Diving into the turbulent history of psychosis and schizophrenia: A thread on landmark papers that shaped psychiatry's successes, pitfalls, and ongoing debates. "Those who cannot remember the past are condemned to repeat it." 🧵
1. The paper that sparked the psychopharmacology revolution. 2. The paper that broke the DSM. 3. The culmination of the dopamine hypothesis. 4. The paper that sparked second-generation antipsychotics. 5. The paper claiming schizophrenia outcomes are better in poorer countries. 6. The paper showing few take antipsychotics anyway. 7. The paper questioning the fundamentals of our treatment.
Drawn from a recent lecture: for psychiatry enthusiasts or those curious about how we got here and where we're headed...1. Delay et al. (1952). Therapeutic use of phenothiazine (4560 RP) in psychiatry. Annales medico-psychologiques.
The paper that sparked the psychopharmacology revolution and maybe even deinstitutionalitazation.
The first use of the antipsychotic Thorazine in psychiatry. In a study of 20 patients with unclear diagnoses, Thorazine effectively treated excitation and confusion (psychotic and manic), as well as insomnia. A notable side effect was hypotension, linked to Thorazine’s significant alpha-1 effect. Thorazine was used for acute symptoms, not long-term treatment.
Psychotropics have problems but may have helped restore freedom to 500,000 Americans.
It doesn't say specifically 0.4%, it says "prevalence rates for depression are under one per 1,000 population for depressive psychoses and two or three times that for depressive neuroses." So technically <0.4%.doi.org/10.1176/ajp.12…
Mar 6 • 6 tweets • 2 min read
A reminder of some of the pharma fines in psychiatry:
• $2.2B J&J Risperdal, antipsychotic, 2013
• $3B GSK Paxil, Wellbutrin, antidepressants 2012
• $500M AstraZeneca Seroquel, antipsychotic, 2010
• $1.4B Eli Lilly Zyprexa, antipsychotic, 2010
• $2.3B Pfizer Geodon, antipsychotic 2009
Links and details below 1/6
$2.2B Johnson & Johnson for Risperdal, antipsychotic, 2013
Risperdal: inappropriately promoted for “anxiety, agitation, depression, hostility and confusion” in dementia as well as “downdplayed” risks, as well as inappropriately promoted in “children” 2/6
Are we wrong about addiction? Should treatment guidelines only be based on the minority who go to rehab and have high rates of relapse, or the larger group who use drugs but don't become addicted?
Maybe we are making a mistake by conflating the two groups./1
In 1974, Robins stated, "We can no longer justify applying policies to every narcotics user that are based only on information about addicts who present to treatment facilities and show an inability to terminate their addiction." /2
Dec 14, 2024 • 14 tweets • 4 min read
Why did I write an article that required the response of a lobbying group, past APA presidents, and DSM chair?
“The involuntary use of long-term antipsychotic treatment for relapse prevention for an asymptomatic patient with severe mental illness is rarely justifiable.” 1/
I have the perspective that psychiatry is anchored on truth. I (the psychiatrist) am honest with you; in return, you trust me with your most intimate thoughts. This is an great responsibility. To live up to this task, psychiatrists must be as fair as possible to the evidence. 2/
Nov 14, 2024 • 10 tweets • 3 min read
The US/UK Diagnostic Project. Every psychiatrist should know about this: a study that changed the course of psychiatry and showed its limits. 🧵
Summary: 1971, 600 psychiatrists reviewed 8 interviews of patients. They came to very different conclusions -> It led to the checklists in the DSM. 1/
If I do a study of schizophrenia in the US and you do a study of schizophrenia in the UK. Can we rely on each other’s work?
Well, we can't if schizophrenia doesn't mean the same thing to you and to me. That is the premise of the US/UK diagnostic project. 2/10
Oct 23, 2024 • 15 tweets • 5 min read
STAR*D a 🧵
If you don’t read the thread - super short: they claimed that antidepressants as used in common practice worked 67%, when the result actually was 35%.
Problem #1
#1 The biggest problem, the extra 931. We were told that STAR*D was about 4,041 patients with depression when in reality 931 (99+508+324) did not score high enough on a depression scale (HSRD of less than 14), so it should have been 3,110 patients.
