal of a government secondary school could provide sufficient support for me  to handle this big task! After reading and ‘chewing’ the whole book, not only was I enriched with tremendous medical knowledge but also informed of a  wide range of interests! I found that I had practically been invited to a house of treasures and was given the privilege of taking away as much treasure as I prefer! As such, the imaginary challenge was turned into real pleasure! 


“A New Home “

Of all the chapters in Am Ang’s book, I was specially impressed by the one titled ‘A New Home’ which not only caused fascination to but also envy from schoolmates of Am Ang’s age!

Here readers were given a detailed account of Am Ang’s early life when he first came to Hong Kong from Shantou of China as a refugee at the age of four! In spite of the initial stage of having to stay in a flat above an abattoir amidst a marketplace in the urban area of Kowloon, Am Ang, upon his father’s joining the family a month later, was soon to move to a cottage house in the countryside of Tai Po, New Territories. The pleasant living conditions in the new home out in the village prompted a new and happy start for Am Ang’s life journey! There also came the joy of dwelling in a refreshing place, in much contrast to living in the crowded city previously experienced! Readers would just be carried away by Am Ang’s vivid description of his new home at Tai Po!

It will be deemed a luxury to have such a living environment in Hong Kong these  days ! It was a cosy, comfortable and joyful experience living in individual houses with a terrace and yard in front, planted with all kinds of fruit trees, similar to those of an orchard! The fruits borne were of different kinds, thus supplying fresh fruits for the family throughout the year! There were also freshly laid eggs by self raised chickens for the family diet. The house was facing large stretches of rice paddy fields which would present a soothing view of a green sea when wind was blowing at the growing rice plants! Readers could imagine how happy life could be during Am Ang’s childhood when the living environment was so much embraced by the beauties of nature! Free time was so much fun by engaging oneself in healthy pastimes such as swimming, snorkeling, fishing, hiking and kite flying…….! I would recommend readers to discover more enjoyment by reading this chapter intensively!



Another point of attraction from this chapter would be the heart warming and mutual caring family relationship Am Ang was enjoying!
The tender love from mother, the wise guidance from father, the strong bondage among relatives and intimate friendship with neighbours all made up for fond and indelible memories for Am Ang. The reasons why Am Ang had developed such a gentle, optimistic and dignified character might also be discovered here!

Family education and parenting skills are crucial and beneficial in shaping a respectable personality!



Accolade to an accomplished child psychiatrist

From Am Ang’s  book, we learned that it was his childhood experiences, gathered through an early exposure to the natural world, a cultivated enthusiasm in living things and the environment around together with a sincere compassion for people’s illnesses that prompted him to pursue a medical course as his career.

While Am Ang’s dream was realized by having become a medical practitioner specializing in child psychiatry, it was his devotion to the job, determination to overcome obstacles, shrewd analytical ability and courage to try out new ideas that finally made him an outstanding and accomplished child psychiatrist with spectacular achievements!

As readers went along with the ways Am Ang adopted in solving knotty and unmanageable cases (to psychiatrists in general) they could not help but marvel at Am Ang’s perceptive analysis of cases and the courage to try out innovative healing methods! Many a success in healing was achieved not by medication but by observation, intervention and analysis! This is what made Am Ang’s book so educational, entertaining, captivating and even amusing! It is comparable to reading detective fiction in which there were many suspenseful plots with endings that could not be surmised until the very end!

Relaxation

There were times when readers, amid reading the suspenseful ‘detective stories’ would be brought to another world of wonders. As a lover of traveling, Am Ang would take readers to tour the rarely visited places around the world! In each of the places visited, Am Ang would introduce its peculiarities, viz. its custom, culture and what not for a deeper understanding of the spot! Coupled with pictures taken by Am Ang’s skilled photography techniques, readers were practically provided with a’VR’ (Virtual Reality) feel!

Alongside with introducing the charming scenery of the places Am Ang would lay out his excitements from drinking the rare wine and trying the local cuisines. Undoubtedly, the wine lovers and food lovers would find it a source of interests and attraction!



Last but not least, music lovers, photography lovers and golf players might also find a share of enjoyment in Am Ang’s book! All in all, no one seems to be left out and there was something after one’s heart to be offered in reading Am Ang’s book!

Concluding remarks

Am Ang’s book is good to read and worth of reading! It is no exaggeration if the book is deemed to be casting magic spells on readers! It is so captivating that one cannot help but keep reading it until it comes to the end!

The book’s cross-discipline contents reveal the affluent aspects of Am Ang’s life - from childhood to schooling, journey to become a medical practitioner and a lively living style after retirement!


From what was narrated, readers might understand that Am Ang’s character building was highly influenced and shaped by his family education in which his parents did set a very good example of dignity, righteousness and benevolence. His career achievements as a successful child psychiatrist was prompted by a true understanding of how mental disorder and emotional distress could be more detrimental than physical sufferings. That drove him to work hard on digging the root causes for mental diseases and finding ways to cure them without having to revert to medicine as far as possible. From the cases recorded, Am Ang showed his painstaking efforts and determination to avoid using traditional healing methods and courage to venture on innovative healing paths! As such, Am Ang has revived hope in many a desperate soul and brought back numerous tragic lives! Life was turned bright and shiny because of you, Am Ang!


Tuesday, April 8, 2025

The Cockroach Catcher II: Attempted Living---The Collection in Colour

 


Barracuda, Peter Island, BVI.

Life is a Beach

"It is perfectly safe, only small fishes, turtles and squids!" This doctor's famous line to his wife's first snorkel attempt in 2002. This was used in my retirement presentation to illustrate how we may sometimes not be right. This photo appeared in Life is a Beach.


Ã…lesund , Norway

Attemptd Living


Jack & Gill Windmills on Pilgrim’s Way



Cade's Country


Tango, Buenos Aires

Tango


Tango


Torres del Paine, Chile

Patagonia Glacier


Jerusalem


Sydney Bridge


Heart and Empathy




Ghost Ranch, Santa Fe

Random Thoughts


Giraffe Kruger National Park



Findland


 Findland - Settled and Unsettled Medical "Truths"


Duoro Vinyard

Private Asylum


Peggy’s Cove
 Nova Scotia


Chicago

Why Psychiatry?

From "Why Psychiaty?" : ......I have not yet replaced my Hasselblad with its digital version.  At a price equivalent to that of a RAV4, that would have been a bit indulgent! By the time we arrived at picturesque Peggy’s Cove, I really wished I had the digital Hasselblad though....


Ylang-Ylang



Custard Apple


Scent Of A Little Girl



Milke Trnine Waterfalls, Plitvice Lakes

Tesla & Autism




El Capitan, Yosemite

Little Red Coat

"Little Red Coat": ...... A "mountaineering accident" of a small boy in London, not Yosemite; claimed by foster parents who previously wrapped a dead baby in a little girl's Little Red Coat......

      

Gap of Dunloe      Ireland 

Das Lied von der Erde

Farewell              Wang Wei (701-761)

Dismounting, let me share your farewell wine  
Where, friend are you heading now?

Inverted Therapy



Night Scene, Hong Kong

Incestuous Failure


Boquete Coffee Finca with Rainbow

The Answer



Dawning at Laguna Azul, Panama

Trauma and Human Resilience

There is always hope!