Talk:Antipsychotic/Archive 1

3rd Generation Anti psychotics

What is the classification for 3rd generation anti-psychotics? I put bifeprunox under the list that already had abilify on it. I presume 3rd generation drugs are partial dopamine antagonist. —Preceding unsigned comment added by Sp0 (talk • contribs) 05:44, 24 September 2008 (UTC)

Efficacy

In Skeptic magazine vol. 13 no. 3, 2007, there is an article, "The Trouble with Psychiatry," by John Sorboro, M.D. He says the following on page 42:

Even what most psychiatrists assume would be an obvious and universal approach of drug therapy to treat the most "biologic" of psychiatric diseases, schizophrenia lacks the kind of clarity most people assume exists. Recent landmark trials over 12-18 month periods funded by the US and British government involving the treatment of schizophrenia, found that regardless of medication used, many patients stopped taking medication, the medications demostrated a relatively poor efficacy, and new expensive medications did not perform any better than the old inexpensive ones.

he cites:

Bola, J.R 2006 "Medication-Free Research in early epsisode schizophrenia: evidence of long -term harm?" schizophrenia bulletin

Lieberman J A 2005, "Effectiveness of antipsychotic drugs in patients with chronic schizophrenia" new england journal of medicine

Rosenheck, R.A 2006 "Outcomes, costs, and policy caution: A Commentary on the cost utility of the latest antipstchotic drugs in schizophrenia study" Archives of general psychiatry. Sp0 (talk) 00:46, 10 May 2008 (UTC)

There's not much new here - it's WELL understood that psychosis is very difficult to manage and poorly understood, and the drugs available (which ARE effective) are the best of a bad bunch rather than brilliant treatments. I think it's generally appreciated that any improvement of new drugs is not light years ahead of older drugs, and despite Sorboro and the research cited there is also a lot of medical opinion and research that suggests later generations are generally at least a bit better or a bit less harmful. Remember that what counts as a "better" drug in practice is based on a complicated balancing act that partly depends on your value system regarding different benefits and side-effects, and depends very much on the individual patient. Having said that, I think it's pretty reasonable to have a brief, not-too-strenuous disclaimer that there is good research that suggests there is less than full support for the wholesale movement of everybody onto later generation drugs. 131.172.99.15 (talk) 06:08, 13 June 2008 (UTC)snaxalotl

I think the second paragraph, detailing as it does the dangers of antipsychotics, is particularly important now that many psychiatrists are augmenting reasonably safe drugs, e.g. SSRI's, with atypicals. It is important to the reader to be acquainted with the considerable risks involved with being treated with these drugs-and use might reasonable be confined to psychosis and not add-ons for depression, anxiety, etc.. A well done and important section, even though that's a POV comment.

Dehughes (talk) 23:01, 20 October 2010 (UTC)

LY2140023

now... i'm reading the article, and i've been wondering... "Dr.Sandeep Patil's team proved that LY2140023 appeared to work as an antipsychotic when tested upon rodents." - i cant help but wonder, how do you measure how psychotic a rodent is? are psychiatric drugs really supposed to show efficacy on animals during clinical trials? are drugs given to humans at random, just because they didn't manage to kill a rodent? i know this is what the source says, and its supposed to be a reliable one, but this sounds too unrealistic to me. Fdskjs (talk) 01:50, 12 April 2008 (UTC)

agree. you absolutely CANNOT say that some drug works as an antipsychotic on rodents. you can only say that some drug has some certain effect within some certain animal model of psychosis. anyone who doesn't understand how to do this has no business making an entry like the one you describe. this is the sort of article that attracts a lot of nutters, and I think it's generally a good idea to summarily weed out anything that is "not very good" or "not very clear", because if something really needs explaining to complete the article, someone who knows what they are talking about will eventually come along and do it. Honestly, large amounts of this article look like it's been mangled by someone with a psychology freshman understanding of psychosis. I have a copy from a couple of years back that read s like a real encyclopedia entry. 131.172.99.15 (talk) 06:20, 13 June 2008 (UTC)snaxalotl

Antipsychiatry opposition

Someone should mention anti-psychiatry's opposition to these drugs. --Daniel C. Boyer 17:33 Jan 13, 2003 (UTC)

I think the main objection has been to the use of forced or coercive medication rather than to any particular treatment per se. Certainly Szasz would aruge that people should have free access to antipsychotic drugs but would argue against their control or imposition against someone's will. - Vaughan 12:25, 1 Aug 2003 (UTC)

I agree that this article is conspicuous by the absence of the initial point raised above. Antipsychotics were a primary target of the original 60s/70s antipsychiatry movement, often referred to as chemical straightjackets. Avoiding them (entirely or relatively) was a key part of developments like soteria. The modern antipsychiatry or consumer/survivor movement is also associated with a lot of criticism of their potentially anti-recovery long-term use, and of the basis for the huge pharmaceutical industry promotion of atypicals now that the typicals are out of patent. I'm sure it could be covered in the context of good balanced sections on effectiveness claims and adverse effects, they're a bit random-seeming in their coverage at the moment. EverSince 02:50, 23 December 2006 (UTC) p.s. i've added a subheading that wasn't there before, to try to clarify the discussion, I hope this is OK

However much you don't like anti-psychotics, without them, labotomies would have taken longer to reduce to their current levels. Supposed 21:58, 28 August 2007 (UTC)

I don't agree that the main objection is coerced medication (but I definitely agree this should be a serious ongoing concern). There are enormous numbers of people who think psychosis drugs interfere with a perfectly normal mode of being (e.g. classic 60's anti-psychiatry movement), or that you can just buckle down and THINK your way out of schizophrenia (e.g. all scientologists). I absolutely don't think it's valid to express these views as established scientific fact in a general encyclopedia article, but I think it should be mentioned that these views exist and who holds them. This is a significant sociological fact. I can think of at least one household name who claims to be a widely read expert on psychiatry, despite having a complete misunderstanding of some of the most basic issues in the field. 131.172.99.15 (talk) 06:29, 13 June 2008 (UTC)snaxalotl

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This article is a bit chaotic but I've added a few things and hopefully cleared up the most obvious red herrings.

I'll try and spend some time to organise and reference it a little better in the near future. - Vaughan 12:25, 1 Aug 2003 (UTC)

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Minor change from 'The term antipsychotic is applied to any drug used to treat psychotic disorders...' to 'The term antipsychotic is applied to a group of drugs used to treat psychotic disorders...' as (for example) benzos and antidepressants can be used to treat psychotic episodes, however these are not considered to be antipsychotics.

- Vaughan 12:30, 1 Aug 2003 (UTC)

I think this is somewhat wrong. as you say, these drugs treat episodes, not the disorder per se. antipsychotics produce a generalized improvement in function (within the context that everyone understands they're more ok than great), so I don't think the examples conflict with the original. the new version is fine, though. —Preceding unsigned comment added by 131.172.99.15 (talk) 06:38, 13 June 2008 (UTC)

Amotivation

The article on dopamine mentions that some anti-psychotics that affect dopamine activity can act as amotivators. Is anyone able to elaborate on this?

Look below in "Making symptoms worse / side effects".

128.151.161.49 17:34, 6 March 2006 (UTC)Iain Marcuson

The part about off-label uses for antipsychotics is incorrect. Pimozide and Haloperidol are indeed used for Tourette's Syndrome, but those are FDA approved drugs for that condition. Off-label refers to treating a disorder with a drug that is not approved for such usage, such as using an anti-seizure medication to correct a mood disorder.

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One thing I notice isn’t mentioned clearly in the article is the disastrous effect some of these drugs can have on people. In 1997 I suffered a mental breakdown and had what was called a severe psychotic episode (basically due to extreme stress), I was sectioned and put in mental hospital and was put on Droperidol, paroxetine and a short course of high dose lorazepam. My symptoms from these 'anti-psychotics' became very severe. I became suicidal while in hospital and I never had been ever before. Worse, as the drugs ‘cured’ my bipolar 'depression' my reality began to slip and for a while after I was out of hospital I lost my core reality completely. I had gone from being psychotic and manic depressive to full blown schizophrenia. Eventually I began to regain reality, and have at least partly recovered but it has been a very difficult process and I don't even know if I would be alive now if it wasn’t for my families (especially my mothers) huge help.

I am probably the ultimate non-typical mental patient, until my breakdown I had been well rooted in reality for all my then 27 years. I was and am a computer scientist, I was specialising in AI and machine intelligence, I had a reasonably good knowledge of neurology and psychology, had been actively studying human consciousness for several years and was specialising in vision systems. What makes me even more untypical was that I had just made a breakthrough and was contemplating something not worth millions but many billions of dollars, and it was the stress of this this that I partly blame for the original breakdown.

The source of all my problems was that the doctors treated me like a sausage in a sausage factory, most of the people in that (uk) hospital got the same drugs as me and its obvious that its not so much the drugs fault so much as the way they were prescribed - the doctors and the system. Understandably I now have a deep fear and a certain hatred of psychiatrists because of this - just like seemingly most other mental patients. Another point not mentioned is the huge physical damage the drugs do to people, the line of emaciated half corpses that were most of the patients in that hospital reminded me unmistakably of Dachau.

I apologise for the length of this but its not easy to put things simply. Lucien86 05:58, 4 June 2006 (UTC)

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Sorry Lucien but it sounds like you were misdiagnosed, essentially malingering. A nervous breakdown and "acting out" often leads people to be misdiagnosed. The problem was lack of honest communication between you and the doctor. Not all mental patients hate psychiatrists. Even many who do do so irrationally or selfishly . . . many wouldn't function without psychiatric treatment. Your claim of a breakthrough in AI worth "billions of dollars" sounds pretty dubious . . . and your entire attitude sounds much like the TYPICAL immature, narcissistic mental patient. Magmagoblin2 (talk) 12:32, 15 October 2009 (UTC)

English please?

As this is an encylopedic article, could we break this down into something more understanable to the common person? I mean, the article isn't in a science magazine, nor is it being presented at a science convention of some sort. It's for the common persons and the researchers. Is it possible to make this more understandable? I read through it and I'm not an expert, but that's exactly my point. Colonel Marksman 06:31, 16 December 2006 (UTC)

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To be fair, this isn't the kind of topic generally looked up by anyone but a student or specialist, and as such, will find much more value in being indepth and technical the way it is, rather than simplified for your average user. More simplified explainations can be found in the various pages for specific antipsychotics, which is quite possibly where the information you're looking for or interested in is covered? ;-)

neodarkcell

Personally I agree that it could and should be more readable, which doesn't preclude depth EverSince 03:02, 23 December 2006 (UTC)

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Not looked up by anyone but med students or specialists? First, specialists are well versed in the knowledge presented in this wiki and likely to find it elementary. Second, what about PATIENTS?

Move?

It seems like this would be less awkward under the title "Antipsychotics," since the article is about the class of drug, not a single thing. Night Gyr (talk/Oy) 03:51, 11 January 2007 (UTC)

External link to objectionable website

There is a link under the subheading "Side Effects" (Tardive dyskinesia) that redirects to what appears to be a pseudoscience website www.yoism.org. Although there are indeed pictures there of what appear to be something like tardive dyskinesia, viewers must sift through alot of highly opinionated non-scientific garbage to get to anything of interest. Would it be ok to remove this link? Surely there must be other sources that would do better here? I will look for some.Neurophysik 05:25, 27 February 2007 (UTC)

Indications

Are antipsychotics indicated to prevent suicide? E.g. would they be given to someone who is suicidal because of depression?--137.205.76.219 16:38, 17 March 2007 (UTC)

Criticism

this section is more or less complete crap. good prognosis in developing countries is unrelated to occurrence rates or neuroleptics, but probably the superior management that arises from being better accepted and integrated into the community. Note that the /appearance/ of schizophrenia is highly dependent on management strategies, and also note that cross cultural studies have huge methodological difficulties, and aren't that common. the basic rule for schizophrenia is that there /is/ no good treatment, only the best of a bad bunch, and I'd hate to see the hippies, anti-psychiatrists and scientologists encouraging people to abandon neuroleptics because of crank science

I've tried making an efficacy/effectiveness section instead of a criticisms section, to include the views and evidence for, as well as against, antipsychotic efficacy. It probably needs to give a fuller account of the case for efficacy, but for now I've at least added coverage of the two major guidelines recommending them. I have tried to reliably describe and source the case against, which is a bit more disparate. There are more specifics on efficacy in the section comparing typicals and atypicals. EverSince 14:52, 10 August 2007 (UTC)

Sounds a good way to make it balanced. This article needs alot of work....cheers, Casliber (talk · contribs) 15:27, 10 August 2007 (UTC)

Research / Upcoming Antipsychotics

Should there be a section describing current research and a list of drugs in the pipeline for each research/future treatment area? — Preceding unsigned comment added by 24.218.137.40 (talk) 20:00, 29 June 2007 (UTC)

cannabidiol

I've no idea where to put cannabidiol in this article. It's been shown to act as an anti-psychotic so can be described as one. However, the definition of both typical and atypical anti-psychotics describes these as prescribed drugs. I also don't know whether to call it a typical or an atypical anti-psychotic. Supposed 21:45, 28 August 2007 (UTC)

how about you just leave out cannabidiol? this article attracts enough nutcase irrelevency as it is. I'm sure YOU are sure you've seen fan-fucking-tastic evidence of it's anti-psychotic efficacy (along with that car that runs on water tha everyone's been hiding) but the simple fact is that you can read a textbook on psychosis, or do a degree in neuroscience, without seeing cannabidiol mentioned. Trying to insert this sort of information will confuse people rather than enhancing the sort of understanding of the topic an encyclopedia article is supposed to deliver. 131.172.99.15 (talk) 05:48, 13 June 2008 (UTC)snaxalotl

The reference given is really very poor. It certainly does not belong in a section on treatment and as such I have removed it. The study details some pre-clinical animal studies, a trial on patients who did not have schizophrenia (using ketamine as a model), a couple of case studies and a preliminary report from a trial of 43 patients. The only one of any significant interest is the trial of the 43 patients against amisulpride (given as Leweke FM, Koethe D, Gerth CW et al. (2005). Cannabidiol as an antipsychotic: a double-blind, controlled clinical trial on cannabidiol vs amisulpride in acute schizophrenics. 2005 Symposium on the Cannabinoids, Burlington, Vermont, International Cannabinoid Research Society. http://CannabinoidSociety.org.) however it unfortunately appears to be impossible to track down, I can only assume it was never published (or we are still waiting) - this is not good enough to belong in an encyclopaedia. If anything it could be mentioned that there is some research at a very early stage but nothing more than that.82.39.196.227 (talk) 23:09, 3 October 2008 (UTC)

Please read this Talk:Effects_of_cannabis#Cancer_section. I actually share your concerns about the sample size of studies and conclusions drawn from them, however I agree with the conclusions of Pundit|utter in his discussion of these issues in the link above which has implications as to wether we should include in this article the studies you make reference to.Supposed (talk) 20:24, 4 October 2008 (UTC)

In the wiki article, CBD is presented as if it is a real option (under the "Common antipsychotics" heading!) for schizophrenia treatment - which it obviously (at least in the real world) absolutely is not. Surely it can be moved elsewhere in the article, preferably under a more suitable heading which properly reflects the reliability of the study's conclusions? Or perhaps changing it to "Cannabidiol One of the main psychoactive components of cannabis. An unpublished randomised controlled trial has been reported to show that cannabidiol could be as effective as atypical antipsychotics in treating schizophrenia". At the very least could we not qualify that raw cannabis drug would not have the same effect? The referenced article itself mentions that THC causes symptoms similar to schizophrenia, and there are many other peer-reviewed papers (although similarly nothing concrete) linking cannabis use to psychosis.82.39.196.227 (talk) 23:02, 5 October 2008 (UTC)

I'm concerned by this as well. I'm intimately familiar with both marijuana and schizophrenia, and I have heard that marijuana can set schizophrenia off. This article could be dangerous. AThousandYoung (talk) 02:04, 6 April 2009 (UTC)

I've modified the text slightly to tone it down. Perhaps further editing would help. --Tryptofish (talk) 14:45, 6 April 2009 (UTC)

Cannabis is the worst thing you could give a schizophrenic. Speaking from experience, I'm terrified of the stuff because it brought all my nightmares and delusions back . . . I was rabid, pacing, and completely freaked out for two days, then crushingly depressed and paranoid for a week. PARANOIA is one of the chief symptoms of schizophrenia and one of the notorious side effects of pot. I'm gonna go ahead and take out this reference, because it's terrible advice, could be very dangerous (many schizophrenics lack medical care, but have easy access to marijuana, and this "study" would encourage them to try it, and then who knows what'll happen) and there is no way cannabis is ever going to be prescribed to the mentally ill. Cancer patients, sure. Schizophrenics, no. Magmagoblin2 (talk) 12:23, 15 October 2009 (UTC)

Hi, the purpose of wikipedia is to provide factually accurate largely scientific information in an encylopedic format. We simply report and cite the conclusion of experts in each field. Wikipedia is not a guide for people taking drugs. If people want to use it as a guide, that is not the business of wikipedia to police it. Besides the fact that you are talking about cannabis not cannabidiol specifically, there is plenty of evidence that people with schizophrenia self-medicate with cannabis, infact that's one of the very reasons why this research on cannabidiol has been done. Wikipedia is not in the business of satisfying the agenda of a concerned party, because of the accurate information presented may not be to their taste. That is censorship and has no place here. I should add that plenty of people in the USA are prescribed cannabis for psychiatric conditions. Even the American Psychiatric Association Assembly (a very large and important medical organization) unanimously Back Medical Marijuana. [1]Supposed (talk) 00:15, 16 October 2009 (UTC)

Making symptoms worse or adding side effects.

To anyone reading this - In my experience, antipsychotics will completely demolish one's sense of social anxiety, paranoia, and being in the dark. If you embrace your healthy sense of paranoia, taking these will make thinking about such things an arduous task. In addition, I used to have love for things like fire and the outdoors, but I no longer have significant feelings for them. —Preceding unsigned comment added by 69.250.158.97 (talk) 17:44, 30 May 2008 (UTC)

Also, in my comment about motivation and desire, there is a scientific study which shows that when rats are injected with antipsychotics and made to run a maze, they do several times better when they are thereafter injected with L-dopa (the bioavailable form of dopamine).

I have schizophrenia and have taken Risperdal and now Zyprexa.

This article describes the dramatic increase in synaptic dopamine bought about by release of endogenous dopamine by electrical stimulation and antipsychotic treatment, and the experiment was successfully repeated a number of times and established.

http://jpet.aspetjournals.org/cgi/content/abstract/232/2/492

Similar levels of dopamine (in the mM range) are achieved with amphetamine and can lead to disturbed sexuality. With such high levels of dopamine, serotonin usually ramps down - could this lower serotonin cause depression and guilt.

-Steve. —Preceding unsigned comment added by 131.181.251.66 (talk) 12:36, 9 October 2007 (UTC)

I've no idea, however as you're no doubt aware the article is in vitro which doesn't help Supposed (talk) 17:07, 15 April 2008 (UTC)

Classes

Added Haloperidol which is never shown under 1st generation antipsychotics. Madglee (talk) 00:03, 15 April 2008 (UTC)

quetiapine, sedation and major-tranquilisers

Quetiapine is quite an effective tranquiliser at doses below 200mg. I was under the impression that quetiapine is referred to as a major-tranquiliser. I can certainly mimic some of the effects of benziadiazapines although it's not itself considered an anxiolytic. My question, is it just typical anti-psychotics that are referred to as major tranquilisers like the article says, because it appears to me that drugs like quetiapine may be even more sedating and anxiolytic in effect than some of the typical anti-psychotics. "Typical antipsychotics are also sometimes referred to as major tranquilizers, because some of them can tranquilize and sedate." Supposed (talk) 06:03, 17 April 2008 (UTC)

Problem is all the uses of labels. Major Tranquiliser is an old term applied to all antipsychotics, while benzodiazepines were minor tranquilisers. The terms aren't used much anymore. Any drug with sedating properties (suhc as quetiapine) will have some anxiolytic properties, however the term anxiolytic as such is generally restricted to drugs like Xanax (alprazolam). Hope that helps. Cheers, Casliber (talk · contribs) 06:41, 17 April 2008 (UTC)

Thanks for your response. "Major Tranquiliser is an old term applied to all antipsychotics, " hmm. Then I think we need to remove the word 'typical from the following sentence, "Typical antipsychotics are also sometimes referred to as major tranquilizers, because some of them can tranquilize and sedate." Is there anything reputable online that refers to all anti-psychotics as major tranquilers, or are you trying to say that the term is merely of historica significance, such that no anti-psychotics would be referred to as that today? Inregards to 'anxiolytic', the same paper that referred to cannabidiol as an anti-psychotic also referred to it as an anxiolytic. This is of particular signifance as in contrast to benzo's it's non addictive and illegal even on prescription. Supposed (talk) 16:02, 18 April 2008 (UTC)

RE ANXIOLYTIC, could you possibly help me clean the article up as there appears to have been an awful lot of crap added to it recently but I didn't keep an eye on it. [2] I haven't heard of cannabidiol actually inducing anxiety in people. Supposed (talk) 16:08, 18 April 2008 (UTC)

Asenapine

This article does not list Asenapine but it lists Bifeprunox — Preceding unsigned comment added by 71.103.92.5 (talk) 10:20, 25 June 2008 (UTC)

It has been said..

• I quote:

  It has been said that these studies require serious attention and that such effects were not clearly tested for by pharmaceutical companies prior to obtaining approval for placing the drugs on the market.[17]

  Is this really the words from the article cited (PMID 18263882)? I've no access and the abstract seems not to mention this theme. --CopperKettle (talk) 02:13, 19 December 2008 (UTC)

Third generation?

There is a subsection "Third generation antipsychotics". Very strange.. who's deciding that Abilify is "third-generation" and on what basis? --CopperKettle (talk) 15:17, 7 January 2009 (UTC)

There are more side-effects

...than just those listed in the side-effects part. Demotivation ought to be listed. 74.195.28.79 (talk) 22:51, 11 March 2009 (UTC)

Zotepine?

Zotepine is an second-generation antipsychotic commonly used in Japan and some countries in East Asia. It is absent in this page. Cause? Ryojames (talk) 10:40, 18 May 2009 (UTC)

I added it and associated info to the list of second-generation agents.--Metalhead94 (talk) 02:26, 3 July 2009 (UTC)

And on a second thought, it may have been left out due to have only been approved in Japan and Germany. It seems to me that a majority of articles on antipsychotics and pharmacueticals in general are overwhelmingly America-centric.--Metalhead94 (talk) 02:30, 3 July 2009 (UTC)

Conflicting Research

[3] It seems that increasing serotonin levels (through omega-3 fatty acids) actually decreased the symptoms of psychosis, but some antipsychotics are actually serotonin antagonists. This also seems to point to the same conclusion. However, this suggests that there is no link between serotonin levels and schizophrenia (or at least its first episode). MichaelExe (talk) 16:56, 7 September 2009 (UTC)

Hi Michael. I think I can answer that. Omega-3 fatty acids do not actually increase the amount of serotonin in the brain, to the best of my knowledge. According the the first source you cited, they get into the lipid bilayer and, by altering the fluidity of the membrane, alter the activity of the 5-HT2 receptor. Those first two sources you cited were using platelets as a model system to look at how the fatty acids might affect the receptor in membranes, not to look at fatty acids as a clinical medication in the brain. Overall, I don't think this information needs to be addressed in the page. --Tryptofish (talk) 17:06, 7 September 2009 (UTC)

Well, these sentences seem a bit confusing, then: "Previously, we have demonstrated a significant inverse correlation between 5-HT responsivity and psychosis severity in unmedicated patients with schizophrenia. Taken together, the present data support the notion that EPA may be mediating its therapeutic effects in schizophrenia via modulation of the 5-HT2 receptor complex." MichaelExe (talk) 19:31, 7 September 2009 (UTC)

Also, from Docosahexaenoic acid: "Low levels of DHA result in reduction of brain serotonin levels[4] and have been associated with ADHD, Alzheimer's disease, and depression, among other diseases, and there is mounting evidence that DHA supplementation may be effective in combating such diseases." Unfortunately, the cited website no longer exists, but a quick google search for "DHA Serotonin" has several results claiming that consumption of DHA (an omega-3 fatty acid) increases serotonin levels/production in the brain. MichaelExe (talk) 19:42, 7 September 2009 (UTC)

I've corrected the unsourced material at the DHA page. I'm afraid there is a lot of "stuff" out there about nutraceutical treatments for diseases that are scientifically speculative. If other editors disagree, I'm open to suggestions, but I'd lean against modifying this page to include material that is as preliminary as this. --Tryptofish (talk) 20:33, 7 September 2009 (UTC)

Prevalence of use?

The data under the heading "Prevalence of use" lists the prevalence of schizophrenia and bipolar disorder, not the prevalence of antipsychotic use. These drugs are increasingly prescribed to individuals not suffering from either of these disorders so that the number of individuals taking the mediation is actually many times the amount of those with either schizophrenia or bipolar disorder. They are used for depression and anxiety and sleeping problems, and are also routinely administered to the elderly in nursing homes to sedate them. —Preceding unsigned comment added by Ilmateur (talk • contribs) 22:18, 12 January 2010 (UTC)

Unauthorized addition of copyrighted material

The material in question was actually on Wikipedia first, and copied from Wikipedia by an external site. The matter has been resolved.

By 'Google sampling' the text, I've now encountered two specific instances where material has been copied and pasted to the article from copyrighted sources by editor Tweak279 over the past several days. Adding an attribution to quoted material is of course required by policy, but neither of the additions that I've encountered so far indicate that the material is a word for word 'lifting' of the source material itself without any indication of it being a direct quotation. Both instances that I've encountered so far appear to be sourced to: [4]. I'm going to revert the material added by Tweak279, until this potentially serious breach of policy is examined more closely and resolved. Please do not continue to add potentially controversial material to articles without engaging other editors in dialog in an attempt at reaching consensus. thanks Deconstructhis (talk) 17:14, 13 March 2010 (UTC) Me waits for this person to realize that the page they found is actually a copy of Wikipedia not hte other way round, and from some time ago as well. Tweak279 (talk) 17:37, 13 March 2010 (UTC) "Me" (lol) is only looking for transparency when it comes to sourcing, that's all. So, just to clarify it for me, what you're saying is that the material found at [5] attributed to a "HealthyPlace.com Staff Writer" dated Oct 05, 2008; sections of which are now contained in the article and apparently protected under current copyright by HealthyPlace.com, is actually lifted from a Wiki article that predates it? cheers Deconstructhis (talk) 18:01, 13 March 2010 (UTC) Whoops,just a bit more clarification. Are you also saying that the material I removed in this edit to the Psychopathy[6] was also originally lifted from an earlier Wiki version as well? This is in no way a personal attack, I've looked at other material you've added to articles and quite enjoyed it. cheers Deconstructhis (talk) 18:07, 13 March 2010 (UTC) Since I never used that HealthyPlaces article I'm at a loss to understand how you're expecting me to clarify things for you. You can see for yourself and apologize for your false accusation about me here. And please adhere to Wikipedia guidelines about talk pages of articles; issues and a mistake relating to other articles are being discussed elsewhere. Tweak279 (talk) 23:15, 13 March 2010 (UTC) Me continues to wait for this person to retract and apologize for their mistaken defamatory comments. Tweak279 (talk) 13:12, 15 March 2010 (UTC) '© 2000 - 2010 HealthyPlace.com, Inc. All rights reserved' I take it this means HealthyPlace.com is breaching the terms of the GFDL? Supposed (talk) 02:16, 16 March 2010 (UTC) Looks like it; their "about us" says their content is written by journalists and reviewed for medical accuracy by their "medical director". The next page, if you click on next, may also be copied from somewhere but, unlike what they appear to have taken from Wikipedia several years ago, it doesn't say written by a staff writer at the top and there is a statement of source at the end. It appears to be a private company and the site is littered with clickable drug company ads mostly for antipsychotics so no doubt they're making money out of it. Tweak279 (talk) 12:24, 16 March 2010 (UTC) Deconstructthis, could you provide more detail on the content that you're discussing so that other people can look into it? I'm talking about diffs or a blockquote of the content duplicated at Healthy Place. II | (t - c) 19:18, 16 March 2010 (UTC) Yes, I would also like to know that, as well as what we are talking about with respect to what was here on WP several years ago, if it is no longer here now. --Tryptofish (talk) 19:44, 16 March 2010 (UTC) Sure, here's an eighteen word sample comparison:[7] and [8] and here's a twenty word grab from further up the page [9] and [10]. These are the two samples that drew my initial attention and created a suspicion that something might be 'going on'. cheers Deconstructhis (talk) 20:03, 16 March 2010 (UTC) EH????? Haven't you looked yet and seen that that content was added to this article ages ago, not just lately???? Doesn't the Wikipedia administration have any compunction about throwing around serious allegations without properly checking??? EVen when it's called to their attention the need to do so???? Tweak279 (talk) 20:18, 16 March 2010 (UTC) Deconstructhis: that wasn't really what either of us was asking. It's not particularly noteworthy that there would be words in common. After all, these are about a particular subject. What we both asked for are diffs of actual edits that you believe were inappropriate. --Tryptofish (talk) 20:26, 16 March 2010 (UTC) Here's this article at end of 2007: http://en.wikipedia.org/w/index.php?title=Antipsychotic&oldid=178669862 see efficacy & typical vs atypical section. Basically the same as the HealthPlace article published 2008 right? except the latter has taken out a chunk which means their article doesn't even make any sense!???? That took me one minute to check, Deconstruthis. Tweak279 (talk) 20:31, 16 March 2010 (UTC) What I can see are two paragraphs in the Efficacy section, one starting "Some doubts..." and the next starting "Some argue...". They are clearly the same. Where did this language appear first: Wikipedia (when?) or the external site? --Tryptofish (talk) 20:38, 16 March 2010 (UTC) Thanks for providing that history, it's basically what I was asking for back here [11]. Is anyone familiar enough with Wiki's required licencing procedures for acknowledging use to look into this further at this point? cheers Deconstructhis (talk) 20:44, 16 March 2010 (UTC) Well, the m:Terms of Use aren't that difficult to understand. Is it the case that we all agree that this language was in Wikipedia first, that it then appeared at another site, and that recent edits were simply working with language that has been here all this time, and therefore, not a problem at all? If so, can we drop this and move on? --Tryptofish (talk) 20:51, 16 March 2010 (UTC) Deconstructhis, sorry but who the f*ck do you think you are? 'Cos you're some admin you can throw around accusations and then blame the person for not spelling out the corrections and links for you, when said person had no f*cking idea where you got your mistaken idea from anyway so how could they correct you? When you were told that the content was already on this article which takes less than one minute to check????? If hte rest of Wikipedia administration considers this acceptable treatment of someone who was actually ADDING CONTENT TO WIKIPEDIA, and doesn't think it requires a retraction and apology, then this whole palce is f*cked. Tweak279 (talk) 20:59, 16 March 2010 (UTC) Tweak, I'm trying to help here. You are not helping your case with that. --Tryptofish (talk) 21:02, 16 March 2010 (UTC) Actually,I'm not an administrator. Deconstructhis (talk) 21:08, 16 March 2010 (UTC) Neither am I. Deconstructhis, do you agree that the material was on Wikipedia before it was at the other website? --Tryptofish (talk) 21:11, 16 March 2010 (UTC) I do'nt care about my case, I havne't got one to answer. My concern is that Wikipedia seems to be populated by protectionistic idiots who think people who try to add ACTUAL CONTENT TO WIKIPEDIA are fame game for being treated like ****s. Tweak279 (talk) 21:18, 16 March 2010 (UTC) I wasn't asking you. I was asking Deconstructhis, and I'm still waiting for an answer. But Tweak, please be WP:CIVIL. --Tryptofish (talk) 21:27, 16 March 2010 (UTC) I wasn't answering that question but replying to your statement addressed to me. Good to see the encouragement of civility guidelines, shame you weren't doing that when Deconstruthis was breaking them above by refusing to check or retract his accusation and making a sarcastic comment about an edit on another article, against talk page guidelines. Tweak279 (talk) 21:37, 16 March 2010 (UTC) By the way someone should make Deconstructhis an admin, you can see from their edits that that's basically all they do round here, adn they clearly have the attitude towards regular editors to fit right in Tweak279 (talk) 21:43, 16 March 2010 (UTC) It looks like EverSince (talk · contribs) drafted some of the language in question (diff) back in 2007, so it seems quite likely that HealthyPlace copied Wikipedia without attribution (unsurprising). I think we can drop this for now - should someone notify HealthyPlace? II | (t - c) 21:46, 16 March 2010 (UTC) Yes, that's what I think too. There is no need to do anything about HealthyPlace, because anything on Wikipedia may be re-used freely by anyone else. HealthyPlace didn't do anything wrong (except demonstrating a lack of original thinking, which is bad scholarship but not a violation of any copyright law—if they attempt to enforce their bogus copyright, which they probably won't, WMF will know what to do). Tweak279 didn't do anything wrong in editing the page, either. Deconstructhis made a mistake in thinking there was a copyright violation, but appears to me to have done so politely, albeit being a little reticent about correcting the mistake. Tweak279 has been very incivil in reacting to Deconstructhis, perhaps because of understandably being offended, and that, in turn, may have made Deconstructhis less helpful in resolving the situation. Anyway, it is now time to move on, I think, and I hope both editors will drop their bad feelings towards each other personally. --Tryptofish (talk) 21:54, 16 March 2010 (UTC) It appears that HealthyPlace did do something wrong, since the Creative Commons License appears to require attribution, and it appears to be copyleft (Wikipedia:Text_of_Creative_Commons_Attribution-ShareAlike_3.0_Unported_License). II | (t - c) 22:07, 16 March 2010 (UTC) Sorry for collapsing the section too soon. If you want to, there's Wikipedia:Contact us/Permit, but I have a feeling that WMF will not be interested in pursuing it. --Tryptofish (talk) 22:23, 16 March 2010 (UTC) Trypo, that section is for releasing material not published on Wikipedia to be published on Wikipedia. I think we should look into this because we don't want this sort of thing to come up again when our discussion has been archived, and force people to again do the research we did. II | (t - c) 23:20, 16 March 2010 (UTC) Go right ahead. --Tryptofish (talk) 23:22, 16 March 2010 (UTC) I sent them an email. We could collapse this I suppose; I'll drop a note in when I get a response. II | (t - c) 23:31, 16 March 2010 (UTC) I agree. And, regarding the important point of valuing actual content provision on Wikipedia, I'm still waiting for Deconstructhis to retract his accusation here and to do something constructive to sort out the appalling intro to the psychopathy article, rather than just administrate or admonish anyone who dares try to build up articles. Tweak279 (talk) 22:10, 16 March 2010 (UTC) WP:STICK. --Tryptofish (talk) 22:23, 16 March 2010 (UTC) Stick it yourself. Tweak279 (talk) 22:26, 16 March 2010 (UTC) It's always been my understanding that if an entire article is republished from Wiki by someone, there's a requirement in the licensing that the source of the material be acknowledged; I'm only guessing, but I'm assuming by extension, that portions lifted verbatim should also be accompanied by notice as well. As I indicated above, I'm unsure if there's a formal mechanism for informing Wikipedia of these sorts of breaches or not. If I get a chance, I'll explore this later on and get back to you on it. cheers Deconstructhis (talk) 22:29, 16 March 2010 (UTC) Thanks for doing that Imperfectly Informed, let us know if you find out anything. cheers Deconstructhis (talk) 23:53, 16 March 2010 (UTC) Summary: There were allegations that a Wikipedia editor copied some material from a 2008 HealthyPlace (article); however, some of the content was added (diff) back in 2007. I sent HealthyPlace an email notifying them of the Creative Commons license (Wikipedia:Text_of_Creative_Commons_Attribution-ShareAlike_3.0_Unported_License) and will post an update if/when I get a response. II | (t - c) 00:36, 17 March 2010 (UTC) Errr this actually makes it sound as if some of teh material WAS copied by the accused editor?? Tweak279 (talk) 08:38, 17 March 2010 (UTC) When in fact ALL the content was here before it was on HealthyPlace and another editor simply made a stupid mistake. Tweak279 (talk) 08:41, 17 March 2010 (UTC)

Changes

Hi, I am bringing a couple of changes to the talk page to try and achieve consensus. This edit removed text for the reason that antipsychotics are not used in non-psychotic individuals and thus saying the review is wrong. Antipsychotics, are not just prescribed for psychosis, they are used for example for nausea and vomiting for example from chemotherapy, sometimes off-label for sleep disorders (especially in the USA), agitation and anxiety and autistic spectrum. The article was a review of the literature so it must have been documented. The withdrawal syndrome of antipsychotics is believed to be due to increased dopamine activity. The mainstream psychiatric viewpoint is that schizophrenia is caused by excessive dopamine activity. So to disagree that withdrawal effects of antipsychotics can cause psychosis in non-psychotic patients means one should also deny the mainstream biological theory of schizophrenia.--Literaturegeek | T@1k? 00:38, 17 May 2010 (UTC)

The other point was the content added to the controversy section, which was a review which stated that research may be flawed due to failure to take into account withdrawal effects of antipsychotics. I agree that on its own it was undue weight, so I have added two other reviews which support maintenance for psychosis. Although my personal view points are not relevant, I would like to say that I do believe that there are many people who require long-term maintenance for serious mental illness and I am quite happy to add balance supporting this viewpoint. I am not trying to push a POV against the long-term use of these drugs. I think it is important knowledge that antipsychotics produce withdrawal effects which can mimic the condition being treated and if maintenance studies have failed to control for this variable, then this controversy should be cited I feel.--Literaturegeek | T@1k? 01:31, 17 May 2010 (UTC)

I see you just added "There is some controversy over maintenance therapy." I think it needs to be stated maintenance therapy for what condition.Doc James (talk · contribs · email) 04:37, 17 May 2010 (UTC)

I think the Controversy section is much better now, thanks. I made a few copyedits, including making the first sentence more specific as suggested just above. I noticed, however, that the sentence about non-psychotic patients in the Withdrawal section was added back but then removed again: I wonder if the removal was a mistake? With the explanation given here, I would have no objection to adding it back, so long as a few words are added to clarify why the patients were taking the drugs, since it was confusing without that explanation. --Tryptofish (talk) 17:54, 17 May 2010 (UTC)

Thanks, glad that you are happy with the changes to the controversy section. Your copy edits look good to me. Yes that was removed by mistake when I reverted one of your other edits. I noticed it at the time but decided to leave it removed while I waited for your response to talk page. :) I will need to get the full text of the paper in order to see why the patients were taking the antipsychotics.--Literaturegeek | T@1k? 21:34, 19 May 2010 (UTC)

Good! --Tryptofish (talk) 21:37, 19 May 2010 (UTC)

My personel experience about antipsychotics.

I am a veteran with Schizophrenia and I have was on multiple types of antipsychotics for nineteen years. However, I do not consider myself psychotic at all. Scizophrenia is one or more of the folowing symptoms as far as I have been told by the doctors. They are hearing voices, delusional, paranoid, catatonic and\or seeing things. Psychotic as far as I know is violent. I am not, but am aware that some of these symptoms could cause psychotic behavior. What I really wanted to say is that the medications are what I would call a modern day lobotomy in that they do turn you into a sort of zombie. It slows your brain down and body down. This might be why my sugar was very very (13 H1C and it should be 6) high on clozapine and 260 lbs. Many of the drugs I took were just plain aweful. The side effects were there and changing all the time. Slobbering puddles on pillows by morning, sleeping too much, no emotion, sad, uncaring, anemic requiring iron, dystonia in the form of unconsious violent cracking of my neck to name few. Once off the medications without telling the doctors my sugar returned to normal I felt better through exercise and eating right, lost 50-60 pounds and learned not to tell the doctors my problems. I asked for a psychologist instead of a psychiatrist. I found they work together over there and if there is no improvement they do recommend drugs. It seemed the side effects and the doctors telling me there was something wrong with me is the problem. On prolixin, I wound up in the mental ward shaking violently. On Haldol, I could not stay seated and getting off the drug was a nightmare of having to stay in bed and not being able to sleep or stay still. If I wanted to take the drugs I would want the lowest possible dose because they are strong and take the the same time every day, don't drink or smoke, eat right and get excercise. Also, be around people you love and trust. Give everyone a chance to be one of them. Choose your friends wisely and find a job you enjoy. —Preceding unsigned comment added by Brian1596 (talk • contribs) 23:32, 17 June 2010 (UTC)

Psychotic does not mean violent (although occasionally psychotic people are violent) but means a severe loss of contact with reality, typified by delusions, severe paranoia and sometimes hallucinations. You maybe are mixing psychotic up with the hollywood version of psychopath. This talk page is not a forum for sharing personal experiences but is for improving the article content. Please see WP:TALK and WP:FORUM.--Literaturegeek | T@1k? 23:55, 17 June 2010 (UTC)

Why isn't this just called a "sedative"?

Why are these chemicals referred to as anti-"psychotics", when what they really basically are is a sedative?

If a patient is acting too wild and crazy for the caregivers to deal with, then the doctors give them this chemical to sedate and calm them, and if the patient still is too much to handle, the amount of chemical given can be cranked up to the point of stupefaction and catatonia.

Personally I believe the name choice is to make patients more willing to accept taking the chemical. It sounds better to be given a chemical to treat your "abnormal psychotic behaviors", than it is to say we're going to slow your thinking and numb you into a fuzzy compliance.

216.56.13.231 (talk) 02:32, 30 June 2010 (UTC)

It's called that here, because that's what the sources say. As for why it's called that elsewhere, this is the wrong place to discuss it. --Tryptofish (talk) 15:23, 30 June 2010 (UTC)

Statement needing sources

"This may refer to common side effects such as reduced activity, lethargy, and impaired motor control. Although these effects are unpleasant and in some cases harmful, they were at one time considered a reliable sign that the drug was working.[citation needed]" This is found in Elliot Valensteins Blaming the brain and he also cites his source in the book but unfortunately I don't have that book anymore. Can somebody who has the book provide the citation? 24.247.174.132 (talk) 17:15, 27 September 2010 (UTC)

WP:MEDRS, etc.

Another editor and I disagree about about this edit that I made: [12]. I had noticed this edit, by another editor: [13]. Looking at the biographical page that is linked in the edit summary, I agreed with that editor that the cited sources were at odds with WP:UNDUE, WP:FRINGE, and, most importantly, WP:MEDRS. I also think that some of the language about "systematic review" and "urgently needed" went against WP:NPOV (when taken in the above context) and WP:PEACOCK, while the part about "a call that had already been made when similar results were found in 2006" goes against WP:SYNTH. Overall, per WP:MEDRS, we have to be very careful about not presenting material that goes against the medical literature in ways that might mislead our readers; these are, after all, medications that remain approved for use. I hope that explains my deletion. --Tryptofish (talk) 22:21, 5 March 2011 (UTC)

Long-term Antipsychotic Treatment and Brain Volumes

Check that out.

http://archpsyc.ama-assn.org/cgi/content/short/68/2/128

During longitudinal follow-up, antipsychotic treatment reflected national prescribing practices in 1991 through 2009. Longer follow-up correlated with smaller brain tissue volumes and larger cerebrospinal fluid volumes. Greater intensity of antipsychotic treatment was associated with indicators of generalized and specific brain tissue reduction after controlling for effects of the other 3 predictors. More antipsychotic treatment was associated with smaller gray matter volumes. Progressive decrement in white matter volume was most evident among patients who received more antipsychotic treatment. Illness severity had relatively modest correlations with tissue volume reduction, and alcohol/illicit drug misuse had no significant associations when effects of the other variables were adjusted. —Preceding unsigned comment added by 74.59.147.209 (talk) 22:38, 23 March 2011 (UTC)

Note: please see WP:COPYVIO. --Tryptofish (talk) 19:43, 28 March 2011 (UTC)

A short quote that links to its original source hardly constitutes a copyright violation. Please read carefully the link you yourself provide on this policy especially as regards the proper use of non-free content. I would be stunned, in any case, if any copy right holder pursued a case involving quotation from an abstract.FiachraByrne (talk) 12:26, 5 April 2011 (UTC)

Additionally, the section in this article discussing brain volume changes as part of the section on side effects does not source the original study. I'm going to put in the original citation and give, I think, a more accurate interpretation of their findings.FiachraByrne (talk) 12:28, 5 April 2011 (UTC)

File:Thorazine advert.jpg Nominated for Deletion

An image used in this article, File:Thorazine advert.jpg, has been nominated for deletion at Wikimedia Commons in the following category: Deletion requests August 2011

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This notification is provided by a Bot --CommonsNotificationBot (talk) 20:15, 11 August 2011 (UTC)

Why has the thorazine advert not been deleted from the page? It was nominated for deletion in 2011, and it is quite the stigmatizing advert to be placed within a page dedicated to a class of drugs still widely used for those suffering from still highly-stigmatized disorders. No need to further disseminate stigmatized ideology via antiquated adverts of a yesterera. Basuraeuropea (talk) 22:12, 10 October 2012 (UTC)

It wasn't deleted because the licensing for reproducing the image was correctly provided. The deletion discussion wasn't about the content suitability. Is your objection based on a perception that the image implies something pejorative about persons with psychoses? My reaction to the image is that (1) it is rather amusing, as a relic of an earlier time, and (2) it shows the disease as unpleasant, but does not imply anything offensive about persons who have the disease. --Tryptofish (talk) 00:30, 11 October 2012 (UTC)

Your basis for its inclusion lies upon an amusement factor? I have highlighted the reasons above as those which make for the advert insensitive given the advancements that have been made within psychiatry as well as the progressive trend of destigmatisation associated with psychotic-spectrum disorders - this advert runs counter to both. Perhaps the advert should be placed within the early history of the class of medication, but not as the primary image which one sees upon viewing the page. Basuraeuropea (talk) 04:06, 25 October 2012 (UTC)

No, that's not what I said. You've stated that the image implies something pejorative about patients (as opposed to presenting the disease as unpleasant), but I'm not seeing where you've really explained why that is so. --Tryptofish (talk) 22:26, 25 October 2012 (UTC)

I changed this section a bit because it fucked up the formatting in the following sections. Hope nobody minds. Firrtree (talk) 17:23, 20 October 2012 (UTC)

The use of a jpg of a 1950s advertisement for Thorazine in the infobox for this article is inappropriate and it should be deleted

The entirety of this articl about antipsychotics is laced with POV and is far from neutral in the way it approaches the topic. The red flag for this state of affairs iss the use of a 1950s ad for Thorazine, a drug which was classified a "major tranquilizer" not an anti-psychotic. It's use at the commencement of this article is tantamount to making use of "Reefer Madness" as an introduction to an article about marijuana. All of medicine 50 years ago seems primitive by comparison to the viewpoint of current times. Ironically, my own observations of the powerful good which Thorazine was capable of occurred when I worked with an ad hoc group of peer counselors in the dormitories where at least once a month someone experienced a bad LSD trip. Bad as in, if I hang by my feet on this 4th flour balcony I can almost touch the ground. I saved this young man's life when I myself was 18 because I reached down and with the help of another equally weak 18 year-old was able to pull him to safety. We sometimes had to resort to calling for medical help in the form of a sympathetic doctor who would arrive, give the bad tripping student a shot of Thorazine and within 20-30 minutes the LSD user would return to a rational being and thank us repeatedly. But I stray from the point that Thorazine has no place whatsoever in this article as it never was classifed as an anti-spychotic by the FDA. I believe that the Thorazone ad should be wholly removed for this among other reasons. QuintBy (talk) 08:24, 13 October 2012 (UTC)

Hi. Thanks for the story relating to your time as a dorm counsellor; I find it very interesting and I'm glad that no-one appears to have come to any personal harm.

I added this jpg to this article some time ago. It's one of a series of US advertising images used throughout the 1950s to characterise the function of this and similar drugs in terms of their potential to instil quiescence in otherwise disturbing individuals. Modern psychiatric drug campaigns would never use such visual imagery, of course, but I do believe this aspect of the marketing of such chemical compounds is relevant to the history of this drug class. I think you would also struggle to find an image that was equally engaging. In any case the image is contextualised in its caption.

The classification question is more interesting but I can't think of any authority that would state that chlorpromazine does not belong to the class of so-called 'antipsychotics' (other than those who would reject the category altogether under the premise that they lack a defined antipsychotic effect). Thus, taking a standard authoritative source such as Stephen M. Stahl's Essential Psychopharmacology: Neuroscientific Basis and Practical Applications, 2nd Edition (Cambridge University Press, 2000), we find that the first drug discussed in Chapter 11, which is entitled 'Antipsychotic Agents', is chlorpromazine. Chlorpromazine is understood to be a conventional or typical antipsychotic drug. The source mentioned above states:

... the first antipsychotic drugs were discovered by accident in the 1950s when a putative antihistamine (chlorpromazine) was serendipitously observed to have an antipsychotic effects when tested in schizophrenic patients. Chlorpromazine indeed has antihistaminic activity, but its therapeutic action in schizophrenia are not mediated by this property. Once Chlorpromazine was observed to be an effective antipsychotic agent, it was tested experimentally to uncover its mechanism of antipsychotic action [blocking of dopamine 2 receptors - my interpolation]

— S.M.Stahl, Essential Psychopharmacology, p.402

Indeed, it would seem that FDA classifies chlorpromazine as a conventional antipsychotic. The WHO's Anatomical Therapeutic Chemical Classification System also includes chlorpromazine as an antipsychotic: N05AA - Phenothiazines with aliphatic side-chain

When these drugs first came out they were initially known as tranquilisers in Anglophone psychiatry (the preferred term in France was neuroleptic) and perhaps that is a source of confusion? FiachraByrne (talk) 16:28, 13 October 2012 (UTC)

Anyhow, I think the classification of chlorpromazine as an antipsychotic is uncontroversial. On the history of the terms used to characterise this drug class you might consult the history section of this article. Personally, and as you might expect given that I added it to the article, I think the use of the image is reasonably appropriate as it is presented as a historical image. You also state that the article is 'laced with POV'. Are there any specific statements in the article that you think reflect this? FiachraByrne (talk) 16:49, 13 October 2012 (UTC)

The historical image belongs within the history section of the article, not placed as the main image. As I've stated in the previous section of the talk page, it is quite the stigmatising advert to be placed within a page dedicated to a class of drugs still widely used for those suffering from still highly-stigmatised disorders. No need to further disseminate stigmatised ideology via antiquated adverts of a yesterera. Some may indeed find such an advert offensive for the reasons aforementioned. Basuraeuropea (talk) 04:15, 25 October 2012 (UTC)

I'm not seeing how it stigmatizes anyone. It presents the disease as being unpleasant, but that isn't stigmatizing the persons who have it. As for it being offensive to some people, WP:NOTCENSORED. --Tryptofish (talk) 22:31, 25 October 2012 (UTC)

As an historical image, place it where it belongs, within the history section of the article. This has nothing to do with censorship, but rather about the modernisation of psychiatric practice and societal perceptions of the psychotic spectrum. The advert as the main image on the page for the neuroleptics placed for the original poster's amusement purposes follows poor logic. Basuraeuropea (talk) 22:47, 25 October 2012 (UTC)

But it isn't there for anybody's "amusement". Wikipedia doesn't only cover the present; we also cover history. No one looking at the lead would be confused into thinking that the image represents present-day best practices. --Tryptofish (talk) 22:51, 25 October 2012 (UTC)

Right, and thus it should be placed within the history section of the article. That aside, you stated within the previous section, "My reaction to the image is that (1) it is rather amusing..." Furthermore, as for stigmatisation, the advert claims that those who need the neuroleptics, thorazine in particular, "lash out against 'them'" further stating that the medication is needed to "put an end to his violent outburst," (note the masculine pronoun) clearly pointing out antiquated views of psychotic-spectrum disorders. Not all who suffer from the aforementioned disorders are violent, nor do all hold paranoid delusions or hallucinations of imagined others. Refer to the article on psychosis as well as review the diagnostic criteria, per the DSM and the ICD, for schizophrenia, and schizoaffective disorder, respectively - http://en.wikipedia.org/wiki/Psychosis#Signs_and_symptoms, http://en.wikipedia.org/wiki/Schizophrenia#Diagnosis, http://en.wikipedia.org/wiki/Schizoaffective_disorder#Diagnosis. Should you wish, you may review other disorders that fall upon the psychotic spectrum of disorders as well. Basuraeuropea (talk) 23:09, 25 October 2012 (UTC)

Additionally, one not well-versed on modernised psychiatric practice or its advancements may very well confuse the image's depictions of treatment as having not changed, as it is, indeed, the main image. Furthermore, one suffering from a psychotic-spectrum disorder viewing the page may additionally confuse the image as a representation of today's best psychiatric practices as it is, again, placed as the main image. Basuraeuropea (talk) 23:13, 25 October 2012 (UTC)

When I said that, I was characterizing my reaction, in part, to an image that another editor put on the page, not stating the reason for including the image. Be that as it may, I think I now understand that your concern is that the image might mislead readers into thinking, wrongly, that psychotic patients tend to be violent. That's a reasonable point, that was not clear from what you said before. I'm not convinced that we need to delete the image for that reason, but I'm friendly to the possibility of altering the image caption in order to dispel that misconception. I made one such edit before I fully understood what you meant, and I'll make a further one now, so please see whether or not these edits are helpful. --Tryptofish (talk) 23:21, 25 October 2012 (UTC)

While the caption is now improved, I still don't think the image is placed appropriately within the article. I am not advocating its removal, but rather its placement within into the more appropriate history section. The Swedish version of the page has more appropriate main images - http://sv.wikipedia.org/wiki/Neuroleptikum. Basuraeuropea (talk) 23:28, 25 October 2012 (UTC)

Ah, good, we are making progress now. I agree with you, and I'm going to make a change like that. Thanks! --Tryptofish (talk) 23:31, 25 October 2012 (UTC)

:) ! Basuraeuropea (talk) 23:36, 25 October 2012 (UTC)

 Done. Thanks again. I'm glad that worked out. --Tryptofish (talk) 23:41, 25 October 2012 (UTC)

Thank you! Looks much better! Basuraeuropea (talk) 23:44, 25 October 2012 (UTC)

Bah! I accept your reasoned arguments. FiachraByrne (talk) 03:55, 19 January 2013 (UTC)

Efficacy of maintenance therapy for schizophrenia

I remember a paragraph in the article several months ago that said maintenance therapy wasn't more effective than placebo. I think there was a citation or two and maybe a link to some study. Does anyone remember it? Or why it was deleted? Also, can anyone link me to the version of the article which still has that paragraph (I can't find one)? Firrtree (talk) 17:17, 20 October 2012 (UTC)

I looked through the edits of this year, and didn't find that. Given what the preponderance of reliable sources say, I think that it's extremely unlikely that maintenance therapy actually would be no better than placebo. --Tryptofish (talk) 19:45, 20 October 2012 (UTC)

Hmm, strange. I'm pretty sure it was this article, this language, and several months ago. Oh well, thanks for your help either way. Firrtree (talk) 10:33, 21 October 2012 (UTC)

No problem. --Tryptofish (talk) 19:36, 21 October 2012 (UTC)

Should not "side effects" here rather be "adverse effects"?

Please see Adverse effect. The Side Effects covered here are unintended and UNDESIREABLE. Is not then the mostly used term "adverse effects"? Nopedia (talk) 22:32, 28 December 2012 (UTC)

I'm open to wording it in any number of ways. Another option is adverse drug reaction. I read what our page on side effects says, but (noting WP:CIRCULAR) it may not sufficiently make it clear that the term is mostly used for adverse effects (less commonly for unintended but therapeutic effects). In fact, it's very common to see the phrase "adverse side effects". --Tryptofish (talk) 15:54, 29 December 2012 (UTC)

Biochemistry of brain damage caused by antipsychotics

This is from an article on depression, but it may explain equally well the findings that antipsychotics (at least the ones studied) shrink the brain. Someone might want to work it into the article, as it's quite important information:

"Conventional drug therapy leaves much to be desired from the metabolic perspective and needs to be re-evaluated with some urgency. If administered to persons whose capacity for replenishing intraglial glycogen and intraglial and intraneuronal ATP stores is impaired mood elevators that act by enhancing neurotransmitter release and increasing the slope of neuron action potentials may compound the severity of the energy deficit present by increasing the demand for ATP hydrolysis beyond the capacity to replenish ATP stores. Any severity of any energy deficit present is likely to be compounded by those antidepressants that impair mitochondrial oxidative phosphorylation. It might also be compounded by drugs used to treat co-existing cardiovascular disorders, notably beta blockers and statins. Of great concern is that any medication or mixing of medications that either induces or compounds the severity of an intracerebral energy deficit might increase the likelihood of developing neurodegenerative disorders in later years especially if the medications are administered for extended periods."

Source: "Depression: a metabolic perspective" Richard Fiddian Green, 27 October 2012, BMJ.

I'll also leave it for others to decide whether they want to add this information to the Wiki article on antidepressants. At least for now. Firrtree (talk) 20:01, 17 January 2013 (UTC)

Side effects vs structural effects; primary vs secondary sources; unsourced section

Hi. I was drawn back to the body of this text by a recent edit removing text [14] that followed a help desk question on the side effects of antipsychotics detailed in this article [15]. I have no particular complaint about this removal as the text, which was unsourced, did not belong in that section I think, but it did draw to my attention some problems in the article.

The Antipsychotic#Structural effects section repeats in greater detail claims already made in the Antipsychotic#Side effects section about the potential impact of antipsychotic usage on brain volumes. Shouldn't these sections come in sequence one after the other and not duplicate information. Also, the statements on decreased brain volume and antipsychotic usage in the side effects section are largely based on a single primary study (which I originally added although I think Tryptofish toned down my original contribution). There are secondary sources/review articles on this topic and would it not be more appropriate to reference these? The Antipsychotic#Mechanism of action section has three paragraphs and a single citation. Is the entire text derived from a single source? FiachraByrne (talk) 17:22, 18 February 2013 (UTC)

It's very clear to me that, indeed, structural effects are really a sub-topic of side effects. I just made an edit making them a combined section. I think that a number of further edits could be considered to reduce any redundancy. Perhaps there should be some further reordering of sections, maybe moving the adverse effects after the therapeutic ones, although that may be made difficult by the need to explain first generation versus second, etc. My concern about brain shrinkage goes to what prompted the Help Desk inquiry: there's solid sourcing for extrapyramidal effects and so forth, but once we get into large-scale lesioning (independent of any ventricle enlargement that may really result from schizophrenia and related conditions, rather than from the drugs), the source material just isn't that advanced and accepted by the scientific community. Thus, we need to be careful and responsible about not giving an exaggerated picture of "your brain is going to shrivel up if you take your medicine" (not that any edits really said that, of course). I'd prefer to rely mostly on secondary rather than primary sources for that. --Tryptofish (talk) 23:11, 19 February 2013 (UTC)

Hi Tryptofish. I think your edit moving the structural effects section to follow the side-effects section is correct [16]. We should now gather the secondary literature on brain volumes & antipsychotic usage and see what if any text on this issue is appropriate to add to the article - aiming to remove the primary studies. The inclusion of animal studies should be dependent on whether they are referenced in the secondary sources and the weight they are given there. I'll post a few references when I get the opportunity later on today (although if your more familiar with the literature or have expertise I certainly won't object to any changes you might make. FiachraByrne (talk) 11:38, 20 February 2013 (UTC)

That all sounds good. I'm super-busy, so please feel free to go ahead, and I'll respond. --Tryptofish (talk) 22:35, 20 February 2013 (UTC)

Just a list from a crude search in pubmed (antipsychotics AND brain volume (in all fields) and publication type "review": (http://www.ncbi.nlm.nih.gov/pubmed/?term=%28%28antipsychotics%29+AND+brain+volume%29+AND+%22review%22[Publication+Type] 40 results]): FiachraByrne (talk) 23:31, 20 February 2013 (UTC)

• Hafeman, D. M.; Chang, K. D.; Garrett, A. S.; Sanders, E. M.; Phillips, M. L. (2012). "Effects of medication on neuroimaging findings in bipolar disorder: An updated review". Bipolar Disorders. 14 (4): 375–410. doi:10.1111/j.1399-5618.2012.01023.x. PMID 22631621.
• Puri, B. K. (2011). "Brain tissue changes and antipsychotic medication". Expert Review of Neurotherapeutics. 11 (7): 943–946. doi:10.1586/ern.11.87. PMID 21721911.
• Kato, T. A.; Monji, A.; Mizoguchi, Y.; Hashioka, S.; Horikawa, H.; Seki, Y.; Kasai, M.; Utsumi, H.; Kanba, S. (2011). "Anti-Inflammatory properties of antipsychotics via microglia modulations: Are antipsychotics a 'fire extinguisher' in the brain of schizophrenia?". Mini reviews in medicinal chemistry. 11 (7): 565–574. doi:10.2174/138955711795906941. PMID 21699487.
• Moncrieff, J.; Leo, J. (2010). "A systematic review of the effects of antipsychotic drugs on brain volume". Psychological Medicine. 40 (9): 1409–1422. doi:10.1017/S0033291709992297. PMID 20085668.
• Hunsberger, J.; Austin, D. R.; Henter, I. D.; Chen, G. (2009). "The neurotrophic and neuroprotective effects of psychotropic agents". Dialogues in clinical neuroscience. 11 (3): 333–348. PMC 2804881. PMID 19877500.
• Smieskova, R.; Fusar-Poli, P.; Allen, P.; Bendfeldt, K.; Stieglitz, R. D.; Drewe, J.; Radue, E. W.; McGuire, P. K.; Riecher-Rössler, A.; Borgwardt, S. (2009). "The effects of antipsychotics on the brain: What have we learnt from structural imaging of schizophrenia?--a systematic review". Current pharmaceutical design. 15 (22): 2535–2549. doi:10.2174/138161209788957456. PMID 19689326.
• Pariante, C. M. (2008). "Pituitary volume in psychosis: The first review of the evidence". Journal of psychopharmacology (Oxford, England). 22 (2 Suppl): 76–81. doi:10.1177/0269881107084020. PMID 18709702.
• Brandt, G. N.; Bonelli, R. M. (2008). "Structural neuroimaging of the basal ganglia in schizophrenic patients: A review". Wiener Medizinische Wochenschrift. 158 (3–4): 84–90. doi:10.1007/s10354-007-0478-7. PMID 18330524.
• Szulc, A. (2007). "First and second generation antipsychotics and morphological and neurochemical brain changes in schizophrenia. Review of magnetic resonance imaging and proton spectroscopy findings". Psychiatria polska. 41 (3): 329–338. PMID 17900049.
• Newton, S. S.; Duman, R. S. (2007). "Neurogenic actions of atypical antipsychotic drugs and therapeutic implications". CNS drugs. 21 (9): 715–725. doi:10.2165/00023210-200721090-00002. PMID 17696572.
• Scherk, H.; Falkai, P. (2006). "Effects of antipsychotics on brain structure". Current Opinion in Psychiatry. 19 (2): 145–150. doi:10.1097/01.yco.0000214339.06507.d8. PMID 16612194.
• Abbott, C.; Bustillo, J. (2006). "What have we learned from proton magnetic resonance spectroscopy about schizophrenia? A critical update". Current Opinion in Psychiatry. 19 (2): 135–139. doi:10.1097/01.yco.0000214337.29378.cd. PMID 16612192.
• Nasrallah, H. A. (2005). "Neurologic comorbidities in schizophrenia". The Journal of clinical psychiatry. 66 Suppl 6: 34–46. PMID 16107182.

Search pubmed (antipsychotics AND brain (in all fields) and publication type "review": [Publication+Type 2092 results - only first 100 results checked):

• Karch, S.; Pogarell, O.; Mulert, C. (2012). "Functional magnetic resonance imaging and treatment strategies in schizophrenia". Current pharmaceutical biotechnology. 13 (8): 1622–1629. doi:10.2174/138920112800784853. PMID 22283762.
• Karch, S.; Pogarell, O.; Mulert, C. (2012). "Functional magnetic resonance imaging and treatment strategies in schizophrenia". Current pharmaceutical biotechnology. 13 (8): 1622–1629. doi:10.2174/138920112800784853. PMID 22283762.
• Van Haren, N.; Cahn, W.; Hulshoff Pol, H.; Kahn, R. (2011). "The course of brain abnormalities in schizophrenia: Can we slow the progression?". Journal of Psychopharmacology. 26 (5 Suppl): 8–14. doi:10.1177/0269881111408964. PMID 21730018.

Sorry, forgot about this. I'll try and get to it this evening. FiachraByrne (talk) 08:49, 25 February 2013 (UTC)

Overprescription of antipsychotics for dementia sufferers

Just removed the following text which was added to the Structural affects section (originally from dementia article)

In the UK around 144,000 people with dementia are unnecessarily prescribed antipsychotic drugs, around 2000 patients die as a result of taking the drugs each year. Selegiline does not appear effective either.

Main claim is sourced to Guardian, but derived from this report [17]. Needs better sourcing &, if it is included, which section should it go in? FiachraByrne (talk) 08:59, 25 February 2013 (UTC)

Article Clarity

I introduced a new paragraph explaining the way antipsychotics work. I made extensive research in the subject, read lots of papers but unfortunately editors keep removing my conclusions and accuse me of biased content. I would like to discuss this so that we can reach a consensus. — Preceding unsigned comment added by Booklaunch (talk • contribs) 15:21, 12 May 2013 (UTC)

Your section was titled "How it works", but it did not even attempt to explain how antipsychotic drugs work to reduce psychotic symptoms, only how they produce undesirable side effects. That's the main point. Also the "bullet" style is not suitable for an encyclopedia article, but that is something that could be fixed. Looie496 (talk) 16:18, 12 May 2013 (UTC)

Hum, that is incorrect, I mentioned the reduced emotional functioning (flat affect), which is pretty much due to being tranquilized. It was in bold letters. and I said "desirable" meaning that was being administered for. Booklaunch (talk) 17:37, 12 May 2013 (UTC)

Yes you want to write in paragraph form. And the section should be called "Mechanism of action" per WP:MEDMOS. Also we should only be using review articles or major textbooks as refs per WP:MEDRS. Wikipedia takes a little while to figure out. I had my first changes reverted when I started. Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:00, 12 May 2013 (UTC)

That section of course is here [18] Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:01, 12 May 2013 (UTC)

I saw that paragraph, but I thought it was completely vague tbh. The whole article is very little to the point. I saw some requests on here about improved clarity too. — Preceding unsigned comment added by Booklaunch (talk • contribs) 18:08, 12 May 2013 (UTC)

If I see a section called "How it works", I would expect it to explain how these drugs suppress psychotic symptoms such as delusions, hallucinations, paranoia, garbled speech, and agitation. Unfortunately, as far as I can tell nobody really knows how these drugs accomplish that. It probably has something to do with tranquilizing, in some sense, but that doesn't come close to an adequate explanation. So it isn't really possible to explain how these drugs work -- but it would at least be necessary to discuss the problem. Looie496 (talk) 18:18, 12 May 2013 (UTC)

the mechanism of action is diminuished brain function. if you block dopamine and serotonin at the same time, as with risperdal, eventually you have 2 neurotransmitter systems shut down and you hit the "hallucinations" spot. — Preceding unsigned comment added by Booklaunch (talk • contribs) 18:54, 12 May 2013 (UTC)

you will also hit ALL THE OTHER SPOTS, including the ability to drink a glass of water, but who cares?? as long as the hallucinations are gone... — Preceding unsigned comment added by Booklaunch (talk • contribs) 19:22, 12 May 2013 (UTC)

Wikipedia is based on reliable sources. Doc James (talk · contribs · email) (if I write on your page reply on mine) 14:40, 13 May 2013 (UTC)

A bit of a sobering look at long term antipsychotic use

Harrow, M (2013 Mar 19). "Does Long-Term Treatment of Schizophrenia With Antipsychotic Medications Facilitate Recovery?". Schizophrenia bulletin. PMID 23512950. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)

Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:07, 12 May 2013 (UTC)

So now the article is even longer, as in long term use Booklaunch (talk) 20:45, 12 May 2013 (UTC)

Not sure what you mean? Doc James (talk · contribs · email) (if I write on your page reply on mine) 14:32, 13 May 2013 (UTC)

Not an expert but many problems in Booklaunch addition

I mention here some of the problems I have found:

The mechanism of action of antipsychotics is very simple. Unreferenced, anyway, hardly simple.

• Dopamine is a neutransmitter, ie, enables communication between neurons.Would be great to have neurotransmitter correctly spelt

• The frontal lobe contains most of the dopamine-sensitive neurons in the cerebral cortex. ::wikipedia

Comment saying wikipedia made by Booklaunch without signing: I do not understand what you mean with wikipedia. If with it you mean it is based on info in wikipedia it is not enough sourcing, and it is certainly not common knowledge so reliable sources are needed.--Garrondo (talk) 07:31, 13 May 2013 (UTC)

• In frontal lobes, dopamine controls the flow of information from other areas of the brain Gross oversimplification that I doubt the source supports.

wikipedia

Comment saying wikipedia made by Booklaunch without signing: I do not understand what you mean with wikipedia. If with it you mean it is based on info in wikipedia it is not enough sourcing, and it is certainly not common knowledge so reliable sources are needed.--Garrondo (talk) 07:31, 13 May 2013 (UTC)

• and is associated with reward, attention, short term memory tasks, planning and motivation (ie, intelligence) and emotions..

• Antipsychotics block receptors of dopamine pathways. Dopamine disorders (deficit) in the frontal lobe can cause a decline in neurocognitive function especially memory, attention, problem solving and the desirable emotional flatness (flat affect or blunted affect).

wikipedia

Comment saying wikipedia made by Booklaunch without signing: I do not understand what you mean with wikipedia. If with it you mean it is based on info in wikipedia it is not enough sourcing, and it is certainly not common knowledge so reliable sources are needed.--Garrondo (talk) 07:31, 13 May 2013 (UTC)

• Dopamine is also necessary to control muscle movement.. Does not control muscles, but motor control. Not the same. Also ref of not very high quality.

I first red to control muscles, and not to control muscle movements so the sentence is correct. Still a higher quality ref would be a great idea. --Garrondo (talk) 07:31, 13 May 2013 (UTC)

• So antipsychotics also include Parkinson's symptoms (Tardive Dyskinesia).. Dyskinesias are not a typical Parkinsonian symptom but most commonly a secondary effect of the medication

- DYSKENISIA results from the same as Parkinsons - dopamine deficiency. the only differemce is the is induced by your local psychiatrist

Comment above made by Booklaunch without signing: Unless you bring a WP:MEDRS source to support such an statement this is blatant original research.--Garrondo (talk) 07:31, 13 May 2013 (UTC)

• Dopamine deficiency is related to mental retardation in children. Irrelevant to the article.

Very relevant to the theory that dopamine deficiency induced by antipsychotics does not cause brain damage and that loss of cognition is due to "illness"

Comment above made by Booklaunch without signing: Article is on antipsychotics, not on dopamine deficiency in children. Unless you bring a WP:MEDRS source relating the three issues (antipsychotics, dopamine deficiency and mental retardation this would be original research.--Garrondo (talk) 07:31, 13 May 2013 (UTC)

If the ref in question support this was high quality and made the comment in direct relation to antipsychotics than maybe. But I assume not ref was provided? Doc James (talk · contribs · email) (if I write on your page reply on mine) 14:34, 13 May 2013 (UTC)

Doc, correct, the edit was this, no ref provided. I did a very quick search on PubMed and did not immediately find any appropriate sourcing supporting the statement. Per WP:BURDEN Book is welcome to provide the sourcing for it, which would also need to explicitly tie it to antipsychotic use. Zad68 14:43, 13 May 2013 (UTC)

Some of the content points towards useful directions, but as of today is not helpful in the article due to problems mentioned. --Garrondo (talk) 21:18, 12 May 2013 (UTC)

While I initially reverted the edition I was unintentionally breaking the 3RR so I reverted myself. I would like to ask other editors for further imput.--Garrondo (talk) 21:41, 12 May 2013 (UTC)

These observations of the problems with the edit are on target and so I have removed the recent proposed addition while we discuss it and develop consensus over its inclusion here on the Talk page. Zad68 13:24, 13 May 2013 (UTC)

Structural changes

I also re-reverted myself regarding a change in wording to this section (See here and here)

I copy here my reasoning at the editor's talk regarding why I consider his changes inadequate. I hope somebody gives further comments. --Garrondo (talk) 21:40, 12 May 2013 (UTC)

Copied conversation from User talk:Booklauch

I have reverted the change of wording to the structural effects section in the Antypsychotics article. Conclussion of the abstract is worded in extremely hyptotetical tone, and that tone should be kept in Wikipedia, otherwise we would be conducting Original Research.--Garrondo (talk) 20:54, 12 May 2013 (UTC)

Specifically source states (Bolded mine): Some evidence points towards the possibility that antipsychotic drugs reduce the volume of brain matter and increase ventricular or fluid volume.

That is not the right article. There is another paper stating very clearly as much as 20% reduction in brain volume in females first time psychotic episode. Most of it grey matter. Long term use (less intense dosage) destroys more white matter.Booklaunch (talk) 21:03, 12 May 2013 (UTC)

You state there is another source? Can you list the source here and is it a recent review article?Doc James (talk · contribs · email) (if I write on your page reply on mine) 14:50, 13 May 2013 (UTC)

That is the source we use. Moreover per WP:MEDRS a primary source should not be used to debunk a secondary source, so unlss you find a review article that states as proof that there is a causal relationship you should not change wording, and even then it should be discussed which of the two sources should be used (most probably the two).--Garrondo (talk) 21:18, 12 May 2013 (UTC)

The last source you added (PMID 17671875)estates (bolded mine): show possible different effects of first and second generation antipsychotics. This is true also for functional parameters, such as regional cerebral blood flow and metabolism, analysed, both in resting condition and after specific activation paradigms, with such diverse techniques as positron emission tomography (PET), single photon emission computed tomography (SPECT), functional MRI and MR spectroscopy. The possible molecular mechanisms underlying such differences and whether they represent direct drug effects or indirect consequences of their different and specific interactions with the 'natural' pathophysiological trajectory of brain abnormalities in schizophrenia are matter of present research and debate. So it is as hypothetical as the other one (and additionally is older, so the 2008 conclussions might slightly prevail over the previous ones). Your change of wording to reflect your POV is not warranted by the sources. --Garrondo (talk) 21:27, 12 May 2013 (UTC)

We continue

This paper is not credible as it assumes brain abnormalities in unmedicated schizophrenia patients. Where is the paper/source/book/video showing abnormalities in non medicated (never been medicated, virgin, out of victorian working house) schizophrenia patients please? Thanks Booklaunch (talk) 06:43, 13 May 2013 (UTC)

We are not the ones to decied if a paper is indeed credible or it is not. We can only decide if it is a WP:MEDRS compliant source and if so follow its conclussions. The two articles above are both secondary sources in high quality peer-reviewed journals, so we should follow their conclussions when citing them, and there is no reason to eliminate them from the article.--Garrondo (talk) 07:35, 13 May 2013 (UTC)

we can chose the sources we use in our articles. this is not a medicine article for a medicine journal, it is an encyclopedia article about medicine. we do not need to chose dubious content regardless if is primary or secondary over others. There are many papers from high quality journals. we can state some sources say one thing, but other papers state another and newpapers and patients state another. — Preceding unsigned comment added by Booklaunch (talk • contribs) 08:36, 13 May 2013 (UTC)

You are actually completely wrong, and it implies that you do not really understand some core policies here in wikipedia like WP:RS and WP:MEDRS. Point is that 1-if we use a source we have to follow it closely, which as I pointed out you have not, since you change the wording of the article to follow your point of view and not the source. 2-If there is a reliable source in the article (and the one under discussion is) you cannot eliminate it at will because you do not like it (as you propose here). You can of course find other sources of similar quality that say different things, and in that case as you say we should indicate the two points of view, but up to this moment you have not brought up any alternative sources.--Garrondo (talk) 09:10, 13 May 2013 (UTC)

As a side note: please sign your posts and include an edit summary.--Garrondo (talk) 09:10, 13 May 2013 (UTC)

Agree with Garrondo that the recent change to Structural effects did not appear to be good as it removed a more recent systematic review and seriously overstated findings. I have reverted the proposed article content change while we discuss on Talk page to develop consensus regarding it. Zad68 13:27, 13 May 2013 (UTC)

Agree as well. The conclusions of high quality sources much be reflect properly. Doc James (talk · contribs · email) (if I write on your page reply on mine) 14:48, 13 May 2013 (UTC)

Neuroleptic vs. antipsychotic

"also known as neuroleptic even though not all antipsychotics have neuroleptic effect". Then what is a neuroleptic/the neuroleptic effect; neuroleptic redirects to antipsychotic, implying they (neuroleptic and antipsychotic) are one and the same, which contradicts the quoted sentence.ZFT (talk) 01:59, 25 September 2013 (UTC)

The term "neuroleptic" was introduced in a 1955 paper by Delay and Deniker, PMID 14392209. Unfortunately the text is not available to me, but as far as I can tell they defined a neuroleptic drug as one that induces Parkinsonian symptoms in high doses -- which basically means a drug that antagonizes dopamine transmission. Looie496 (talk) 02:49, 25 September 2013 (UTC)

Per this they are used synonomously [19] Will correct. Doc James (talk · contribs · email) (if I write on your page reply on mine) 12:36, 25 September 2013 (UTC)

Permanent Side Effects of Antipsychotic

I suggest the inclussion of more information about the permanent or semi-permanent side effects of the antipsychotic drugs. For example, while most side effects of antipsychotic drugs resolve quickly after discontinuation, several side effects are permanent or semi-permanent, such as tardive akathisia (in 98% irriversible), tardive dysckinesia, tardive dystonia, tardive dysphrenia, tardive psychosis, cataracts, glaucoma, side effects on the heart such as QT interval prolongation which leads to torsades des pointes (potentially fatal), etc. Many side effects are fatal: eg. stroke, neuroleptic malignant syndrome (may kill within 24 hrs if untreated), etc.

In the list of side effects, only very few common side effects are listed. The probability of some of them happening is greater than 1%, yes, but this is misleading, as many of them, for example insomnia, can happen with a probability of up to 40%. So I would recommend to change it to read "a probability of more than 1% up to 50%"

I would also recommend including the following: "The probability of side effects, ranging from less than 1% to 50%, is tipically obtained from drug trials of a few thaousand people for a few months. Since each person has different neurochemistry and genetics, the probability of side effects ocurring on one particular person is unpredictable, and it could happen at any time" — Preceding unsigned comment added by 190.52.139.38 (talk) 15:26, 6 October 2013 (UTC)

Hi 190.52.139.38 and thank you for your comments. Do you have good sources for your statements? Before adding any of your suggestions, please make sure that you have sources that are good enough according to WP:MEDRS. With friendly regards, Lova Falk talk 08:17, 20 October 2013 (UTC)

There are several references on the subject. To name a few: Metabolic syndrome: [20], Prolonged neurological sequelae: [21]; Tardive dyskinesia: [22]; Tardive akhatisia: [23]; Tardive dystonia: [24]; Tardive dysmentia: [25]; Potentially permanent effects on the heart: [26]; Neuroleptic malignant syndrome: [27]; Cerebrovascular adverse events (stroke): [28] 190.23.90.121 (talk) 09:37, 5 November 2013 (UTC)

5HT2A

The section on 5HT2A claimed two things that are not substantiated. One, it claimed that antipsychotics antagonize the receptor, instead of partially agonizing it, which is an important distinction, in particular with this receptor. It also claimed that agonism of this receptor is associated with psychosis. This is not well-substantiated, as antipsychotics do agonize the drug, not antagonize it, and also because psychedelic drug use, which also agonize to antagonize this receptor, are associated with lower psychosis risk.

I added reviews claiming that different alleles are associated with psychosis, and also that higher receptor concentrations in certain areas associate with psychosis. I also added brief mention to SSRIs and psychedelic drugs. — Preceding unsigned comment added by 205.208.122.240 (talk) 22:14, 16 December 2013 (UTC)

Ok I fixed what you messed up, atypical antipsychotics DO antagonize the 5HT2A receptor, not agonize, I believe that you are confusing the tendency of atypical antipsychotics to partially agonize the 5HT1A receptor with the 2A receptor. Psychedelic drugs agonize the 5HT2A receptor and have been shown to potentiate psychosis in schizophrenic patients. — Preceding unsigned comment added by 208.123.246.67 (talk) 07:57, 26 January 2014 (UTC)

Off topic chat

Anti-psychotics = inspired by LSD-like substances Anti-psychotics, like urotherapy is inspired by LSD-like substances. Originally called "trepanning", and later called "lobotomy", "anti-psychotics" seeks to do similar things, "chemically". However no-one is cured, just like trepanning and lobotomy. Instead trepanning, and lobotomy is connected to hallucinogenic art. It is actually quite common to see divided minds on LSD-like substances. Some examples from popular culture: Pink Floyd - Division Bell, H.R. Giger - Atomkinder, Mac Logo Smiley. Psychiatry often still proposes LSD as a theraputic agent, along with many other drugs, equally without any rational basis. They never cured anyone, while people are getting cured WITHOUT drugs, just by simple religion. "God is one and without partners". A positive lifestyle in an oversexualized society, makes a lot of sense. PBWY.

Schizophrenia

This section is biased. It cherry-picks sources and reads like a sale pitch against antipsychotics. The section should be rewritten to include actual medical use of antipsychotics in schizophrenia and its existing content should be moved to the "Controversy" section. Jm292 (talk) 02:59, 16 November 2013 (UTC)

It is based on systematic reviews and meta analysis from the Cochrane collaboration. The evidence for antipsychotic use is poor. Which incredible seeing that they are so extensively used and the condition is relatively common. Doc James (talk · contribs · email) (if I write on your page reply on mine) 09:08, 17 November 2013 (UTC)

Nevertheless, it reads as if written by someone with an axe to grind, and WP articles are not appropriate places for advocacy. Presumably there are psychiatrists and researchers who advocate these drugs, and their positions should be documented appropriately. It's important to get the tone right in psychiatry articles, as they are often read by vulnerable patients. --Ef80 (talk) 11:20, 2 February 2014 (UTC)

@Ef80 I would probably agree with you partially. The section is packed with a lot of information, and is not easy to read. However it does reflects the real evidence. I think evidence from systematically pooled research information like Systematic Reviews, take priority over single studies and expert opinion. But that does not understate the importance of highlighting a real debate either. Manu Mathew (talk) 12:08, 2 February 2014 (UTC)

I agree we can probably do a better job of highlighting how usage / prescribing does not match the evidence. This is a great deal of sources to support this for dementia but also some for other indications like sleep.Doc James (talk · contribs · email) (if I write on your page reply on mine) 12:34, 2 February 2014 (UTC)

What a terrible article.

In general this article is unreadable. It is ironic that the disjointedness apparent here is symptomatic of psychosis, don't you think? It needs a total rewrite. Some hints: lists do NOT add to the understandability of the prose, and should be separated (either into a table or a dedicated page). typical vs atypical isn't, as it appears here, very useful in advancing the subject. If they are substantially different, then separate the discussion of them. If they are not, then don't use them as subdivisions in each of the other sections! How can you write a section on comparison of side-effects when the list of drugs is as large as this one's?? It is unintelligible as written. Now, I came to this article to find a common (I almost wrote "typical" but that would mean something else here, wouldn't it?) antipsychotic. Aside from a laundry list of 60 or so, I could find nothing. The Sales section is pathetic. It states:"Antipsychotics were once among the biggest selling and most profitable of all drugs..." AND [in 2008 they were] "the biggest selling drugs in the US..." No effort is made to reconcile the conflict between the implied status of no longer being the biggest selling, and being the biggest selling (in the USA). Sloppy and pathetic. I'd think that with a highly regulated business this large, that it wouldn't be that difficult to pick-out the top sellers; but then again, I like to think of myself as sane.216.96.76.190 (talk) 18:10, 16 December 2014 (UTC)

If you don't like it, fix it. This is Wikipedia, after all, one of the few places on the internet where you can edit things you think are poorly written. Formerly 98 (talk) 18:17, 16 December 2014 (UTC)

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neuroleptic and major tranquilizer

Some months ago, another editor questioned the assertion that neuroleptic and major tranquilizer are no longer commonly used in professional literature; requesting a citation. Neuroleptic is absolutely still in common use as I know from being a mental health professional. I have no intention of creating a primary source hence my knowledge is not an appropriate source. However, unless someone can add an appropriate citation, the statement of obsolescence needs to be deleted.Dstern1 (talk) 17:43, 13 June 2016 (UTC)

Old usage is 1984 ? https://news.google.com/newspapers?id=2gQuAAAAIBAJ&sjid=0TQDAAAAIBAJ&pg=3715%2C825725 . --Mark v1.0 (talk) 01:14, 23 August 2016 (UTC)

http://www.jneurosci.org/search?submit=yes&y=9&fulltext=Neuroleptic and http://www.ncbi.nlm.nih.gov/pubmed/?term=Neuroleptic are something but I don't think these links can be used as references. --Mark v1.0 (talk) 01:24, 23 August 2016 (UTC)

This looks like a better source of reference? http://ijnp.oxfordjournals.org/search/Neuroleptic . Two of the first three articles use the word "Neuroleptic" as a common term (2014).--Mark v1.0 (talk) 01:30, 23 August 2016 (UTC)

I put the descriptive word back but I don't know how long it will stay because of the POV of different editors.--Mark v1.0 (talk) 01:36, 23 August 2016 (UTC)

Section “see also”

Reply to Doc James: I added some categories to the section “see also” (diff) to make these categories more salient and provide a convenient way to browse among related articles. Categories are highly underused by readers of the encyclopedia as anybody can ascertain by comparing the statistic of a category to some related articles. I conjecture that the reason is that the general public is not aware of Wikipedia's category system. This is a way to make it more known and therefore a way to make it useful.

This system is not redundant with navboxes; and it performs a related, but not the same function. Users can browse in principle, all drug-reated articles from these categories. Although all the categories I included Category:Psychoactive drugs are accessible through it, I included the other 3 because they are especially relevant for the topic, to make sure that interested users won't miss them (as currently happens with just listing categories at the bottom of the article).

Mario Castelán Castro (talk) 01:49, 6 September 2016 (UTC).

Being discussed here [29] Please join. See also sections are discouraged. Doc James (talk · contribs · email) 07:36, 6 September 2016 (UTC)

Note that WP:MED has no power to make any binding decisions on article content per WP:local consensus and participation in Wikiprojects is optional. I welcome a discussion of this issue at this article's talk page. Mario Castelán Castro (talk) 14:05, 6 September 2016 (UTC).

What you are proposing is a wide scale change so you would need to get consensus here Wikipedia:Village_pump_(technical) Doc James (talk · contribs · email) 15:39, 6 September 2016 (UTC)

OR vs RR in Comparison of Medications "Discontinuation rate" (OR with 95% CI in brackets) column of chart

This is a rather picky question! I updated a couple of references that were flagged as having a more recent Cochrane version available. One of them is a systematic review on the drug Perazine. The conclusions of both reports are similar (more work needed). On review of the full-length results, I noticed that the review paper uses RR, and the wiki chart is in OR. If you think for the purpose of this wikipedia article, using RR and OR interchangeably is alright, that is fine by me! I have enough of a stats background to know that OR and RR are not the same. My stats are a little rusty these days to be able to make a judgement call as to how important it is in this context. I googled RR and OR and found this cochrane website describing the difference http://handbook.cochrane.org/chapter_9/9_2_2_3_warning_or_and_rr_are_not_the_same.htm Unfortunately I don't have time to go through all the drugs in the wiki table and compare if an RR or OR was calculated in the original reviews. If you are super interested in this, the authors of the cochrane review on perazine wrote the following (quoted): "Binary data For binary outcomes we calculated a standard estimation of the risk ratio (RR) and its 95% confidence interval (CI). It has been shown that RR is more intuitive (Boissel 1999) than odds ratios and that odds ratios tend to be interpreted as RR by clinicians (Deeks 2000)." cochrane ref: https://www.ncbi.nlm.nih.gov/pubmed/24425538 Thanks. JenOttawa (talk) 17:43, 11 November 2016 (UTC)

External links modified

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Page apparently loads, but doesn't otherwise work. Tgeorgescu (talk) 02:01, 26 November 2016 (UTC)

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Link : tranquilizers

Is at the first position, as according to Wikipedia policy, instead of an alternative within a further-into-the-article position 1a16additional (talk) 12:07, 14 October 2017 (UTC)

Except if it is within the bolded term. Doc James (talk · contribs · email) 12:21, 14 October 2017 (UTC)

Specifically it says "Links should not be placed in the boldface reiteration of the title in the opening sentence of a lead"[30] Doc James (talk · contribs · email) 12:33, 14 October 2017 (UTC)

debated material (copied from talk-page)

as far I could tell from the nature of the inclusions of material and the quality of the sources used, the material was strong enough for inclusion, I'm interested to see you've exercised your opinion Jytdog is removing most of the material, although there is a little remaining from the entire editorial contribution you and the Doctor are expressing having some doubts about. You understand I'd like to know how the content is inadmissable, tell me how so, if you would, then we might be enlightened as to this situation, where I look for information to add to the article, produced by globally recognised organisations, professors, employees of universities and the like, which for some reason, Jytdog, is not relevant to the article. So show me how this is possible if you will, then we might both know how it is possible. Or I'll think that, for some reason, you are supporting the bias of a medically trained professional, who for some reason, thinks his own personal preferences represent a global situation, and expresses the wishes and needs of the English speaking people of the world, who wouldn't need to read the deleted content.

For example - psychotropic

supported by the following sources:

---

P.J. Perry (Professor of Psychiatry at the College of Medicine and Professor at the College of Pharmacy, University of Iowa) American Psychiatric Publication Incorporated

https://books.google.co.uk/books/about/Psychotropic_Drug_Handbook_Seventh_Editi.html?id=PAP8mgEACAAJ&redir_esc=y

http://www.brendanlsmith.com/ is an independent source

the World Health Organization is important enough to have a wikipedia article

H.J. Bein Springer Science & Business Media is a reliable publishing house

---

24 relevant drugs are listed https://en.wikipedia.org/wiki/List_of_psychotropic_medications

---

http://abcnews.go.com/blogs/health/2011/12/02/what-you-need-to-know-about-psychotropic-drugs/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2690138/

https://www.ncbi.nlm.nih.gov/pubmed/20669865

https://www.nice.org.uk/guidance/ktt19/resources/psychotropic-medicines-in-people-with-learning-disabilities-whose-behaviour-challenges-pdf-58757961132997 source: National Institute for Health and Care Excellence

---

---

Autism source: DJ. Posey, KA. Stigler, CA. Erickson, and CJ. McDougle - Antipsychotics in the treatment of autism 2008 Journal of Clinical Investigation (The American Society for Clinical investigation) January 2; 118(1): 6–14. doi:10.1172/JCI32483 Accessed October 14th, 2017

also shows the content is going to be included

http://www.bmj.com/content/334/7603/1069 BMJ 2007; 334 doi: https://doi.org/10.1136/bmj.39216.583333.80 (Published 24 May 2007) Cite this as: BMJ 2007;334:1069

https://www.scientificamerican.com/article/antianxiety-drugs-successfully-treat-autism/ - " Currently, treatments for autism are usually prescribed off-label and focus on helping treat aggression or hyperactivity with medications including Ritalin and antipsychotic medications ..."

https://www.intechopen.com/books/autism-spectrum-disorders-from-genes-to-environment/antipsychotics-in-the-treatment-of-autism DOI: 10.5772/18608

http://www.dtic.mil/docs/citations/ADA591182 - Corporate Author : Cincinatti University Ohio

23h112e (talk) 14:56, 16 October 2017 (UTC)

Did you read WP:MEDRS thoroughly? Tgeorgescu (talk) 15:02, 16 October 2017 (UTC)

No I haven't yet, because the information from the sources seems (is) relevant, and so I didn't deem it necessary. Indicate the reason why you think the content I would like to add is not applicable, since the content is supported by sources like any other content which might be at a future time added. 23h112e (talk) 16:13, 26 October 2017 (UTC)

Please see your talk page. Jytdog (talk) 16:46, 26 October 2017 (UTC)

This is why we DO NOT use the popular press for medical content.[31] Doc James (talk · contribs · email) 17:58, 26 October 2017 (UTC)

Suggestion- list tradenames

In the section that lists types of medication I think it would be helpful to add tradenames and other names in parenthesis. For instance, I came to this page to verify that Seroquel is in face an antipsychotic. It would have been immensely helpful to see this "Quetiapine (Seroquel)...." — Preceding unsigned comment added by 159.39.19.139 (talk) 15:24, 11 December 2017 (UTC)

Editing headings

I suggest you change "Other" into maybe Other Treatment Plans or Other Medical uses. Overall the article provided a lot of great information but my only edit to the article would be your the heading of your topic. One of your sources for the special populations topic was great with elaborating on those individuals and their needs. Your sources supported your topic. - T.Davis — Preceding unsigned comment added by LaShaeDavis (talk • contribs) 17:11, 18 February 2019 (UTC)

Exceptional claim requires exceptional evidence

The claim that antipsychotics do more harm than good is WP:EXCEPTIONAL. Also, it seems that it goes against the common wisdom in psychiatry. While the sources given are not WP:FRINGE, it is a common claim in anti-psychiatry that mainstream psychiatry does more harm than good.

Also, I would point out some sources of bias:

• psychiatric patients don't like to take their pills, due to their side effects: "They make me sick, doctor!"

• people with psychoses don't think that they themselves are sick, they think that the world is sick; so they consider they don't have a problem, so there is no need to take their pills.

• (recreational) drugs abuse: people with psychiatric problems are likely to fall prey to drugs.

• alcohol abuse: same as above.

So, these factors would have had to be controlled during research. Tgeorgescu (talk) 01:15, 6 October 2016 (UTC)

We need to reflect what high quality review articles say as well as position statements from major medical organizations. Doc James (talk · contribs · email) 01:17, 6 October 2016 (UTC)

• • • this is not really true, in outpatient clinics people do acknowledge that they were sick and are able to describe their delusions. Others with hallucinations are well aware that their treatment is treat them.
    • the problems is with the diagnostic "schizophrenia" which is used to brand them as incompetent, if the courts are used to force them treatment they are presented as literally legally incompetent when they are
    • correctly (contrary to psychiatrist opinion) saying that the antipsychotics are intolerable, high doses especially, and that the treatment is worse (but cheaper) than returning to the hospital periodically this on account
    • of minimal support other than the the drugs. Among dozens of patients with diagnosies of schizophrenia it would be hard to find a single one that claims the entire world is sick although they may blame their immediate ***surroundings (and reasonably so) on their demise. One aspect which is never discussed is when the psychiatrist(s) are incompetent to make a correct diagnosis (usually for the worse). This is hard to
    • argue as the patient would have to study psychiatry to prove them wrong and once on medication the patient is neutralized and can no longer defend himself. Rarely noted is that antipsychotics such as
    • Haldol were used in the former Soviet Union to punish dissidents ( they were held in psychiatric facilities) which means they are really bad.— Preceding unsigned comment added by 24.202.197.28 (talk) 20:32, 25 November 2016 (UTC)

OK, as a student and a consumer, this debate needs to stop. the evidence is now ample that antipsychotics are neurotoxic and can cause permanent extrapyramidal symptoms like #akathisia. antidepressants are showing similar ill effects because our treatment of mental health issues with newly patented drugs IS CRAZY.2602:306:B8D4:EB80:900B:9FE1:D08A:B5F8 (talk) 09:40, 1 October 2017 (UTC)

Just bring high quality sources per WP:MEDRS and we can discuss. Doc James (talk · contribs · email) 03:26, 4 October 2017 (UTC)

I don't exactly know what could be qualified as a high quality source, because everything against that current day common wisdom that antipsychotics help people with psychosis is automatically deleted here as exceptional claim. Currently the most widespread critique against antipsychotics comes from Robert Whitaker's books that cite the research done. Anatomy of an Epidemic won awards as the best investigative journalism book of 2010 and studies it cites are valid. That book goes through research history of antipsychotics and explains how that common wisdom about their usefulness was formed: At many studies antipsychotics lowered symptoms little faster than placebo (symptoms lowered also with placebo) and withdrawing them abruptly caused more psychosis that was considered as proof that people with psychosis or schizophrenia needed maintenance medication to control their symptoms. The problem he found was that those drugs made patients more chronically ill. Antipsychotics treated patients had more relapses even while they didn't stop medication and their ability to take care of themselves was lowered.

That book also criticizes RCT research standard using medicated patients whose medication are stopped abruptly as placebo group which made drugs seem like more effective than they were. Later in 2016 Whitaker wrote a public article Case Against Antipsychocis as shortening of his findings. It cites Harrow's ja Wunderlink's result's about long-term outcomes between those who have lowered or discontinued drug and those ones who were using it. In both studies drug free patients had about twice as much full recovery.

Also, there is a little study by Suzie Fu that compares those who have fully recovered while using antipsychotics and those ones who have fully recovered not using it. Those recovered without drugs recovered faster with fewer relapses and had better social and cognitive functioning even while their baseline was worse.

Wikipedia isn't area for scientific debates and it reflects majority's opinions, but I think antipsychotic article is severely lacking if it doesn't provide any real critique against them and just considers any critique as stupid opinions of biased patients not understanding their own state. That "They make me sick doctor!" opinion about antipsychotics is also shared by some therapists and psychiatrists even while they are not the majority.— Preceding unsigned comment added by 86.115.63.51 (talk • contribs)

Give us multiple, high-quality, WP:MEDRS-compliant sources and we will listen. We just don't listen to cock and bull stories. Tgeorgescu (talk) 14:52, 8 March 2019 (UTC)'

Well, those Harrow's 15-year and Harrow's 20-year and Wunderlink's 7 year follow up studies are almost the only and the most recent ones about long term effects of antipsychotics Google Scholar can find. Don't you find it strange if they won't be accepted in "Long term effects" and "Maintenance therapy" sections? That WP:MEDRS-compliant sources section says that "PubMed is an excellent starting point for locating peer-reviewed medical literature reviews on humans from the last five years." and all three articles are from there.

Here's a Harrow's 2013 published article in Schizophrenia Bulletin about current scientific knowledge of long term effects of antipsychotics. I recommend to read it fully. Schizophrenia Bulletin is a peer-reviewed medical journal. That article has about problems of existing evidence about usefulness of antipsychotics. A) It excludes 20%-40% patients outside the system B) Instead of assessing full recovery, patients who still have mild to moderate symptoms are considered as remission. C) Medication versus placebo is based much on discontinuation trials. Harrow's article points that prolonged use of antipsychotics raises probability of relapse when medication is discontinued. Article also has about "discontinuation paradox" that many of those whose medication is discontinued have relapse, but those ones without medication prolonged times remain stable. It combines with Wunderlink's research that those patients who have successfully withdrawn from antipsychotics have twice as much full recovery.

Moncrieff's free article Antipsychotic Maintenance Treatment: Time to Rethink? is published 2015 online on PLoS Medicine that is considered high quality source in WP:MEDRS. That article states that "Therefore, antipsychotic discontinuation studies may partially, or even wholly, reflect the adverse effects of antipsychotic withdrawal, rather than the benefits of initiating maintenance treatment." and under header "New Evidence on Long-Term Treatment" it has "Fifteen- and twenty-year outcomes from a long-term cohort study involving people with early psychosis have recently been published. The data suggest that people who take antipsychotics on a continuous basis have poorer outcomes than people who have periods of not taking antipsychotics. The effect persisted after controlling for early prognostic factors. Moreover, participants diagnosed with schizophrenia, who were not taking antipsychotics, showed better outcomes than those diagnosed with other forms of psychosis (usually associated with a better prognosis), who were on continuous treatment." Again I recommend to read the full article.

Here’s a good one. They shrink the brain. [32] —Wikiman2718 (talk) 06:35, 21 June 2019 (UTC)

ADHD

It can be summarized as "Antipsychotics may be an option, together with stimulants, in people with ADHD and aggressive behavior when other treatments have not worked."

We should stick with secondary sources per WP:MEDRS Doc James (talk · contribs · email) 20:35, 30 July 2019 (UTC)

Removing "major tranquilizers" definition Comment

In the first few words of the article, one of the definitions of antipsychotics cited is "major tranquilizers". I feel this is misleading and not supported by a proper medical reference. It references a textbook (a primary source) written by people who can't be considered "experts" in their field as I can't find any other works published by them (maybe I'm looking in the wrong places??). It is misleading in that many of the atypicals couldn't remotely be considered tranquilizers; in fact, the opposite is the case for most of them in that they're taken in the morning because they have mild stimulant properties. Would people be okay with me removing the reference to "major tranquilizers"? I was going to be bold and just remove it, but I felt it would be better to give it a few days on the talk page to see if my feelings are shared by the community.

Looking forward to your responses. -Schaea (talk) 20:10, 28 March 2020 (UTC)

Alright, so it's been over a week since my post above and no replies. As such, I'm going to be bold and remove the reference to antipsychotics also being called "major tranquilizers" for the reasons set out in my post above. I would appreciate it that if someone wants to revert my edit, that they please come on here before they do, so that we can have a conversation about it. -Schaea (talk) 19:24, 5 April 2020 (UTC)

Thank you for your interest in the article, Schaea. The term "major tranquilizer" is a historical term ("neuroleptics" is as well, which is still—albeit uncommonly—used today), preceding the modern convention of referring to these agents as "antipsychotics." The so-called "atypical antipsychotics" (or "second-generation" antipsychotics) came on the scene with clozapine in the 1970's, by which time the use of the term "tranquilizer" has already fallen out of favor. I hope that helps clarify things. I think that Doc James's edit, moving the synonym of "major tranquilizer" to the infobox will suffice, given the historical significance of the term. ―Biochemistry🙴❤ 00:28, 10 May 2020 (UTC)

Compliance versus adherence

I'm happy to use the term adherence. To protect my character :p, both terms seem to exist in the literature and nice guidelines:

e.g.

• adherence: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6657546/
• compliance: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5419016/

Searching google:

• psychosis "adherence", yields 1.6 million results
• psychosis "nonadherence" yields 143k results
• psychosis "compliance" yields 3.2 million results
• psychosis "noncompliance" yields 379k results

--Talpedia (talk) 19:26, 25 June 2020 (UTC)

Thanks, Talpedia! The term "compliance" is older and reflects a more traditional and paternalistic approach to medicine, whereas the term "adherence" has caught on as the more modern way of referring to the practice of patients following the advice of their healthcare providers. Medicine is striving to be less paternalistic these days. ―Biochemistry🙴❤ 21:12, 25 June 2020 (UTC)

Commitment for non-compulsory treatment: Severe mental illness

"To improve adherence, people with severe mental illness are sometimes compelled to treatment through a process called committment, in which they can be forced to accept treatment (including antipsychotics). A person can also be committed to treatment outside of a hospital, called outpatient commitment. "

I want to remove "with severe mental illness" and replace it with "patients". Or maybe "people who have been diagnosed with mental health disorders". community treatment orders are used in Canada, Australia and the UK. In Australia study found around 20% of people with FEP were placed on CTOs. These people cannot be considered to have a severe mental illness since some 20-30% will recover with no further symptoms (https://www.researchgate.net/publication/312043640_Community_Treatment_Order_Identifying_the_need_for_more_evidence_based_justification_of_its_use_in_first_episode_psychosis_patients) The author notes:

"[CTO use] may be related to clinicians' wish to minimize duration of inpatient stay, hospitalization being commonly considered as potentially deleterious in young patients with regards to social integration and promotion of engagement into treatment. It may also be related to insufficient staffing of outpatient services and lack of availability to really work in depth on engagement and provision of home based support of patients. Finally, CTOs may also have been used as a mean to minimize disengagement which is known to be frequent among FEP patients."

So outpatient commitment seems to be used for reducing the chance of relapse for those who are *at risk* of developing a disorder rather than having one. The source also references "a specific cluster of patients placed under CTO, composed of young males suffering from schizophrenia, with a lower level of education and a high rate of history of substance use disorder." so the decision making seems to be in part due to social reasons.

--Talpedia (talk) 18:32, 25 June 2020 (UTC)

Person-first language is preferred to "patients." And it is presumed that the people with severe mental illness were diagnosed with it, since the application of the label itself involves diagnosis.―Biochemistry🙴❤ 21:15, 25 June 2020 (UTC)

I also just want to clarify a couple terms, as this gets tricky. "Commitment" is different from hospitalization. Basically, commitment refers to the state of needing mental health treatment, based on whatever those criteria are in a given municipality (sometimes defined as a "person requiring treatment" in the mental health code). The setting (inpatient vs outpatient) is a different matter, pertaining to the acuity of a person's symptoms, and whatever other criteria a hospital has for its admission criteria (e.g. inability to convincingly contract for safety). Thus, a person can be both committed on the inpatient side or on the outpatient side. Outpatient commitment is not just for reducing relapse (as patients that leave the hospital are usually still unwell, but well enough to no longer meet criteria for inpatient admission). In addition, commitment is technically separate from court-ordered medication management (i.e., not only must the person requiring treatment receive treatment--aka, inpatient or outpatient psychiatric assessment--, but also is court-ordered to take medications), but the two often go together.―Biochemistry🙴❤ 21:39, 25 June 2020 (UTC)

People being treated by doctors? Hmm, so you can have a severe mental illness without being diagnosed with one, and you can be diagnosed with a severe mental illness without actually possessing one. What is going on in some countries is this: people have a single episode of psychosis, possible induced by drug use, they are then committed as an outpatient, and forced to take drugs via injections to avoid being locked in hospital. The power exists in a number of countries to indefinitely force people to take antipsychotics after a single episode of psychosis.

Is is worth mentioning here? Yes, I think it is. The manner in which antipsychotics are used is relevant, and the fact that people are forced to take them against their will at the threat of being hospitalized is relevant.

--Talpedia (talk) 21:32, 25 June 2020 (UTC)

People with substance-induced psychosis, without a primary psychotic disorder, may still be psychotic when they leave the hospital. The patient with a purely substance-induced psychosis, if no longer at risk to themselves or others, cannot be kept on a court-order once it expires. Court orders are never indefinite. The article is not improved by casting doubt on whether the people that are committed are actually sick or not, which seems to be what you're implying by suggesting that "people with severe mental illness" be changed to "people who have been diagnosed with mental health disorders." I'm as cynical as the next person, but that is not what is happening.―Biochemistry🙴❤ 21:46, 25 June 2020 (UTC)

No one has any idea what the difference between a purely substance induced psychosis and a long term psychosis is, as far as I know. You will frequently read the word "trigger" in literature regarding drug induced psychosis, which makes this clear.

In the UK, people if moved onto a section 3 for treatment after one month of assessment, a decision which may be quite subjective given the side effects of antipsychotics. At this point they may be released and permanently made to take medication. Section 3 detention can be approved after six months and a year thereafter. I don't believe a judge is involved in any of these decisions (unless an appeal is made)

I do not believe that people who were not at some stage mentally ill are being committed. I do believe that people who would be asymptomatic if they stopped taking antipsychotics (though might experience relapses) may be being committed as outpatients in Australia and Canada to enforce maintenance therapy. I know for certain that people with imtermittent mental disorders who have been stable for an extended period of time are being forced to take antipsychotics in Australia.

Am I trying to cast doubt on whether people are sick or not? Not exactly. I want language that teases apart the assumption that psychiatrists always make correct decisions because they don't and there is a whole legal system to deal with this risk in most countries. I guess I want the laguange that a lawyer would use when talking to their mental health client, rather than the language a doctor would use whe telling someone what to do -- particularly since this is a legal topic.

--Talpedia (talk) 23:15, 25 June 2020 (UTC)

Frankly, patients should see psychiatrists as their friends, not as their enemies. This prevents a lot of trouble for both. Psychiatrists could agree to oblige what their patients want, provided that they do no see their patients as negativists. In the end, the purpose of psychiatrists is to help their patients. Tgeorgescu (talk) 23:52, 25 June 2020 (UTC)

Kind of off topic. But let's go with this. Frankly, patients need to make their own decisions about what to do. A position that says "people in power are only their to help you" is kind of predictable for people in positions of powers, and it's equally predictable that this opinion should trickle down through the rest of "accepted understanding" through a combination of the just world hypothesis, respect for status, and a wanting to trust those who can help them. The idea that you should see people who have power over you as your friends just strikes me as a little... silly.

Psychiatrists serve a number of masters other than trying to help their patients. They are trying to protect society from their patients. They are trying to live up to the standards and norms of their profession. They are trying to look after all their patients. They they are trying to not be sued. And they are trying to be consistent with their understanding of the world. They also have a limited understanding of their patients, are busy, and don't have time to read the relevant literature.

Psychiatrists are not only there to help their patients, they are there to help themselves, follow the law, follow process, and help society. And I suspect that they are far more involved in the everything other than the first.

--Talpedia (talk) 00:04, 26 June 2020 (UTC)

Well, again, that depends very much upon how cooperating are the patients. The easy way is to accept therapy "voluntarily", the hard way is to be forced to receive therapy. I know that generally psychotics think they are healthy and the rest of the world is sick. But that changes after receiving proper medication. One Flew Over the Cuckoo's Nest (film) is a nice movie, but gives one a totally distorted image of contemporary psychiatry. Tgeorgescu (talk) 02:54, 26 June 2020 (UTC)

There is a world of grey in the middle there. Large doses, side effects from antipsychotic that resemble psychotic symptoms, lack of review while committed, heavy pressure for use of prophylactic drugs, unacknowledged manic side effects of antidepressants, ill-informed mental health nurses, failure to distinguish between "normal behaviour" and manic behaviour once psychotic symptoms have subsided, kakfaesque legal authority, use of threat of commitment to force "volunatry" treatment. My image of contemporary psychiatry is very accurate thank you very much.

--Talpedia (talk) 09:06, 26 June 2020 (UTC)

I admit that I am a little lost now, as it seems that the discussion has gone off topic. Are there any specific edits that are being proposed? Otherwise, I suggest we close this discussion. Also, can we please thread our comments?―Biochemistry🙴❤ 02:49, 27 June 2020 (UTC)

At least I write my files according to DSM 6. I think Synology will release DSM 7 later this year. Tgeorgescu (talk) 13:15, 29 June 2020 (UTC)

Tables

Hey, I agree that these tables are quite niche knowledge. However, I think they are pretty useful for anyone researching which antipsychotics to take, and I think this might be a common use of this page.

• Antipsychotics can have quite ideosyncratic side effects, and these can be nasty, knowledge of mechanism might be particularly useful if an individual is deciding what drugs to take to avoid these side effects.
• Half lives are useful when tapering (though this might be more useful on a specific page rather than on this page - though if an individual is selecting which drug to take in order to more effectively taper this might be useful).
• Having a complete list of of all antipsychotics and their mechanisms is useful if an individual wishes to choose which antipsychotic to take.

I'm not sure if this is a good argument, I haven't seen many arguments here based on "this is very important for group X" win. Might it be better to move this off to a separate page? List of antipsychotics or semething like that? Talpedia (talk) 20:35, 8 March 2021 (UTC)

I don't know much about this subject so I may have been mistaken in removing the tables. I'm going to abstain from this discussion to focus on other things. Velayinosu (talk) 00:49, 9 March 2021 (UTC)

Revert

Reverted edits are both WP:FRINGE and dated (outdated). Debunked at https://www.nature.com/articles/s41386-021-00980-0 Tgeorgescu (talk) 15:22, 15 March 2021 (UTC)

Why do you think it's WP:FRINGE? I think the original summary is perhaps not representative. I don't think the theory has exactly been debunked, the papers underlying the theory still had good methodology. I note this paper is a very recent primary source, while the original source is a systematic review. From a purely "wikilaw" perspective the first review is WP:MEDRS though perhaps not well-summarized.

Going off the rails and assessing source quality myself. I think this primary source is quite relevant to a discussion on this topic, but note that the result was "not significant" rather than "the effects are tiny", I don t know if the test could have been underpowered and the assessment was made after three months of antipsychotic use. The primate experiments were also able to actually examine brains, which is superior to MRI in many ways. Talpedia (talk) 17:58, 15 March 2021 (UTC)

By outdated I mean sources from the seventies. Those were used to affirm in 2021 that antipsychotics are ineffective. "Reduce brain size" is just a way to play the anti-psychiatry card. I will open a topic at WP:FTN. Tgeorgescu (talk) 22:42, 15 March 2021 (UTC)

The sources are from the early 2000's (https://www.nature.com/articles/1300710). If there is no better research on the topic they are the best evidence. "Reduce brain size" is a factual statement, confirmed in animal studies, that those who identify as anti-psychiatry quote this theory does not affect the fact that there is evidence for it. Talpedia (talk) 23:22, 15 March 2021 (UTC)

I'll wait for the ordeal of WP:FTN. Anyway, just at a glance, it is confounding by body weight. Tgeorgescu (talk) 00:05, 16 March 2021 (UTC)

There seems to be some overgeneralization or alarmism there also with source misrepresentation. The source that's more recent (2011) has in its abstract: "Progressive brain volume changes in schizophrenia are thought to be due principally to the disease. However, recent animal studies indicate that antipsychotics, the mainstay of treatment for schizophrenia patients, may also contribute to brain tissue volume decrement. Because antipsychotics are prescribed for long periods ...", "More antipsychotic treatment was associated with smaller gray matter volumes. Progressive decrement in white matter volume was most evident among patients who received more antipsychotic treatment", " Viewed together with data from animal studies, our study suggests that antipsychotics have a subtle but measurable influence on brain tissue loss over time, suggesting the importance of careful risk-benefit review of dosage and duration of treatment as well as their off-label use". So it's clear that it's related to long term and extensive use for the management of already serious disease, that the disease itself is mostly responsible for the tissue damage, etc. The optic of the article is not to prevent or discourage use, but in relation to dose management... —PaleoNeonate – 12:28, 16 March 2021 (UTC)

Thanks for your input Paleo, one the question of antipsychotics only being used for a preexisting serious disease. Some psychiatrists will suggest lifelong prophylactic use of antipsychotics for asymptomatic people who have had a single psychotic episode that has resolved itself. Health bodies will suggest 1 to 2 years of antipsychotics. Many episodes of antipsychotic may be drug related. Long-term use of antipsychotics takes place in people who may never have any further psychotic symptoms (sources on request). Talpedia (talk) 12:37, 16 March 2021 (UTC)

There is always danger of misusing some well-meant and effective drugs. My take: antipsychotics increase body weight, increased body weight reduces brain size. So, it's mediator. That means I don't deny the observed effect, however the causality is mediated by something else.

Also, as I stated, I can grant one point if the IP drops the other point. Tgeorgescu (talk) 13:09, 16 March 2021 (UTC)

So sure that's a plausible theory that could be investigated and would have to be corrected for. In a sense AP still "cause" brain loss even if this is the mechanism. This is all speculative OR territory. I would be more inclined to think the effect on the brain was due to a drug that acted on the brain. I guess you could do animal studies where you corrected for weight. Talpedia (talk) 17:42, 16 March 2021 (UTC)

Too lazy to search for it, but I recently read that research has established that increasing body weight decreases brain size. So, let's restore one half of the disputed edit and drop the other half.

So, yeah, the first medical claim of the IP is supported by a recent review indexed for MEDLINE, so it is WP:MEDRS-compliant. The second claim is not MEDRS-compliant because of consisting of WP:PRIMARY studies and because of WP:MEDDATE.

There is one ground for accepting the first claim, and two very good reasons for reverting the second one.

For the record: Joanna Moncrieff has an axe to grind against medicines in psychiatry. Tgeorgescu (talk) 19:07, 16 March 2021 (UTC)

Joanna Moncrieff has an axe to grind

indeed, but she is a psychiatrist publishing in peer reviewed journals. It's perhaps unsurprising that critique comes from people with quite a different theoretical outlook. Talpedia (talk) 19:33, 16 March 2021 (UTC)

Hmm if independent sources report on her work in the context of general psychiatry it could be covered there where due of course, —PaleoNeonate – 21:34, 16 March 2021 (UTC)

I suspect you meant episodes of psychosis (that can be for any reason not only schizophrenia), yes, mismanagement and lack of resources is of course always a problem. It could have changed but when I studied a bit to better understand some people I know (I'm no MD, psychologist or psychiatrist), 1.5y in my country seemed to be common for a first treatment attempt with a medication (antipsychotic and/or antidepressant, depending), ideally supported by a type of therapy and a longer follow-up that is often agreed to be deficient even in countries considered to have good health systems... Individual response varying, years may be needed to discover what works best and to minimize unintended side effects, some unevitable, blood tests regularly done, dosage adjusted, etc. —PaleoNeonate – 21:26, 16 March 2021 (UTC)

Yup, that's what I'm referring to. Turns out that there is no evidence that use of medication prior to cessation decreases the likelihood of relapse once medication is withdrawn.... Talpedia (talk) 21:56, 16 March 2021 (UTC)

Dementia and alzheimers: Adverse effect on cognition

Evidence shows adverse effect such as Alzheimer's disease , Cognitive dysfunction , Dementia worsening, etc.

RIT RAJARSHI (talk) 07:37, 30 May 2021 (UTC)

References

Ironically, chemical lobotomy is frequently given to those with dementia, dramatically shortening their rremaining lifespans. Probably because it makes them docile in the short term.DrBoller (talk)