Podcasts about zyprexa

Should my stepson take a genetic test to evaluate his risk for pancreatic cancer?I had abdominal surgery last month. What can I do or take to minimize scarring?I have dry mouth. What treatments can I use to restore saliva?Could metoprolol be contributing to my restless legs syndrome?I've been diagnosed with a chemical imbalance and prescribed Zyprexa. What are your thoughts? 

Welcome back to our antipsychotic series. Today, we will be discussing Olanzapine, brand-name, Zyprexa.

Contributors: Andrew White MD & Travis Barlock MD In this follow-up episode Dr. Andrew White, a practicing psychiatrist with an addiction medicine fellowship, and Dr. Travis Barlock, an emergency physician at Swedish Medical Center, discuss mental health holds, psychiatric placement, pharmacologic vs. non-pharmacologic treatments, and outpatient care of psychotic patients. If you missed it, be sure to listen to part I for details on the management of psychotic patients in the ED. Educational Pearls: Mental health holds should be approached on a case-by-case basis; this includes assessing safety risks immediately, over a 24-hour period, and chronically over the last few months. Lastly, collateral information is useful in assessing a mental health hold.   What happens after patients get placed in inpatient psychiatry? Typically an antipsychotic is started; in the absence of metabolic risks, patients will often be started on Zyprexa, especially in oral dissolvable form. Doses of Zyprexa ODT start at 2.5 - 5 mg per day.   If psychotic patients do not pose direct harm to the environment, they do not necessarily need to be medicated. However, patients will often need medication at some point; for example, some people may be calm during their psychosis but unable to feed themselves or perform other ADLs.   The goal of pharmacologic treatment for psychosis is to save the brain; each episode of psychosis damages the brain. Oftentimes, patients will be started on long-acting injectables like aripiprazole or risperidone to give patients 30 days of treatment with one shot.   Non-pharmacologic approaches to psychosis are challenging given the nature of the disease. There have been attempts at therapy for psychosis but not have not been hugely successful. Options for support include PT/OT, family support via organizations like NAMI, and other resources for families of patients with psychosis.   Outpatient care of patients with psychosis includes contextualizing the events. For example, many people who experience brief psychotic episodes do not go on to develop schizophrenia so it is important to identify a prognosis. On the other hand, someone who has worsening symptoms over several months may require more aggressive treatment.   The primary goal of outpatient management of older patients is to reduce the adverse effects of long-term treatments. The CATIE trial in the early 2000s showed that only 25% of people were on antipsychotics by the end of the trial; it is more important to engage patients than focus too much on medications' adverse effects. Summarized and edited by Jorge Chalit, OMSII | Studio production by Jeffrey Olson, MS1  

With summer just around the corner, there's no doubt you want to look and feel your best. But some people have trouble losing weight because they constantly feel hungry. Today we'll talk about why you often feel hungry and some ways you can feel more satisfied.  Why am I hungry all the time? Unfortunately, the answer isn't simple, and many factors must be considered. The first step is to talk with your primary care physician to rule out certain health conditions. For example, conditions like hyperthyroidism, diabetes, hypoglycemia, anxiety disorder, major depressive disorder, and eating disorder that lead to restriction, binging, or purging can make you feel more hungry.  And interestingly enough, during times when our sex hormones are changing (e.g., menopause, first days of your period, polycystic ovarian syndrome, and pregnancy), your appetite can increase.  Medications that can make you hungry include steroids like prednisone, seizure medications like gabapentin, certain atypical antipsychotic medications like Seroquel and Zyprexa, and antihistamines like Benadryl and hydroxyzine.  Several weeks ago, we discussed the importance of healthy sleep and peptide therapy and how not getting enough sleep can significantly impact your body and mind. This can include unintentional weight gain and an increased appetite. In addition, research has found that you're more likely to choose less nutritious food when you do not get enough sleep. In the past, we also discussed how chronic stress can affect our body and mind. For example, if you're dealing with chronic stress, your cortisol levels ("stress hormone") may increase, leading to fatigue, depression, and weight gain.  Simply put, stress makes you more likely to engage in emotional eating and crave comforting foods, which in turn, causes you to eat more calories. You may also experience upset stomach, constipation, diarrhea, headaches, difficulty sleeping, and low sex drive. What can I do if I'm still hungry after eating? Try to avoid refined sugars, which are usually found in processed foods. These include foods like packaged snacks, candy, soda, and cereals. These foods aren't filling and lead to weight gain.  A healthier alternative would be complex carbohydrates like quinoa, lentils, beans, and sweet potato, as they slowly release sugar (glucose) into the blood and provide the body with a steady energy supply. Try to eat slower. Studies have shown that when you eat slower, you suppress ghrelin, a hormone that makes you feel hungry. Remember that if you increase your physical activity levels, you'll require more calories. Don't restrict your calories too much, which will then cause your body to want more food.  What about semaglutide? Let's say you've talked to your healthcare provider to rule out certain health conditions or medications that could be causing you to feel hungry all the time. And you've set realistic weight goals, changed your diet, and kept a daily food log. You've also increased your physical activity. But you're still hungry and can't seem to lose any additional weight.  When these lifestyle changes (diet and exercise) aren't enough to lose the weight you desire, weight-loss medications like semaglutide may be helpful.  Thanks again for listening to The Peptide Podcast, we love having you as part of our community. You can find out more information about semaglutide on our previous podcasts. If you love this podcast, please share it with your friends and family on social media, and have a happy, healthy week! Pro Tips We're huge advocates of using daily collagen peptide supplements in your routine to help with skin, nail, bone, and joint health. But what do you know about peptides for health and wellness? Giving yourself a peptide injection can be scary or confusing. But we've got you covered. Check out 6 tips to make peptide injections easier. 

This is the 18th podcast episode for the Psychiatric Medication Podcast Series. Series Description: Current literature indicates that podcasts can be an effective educational format to reach health professionals across the continuum of medical education, addressing a myriad of topics pertinent to providers. This episode serves as an overview of Olanzapine/Zyprexa. This podcast season is the second released by East Carolina University's Office of Continuing Medical Education and may be beneficial for physicians, residents, fellows, nurse practitioners, physician assistants, and nurses. This podcast season is comprised of approximately 30 episodes, each focusing on different psychiatric medications for the non-psychiatric provider. Those tuning into the podcast's second season will receive a primer on the "bread and butter" behavioral health medications for primary care: antidepressants, antipsychotics, and mood stabilizers. Episodes will be released weekly on Wednesdays.Rachel Gooding, MD & Maxwell Miller, DO

This podcast, Elizabeth Hopfenspirger, DNP, a psychiatric and family practice nurse practitioner with Lakeview Clinic, discusses various mental health topics, primarily in the adult patient, but also touches on some pediatric issues. Today's discussion will focus on the following areas of mental health - depression, anxiety, mixed disorders, ADHD and psychosis. Enjoy the podcast. Objectives:Upon completion of this podcast, participants should be able to: Describe different implemention stratgies in how to better establish a therapeutic relationship with the patient. Recognize how many psychotropics medications are on a "spectrum". Realize that treatment choice depends on several variables - including presenting symptoms and underlying organic issues. CME credit is only offered to Ridgeview Providers & Allied Health staff for this podcast activity. After listening to the podcast, complete and submit the online evaluation form.  Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at Education@ridgeviewmedical.org. Click the link below, to complete the activity's evaluation. CME Evaluation (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  DISCLOSURE ANNOUNCEMENT  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview Medical Center & Clinics.  Any re-reproduction of any of the materials presented would be infringement of copyright laws.  It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker's outside interest may reflect a possible bias, either the exposition or the conclusions presented. Ridgeview's CME planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event. Thank-you for listening to the podcast. SHOW NOTES:  *See the attachment for additional information.  The state of mental health care in the US is not ideal- Lack of resources - Lack of practitioners - social, physical, economic and environmental challenges CASE REVIEW #1- 18 year old female with predominantly anxiety - Respectful curiosity: listening and asking questions without judgement - Medication for generalilzed anxiety disorder- High intensity aerobic exercise can improve anxiety symptoms. - Trauma? ADHD/Learning difficulties? Sleep? Appette and restriction of food/eating disorders? Substance use/abuse? - SSRI: bupropion>fluoxetine?Sertaline?escitalopram>fluvoxamine>paxil (most activating to least activating) - For pure anxiety - Elizabeth prefers escitalopram, citalopram and sertaline - Trauma and trauma therapy: Trauma can be anything (death of a loved one, MVC, etc.)      - Trauma therapy (EMDR: eye movement desensitization reprocessing)      - IFS (internal family systems - recognizing and connecting with your own history and younger self)     - ART (acceleraed resolution therapy) - Substance use: What is the substance doing for the patient? Why are they using? Helps to direct therapy and arrive at diagnosis. - ADHD (attention deficit hyperactivity disorder)     - sometimes missed or ignored     - PCPs have discomfort treating at times     - trial of stimulant may be beneficial - Suicide ideation and other adverse effects while first starting certain meds is real, but rare- Article resources:        Walkup, et.al   (https://pubmed.ncbi.nlm.nih.gov/18974308/)       Wetherell, et.al  (https://pubmed.ncbi.nlm.nih.gov/23680817/)       Critz-Christoph, et.al  (https://pubmed.ncbi.nlm.nih.gov/21840164/)      Trauma therapy : https://www.emdria.org/ CASE REVIEW #2- 32 year old male with depression - Labs? Physical activity? Testosterone concerns? - Lifestyle and sexual function - Post-retirement? (identity and purpose has changed/gone) - Consider bupropion if no seizures or other contraindications. Consult with neurologist if significant history - Sexual dysfunction an issue? Vortioxetine can be an option wich may help enhance libido - Physical activity (natural endorphins) and exposure to nature are improtant - Screen time? Smart phone and other screen time has dopaminergic effects; too much 'negative' screen time can be detrimental  (If AHDH is poorly treated, screen addiction may increase.) CASE REVIEW #3- 65 year old male with mixed depression and anxiety, off meds for many months - Find as many of patient's historical records as possible - Meeting a patient "where they are at". How motivates is the patient to get better? - Are they coasting (teenagers)? Are they taking an active role in getting better?       - may need to wait to push/empower patient until after giving medication and psychotherapy some time        - where is the patient in their willingness to change and get better?  - Meds in this ager group (and many others) to avoid:  TCAs and MAOIs - IF DM, HTN, CAD and other co-morbidities, fluoxetine is less likely to have interactions and adverse effects- Article resources:       Prochasa and DiClemente - Stages of Change https://www.ncbi.nlm.nih.gov/books/NBK556005/) Psychosis- Caplyta (stimulating) if more depressed with psychotic features - Zyprexa (sedating) if more manic/psychotic Genetic testing for optimization of medications is an option - Serves as a 'guide' for medication choice - SLC6A4 gene, for instance, is responsible for serotonin reuptake into the presynaptic neuron What to do while waiting for SSRI and SNRI to "work"?- Hydroxyzine, benzodiazepine - Sleep medication:      - Doxylamine, Trazadone or Remeron (older patients)      - Sleep medication: lunesta, sonata Polypharmacy- Is polypharmacy present and patients feeling poorly with persistent symptoms? May need thoughtful/ careful deprescribing. Nontraditional/novel treatment options- Nontraditional/novel options for treatment resistant depression, PTSD treatment, chronic pain, etc. - Ketamine - Psilocybe Psychiatry & Primary Care- Incorporating psychiatry into our own primary care practices is anxiety provoking but inevitable in this day and age of healthcare - We can learn new things and leverage our existing resources to better help our patients - Time with our patients is a barrier - Ask the patient: what is the most pressing issue for you today? What is the most distressing thing for the patient? Then consider Maslow's Hierarchy of Needs and build up from there.- Article resources:       Maslow Hierarcy of Needs (https://www.simplypsychology.org/maslow.html) Please check out the additonal show notes for additional information/resources.

Download the cheat: https://bit.ly/50-meds  View the lesson:   Generic Name olanzapine Trade Name Zyprexa Indication schizophrenia, mania, depression, anorexia nervosa, nausea/vomiting related to chemotherapy Action antagonizes dopamine and serotonin Therapeutic Class antipsychotic, mood stabilizers Pharmacologic Class thienobenzodiazepines Nursing Considerations • do not use while breastfeeding • can cause neurolyptic malignant syndrome, seizures, suicidal thoughts, insomnia, tardive dyskinesia, agranulocytosis, constipation, tremors • assess mental status • monitor hemodynamics • assess blood sugars • assess intake and output • monitor liver function tests

Study referenced at 17:15 - https://pubmed.ncbi.nlm.nih.gov/21300943/ --- Support this podcast: https://anchor.fm/psychology-is/support

With five sessions down, Natasha feels less like a nurse and more like a patient. Her final chemo treatment is next Wednesday, and the planned end-of-chemo celebration feels fake because surgery and radiation are still ahead. Because food tastes even worse than before, she lives off rice and beans. To keep the weight loss from further eroding her self esteem, she downloads an app to send her daily affirmations. Links Support the Breast Cancer Stories podcast https://www.breastcancerstoriespodcast.com/donate Subscribe to our newsletter here: http://eepurl.com/hX12YD About Breast Cancer Stories Breast Cancer Stories follows Natasha Curry, a palliative care nurse practitioner at San Francisco General Hospital, through her experience of going from being a nurse to a patient after being diagnosed with breast cancer. Natasha was in Malawi on a Doctors Without Borders mission in 2021 when her husband of 25 years announced in a text message that he was leaving. She returned home, fell into bed for a few weeks, and eventually pulled herself together and went back to work. A few months later when she discovered an almond-sized lump in her armpit, she did everything she tells her patients not to do and dismissed it, or wrote it off as a “fat lump." Months went by before Natasha finally got a mammogram, but radiology saw nothing in either breast. It was the armpit lump that caught their attention. Next step was an ultrasound, where the lump was clearly visible. One painful biopsy later, Natasha found out she had cancer; in one life-changing moment, the nurse became the patient. This podcast is about what happens when you have breast cancer, told in real time. Host and Executive Producer: Eva Sheie Co-Host: Kristen Vengler Editor and Audio Engineer: Daniel Croeser Theme Music: Them Highs and Lows, Bird of Figment (https://music.apple.com/us/artist/bird-of-figment/1434663902) Production Assistant: Mary Ellen Clarkson Cover Art Designer: Shawn Hiatt Breast Cancer Stories is a production of The Axis. (http://www.theaxis.io/) PROUDLY MADE IN AUSTIN, TEXAS

CHP lideri Kemal Kılıçdaroğlu'nun başörtüsü yasağıyla ilgili günah çıkarma hamlesini anlayışla karşılamak mümkün. Nihayetinde binlerce insan sırf dini inançlarından dolayı CHP zihniyeti yüzünden zulme uğradı. Seçime giderken yüzde 50+1'e ihtiyacı olan CHP liderinin böyle bir manevrayı yapmaktan başka çaresi yoktu. Öte yandan, ittifak kurduğu Saadet Partisi ve diğer siyasi münafıklar sahada zor anlar yaşıyor. Yıllarca CHP'nin zulmüne maruz kalan vatandaşlar, SP ve diğer siyasi münafıklara, “Bu CHP'nin yanında ne işiniz var?” diyor. Kılıçdaroğlu bu manevrayla onların elini de rahatlatacak adım attığını düşünüyor. Zaten Kılıçdaroğlu'nun çıkışından sonra yapılan açıklamalara baktığımızda bunun emarelerini görüyoruz. CHP'nin verdiği yasa teklifini “Kazanımların yasal güvenceye alınması” şeklinde değerlendirenler olurken, Kemal Bey'in hidayete erdiğini düşünenler de var. Tabii hidayete ermesine vesile olduklarını da el altından söylüyorlar. CHP'den gelen teklifin siyasi istismar olup olmadığına bakılmaksızın değerlendirilmesi gerektiğini ilk yazanlardan biriyim. Zira CHP tabanında dindar insanlara yönelik öfke, korkunç seviyelere ulaştı. Ellerine fırsat geçse, bırakın kamuda çalışmayı, üniversitede okumayı, başörtülülerin sokağa çıkmasına bile izin vermezler.

The investigation into the illegal promotion of the drug Zyprexa by the US justice department resulted in the largest sum for both a corporate whistleblower claim and the largest criminal fine ever imposed by the US upon a single company.  On today's podcast we welcome Jim Gottstein, famous for subpoenaing and releasing the Zyprexa papers.The Zyprexa Papers Paperback - Jim GottsteinIf you are in a crisis or think you have an emergency, call your doctor or 911. If you're considering suicide, call 1-800-273-TALK to speak with a skilled trained counselor.RADICALLY GENUINE PODCASTRadically Genuine Podcast Website Twitter: Roger K. McFillin, Psy.D., ABPPInstagram @radgenpodTikTok @radgenpodRadGenPodcast@gmail.comADDITIONAL RESOURCES4:30 - Eli Lilly Said to Play Down Risk of Top Pill - The New York Times5:00 - Eli Lilly and Company Agrees to Pay $1.415 Billion to Resolve Allegations of Off-label Promotion of Zyprexa11:00 - Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill: Whitaker, Robert12:00 - Law Project for Psychiatric Rights20:00 - Olanzapine (Zyprexa) | NAMI: National Alliance on Mental Illness37:00 - The Psychiatric Drugging of Children & Elderly44:00 - PsychRights: Lucy Booth: Psychiatric "help" - The Doctor was Fooled or Complicit54:00 - Why is the FDA Funded in Part by the Companies It Regulates? - UConn Today.54:40 - Federal Register :: Revised Draft Guidance for Industry on Distributing Scientific and Medical Publications on Unapproved New Uses-Recommended Practices; Availability59:00 - A Strategic Approach to Mental Health System Change1:02:30 - California COVID misinformation bill targets doctors spreading false information

In this second episode of a two-part mini-series, we feature Dr. Nadia Haddad, a Colorado psychiatrist, and Dr. Ricky Dhaliwal, an emergency medicine physician, as they discuss the various treatment modalities for substance-induced psychosis. They explore pharmacologic treatments, inpatient and outpatient treatments, and ways that emergency providers can improve their care for psychiatric patients with comorbid medical conditions. Lastly, they consider the different causes for repeat visits from mentally ill patients.    Key Points:   Pharmacologic treatments for substance-induced psychosis are similar to those for other types of psychosis; these include medications like Zyprexa, Haldol, and, as a third-line treatment, IM Thorazine.  Droperidol is used more commonly in the emergency setting, compared with the psychiatric setting.  Given the risk for respiratory depression from Zyprexa combined with benzodiazepines, psychiatrists may choose to use Thorazine or Haldol/Ativan/Benadryl instead.  It is important to reassess patients after substances wear off to determine whether they meet criteria for admission to inpatient psychiatry, though psychiatric assessments are limited by geographic constraints. The admitting psychiatry team will reassess the patient to differentiate substance-induced psychosis vs other psychoses; often this includes obtaining collateral. Helpful notes from the ED include: medications administered or restraints placed (can help extrapolate a patient's level of agitation), vital signs, prior records.  Some people will be more open about suicidality while intoxicated and less open about it while sober so it is important to obtain additional information for corroboration.  On average, patients stay in the detox unit for 3-4 days, though some may stay longer for protracted substance-induced psychosis if they have a long-standing history of daily substance use.  It is important to discharge patients with quick follow-up and potential placement into the various mental health programs including partial hospitalization, residential, or outpatient programs. Emergency rooms can improve by taking psychiatric patients seriously, especially when they are transferred to the hospital from a psychiatric facility for medical management.  Repeat visits stem partially from the ambivalence that accompanies substance use disorders, including patients' difficulty in giving up the substance due the purpose it may serve in their lives.  Many substance use disorder programs are siloed from the medical system, which pose a challenge to interdisciplinary communication. 

AND SHE WAS WAS "RECALLED TO LIFE"**This phrase is from A Tale of Two Cities by Charles Dickens.Suzanne took the antidepressant Paxil, a “selective serotonin reuptake inhibitor,” (SSRI) for six years. These cause brain damage, but no doctor had ever warned her. When her psychiatrist finally transitioned her off the medication, she immediately began to have sexual dysfunction and other withdrawal symptoms. So he recommended restarting 10mg a day, a minimal dose.Noxious, menacing effects due to SSRIs occur frequently after the second or the third time that a patient stops or restarts them.  This is what happened to Suzanne.   While taking the 10mg of Paxil, Suzanne became paranoid, had violent verbal outbursts, and had her first involuntary movements (dystonia or possibly tardive dyskinesia). She became suicidal, had other violent thoughts, and fantasized about cutting herself.  These are well-known occasional effects of SSRIs.The doctors forcibly hospitalized her. Her family, having little understanding or other options, went along with it. She was soon hallucinating and repeatedly screaming nonsense words. She wanted to hurt the people around her and had to be physically restrained by hospital security personnel.So the doctors increased her Paxil to 30mg a day—triple the dosage that initially caused problems. Even though this made Suzanne worse, they also added Zyprexa, (an antipsychotic), Ativan (a sedative), and Ambien (a sleep drug). She says Zyprexa was horrible. It made her feel as if knives were stabbing all over her body. It also gave her thoughts that people were trying to kill her. She was held in a locked mental health facility similar to a prison and was threatened with increased medication dosage if she did not improve.Since these effects occurred suddenly after starting the drugs, she realized that they were to blame. Fortunately, she was allowed to keep her smartphone, although the staff repeatedly threatened to take it. Suzanne started studying 14 hours a day from inside her solitary prison-like cell. She first read in Dutch but later began using English on the Facebook group dedicated to her primary drug effect, “akathisia.”She found MISSD.CO, Woodymatters.com, MadinAmerica.com, and other websites dedicated to psychiatric medication disasters like hers. Suzanne was dumbfounded by Katinka Blackford-Newmann's story because her involuntary hospitalization in the EU was nearly identical to Suzanne's. When Suzanne explained akathisia and dystonia to her state-employed Dutch psychiatrists, they insisted that there was no such thing. They also said that she must stop researching or they would never release her. She soon developed severe insomnia and deteriorated mentally and physically. See RobertYoho.substack.com for the complete essay. See RobertYohoAuthor.com to learn about my books, Butchered by “Healthcare” and Hormone Secrets. My essay with links to COVID treatment and more is HERE. “LEGAL” DISCLAIMER: Use this information at your own risk. It is general commentary and not medical advice. Robert Yoho is retired and no longer practices medicine. Make your healthcare decisions with the help of a physician or other licensed provider. Support the show

SUMMARY In Part 2 of this podcast on Schizophrenia, we're joined again by Katrina Tinman (peer support worker with lived experience of schizophrenia), Chris Summerville (CEO of the Canadian Schizophrenia Society), and Dr. Phil Tibbo (clinical/research psychiatrist who specializes in psychosis-related illnesses). They dig deep into emerging holistic recovery approaches that integrate biological, psychological, social, vocational, and spiritual supports. They also explore stigma, impacts of COVID-19, needed changes to public policy and the mental healthcare system, and the world of schizophrenia 20-30 years from now. TAKEAWAYS This Part 2 podcast will help you understand: Emerging diagnostic practices and medications Integrated healing that incorporates biological, psychological, social, vocational, and spiritual recovery supports Benefits of meditation/mindfulness and positive lifestyle choices Benefits of creative therapies that use art, music, drama, and writing Advances in personalized/precision medicine Advances in technology and the Internet to support recovery Effects of COVID-19 Stigma's impact on recovery Challenges for families of people with schizophrenia What medical professionals need to know about schizophrenia What public policy changes would support recovery Why changes should be made to the mental healthcare system What the world of schizophrenia could look like in the future SPONSORS RESOURCES RECOVERY: Research Into Recovery Recovery Model of Mental Illness: A Complementary Approach to Psychiatric Care A National Framework for Recovery in Mental Health Recovery-oriented Practice − An Implementation Toolkit PEER SUPPORT: Peer Support  The Future is Peer Support Using Peer Support in Developing Empowering Mental Health Services MENTAL HEALTH STIGMA: Fighting Stigma and Discrimination Is Fighting for Mental Health Stigma and Discrimination Addressing Stigma Five Ways to End Mental Health Stigma SCHIZOPHRENIA: Hope and Recovery Schizophrenia Treatment and Self-help   GUESTS  Katrina Tinman Katrina Tinman is a peer support worker for Peer Connections Manitoba, formerly the Manitoba Schizophrenia Society, and is located at the Mental Health Crisis Response Centre in Winnipeg, Manitoba. Katrina is currently working toward formal peer support worker certification with Peer Support Canada, though she already has peer support certification through the Ontario Peer Development Initiative. Katrina received a university education in journalism and political science in 1998, from North Dakota State University in Fargo, North Dakota. Since then, she's had a wide range of life experiences from working in the professional arena, extensive travel, motorcycle riding, alpine skiing, and SCUBA diving, to homelessness and mental illness. Regardless of some negative life experiences, Katrina's greatest achievement was a sense of fearlessness that carried her through along with hope for the future. Now she's able, through her peer support work, to use her life's insights to help others in their recovery from crisis and mental illness. Email: k.tinman@peerconnectionsmb.ca Website: www.peerconnectionsmb.ca  Facebook: www.facebook.com/katrina.tinman.5 Twitter: https://twitter.com/tinman_katrina Linkedin: www.linkedin.com/in/katrinatinman Chris Summerville, BA, MDiv, M.Miss, D.Min, LLD (Honorary) Chris Summerville is from a family with mental health challenges (father and brother with bi-polar disorder, a brother with schizophrenia, siblings living with depression, and two suicides). He has also received mental health care himself, which has informed and inspired his work as CEO of the Schizophrenia Society of Canada since 2007. Chris has been involved with the schizophrenia-recovery movement for nearly 30 years, having served on the boards of the Mental Health Commission of Canada, Mood Disorders Society of Canada, National Network for Mental Health, and Psychosocial Rehabilitation Canada. Chris earned a doctorate from Dallas Theological Seminary, is a certified psychosocial rehabilitation recovery practitioner (CPRRP), and received an honorary Doctor of Laws from Brandon University in 2014. He is a regional, provincial, and national leader and advocate for a transformed, person-centered, recovery-oriented mental healthcare system, and believes mental health concerns should be addressed using integrated bio-psycho-social-spiritual-vocational approaches.  Email: Chris@schizophrenia.ca Website: www.schizophrenia.ca Facebook: https://www.facebook.com/SchizophreniaSocietyCanada Twitter: https://twitter.com/SchizophreniaCa LinkedIn: https://www.linkedin.com/company/schizophrenia-society-of-canada Phil Tibbo, MD, FRCPC Phil Tibbo was named the first Dr. Paul Janssen Chair in Psychotic Disorders, an endowed research chair, at Dalhousie University in Halifax, Nova Scotia, Canada. He is a professor in the Department of Psychiatry with a cross-appointment in psychology at Dalhousie University, and an adjunct professor in the Department of Psychiatry at the University of Alberta. He is also director of the Nova Scotia Early Psychosis Program (NSEPP) and co-director of the Nova Scotia Psychosis Research Unit (NSPRU). Dr. Tibbo is funded by local and national peer reviewed funding agencies and well published in leading journals. His publications are primarily around schizophrenia, and his current foci of study include individuals at the early phase of, and individuals at risk for, a psychotic illness. Dr. Tibbo's areas of research include application of in vivo brain neuroimaging techniques, to study psychosis as well as research interests in co-morbidities in schizophrenia, psychosis genetics, addictions and psychosis, stigma and burden, pathways to care, education, and non-pharmacological treatment options. Dr. Tibbo is president of the Canadian Consortium for Early Intervention in Psychosis (CCEIP), helping to advance early intervention care at the national level. He is a recipient (2015) of the Michael Smith Award from the Schizophrenia Society of Canada for research and leadership in schizophrenia, recipient of the Canadian Alliance on Mental Illness and Mental Health's Champion of Mental Health Research/Clinician award in 2017 and, most recently, recipient of the 2018 Regional Prix d'excellence – Specialist of the Year – Region 5 by the Royal College of Physicians and Surgeons of Canada. Email: phil.tibbo@nshealth.ca LinkedIn: https://www.linkedin.com/in/phil-tibbo-62170b18/ HOST Jo de Vries is a community education and engagement specialist with 30 years of experience helping local governments in British Columbia connect with their citizens about important sustainability issues. In 2006, she established the Fresh Outlook Foundation (FOF) to “inspire community conversations for sustainable change.” FOF's highly acclaimed events include Building SustainABLE Communities conferences, Reel Change SustainAbility Film Fest, Eco-Blast Kids' Camps, CommUnity Innovation Lab, Breakfast of Champions, and Women 4 SustainAbility. FOF's newest ventures are the HEADS UP! Community Mental Health Summit and HEADS UP! Community Mental Health Podcast. Website: Fresh Outlook Foundation Phone: 250-300-8797   PLAY IT FORWARD The move toward optimal mental health becomes possible as more people learn about the challenges, successes, and opportunities. To that end, please share this podcast with anyone who has an interest or stake in the future of mental health and wellness. FOLLOW US For more information about the Fresh Outlook Foundation (FOF) and our programs and events, visit our website, sign up for our newsletter, and like us on Facebook and Twitter.   HELP US As a charity, FOF relies on support from grants, sponsors, and donors to continue its valuable work. If you benefited from the podcast, please help fund future episodes by making a one-time or monthly donation. Katrina Tinman, Chris Summerville, Phil Tibbo Interview Transcript You can download a pdf of the transcript here. The entire transcript is also found below: RICK  0:10 Welcome to the HEADS UP Community Mental Health podcast. Join our host Jo de Vries with the Fresh Outlook Foundation, as she combines science with storytelling to explore a variety of mental health issues with people from all walks of life. Stay tuned. JO  0:32 Hey, Jo here. Thanks for joining me again with my three incredible guests as we continue our conversation about schizophrenia, this time focusing on integrated recovery support, emerging science, and advancing technology. We'll also touch on the stigma faced by people with the illness, and gaps in the current mental health care system. But before we dig back in, a big shout out to our amazing sponsors, the Social Planning and Research Council of BC, Emil Anderson Construction, WorkSafe BC, and AECOM Engineering Canada. We celebrate them as their continued support is fueling our passion for improving mental health literacy. Again, my three guests are Katrina Tinman, a peer support worker with Peer Connections Manitoba, Chris Summerville, Executive Director of the Schizophrenia Society of Canada, and Dr. Phil Tibbo, a Canadian psychiatrist who studies, treats, and advocates for people with psychosis and schizophrenia. In Part 1 of this podcast, we heard personal stories and learned about signs of the illness, myths, and recovery movements. Dr. Phil Tibbo also talked about past diagnostic practices. To start this episode, we'll connect with Phil again about diagnostic practices today, and what research is telling us about them. PHIL  2:06 It's a big area of research. And I think I mentioned earlier, we're still not at a point where we can do a blood test similar to other medical illnesses, and from that result in a diagnosis. So there's still a lot of work going on here, and especially at early phases of illness as well. And so a lot of the research is looking at multimodal or multifaceted approaches to diagnosis, that can include not only from interview and behavioral, looking at symptoms, but as well as what we call the biological markers, biological indices, which can be some of the neuroimaging research. Some very exciting work going on even EEG type of research within brainwaves, but as well as in genetics too. The one difficulty with schizophrenia, and again, different from some other medical illnesses where it's a single gene, and something wrong with that gene causes a medical illness. We know that's not the case for psychosis and schizophrenia. And often what it's called is an illness with multiple genes of small effect. Research is active in here, but really that focus is to really help us to identify early. But it'll probably be, like I say, multifaceted or a multimodal sort of approach to diagnosis. I wish I can kind of drop in in 20 30 years time and see what the approach is going to be. I think we're going to see a difference from how we're approaching things now to what it will be in the future, which is of course, the way that it should be. I mean, we're doing things differently than what we were doing 20 30 years ago as well. JO  3:38 Let's now hone in on current treatment strategies that focus on integrating biological, psychological, social, and vocational support, as well as psychosocial rehabilitation. And we're gonna break that down, so don't worry about all those big terms. Starting with biological support, Phil from what I understand, biological or brain-related effects are still best treated with anti-psychotic medications, which ideally, are only one part of an overall treatment plan. Is that what you're seeing? PHIL  4:17 Yes, you still have to consider that schizophrenia is a brain illness which needs to be treated, and medication can be a cornerstone of that treatment. But as a result of the illness, there are other things that may be needed when we were looking at other non-biological therapies. Definitely have psychotic medications are a cornerstone. Now that said, the amount of medication or the length that somebody is on a medication really depends on the individual and really what their needs are as well. Because I have individuals that I see that may need medications for actually a fairly short period of time, and they've been doing well with no medications at this point. It really is kind of individual, but yet yes from biological standpoint, the anti-psychotic medications are a cornerstone treatment. JO  5:04 Kat and Chris, in your personal experience and as shared by your peers, what are the pros and cons of anti-psychotic medication? And are people's responses changing over time as the medications change? KATRINA  5:21 It gets to symptoms versus side effects. As I went through the process of finding what medication would work, it was a journey that lasted about 10 years. And I'd ran the gamut of, well, three I can remember Lexapro, Risperdal, and Zyprexa. But nothing really fit. Remember the description of the spectrum, and trying to find where things fit. And for me, it wasn't until 2013 when I ended up fortunate enough to have a doctor to work with me at length, to find the right medication that would actually be the best fit for me, in communication with me. And it turned out it was one of those that hadn't even been invented until right around that timeframe. Abilify turned out to be the right one for me. CHRIS  6:15 Well, certainly, antipsychotics and antidepressants can address the symptoms of psychosis and mood disorders and minimize them. But as one of our former chiefs of psychiatry here in Manitoba said, "If only the medications did everything that we hoped that they would do." Unfortunately, as Katrina stated, there can be significant side effects. And there are many side effects that we don't have time to go into. But the two that I would mention most pronounced are cardiovascular illnesses and metabolic illnesses. And that's one reason why many people don't want to take the medications or discontinue after a while, because of that fear. JO  6:57 Phil, what advances are being made to make these medications more accessible and effective with fewer side effects? PHIL  7:05 There's a lot of research and development going into newer medications. And I think we always have to be careful in our discussion around this. Because while there may be cardiovascular, may be metabolic side effects, it's not a given. Significant number of individuals that I see that do not have any side effects with their medications. That's with our open and honest discussions. But we have to be mindful of when that can occur, and just be able to catch it early. I know we'll talk about stigma, but there is a stigma about medication that has resulted and it's probably from the older medication. The research and development these days, the focus is on developing an effective medication with little to no side effects. With a better understanding of the illness, with better understanding of brain receptors, there's more targeted, more focused research on the development of these types of medications. I have to agree that there was a period of time where there's a lot of sort of what I call 'me to' medications being developed, very similar to ones that are already out there. But what we're seeing now is just that more focused, more targeted development. JO  8:14 Phil, what about options for people who might forget to take their medications, or choose not to take them for whatever reason? PHIL  8:21 We've had, I'll use the term LAI's, long-acting injectable medication. We've had them for a while. But for similar reasons Katrina and Chris mentioned, you know, they've kind of fell out of favor because of their side effect profile. But recent developments have allowed us to have newer medications in that particular format with much fewer side effects. People can just be on a once-a-month injection medication, or once every three months. And there's product and development for other medications for once every two months. I have this conversation with individuals that I see. It allows them to focus on their recovery, because they don't have to remember to take their medication. And I think that's an important piece. What some of young adults tell me is that they have to take a pill every day that just reminds them that they have an illness. But if they just need to come into the clinic once a month, or every three months for an injection, that helps them focus on their recovery as well. JO  9:18 And Phil, while doing research for this episode, I came across information about using cannabis to treat psychosis. Is that legitimate? PHIL  9:27 No. First of all, a couple of points around that. When we talk about cannabis, keep in mind if we're talking about just overall cannabis plant, there's over 100 active compounds within that. The two most common compounds people hear about, of course, are THC and CBD. And we know that THC is actually more of the risk factor with respect to psychosis development, and poor outcomes after the development of psychosis. There have been some studies trying to look at CBD, cannabidiol, and its potential role within a psychosis, but honestly, there's not a lot. And we just recently published a position statement for the Canadian Psychiatric Association as well as a systematic review and meta-analysis, examining this literature and looking at randomized, controlled trials of different cannabis or cannabinoid products. There's actually only six studies in schizophrenia where they've looked at cannabinoid products, really not much effect. I'm not being negative about it. But just highlighting that we do need a lot more research into this area. And we have to be very clear on what sort of cannabinoid product that we're talking about. JO  10:39 Let's talk about another piece of the recovery puzzle, which is psychological support. Psychological or mental and emotional effects associated with schizophrenia can include depression, anxiety, substance-use, suicidal ideation, and others. These often respond well to treatments such as cognitive behavior therapy, and other emerging approaches such as reality therapy and cognitive remediation. Phil, how do these work? And how can they be integrated with biological solutions? PHIL  11:16 Well first of all, our approach is integrated. We look at, say, medication plus as well as the psychotherapy and psychosocial treatments as well. Having more tools in our toolkit to be able to address the illness. We will have some people who will definitely benefit from cognitive behavioral therapy for psychosis. And that really allows an individual to learn how to adapt, and respond, and develop strategies to work with their symptoms, for example, so that an individual is not as stressed by their symptoms or able to manage them so that they can do what they want to do, basically, in their day-to-day lives. There's a number of different strategies and therapies along these lines. Some are more similar to each other than not. We have a sort of service and commitment therapy as well, ACT, plus as you mentioned, CBT. But they're really there to help augment that individual's experience with their symptoms, or for example, with comorbid symptoms as well, such as depression and anxiety. JO  12:17 So Chris and Kat, are your peers ever hesitant to add these therapies to their recovery plans? KATRINA  12:25 I know I wasn't. In talking with peers, we usually do touch on some of these possibilities. And there's usually enthusiasm at the idea. Oh yeah, I heard of that, or along those lines where they are willing to engage. CHRIS  12:43 I don't think there would be a hesitancy in general, if people were aware of what their various therapies are. There are many what I call, talk therapies that we can utilize today. Some have been mentioned, cognitive remediation, cognitive behavioral therapy, dialectical behavioral therapy, and acceptance commitment therapy, and family therapy. People in general, I think, have a fear of going into therapy because someone's going to try to fix me, and I have to expose them to, and I have to reveal all of my problematic thinking or what have you. So, I think the goal of these therapies have to be clearer for the patient or the client, and that is helping one to manage difficulty in the area of cognition and their thinking, helping them in their executive skills, helping them to improve their communication skills and relationships. So, the therapy has to be explained to people that it will be more than a supplement to the medication, where the medication is not able to address certain issues. Talk therapies have been demonstrated to promote the recovery process. JO  13:47 What are the biggest barriers to people not receiving the psychological support they need? CHRIS  13:53 Well number one, here in Canada, psychological support services are not covered by our health care system unless you're a patient in the hospital. But once you're out in the community, you have to shell it out of your own pocket, and most people can't afford psychological support therapies. And also, the lack of awareness about the role that trauma can play in psychosis and recovery. A lot of people don't know about that. And many service providers may not actually be trained in trauma informed care, due to the lack of trauma informed services. So all those things that I've just mentioned, can be great barriers to people receiving the appropriate psychological supports that they need. PHIL  14:32 I'll have to step in and agree with that. Access and availability is a big thing. The other thing to consider as a barrier. Families talk to me about this kind of at the beginning, when is psychotherapy going to start? And sometimes the barrier, of course, is the illness itself and that person to be able to engage and work within some of these therapies, they have to get to a certain cognitive level to be able to do that. And that's where sometimes we have to wait a little bit of time until we get some better control on some of those symptoms, so that people are then able to engage in some of the psychosocial and talk therapies that would be helpful. JO  15:08 What about creative therapies that use art, music, drama, and writing? KATRINA  15:14 Those, speaking from a person of lived experience and pure perspective, can be very, very useful for meditations and journaling, because really it helps somebody walk through and process thoughts, feelings, and experiences. And I personally think that can be very valuable, as it's really helped me in many ways. PHIL  15:40 I'd have to agree. We've been researching areas of this as well, and we published on this too in a number of different formats and looking at mindfulness-based support groups for families looking at self compassion, and mindfulness, in relation to depression and anxiety. And interestingly too, we've even published on claymation art therapy in our youth and young adult population and the benefits of that. One person may do well with claymation art therapy, and another person not interested at all. So, it helps to be able to investigate and to know that these types of therapies and creative therapies can be helpful. JO  16:14 In your stories and insights, I'm hearing that social support is also vital for people recovering from schizophrenia, this being available through peer support, self-help programs, and family education and support. Chris, what are the biggest barriers to people receiving the social support they need? CHRIS  16:35 Society in general and the media as well, they tend to think that it's just all about medication. You wouldn't believe how many times I've been asked this question through the over 1500 media interviews that I've done, in which I will be asked, "well, how do we make sure these people stay on their medication?" As if medication was the cure all? Again, education is needed that, quote, the treatment of mental illness, and particularly schizophrenia that we're talking about today, is very holistic, so a holistic approach. And that means, what do we do to help people when they're in the community, back at home, back in the community? What kinds of social supports do they need? Whether it's peer support, support groups, whether it's accommodations in pursuing education, accommodation and getting a job, adequate housing, decent income, all those factors. As a society, I think we get it with most other illnesses. These kinds of questions didn't come up when my wife was experiencing breast cancer. There was pure support, there was family engagement, there was family education. There was not just attempts but helping her to connect with various community agencies. One of the things that perhaps gets in the way, which we'll talk about later, is that this profound stigma and prejudice towards people who have a mental illness that live in our community, that affects our policies, that affects our funding. It's a great misconception out there that to address mental illnesses is just a matter of the medical. But as we've listened to Dr. Tibbo and Katrina, they've articulated well that psychological, social, the communal aspects involved in recovery are equally important. JO  18:35 Kat, can you share a story of how important social support is? KATRINA  18:40 The way I'll share it is actually to state that sometimes we hear feedback as peer support workers from our peers, as we're going through the process and discussing with them where they're at and where they're going, and what they're working on, and what they're trying to accomplish. And one of my peers sent back the message, for instance, that I made them feel comfortable, and that I connected with her, that I was nurturing, and calming, and helped that peer make their own decisions that were right for them. And that's, I think, an important piece, that connection to the recovery process and that non-aloneness. And I think that is something that peer support is demonstrating. What we're doing right now at the Mental Health Crisis Response Center is a pilot program. The feedback that we're getting is huge, phenomenal to positive that, yes, this is worth it. JO  19:41 I know you're researching the effectiveness of non-pharmaceutical treatment options like therapy and peer support. What have you learned so far? PHIL  19:52 Well, I think the high-level approach to this question is really important. And that we need to continue with our research in looking at non-pharmaceutical options, and the different types of therapy and peer support. Specifically finding out what we can use, what has the best effect, will be important for the population that we work with as well. We have researched peer support and we have found, yes definitely, it is needed and people, as Katrina mentioned, do benefit from it in many varieties of ways. JO  20:21 Chris as a recovery practitioner, you're very familiar with psychosocial rehabilitation, which I've learned among other things, includes case management, advocacy, structured living residences, and rehab centers, for example. Tell us more about that. And what are the biggest barriers to people receiving the rehabilitation they do need? CHRIS  20:46 We have here in Canada, what's called Psychosocial Rehabilitation Canada, an organization that promotes psychosocial rehabilitation of all mental health service providers. So it's not just limited, let's say, to social workers or mental health workers. So let me just define it. First of all, psychosocial rehabilitation, also sometimes called psychiatric rehabilitation, it promotes personal recovery, successful community integration, the satisfactory quality of life for persons who have a mental health problem or mental illness. Psychosocial rehabilitation services and supports, they're what we call collaborative, person directed, individualized, and we believe they're essential element of human service prospective. And so the goal of psychiatric rehabilitation, or psychosocial rehabilitation is focused on helping individuals develop skills, and access the resources needed to increase their capacity to be successful and satisfied, in what we would call living, working, learning, and social environments of their choice. And so you need a wide continuum of services and supports. The approaches, they are evidence based. And they are promising practices in key life domains of, let's say, employment, education, leisure, wellness, and basic living skills. And family involvement, family peer support, individual peer support are very important aspects of psychosocial rehabilitation. JO  22:18 Chris, what needs to be in place for this to happen? CHRIS  22:22 Truly integrated comprehensive mental health services in which the various sectors are endorsing and creating relationships with each other. So whether that's psychiatrists, social worker, a mental health worker, spiritual health care director. The team of support around the patient, they're not in competition with each other. They are to be working as a team when they have their meetings, and hopefully, with the patient there, listening to the patient. Again, that's that question. What do you feel would help you? What do you feel you need at this point? And as well as offering, what I want to say as wisdom through listening, offering a wisdom back to the patient in helping them to find the various supports and services in and outside of the hospital, that can promote the recovery experience. JO  23:15 Let's expand upon that and look at vocational rehabilitation, and or training that prepares people with schizophrenia for work that best meets their individual wants and needs. Chris, can you tell us more about that? CHRIS  23:31 So let me just tell you a story to illustrate this point about vocational training. This individual's true-life story who had schizophrenia and he had gone through four mental health workers. Well, what happened with the fourth mental health worker? Began to listen to the individual because he was always very persistent with his mental health workers, that he wanted to be an astronaut. They would just dismiss that, "There's no way you can do that, because you have schizophrenia." Well, the fourth mental health worker began to listen to him and ask him, let's just assume that his name is Joe, and said, "Joe, why would you like to be an astronaut?" And he had seen the first moon landing and other things, and he was very enchanted that he wanted to be an astronaut. So, she asked him then in the course of not just in one conversation, but as they developed their relationship. "Well Joe, what do you think would help you to be able to reach that goal?" And they talked about that, and perhaps hygiene could be a problem. Of course, they began to focus on education. "And so what school do you think there might be, and where would you like to go to school to learn more about this?" And so she encouraged him. "Well, why don't you try for one course?" And he took the course and guess what happened? He failed. But that's not the end of the story. She continued to encourage him about other options, and again, a true-life story. He eventually found work and began to work in a space aeronautics museum, welcoming guests and introducing them to the museum. So did he fulfill his goal and his dream? Yes, but it had to be adjusted. But she didn't give up hope on him in terms of his vocational desire. JO  25:06 What a great story. In my research, I continually came upon the term personalized medicine. Phil, what is personalized medicine? And how could it revolutionize diagnosis and treatment strategies for schizophrenia? PHIL  25:24 Personalized medicine, and sometimes people refer to it as precision medicine as well. So sometimes you hear those terms interchangeably. And really what it is, is the tailoring of the medical treatment to the individual, to the individual characteristics of each patient. It does rely on research, it does rely on an understanding of a person's own unique, molecular, and genetic profile as well, and how that can influence treatment. If you think about a personalized medicine, it is really what's going to be appropriate, what's going to work for you specifically based on who you are, both biologically and otherwise. And really, this sort of came out of the advent of trying to figure out from a genetic perspective, how can we use an individual's unique genetic makeup to guide treatment decision? We're not quite there yet, in that respect, but it allowed us to be able to step back, though, and still think about, okay, what is appropriate for this person that's sitting in front of me. And I think that's a little bit more of a holistic approach to our treatment, and that is truly personalized. Now, if we get to that stage where we can do a cheek swab, get a genetic makeup, and then say, okay, this particular treatment, either medication or otherwise, this is specific to you and will work the best. Obviously, that's a great outcome. Are we there yet? No. But research is going in that direction. JO  26:46 One topic I didn't come across in my research is the role of lifestyle choices in recovery. Healthy habits, like getting enough sleep, eating well, and exercising regularly. Kat, how important have lifestyle choices been in your recovery? And do you teach life skills as part of your work with peers? KATRINA  27:09 Lifestyle choices are very important in my recovery. It's something I pay very close attention to. As far as teaching life skills, we do workshops that do some form of teaching, but teaching as an agenda. It's more of an exploration type discussion. JO  27:30 Phil, what do you see in your research and hear from your patients about the importance of lifestyle choices? PHIL  27:36 Research obviously has shown that it's very important, these lifestyle choices. What are lifestyle choices? These could be anything from smoking, cannabis use, to sedentary lifestyle, activity, diet, a number of different choices. We know that individually each of those, and accumulatively each of those can have an effect on outcomes. And the research is pretty solid with respect to that. And so a lot of our focus, so once we get to some of the early sort of phases is, okay really, how can we improve lifestyle, what kind of healthy choices we can help people with lived experience make. We do things, we have a project where we got some funding currently from our Mental Health Foundation, where we're trying to target our rural population. So we got Fitbits. So that allows us to measure and monitor some things along the lines of sleep and steps and exercise. But to be able to send that to their clinicians and to be able to have those discussions, that's sort of great talking points about lifestyle. CHRIS  28:36 Let me combine that question about lifestyle choices and the previous one about personal medicine. Personal medicine, in terms of consumer movement or people who live with mental illnesses, it was really first introduced in early 2003 as a result of qualitative research conducted by Dr. Patricia Deegan. Now, Patricia Deegan is a psychologist, PhD, has lived experience of schizophrenia and experience of recovery. And so personal medicine along with what Dr. Tibbo said, is also about what we do that's medicinal for us in managing, let's say, my depression. What are those lifestyle choices that I know helped me in terms of managing all the stress associated with living with a mental illness? And stress can lead to relapse, we know. So it's not necessarily something prescribed by a doctor or nurse. It comes from within, and it's finding that right balance of what to do and what we take in our pathway to recovery. So that can be mindfulness, can be spirituality, it can be running and exercise. Those things that you know help you to manage your illness in terms of stress management, increasing your resiliency, and your mental health as well, because people with a mental illness can have positive mental health. We know that. And so that word as Patricia Deegan has written about it, personalized medicine has to do with those things that we know that are uniquely medicinal for us, and helping us move forward in our recovery. JO  30:16 Thanks Chris, great comments. Phil, is there any science to support the role of practices such as meditation in recovery? PHIL  30:26 Yes, there is research on this. It's not necessarily for everyone. But for people who can do mindfulness-based practices and meditation, it definitely has been shown to be quite helpful in a number of different ways. I don't say for individuals with lived experience, but we published actually on mindfulness-based techniques for family members, and definitely see the benefits within that group as well. JO  30:50 Advancing technology is another thing I'm hearing a lot about for diagnostic and treatment purposes. Phil, from your perspective and in your practice, can you bring us up to speed on that? PHIL  31:02 Our advances of technology, we're trying to utilize those as best as we can, as quickly as we can as well. And also moving from research to clinical applications, of course, is really quite important. Kind of alluded to this a little bit earlier. We have had advances in the various brain imaging techniques to help us with diagnosis. And there's a lot of different types of brain imaging techniques that are focused either on brain structure, but as well as brain function, and of course, the different parts of the brain, white matter and gray matter. And then other types of diagnostic technologies are there, treatments as well, such as rTMS. There's a lot of this that's happening. And I don't want to minimize that there's a lot of research that have gone into the development and use of smartphone apps as well, and their utility within helping people move forward with their lives and on their treatment to recovery goals. JO  31:56 Chris, what about that technology for social support services? CHRIS  32:01 Well, there are two things that COVID has surfaced for us. Number one has placed mental health definitely on the radar. Ninety-eight percent of Canadians are more concerned about the impact of mental health. Secondly, the use of virtual technology, and that will not go away after the pandemic. In fact, about a year and a half ago, I had my first FaceTime experience with my GP. I never thought that would happen. So use of Zoom and other technology to offer peer support individually, to offer support groups. Many of the schizophrenia societies across Canada are doing education with family members through virtual technology. So that's not going to go away after the pandemic. It is all in a state of development. I think Dr. Tibbo, when he and I've had discussions on this, we have to look at safety, confidentiality issues, privacy, and having good standards. And then, are the various apps that have been developed and ought to be developed, are they evidence based and effective? So I'm excited about where virtual technology can lead us, especially for people who live outside of urban areas. But the great challenge is that many people with mental illnesses, especially if they're on income security, they don't have access to internet, they can't afford a laptop or an iPhone. JO  33:24 Kat, how willing are your peers to take advantage of advancing technologies? KATRINA  33:30 It's hard to conjecture, because every peer is different. As Chris pointed out, even the ability of some might be limited. But from what I'm hearing as we compare notes, peers and I, now hey I have that app, this app that works really good for me. It comes up. So I think, for the most part, it's very favorable in that direction. JO  33:53 Chris mentioned COVID-19, and just a very quick question. Phil, how has COVID affected your patients with schizophrenia? PHIL  34:03 Keep in mind that for my particular patients that I see, it's mainly youth and young adults, and actually the resilience there is really quite high. And the adaptation to virtual technologies, such as Zoom and having meetings along those lines, they're actually fairly quick to adapt to. However, what is also interesting is that a lot of the youth and young adults that I see actually didn't want to have their meetings via Zoom. They'd rather be in person. So we've tried our best to work with that. We obviously want to make sure that nobody is going to have relapse or have any ill effects because of COVID. I think we did a pretty good job of pivoting and shifting service delivery and care to accommodate that. COVID-19 overall in the general population, there's a lot of research that has gone into that and we have seen an increase in, for example, substance use in this population. We've also studied acute care admissions to the inpatient units, and I've seen a shift during the height of COVID in states of emergency declarations, where the substances have played a role, a more significant role in admissions than they did before, as well as in a little bit older age group than what we would normally see in a non-COVID year. JO  35:15 Chris, what are you seeing with your peers and their families as a result of COVID? CHRIS  35:22 Each of my workdays, two to three hours now, have been devoted to taking phone calls and answering emails since the pandemic began, by individuals and family members who are looking for additional help. There is evidence that people with schizophrenia are more likely to develop the illness resulting from COVID-19, as opposed to the general population. I think fundamentally, what some recent reports have indicated is that it's become somewhat harder for people with pre-existing mental illnesses to consistently get not only psychiatric care, but also primary health care. JO  36:02 Kat has the pandemic been difficult for you? KATRINA  36:07 It's been challenging in ways for myself and for my peers. For instance, some describe that it slammed them when they were in healthy spaces. It actually slammed them right back into illness because it looked the same. Now, we were isolating, so they were isolated, again, or still. And that just took them back into it. Just as one example alone. For me, I have to admit riding buses to commute to and from work is a challenge because of what I see. And it causes me a little stress. The people that pull their masks down on the bus when they're supposed to have it up, and stuff like that. But for the most part, I think it's, we're just all hanging in there. JO  36:57 Before moving on to talk about stigma, I'd like to thank our major sponsors again, the Social Planning and Research Council of BC, Emil Anderson Construction, WorkSafeBC, and AECOM Engineering Canada. As a registered charity, we rely on support from sponsorships, grants, and donations. If you'd like to support our HEADS UP programming, please visit freshoutlookfoundation.org/donations. As I say on every podcast, you can't have a conversation about mental health, without talking about stigma. Phil, how does stigma affect people you've researched and treated biologically and psychologically? PHIL  37:40 Stigma can be a huge part of the illness. There are a number of elements to stigma as well. And I'm sure Chris and Katrina will elaborate on these as well, and some we've already alluded to as well within our discussion. Because stigma can affect people's entry into care. And that because of the stigma around the illness, or stigma actually even towards mental health, either themselves or even within their family members as well, can actually affect their pathways to care. And we've done some research on that and have been able to show that. And then when somebody is in care too, and we do have to work with what we sometimes call self stigma, people's perceptions and ideas of what a diagnosis of schizophrenia means and what it can mean. And so there's those elements as well. And of course, we're trying to be the best advocates that we can for patients and our families. And that's where we try to work with the stigma in other areas around society towards the illness, towards mental health, of course, in general. Being those advocates and supports towards vocational or educational pursuits as well. We've definitely gotten a lot better with respect to that over the last number of years, but there still exists some of that stigma out there. JO  38:54 Kat, how would you describe stigma from the perspective of a person with schizophrenia? KATRINA  38:59 I would describe it as a belittlement. And a discreditation is a way of writing somebody off to make them not count. It's even, now how many times do you see it on TV used in a court of law, theoretically, to discredit somebody so much that that witness doesn't even count. It's a write off, and that's not fair. JO  39:21 Chris, what about the impacts of social and vocational stigma on the people you're advocating for? CHRIS  39:28 Well, first of all, we need to understand that all stigmas are built on the same formula. And that is misconceptions and myths, plus lack of education multiplied by fear, results in prejudice, and none of us are immune from prejudice. We all as a human experience. And what we need to do is to be able to look at our attitudes, confront them, and be willing to grow up, to change. Because there is societal stigma, and then when an individual with a mental illness internalizes society's stigma, we call that self stigma. So they think, well, I must have a broken brain and I'm not deserving. And then there's structural stigma in terms of laws, and policies, and practices that result in unfair treatment of people with a mental illness. Now, what does it all result in? It's not just about hurt feelings. Stigma results in a reluctance to seek out treatment. It delays treatment, it increases morbidity and mortality, it results in social rejection, avoidance, and isolation. It results in worse psychological well-being for individuals living with a mental illness. There's poor understanding amongst friends and families. Stigma can lead to harassment, violence, and bullying, poor quality of life, increased socio-economic burden. That's above and beyond the shame and the self doubt that the individual may face. That is perhaps our greatest enemy in promoting comprehensive mental health services and recovery oriented mental health services. That's why we have to advocate as Martin Luther King did, as other leaders and various other movements did, to claim our voice and to identify injustices where they are, and what impedes our being able to see people with mental illnesses as our brothers and sisters, our neighbor, and the fact that we should love one another as we love ourselves. JO  41:33 Kat, you and Chris have both experienced the mental health care system. Just wondering what you've seen, as far as stigma goes within that system. CHRIS  41:43 Well, the Mental Health Commission did a study a number of years ago amongst mental health service providers, and it found that stigma is alive and well within our mental health system, and those who provide psychiatric supports and services. So that might be surprising to people. None of us are immune to stigma, it has to be addressed. And whether you're a doctor, a psychiatrist, a police officer, a correctional guard in one of our prisons, people have to receive supportive education, which helps them to identify their attitudes, which leads to actions of discrimination, or improper behavior, or working with clients, patients, prisoners, etc. So this is a huge issue. JO  42:36 So we're on the homestretch. Now, given what you've learned over the years, what would you say to give hope to people who are early in their recovery journeys? CHRIS  42:48 What I would say is, I want you to meet Katrina. Katrina has lived experience of psychosis. But she also has found ways to move forward and live beyond the limitations of mental illness. She's a peer support worker. And so Katrina, through her lived experience, she will listen. And she will give you realistic hope. Because the hope for recovery is possible. I know this is a difficult time for you right now. And the next couple of years, it may seem like you're not coming out of this deep, dark hole. So what I'm saying here is that I think introducing patients to a peer support worker as soon as possible, can help with the depression and the forlornness that a person may be experiencing by receiving a diagnosis of psychosis or schizophrenia. We need to be realistic, but also, we need to communicate hope that things can get better. And the person who can communicate that the best is a peer support worker who's been down that road and knows what helps and hinders recovery. JO  43:53 Kat, what have you learned about hope? KATRINA  43:56 I've learned that it is the most wondrous and beautiful thing in existence to have hope, and that life without hope, isn't life at all. JO  44:06 Chris, what would you say to family members who are confused, fearful, and frustrated? CHRIS  44:13 I would say that it's normal. It's very normal to be confused, and frustrated, and fearful, and to feel shame. It's normal. And that is not your fault. But that help is available. We know more than we've ever known before about schizophrenia, psychosis, treatment modalities, what helps in the recovery process. And so I would encourage the family who's new at all of this, that there are individuals known as family navigators, or family peer support workers, and that there's family education. There are support groups because the family is in recovery too. The individual with schizophrenia or psychosis, they're not the only one in recovery. But the family is also on a recovery journey, in terms of dealing with their stigma. Dealing with their fears and their frustration, learning communication skills with their loved one who has a mental illness, and that there's hope for the entire family. And things can get better, but not minimizing the barriers and the frustrations that are there. JO  45:17 Phil, what would you say to medical and mental health professionals to help them better understand schizophrenia, and to respond more compassionately? PHIL  45:26 A lot of it is that storytelling, and a lot of what we're doing here tonight too, as well, and just appreciate that a diagnosis of schizophrenia is not necessarily a negative diagnosis, and that people can have great outcomes. And its outcomes based on the individual and what they perceive that their own personal sense of well-being and psychological well-being. And so appreciating and having them appreciate the various outcomes that can exist within schizophrenia and psychosis. So it really comes down to still a lot of that education, that's important. It's not necessarily education, for example, from me from the medical community. It's also education for family members. It's education from people with lived experience, as well. And these are very important stories for the medical community to hear. JO  46:08 How would you pitch the need for wholesale change in mental health care to the people making those policy and funding decisions, Chris? CHRIS  46:18 Well, in terms of policymakers and politicians, I think that we not only point out to them, and most the time they know this already, that our current mental health system is not adequate. And it fails many people. And that most people struggling with a mental health problem or mental illness, are not getting the kinds of supports and services that we've talked about on this podcast today. But then I would move forward, promoting transformation of the mental health system through the recovery philosophy. Australia, New Zealand, Scotland, England, has moved towards recovery oriented mental health services. In fact, the fastest growing occupation in the mental health system in England is that of peer support workers, embedding peer support workers in the mental health system, which can help transform the mental health system. We have to educate those who make policy, in politicians. And we have to get to administrators and hospitals and other domains, and not just write recovery into policies, but develop toolkits to help practitioners to move towards a recovery environment. We have to be patient, but we have to be persistent. And we have to be consistent in our advocacy. And we have to speak with one voice. The best advocacy is collaborative advocacy. Unfortunately, there is still much debate within the mental health community about the medical model versus the recovery philosophy. But we have to persist, we have to be determined we can overcome. PHIL  47:57 So it's a great question. And I guess I kind of go back to some of a little bit what I mentioned earlier, it shouldn't be me doing this pitch for wholesale change. And sometimes I really think it needs to come from those individuals who are living it, both the individuals with lived experience, and their family members. And oftentimes, our major changes in either service delivery, or funding, or policy have come because of the advocacy of family and individuals with lived experience as well. We can be there in the medical community to help support, and give that research, and give the data, and look at cost analysis. But the pitch needs to be unified with all the important stakeholders. JO  48:38 And what would you say to those of us who may not know enough about schizophrenia, but who are willing to explore our ignorance and our conscious and or unconscious biases? CHRIS  48:50 Well, it's all about contact-based education. So what I would say to a person is get to know someone, get to know that relative who has schizophrenia, and get to know that neighbour who is experiencing psychosis the same way I had to do when I was a racist in the deep south. In the first part of my life, as a child, as a teenager and young adult, I had to confront my racism. And the way I did that was by moving out of my supposed circle of safety. And that was getting to know people different from me, people of colour. Eating with them, praying with them, interacting, listening to their hopes and dreams. And then you see a person. So we have to do the same thing in terms of going beyond our comfort zones, to learning the truth about the reality of people who live with psychosis or any mental illness. JO  49:44 Kat, any comments? KATRINA  49:46 To those who are willing to explore, you'll find a whole new world because you'll rediscover people that were there the whole time. JO  49:56 What I've discovered is a whole new world of potential. So, not only for people with schizophrenia, but for collaborative change. CHRIS  50:06 Exactly. You mentioned a wonderful word, their potential. In fact, that is the mission of the Schizophrenia Society of Canada. Build a Canada, where people living with psychosis and schizophrenia achieve their potential. And that's what recovery is all about. JO  50:26 So in closing, I have just one more question for each of you. Given what you've learned, personally and professionally, and what we're collectively learning through research and advancing technology, how do you envision the world of schizophrenia changing over the next 20 or 30 years? Kat, let's start with you. KATRINA  50:48 That there won't be the fear of the illness to stop people from finding out if they need help, how to do it. That there won't be this belittlement that can lead to the self stigma, which feels horrible. That there will be treatments that encompass the wholeness of who you are, working together in greater capacity than where we're at now. We have made some progress, but we're not there yet. JO  51:23 Chris, your vision? CHRIS  51:24 We will live in a society in which no one is left behind. Not because they have schizophrenia or psychosis. That stigma will basically be a thing of the past, and it will not be our big albatross. That in fact, that treatments will go beyond anti-psychotics and won't even have to use antipsychotics. And that the recovery philosophy will be fully ingrained within our mental health system. That's what I hope for. PHIL  51:56 I think we'll have a better understanding of the illness and understanding, for example, from the biological underpinnings of the illness. That will in itself help us to understand the best treatments for schizophrenia. So I think we'll see some advancement there within the biological treatments, but as well as the psychosocial or psychotherapy type of treatments, as well. And I think really what we're seeing as well, is just that better understanding and appreciation. I think in 20 or 30 years, we'll see some of the stigma being reduced as well. I think what will continue to happen is that understanding of illness, and it's really getting back to that early intervention piece. And people understanding that if things aren't really quite right, they should get it checked out. And I do make that analogy when I do some public speaking about skin cancer, and that we've had enough education at this point to realize, okay, if we have a funny looking mole, we should get it checked out. May not be anything, but it may be something that needs a little bit more attention. Hopefully, we will be in 20 or 30 years with mental health and wellness as well, is that enough education there to say, okay, if things aren't really quite right, then we should get it checked out. Again, maybe nothing, but it may be something that needs attention. The earlier that attention is there and the treatment than the better the outcomes. JO  53:10 Thanks so much to all of you for your profound insights, ideas, and passions for making the world a much better place for people with schizophrenia, their families and friends, their employers, and society at large. Phil, I so admire and applaud your attention to the ever-changing details of diagnosis, and both pharmaceutical and non-pharmaceutical treatment options. Your boundless curiosity will certainly make schizophrenia less mysterious, and perhaps one day even curable or preventable. PHIL  53:46 Thank you so much for that. And importantly, as these venues, these educational opportunities, these podcasts, are really going to help us to those eventual goals as well. Thank you very much for this opportunity. JO  53:58 Kat and Chris, your willingness to be vulnerable so that others might be helped, is truly inspiring. And I'm sure will help to inform and transform the evolving conversation around social support and advocacy. KATRINA  54:14 It's a pleasure to help. I know, if I would have had peer support years ago, things would have been different. And that's why I'm working so hard to be a peer support worker is to make that difference. JO  54:31 Chris? CHRIS  54:31 I hope that the listeners of this podcast will be inspired and motivated to take a different approach to seeing people who have a mental illness. And here's the statement, ask not what illness a person has, ask what person the illness has. See a person, not an illness. JO  54:53 Thank you both. This is one of the most robust and powerful discussions I've had. The three of you, what you bring to the conversation individually is astounding, but how well you blended your experiences and insights is really truly remarkable. This has been a wonderful, wonderful experience for me. That's a wrap on Part 2 of our podcast on schizophrenia. Be sure to catch Part 1, which focuses on stories, signs, myths, and recovery philosophy. Huge thanks again to our guests for sharing their amazing minds and spirits. To connect with Kat, Chris, or Phil, check out the episode show notes at freshoutlookfoundation.org/podcasts where you'll find contact info, complete bios, and a transcript. I'd appreciate you leaving a review as well. I'm also grateful for all you listeners and hope this information inspires and mobilizes you along the rapidly changing road to recovery. If you haven't already signed up for monthly HEADS UP e-blasts about new episodes, please visit freshoutlookfoundation.org. And for ongoing information, follow us on Facebook at FreshOutlookFoundation and Twitter at FreshOutlook. In closing, be healthy and let's connect again soon. Episode Reviews

This episode deals with the question of weight gain from antipsychotic medication: I'm on 20 milligrams of olanzapine. It's helping me and I don't want to change it. The only thing is that I've gained a lot of weight that makes me feel very unattractive. I've spoken to my psychiatrist about it, but I haven't gotten any guidance on the matter. Are there any solutions to weight gain from this kind of medicine? Modern antipsychotic medications can be very helpful for some people. And they are less likely to cause neurological side effects, compared to their first-generation predecessors. However, many of these newer medicines can cause someone to gain significant amounts of weight. This is a serious problem that the psychiatric profession (in my view) has been very slow to address. In this episode, Dr. Erik Messamore describes several strategies that can reduce the risk of medication-related weight gain or that can reverse weight gain once it has started.   Strategy 1. Choose antipsychotic medications with low weight gain risk Different antipsychotic medications come with different degrees of weight gain risk. Table 1 in this open-access medical journal article lists medications with higher or lower risk of weight gain. The graph in this article also illustrates the differences in weight gain risk among the various antipsychotic medications.   Strategy 2. Switch to an antipsychotic medication with lower weight gain risk People who have gained weight from higher-risk medications – like quetiapine (Seroquel) or olanzapine (Zyprexa), for example – may lose weight after switching to a lower-risk medication. On the other hand, some people (like the person who sent in today's question) might mostly like their current medication, or may not want to take the risks involved in medication switching (e.g., the switched-to medication might not work as well, or might have other side effects). In situations like these, there are several weight loss options worth considering.   Strategy 3. Diet and exercise to reduce weight from antipsychotic medication Many studies show that antipsychotic-induced weight gain does respond to standard diet or exercise interventions. A relatively small reduction of 150 calories per day can lead to about 16 pounds of weight loss over a year. For many people, that can be achieved by sticking to natural, whole foods and avoiding processed foods with a lot of carbohydrates or added sugars. Exercise and physical activity can enhance weight loss. And numerous studies show that exercise can improve mood, reduce anxiety, increase cognitive performance, and reduce symptoms of psychosis. Very low carbohydrate diets like the ketogenic diet are popular these days. These diets are designed to reduce insulin levels, which can make it easier to lose weight (because insulin is a fat-storage signal). Many people who undertake these diets can maintain calorie deficits without feeling hungry. Several case reports and a small clinical study suggest that the low-carb/ketogenic diet might help some people with schizophrenia, psychosis, or bipolar disorder to experience fewer symptoms.   Strategy 4. Metformin to reduce weight from antipsychotic medication Metformin is a widely-used treatment for type-2 diabetes. It improves the body's insulin signals and reduces spikes in blood sugar. Metformin can also help people without diabetes to lose weight. And there are many studies showing the metformin can reduce weight in people who have gained weight from antipsychotic medications.   Strategy 5. GLP-1 Agonists to reduce weight from antipsychotic medication GLP-1 is an abbreviation for glucagon-like peptide 1. The GLP-1 agonist drugs mimic the action of natural GLP-1. They optimize the body's insulin responses and reduce appetite. Some of these medications – liraglutide (Victoza, Saxenda); semaglutide (Ozempic, Rybelsus, Wegovy) – even have FDA approval for treating obesity. Lirgalutide has been studied in weight gain from antipsychotic medication and appears to produce more weight loss than metformin.   Strategy 6. Melatonin might reduce weight gain from antipsychotic medications This episode mentions that some studies show that melatonin might reduce the amount of weight gained from antipsychotic medication, while at the same time helping to further reduce symptoms of psychosis. The studies referred to are: Romo-Nava F et al. (2014) Melatonin attenuates antipsychotic metabolic effects: an eight-week randomized, double-blind, parallel-group, placebo-controlled clinical trial Modabbernia A et al. (2014) Melatonin for prevention of metabolic side-effects of olanzapine in patients with first-episode schizophrenia: randomized double-blind placebo-controlled study. Mostafavi A et al. (2014) Melatonin decreases olanzapine induced metabolic side-effects in adolescents with bipolar disorder: a randomized double-blind placebo-controlled trial.   Summary and suggestions Although the psychiatric profession has been slow to respond to the problem of antipsychotic-related weight gain, there are several options that can reduce the risk of weight gain or that can help someone lose weight. Many psychiatrists are aware of these options and are willing to help. But in cases where the psychiatrist does not know about these options or does not have experience with prescribing medications to assist with weight loss, it's likely that a general practice doctor or an endocrinologist does. The goal of treatment is always to maximize improvement and to avoid side effects whenever possible. And in cases where side effects are unavoidable, the goal should be to minimize them as much as possible. If you're concerned about weight gain, there are options and solutions. Your health care provider should be able to address them, or refer you to someone who can.   Topics 0:44 This episode's question is about weight gain from antipsychotic medication 1:20 – How common is the weight gain problem? 5:49 – Which medications are more likely (or less likely) to cause weight gain? 12:38 – How to these medications lead to weight gain? 15:27 – What are some strategies to prevent or reduce weight gain from antipsychotic medications? 20:56 – How effective is diet and exercise for antipsychotic-related weight gain? 26:28 – Suggestions for someone who is concerned about weight gain from antipsychotic medications.   About the Podcast: Dr. Erik Messamore is a board-certified psychiatric physician and PhD-level pharmacologist. He's a consultant psychiatrist, researcher, lecturer, teacher, and solution-focused scholar currently affiliated with the Northeast Ohio Medical University in Rootstown, Ohio. He is joined on this podcast by Melissa Xenophontos, a journalist, radio producer and longtime mental health advocate. Send us a question   Useful Links Dr. Erik's website and blog Podcast website Ask A Psychiatrist YouTube Channel

Along with several regular colourful CROWSNEST personalities, the show's main host Japhy has been asked to produce a single 90 minute episode each week. Flagship to the wider network, their mission is mostly to provide quality content and interviews; as well as potentially aim at combining online forces with other outstanding talent & projects of interest. WEBSITE: www.wprpn.com/ Powered by Public Streaming Network To listen live remember check out first! publicstreamingnetwork.com www.youtube.com/c/PSNTVMedia twitch.tv/psntvlive dlive.tv/PSNTV twitter.com/PSNBroadcast Share this podcast pages. Also check out Angels Patreon page over at patreon.com/angelespino

Psychiatric rights continues to be a contentious issue as psychiatric drugging and other controversial treatments continue to be used in alarmingly increasing rates. This strikes a particularly painful chord for Jim Gottstein, who had personally experienced how abusive the psychiatric health system can be. Not long after his personal experience, he went on to become an advocate for people being subjected to involuntary commitment and forced drugging by launching litigation campaigns. He documents one particularly compelling story of how he helped one individual go through these hearings in his book, The Zyprexa Papers. Jim joins Timothy J. Hayes, Psy.D. to explain in detail how he fought and won that landmark case. Tune in and take part in this conversation that opens our eyes to the realities of the psychiatric system and big pharma and how a few brave voices are fighting back.Love the show? Subscribe, rate, review, and share!Here's How »Join the On Your Mind Community today:journeysdream.orgTwitterInstagramFacebookYouTube

Contributor: Nick Tsipis, MD Educational Pearls: Prospective trial studied 5 mg IM droperidol to 10 mg IM olanzapine (Zyprexa) in the reducing levels of agitation Time to adequate sedation was about 16 minutes for both agents Droperidol was slightly less sedating than olanzapine and length of stay for olanzapine was longer Olanzapine had a higher rate of requiring another agent for adequate sedation Droperidol had a higher rate of adverse events (mainly extrapyramidal symptoms) than olanzapine Remember to put the safety of the staff and patient at the forefront of sedation practices and be cognizant of the psychological effect of giving involuntary medications to patients References Cole JB, Stang JL, DeVries PA, Martel ML, Miner JR, Driver BE. A Prospective Study of Intramuscular Droperidol or Olanzapine for Acute Agitation in the Emergency Department: A Natural Experiment Owing to Drug Shortages. Ann Emerg Med. 2021;78(2):274-286. doi:10.1016/j.annemergmed.2021.01.005 Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD   The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at https://emergencymedicalminute.org/cme-courses/ and create an account.  Donate to EMM today!

In this episode of Medicated Michelle I tell the harrowing story of my experience with zyprexa. One of the worst times in my life and a HUGE wake up call to finding out the truth behind the mental health care industry.

This time on the Couch: Mike, James, and Shée stop and frisk 1988's COPS no. 5! In the distant future of the year 2020, a crack team of law enforcement agents have banded together around a single noble goal: To shove another half-baked franchise in front of millions of impressionable children and cash out before the Supreme Court shuts this whole scam down! In this issue, canine unit officer Bowser is bummed because his robot dog got blown up, which is especially scary because that guy is a psychological minefield even on a good day. But don't you worry, because if there's one thing the police know how to handle, it's the de-escalation of delicate mental health episodes with compassion and tact. The boys in blue'll unload 40 rounds into that pesky psychotic breakdown faster than you can say, "Zyprexa"!

Antidepressants, mood stabilizers, antipsychotics, benzodiazepines, stimulants.....READY SET GO!Med cheat sheetSSRIs (selective serotonin reuptake inhibitors)-- Prozac, Lexapro, Paxil, Celexa, Zoloft, Luvox, Trintellix, Viibryd-- They are generally NOT antidepressantsMainly helpful for OCD, body dysmorphia,  panic (if not from trauma), depression if postpartum or fueled by neuroticism or ruminative anxietySNRIs (serotonin norepinephrine reuptake inhibitors)-- Effexor/venlafaxine, Cymbalta/duloxetineMostly helpful for combined depression/anxiety, especially with insomniaWellbutrin/bupropion-- very stimulating (prison crack!), true antidepressant; can trigger/worsen anxietyMAO  (monoamine oxidase) inhibitors-- powerful antidepressants, lots of side effects and med interactionsLamictal/lamotrigine-- definitely ALL THAT and a bag of chips (see My Desert Island Meds in Season 1)Atypical antipsychotics-  Abilify/aripiprazole, Latuda/lurasidone, Seroquel/quetiapine, Saphris/asenapine, Vraylar/cariprazine, Risperdal/risperidone, Zyprexa/olanzapine, Geodon/ziprasidone, Invega/paliperidone Generally good mood stabilizers (in contrast to the putative "mood stabilizers" below); typically more helpful for severe depression and bipolar disorder than true psychosis (Zyprexa and Risperdal excepted)"Mood stabilizers"- (big misnomer, most effective for  mania/agitation, not depression)-- Depakote/valproic acid, Trileptal/oxcarbazepine, Tegretol/carbamazepineLithium- it's not clozapine, but gets the silver medal as a true mood stabilizer (see My Desert Island Meds in Season 1)Clozapine- the winner of the psychiatric med decathlon in most every event; needs weekly blood monitoring and has a few very serious potential side effectsBenzodiazepines- Xanax/alprazolam; Klonopin/clonazepam, Librium/chlordiazepoxide, Ativan/lorazepam, Valium/diazepamStimulants- Adderall/amphetamine; Vyvanse; Ritalin/Concerta/Focalin/methylphenidateAmphetamines are more euphoria-inducing, thus more abused and addictive and also tend to have more side effects; both amphetamines and methylphenidate are roughly equally effective for ADD/ADHDBFTAhttps://www.craigheacockmd.com/podcast-page/

What happens when the esteemed godfather of mass torts, Howard Nations, decides to hit the town and shoot the breeze with Mirena? Well, of course, we stutter to a stop, sit mesmerized, and hang onto every perfect doctrine he sends our way! In The Heart of Law's third episode, our incisive host, Mirena Umizaj enjoys the riveting, first-hand account of Howard's stint as a US Army intelligence officer commissioned as a Russian translator—intercepting cryptic messages from a Soviet naval base in a northern island off Hokkaido, Japan. After eavesdropping on submarines, fleets, and every bit of water traffic for months, life in the military intelligence pretty much set the tone for the disciplined and purposeful life Howard led throughout his 55+ years practicing law. Howard gives copious, razor-sharp advice on how to survive in the cutthroat mass tort business. Ironically, resisting avarice and the “absolute disregard for money,”  with “total expulsion” of materialism charts the course to a successful outcome of a case. Dovetailing that ideology with mental fortitude, depositional ingenuity, strategic witness management, and profound procedural patience, he gives us a basic (even banal) formula of an honorable value-system tested by time. During half of the show, their conversation turns on a sober note as Howard and Mirena immerse us into the complex acquisition of mass tort cases, hundreds of millions of dollars depleted, ethical dilemmas, hedge fund controversies, conflict of interests, lead purchasing, and contentions within the industry. They touch on austere issues like gigantic med-tech and pharma companies distributing defective products, as well as disquieting financial games negatively affecting people's lives. Inversely, we have an awareness about the meaningful life Howard leads. We hear a deep love for his family, his plight for the weak (he is famed for representing over 300 pro bono cases), and three decades of passionately teaching law. We grasp how he fearlessly copes with a family tragedy, endearing us as he flouts every cynicism life thrusts his way. He shares his knowledge freely, exercises systematically, reads voraciously … all the while, managing to disarm us with his stalwart faith. What a testament to us all. People like Howard make living in this not-so-happy world so worthwhile.   EPISODE SURVEY  [00:07:02] In the U.S. Army Military Intelligence as a Russian linguist  [00:12:23] once tort reform happened in Texas, Howard adapted and reinvented himself, starting a mass tort firm and changing the entire game. [00:16:35] Howard officially declares himself to be a mass tort lawyer. [00:16:57] Adventures with Zyprexa and 78 depositions all over the country. [00:21:48] "And they said, 'We'll never pay you a thousand cases!' So I said, 'Okay; then pay me on 999.' " [00:41:58] On the Trial Lawyer's Summit and the  Entrepreneurship of Law. QUOTABLE QUOTES " The thing is, you have to have an absolute disregard for money because if you're worried about money, don't get in the mass tort business because [in the industry] there's a complete, total expulsion of money." "You have to be fearless because if you're not fearless, you'll worry yourself to death." "The outcomes are only as good as what you gather." "You have to have skillsets for a trial ... you have to have a lot of skills in depositions because depositions are a crucial part of mass torts." You have to be articulate with experts because choosing the right expert [and] getting them prepared … [and] keeping them under control is a major part of mass torts." "You have to have the world's greatest patience ... because it's a five-year proposition." “I give back by education and by sharing everything.” LINKS FROM THE SHOW Check out Howard's Fully Loaded Bio Swing by Howard's Practice Catch Howard's NTL Interview of Top 100 Lawyers Visit Mirena's Chic Website and  LinkedIn Resources Howard recommends: Trial Lawyers College, Trial School  Show Notes and content management by Almond Tree Writers' Ink, LLC's Founder, Caryl Veloso ABOUT OUR GUEST: Howard Nations A trailblazer in personal injury and civil litigation, as well as mass tort for over 55 years. Leader of the trial bar President of The National Trial Lawyers, Texas Trial Lawyers Association, the Southern Trial Lawyers Association, the Belli Society, and the Aletheia Institute Five years on AAJ's Executive Committee A pioneer in courtroom technology and the first attorney to have computer-generated liability and medical animations admitted into evidence at trial. Co-founded AAJ's National College of Advocacy One of the most sought-after educators in the law profession. Howard's Published Papers, Articles, & Editorials Howard's Awards Howard's Acceptance Speech for Trial Lawyers Hall of Fame Award 2012 Howard's Superlative Resume'  

Drs Kurt DeVine & Heather Bell continue the series on drugs felt to be safe…. But are not necessarily! In Episode #8 of “Safe Drugs- or Not” we discuss olanzapine aka Zyprexa, another second-generation antipsychotic! FDA approved for schizophrenia and bipolar but often used off label for anxiety, insomnia and many more things- especially in correctional settings! To learn more about the doctors as well as keep up with current happenings follow us on twitter: @echocsct and Facebook: @theaddictionconnectionhk

Drs Kurt DeVine & Heather Bell continue the series on drugs felt to be safe…. But are not necessarily! In Episode #8 of “Safe Drugs- or Not” we discuss olanzapine aka Zyprexa, another second-generation antipsychotic! FDA approved for schizophrenia and bipolar but often used off label for anxiety, insomnia and many more things- especially in correctional settings! To learn more about the doctors as well as keep up with current happenings follow us on twitter: @echocsct and Facebook: @theaddictionconnectionhk

In this episode I interview Attorney Michael Mosher who has 30 years of experience. Mr. Mosher has an extensive background in pharmacokinetics, the adverse reactions of various drugs as well as the proper administration of each psychotropic drug including anxiolytics (eg. Xanax, Ativan, Klonopin), hypnotics (Halcion, Dalmane, Restoril), stimulants (eg. Ritalin, dexedrine, Adderall), anticonvulsants (eg. Tegretol, Depakote, Neurontin), antidepressants (eg. all the SSRIs, Effexor and the tricyclic antidepressants), and neuroleptics, (eg. Zyprexa, Risperdal, Seroquil, Abilify). Mr. Mosher has also settled numerous cases against doctors and drug companies involving illnesses and damage due to addiction/dependence via the use of Xanax, Klonopin and other benzodiazepines as well as injuries resulting from SSRIs.

Contributor:  Katie Sprinkel, MD Educational Pearls: Psychogenic Non-Epileptic Seizures (PNES) are due to a psychogenic rather than an epileptic cause Despite common assumption, PNES are not always volitional  20-40% of those with PNES can also have true epileptic seizures 20-40% True diagnosis requires a video EEG  Characteristics of PNES include: Waxing and waning of the seizure intensity Eyes clenched shut Pelvic thrusting, rolling from side-to-side Ability to respond to verbal stimuli during the seizure  Ability to recall information during the seizure Weeping or stuttering Guarding the face on passive hand drop Characteristics of epileptic seizures: Tongue biting Prolonged postictal state Incontinence Haldol or Zyprexa may be better for PNES and benzodiazepines tend to be better for epileptic seizures References Huff JS, Murr N. Psychogenic Nonepileptic Seizures. 2021 Jan 28. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 28722901. Asadi-Pooya AA. Psychogenic nonepileptic seizures: a concise review. Neurol Sci. 2017 Jun;38(6):935-940. doi: 10.1007/s10072-017-2887-8. Epub 2017 Mar 8. PMID: 28275874.   Summarized by John Spartz, MS3 | Edited by Erik Verzemnieks, MD

A new track by DJ Habett from the album "Les forces de l'esprit" (2021-02-21). Tags: Genre, Kicks, Frequencies, Deep, Synthesizer, Mono, Psycho, Mental, Hope, Relief, Coaxial, Frontier CC(by)

Contributor: Don Stader, MD Educational Pearls: Zyprexa (olanzapine) is a second generation antipsychotic with multiple other uses Excellent for treating nausea in patients undergoing chemotherapy or with THC hyperemesis syndrome Helps with the psychological and emotional aspect of pain Effective in treatment of headaches Can be given under the tongue Fewer incidences of dystonic reactions compared with first generation antipsychotics Patients using anti-dopaminergic should not receive antipsychotics because they also work on dopaminergic receptors References Navari RM, Qin R, Ruddy KJ, Liu H, Powell SF, Bajaj M, Dietrich L, Biggs D, Lafky JM, Loprinzi CL. Olanzapine for the Prevention of Chemotherapy-Induced Nausea and Vomiting. N Engl J Med. 2016 Jul 14;375(2):134-42. doi: 10.1056/NEJMoa1515725. PMID: 27410922; PMCID: PMC5344450. Jimenez XF, Sundararajan T, Covington EC. A Systematic Review of Atypical Antipsychotics in Chronic Pain Management: Olanzapine Demonstrates Potential in Central Sensitization, Fibromyalgia, and Headache/Migraine. Clin J Pain. 2018 Jun;34(6):585-591. doi: 10.1097/AJP.0000000000000567. PMID: 29077621. Summarized by Jackson Roos, MS4 | Edited by Erik Verzemnieks, MD The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at www.emergencymedicalminute.com/cme-courses/ and create an account.

Contributor: Don Stader, MD Educational Pearls: Majority of patients experience side effects while taking opioids Most common include nausea/vomiting, puriitis, constipation; more severe and less common include respiratory depression, addiction and overdose Opiates can cause nausea, but ondansetron (Zofran) is the wrong treatment because it’s not antidopaminergic. Instead consider using metoclopramide (Reglan), olanzapine (Zyprexa), or haloperidol (Haldol) Itching from opiates isn’t histamine mediated so hydroxyzine (Atarax) and diphenhydramine (Benadryl) aren’t effective - oddly ondansetron may help with itching. Constipation is best treated with promotility agents like Senna, rather than stool softeners References Rogers E, Mehta S, Shengelia R, Reid MC. Four Strategies for Managing Opioid-Induced Side Effects in Older Adults. Clin Geriatr. 2013 Apr;21(4):  PMID: 25949094; PMCID: PMC4418642. Farmer AD, Holt CB, Downes TJ, Ruggeri E, Del Vecchio S, De Giorgio R. Pathophysiology, diagnosis, and management of opioid-induced constipation. Lancet Gastroenterol Hepatol. 2018 Mar;3(3):203-212. doi: 10.1016/S2468-1253(18)30008-6. PMID: 29870734. Summarized by Jackson Roos, MS4 | Edited by Erik Verzemnieks, MD The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at www.emergencymedicalminute.com/cme-courses/ and create an account. 

Jim Gottstein is an attorney in Alaska, with a law degree from Harvard Law School who has been representing and advocating for sane psychiatric treatment for individuals diagnosed with a mental illness.  In 2002 he founded the Law Project for Psychiatric Rights to mount a strategic litigation campaign against forced psychiatric drugging and electroshock therapy.  The Project is committed to informing the public about the counterproductive and harmful effects of conventional psychiatric treatments.  He is the author of the book "The Zyprexa Papers" which recounts the story and first-hand account of corruption about one of the most prescribed psychiatric drugs for mental disorders. The drug's maker, Eli Lilly intentionally concealed that its top selling drug caused diabetes and other life-shortening metabolic conditions; it also illegally promoted Zyprexa on children and the elderly.  Upon receipt of documents, Eli Lilly threatened Jim with criminal contempt charges. More about the Zyprexa Papers can be found at TheZyprexaPapers.com, and the website for the Law Project for Psychiatric Rights is  PsychRights.org

1. What is off-label drug use? a. Off-label drug use is when doctors prescribe medications for unapproved uses b. FDA cannot control how doctors prescribe c. 20% of Rx in US are fore off-label uses 2. Why use a drug for off-label purposes? a. Tried all other options without success b. Literature to support drug’s use, even if limited c. Different dosage form d. Dosage for which there is evidence that a higher dose may be effective e. Drug is generic so there is no financial benefit for a manufacturer to obtain approvals 3. What are the risks? a. Balance between effectiveness and risk is tilted toward risk b. Investigational studies with close monitoring of safety 4. Approvals a. Experimental b. Benefit unknown c. Risks unknown d. Plan must pay for all consequences 5. Examples a. Gabapentin for anxiety b. High dose/strength opiates for pain c. Stimulants for weight loss d. Anti-epileptic medications for mood disorders/bipolar disease e. Examples of atypical antipsychotics include Seroquel, Zyprexa and Abilify. They are being used to treat an array of conditions off-label, including anxiety, attention-deficit disorder, sleep problems, behavioral problems in toddlers and dementia. f. Antipsychotics to treat dementia g. Cancer treatment – estimated 50% are off-label _____ Make sure to subscribe to get the latest episode. Contact Us: Pharmacy Benefit News: http://www.propharmaconsultants.com/pbn.html Email: info@propharmaconsultants.com Website: http://www.propharmaconsultants.com/ Facebook: https://www.facebook.com/propharmainc Twitter: https://twitter.com/ProPharma/ Instagram: https://www.instagram.com/propharmainc/ LinkedIn: https://www.linkedin.com/company/pro-pharma-pharmaceutical-consultants-inc/ Podcast: https://anchor.fm/pro-pharma-talks

Dr. Walter Kaye is a Professor in the Department of Psychiatry and the Founder & Executive Director of the Eating Disorders Program at the Eating Disorders Center for Treatment and Research at UC San Diego. Dr Kay is a leading expert in Eating Disorders and is a co-editor in the Clinical Handbook of Complex and Atypical Eating Disorders and the Behavioral Neurobiology of Eating Disorders. Dr. Kaye’s current research is focused on exploring the relationship between brain and behavior using brain imaging and genetics and developing and applying new treatments for anorexia and bulimia nervosa. Eating Disorders are severe disturbances in eating behaviors, thoughts and emotions. Many who suffer with eating disorders are preoccupied with both food and their weight. They can have severe body image dissatisfaction and a need for perfection. Even though eating disorders are grouped together in the DSM-5, they are distinct illnesses. Anorexia Nervosa symptoms include a distorted body image and a belief in being overweight despite being dangerously underweight. There are two types of anorexia nervosa, one restrictive and one binge-purge type. Bulimia Nervosa is characterized by eating excessive amounts of food in short period of time, and then purging the food using compensatory behaviors like vomiting and laxatives. Binge Eating Disorder is engaging in episodes of excessive eating, but unlike bulimia, there is not purging of the food or calories. Eating disorders affect people from all racial and ethnic backgrounds on many psychosocial levels. They can cause serious medical problems, and a multidisciplinary approach to care is needed.   Transcript Dr. Bridget Nash (2s): Hello, my name is Dr. Bridget Nash and I'd like to welcome you to the Therapy Show, a podcast series that seeks to demystify mental health treatment. Today I am honored to welcome Dr. Walter Kaye who is a Professor in the Department of Psychiatry and the founder and Executive Director of the Eating Disorders Program at the Eating Disorders Center for Treatment and Research at UC San Diego. Dr Kaye is a co-editor of the Clinical Handbook of Complex and Atypical Eating Disorders and Behavioral Neurobiology of Eating Disorders. He is a leading expert in eating disorders, and it's here to discuss some of the new research in the field of Treatment. Dr. Kaye welcome to the Therapy Show! Dr. Walter Kaye (42s): Oh, thank you very much. Dr. Bridget Nash (45s): Can you start by telling us a little bit about your personal background and professional development that led to your research in the field of eating disorders? Dr. Walter Kaye (53s): Yeah, certainly. I first trained as a neurologist and then trained in Psychiatry a number of years ago, and I've always been interested in doing research. I didn't particularly have an interest in eating disorders, but I got a fellowship at the National Institute of Mental Health, and when I went there I was asked to take over a study on Anorexia, and actually in my training I had never met anybody with Anorexia and at the time, I was particularly interested in trying to understand how behavior was encoded in the brain. Dr. Walter Kaye (1m 24s): And so, I was thinking about studying some disorders like Parkinson's that have certain changes in behavior, and we know that that's due to the neurologic disturbances in treating people with Anorexia. I was really struggling how, what we call it a stereotypic their behavior is, that it is people with Anorexia resemble each other much more so than probably any other psychiatric disorders in terms of people resembling each other. For example, if you have schizophrenia, people have all kinds of different symptoms. But people with Anorexia tend to have the same, relatively the same symptoms, and you know, that it can make you think that there is something in the brain that's causing this a, so that is actually been what got me interested in in studying brain and biology and Anorexia. I was at NIMH for about seven years, and then I went to the University of Pittsburg for 20 years, and now I'm here at a University of California, San Diego, where I do research and also, I oversee the treatment program for Anorexia and Bulimia.  Dr. Bridget Nash (2m 27s): So how would you briefly explain Eating disorders to a non-professional? Dr. Walter Kaye (2m 31s): This is a number of ways to explain it to it. I think that's what's really confuses people because people with the Anorexia often, but not all the time, they see themselves as being too fat and they go on a relentless pursuit of the thinness. And initially the other disorder that we treated very often is Bulimia Nervosa, which is where people are kind of alternate between restricted eating, overeating and then sometimes purging and people also have a body image distortion, but these are disorders that are often also associated with things like anxiety in obsessionality. Dr. Walter Kaye (3m 5s): And people have a certain time pattern of temperament traits. These tend to be perfectionistic, sometimes obsessive, anxious people. And so this has been very, very puzzling because the eating disorders, you know, tend to start mostly in females around early teenage or mid teenage years and so the prevailing notion is that this is a disorder of this caused by culture or society and people are dieting to achieve some kind of desired look. Dr. Walter Kaye (3m 39s): But the reality is that people with Anorexia diet to a weight that, they can be 50, 60 pounds, and and nobody would consider that to be fashionably slim. In fact, people with Anorexia, when they get to that weight, they still see themselves often as being too fat, and they want to pursue a lower weight. And the other thing that's really noticeable about Anorexia is that, it's very hard for people to diet or lose weight. The recidivism rate in obesity is very high and to be able to eat a few hundred calories a day, every day for years at a time is not something that most people can’t do. Dr. Walter Kaye (4m 21s): We've really been very interested in the question of whether it is really an underlying biology that explains a lot of these puzzling symptoms that you see in the Anorexia and Bulimia. Dr. Bridget Nash (4m 31s): Can you talk about what's happening in the brain and the body when a person has an eating disorder? Dr. Walter Kaye (4m 36s): Well, there's two levels of it. One is the question of whether there is some underlying biology that causes an eating disorder. And then the second part is, “gee what happens when you starve yourself and what effects does that have on their brain and the body.” Let's talk mostly about Anorexia cause that's really where I do most of my research. People with Anorexia go on this, this is kind of relentless diet and they may be 12, 14 and 15 years old when they start it. Dr. Walter Kaye (5m 7s): But if you ask somebody with Anorexia what they were like is a child before they ever developed the eating disorder, what most of the time they'll tell you is they have a certain pattern of temperament and personality traits. These tend to be as children they're very achievement oriented, or they want to get all A's. They tend to be often kind of perfectionistic. They may be anxious and worried about what might happen, concerned about risk, inhibited, sometimes very obsessional, and organized, sometimes kind of inflexible, but these are, for the most part, this isn't the problem for them. Dr. Walter Kaye (5m 44s): Their parents there pretty compliant kids. They do well in school. They are, but something happens when they start to get into these teenage years and often, they have exaggerated anxiety. And what they'll often tell you is, there something about food, or wanting to eat food that makes them very anxious, and something about not eating that either makes ... doesn't increase the anxiety or it actually feels kind of empowering. And so, they get into this, because food is so uncomfortable for them, that they get into this escalating downwards spiral where the more weight they lose, the more weight they want to lose, and they can literally starve themselves to death. Dr. Walter Kaye (6m 25s): In fact, this disorder has the highest death rate of any behavioral disorder. It's thought that somewhere between five or ten percent, maybe even more, people with Anorexia will die from the Anorexia. And so once you start to starve yourself and lose weight like this, there is a whole host of secondary changes that occur in the body as your body is trying to a conserve energy and live with very few calories and it effects nearly every organ system in the body as you lose weight. Dr. Walter Kaye (6m 56s): So, it's been very hard to tease apart what's the cause and what's the consequence of Anorexia. Now, over the course of this disorder, what we find is that a group of people recover and somewhere probably around about 50% of the people eventually recover and may do very well in life. But it's not unusual that people may be ill with Anorexia for two or five or even ten years before they get better. And about maybe about 30% or so have a partial recovery, and then you have a group of people that have very chronic disorder or die from it. Dr. Walter Kaye (7m 34s): And the thing that's really the most concerning thing to recognize is we don't really have very powerful treatments for Anorexia. There's no medication that's been proven to work. We have some treatments that seem to work more effectively in adolescents and children with the Anorexia, it's a, it's called Family Based Treatment or Maudsley, we can go back and talk a little bit more about that. But even with that treatment, it's very hard to change this anxious behavior that happens when people eat. Dr. Walter Kaye (8m 6s): And so it's very important to really understand the biology and the mechanisms underlying this behavior in order to come up with more effective kinds of therapy both to keep people from being ill for many, many years before they get better or to prevent them from becoming chronically ill or dying from this illness Dr. Bridget Nash (8m 28s): For Bulimia, can you talk a little bit about the body image symptoms? And also, is there a secondary gain that somebody might experience from binging and purging? Dr. Walter Kaye (8m 37s): Human behavior is complicated and, as similar as people with Anorexia are to each other, everybody's an individual, and there's probably always a mixture of different kinds of environmental and biologic factors that contribute to anybody developing a disorder like this. People was Bulimia -- why do people binge and purge --well people with Bulimia often tell you that when they're stressed or upset or anxious, have a fight with their mother or something like that, there is something about bingeing and purging behavior that actually is kind of comforting and may make the uncomfortable feelings go away, at least temporarily, even though in the long run they return and they may feel worse. So, they're, just like with Anorexia, there there's some beneficial response to extremes of food intake or extremes of not eating food, and now that we're beginning to understand more about the brain, some of the biology about this, begins to make sense. And with some people with Bulimia, because people with Bulimia often stay around the more normal weight, the body image issues that may be part of what's is also driving their desire to, to lose weight and to, to remain at a certain, what they consider ideal body weight. Dr. Walter Kaye (9m 58s): So, it's complicated, but again, most people with Bulimia don't get to the extremes of weight loss that you see with Anorexia. Then, of course, there's actually a third disorder here, which are people that have both a mixture of Anorexia and Bulimia and they lose a lot of weight, but they also binge and purge. Dr. Bridget Nash (10m 18s): Eating disorder behaviors are very secretive. Are there any signs or symptoms that a family can look for in the early stages of illness that can help them? Dr. Walter Kaye (10m 27s): You see two different kinds of patterns here. In people with Bulimia that don't lose an extreme amount of weight, they often tell you they're ashamed and a distressed about binging and purging. And they tend to be the most secretive. They're the people that nobody in the family will know that they're bingeing and purging, they're doing this at night, or they're hiding, or they're any number of things that people do to keep it a secret from their family. This may go on for years and sometimes it’s very hard to discover and the family begins to notice that there's large amounts of foods missing or that is a toilet has gotten clogged up by vomitus. Dr. Walter Kaye (10m 59s): You know one of the things that happens when people binge or purge to an extreme, it may affect their menstrual periods then they stop having a menstrual period or they may be very irregular. We see in a very different pattern in Anorexia and people with Anorexia don't usually try and hide it, they have more of a, a denial so that they don't see themselves as well being too thin. And in fact, even though they may lose 30, 40 pounds, they'll look at it their arm, you know, hold their arm out to say... Dr. Walter Kaye (11m 30s): "Can't you see how fat I am." And they're not really very motivated to get into treatment and there's a lot of denial and a lot of resistance to being in therapy and sometimes frank hostility to try to get them into treatment. And that's of course, one of the problems with Anorexia because it says it can be a life threatening illness. Yet this is a group of people that don't feel that they're at any risk. Dr. Bridget Nash (11m 56s): Why is the early intervention critical for people suffering with eating disorders? Dr. Walter Kaye (12m 0s): This goes back to a couple of different reasons. 1) There is there is some evidence that the earlier you get somebody into treatment, the better they might do. So, the most effective treatment we have, particularly for Anorexia, is called Family Based Treatment or Maudsley. And because this can be a very chronic disorder, and people get into treatment or are forced into treatment and forced to gain weight, but they leave treatment and they lose that weight all over again. Dr. Walter Kaye (12m 30s): And they may go through repeated cycles. So, because most families are unable to keep their child in a treatment program for a long period of time, and because this is a chronic disorder, this therapy has been effective because it makes parents an ally. Instead of saying to parents, you are bad people, you've caused this. There is really no evidence that families cause eating disorders or that bad parenting causes eating disorders. You want to bring them in as an ally and try to explain to them reasons why your child is acting this way, and more importantly make the parents part of the treatment team so once your child goes home, the parents have strategies and knows how to most effectively get them to eat and maintain their weight. And that treatment has really been a game changer in that there's a number of studies that have shown that is a more effective treatments for many people, especially if they’re younger than older treatments as usual. But say that there's a large proportion of people that don't really respond very well to Family Based Treatment and go on to have a chronic disorder. Dr. Walter Kaye (13m 33s): And so that's one of the reasons we need to learn more about the biology so that we come up with more effective approaches here. But what happens to people when they get malnourished? Well, there are certain systems in the body that growth during the teenage years is a very important, and so one of those is bone strength. And actually, your bones continue to develop and get stronger during your teenage years and your bone growth becomes peak in your late teens, early twenties, and then its, then you slowly lose strength as you get older. Dr. Walter Kaye (14m 11s): If you miss that are critical period of bone growth, you're gonna, your likely to have weak bones all your life. You cannot make up for it later with better nutrition when you're in their twenties and thirties. And it is not unusual that we see people who have had a period of Anorexia and now are fully recovered, but they suffer, they're very susceptible to fractures as they get into their thirties and forties that other people might not have just because their bones are so weak. And they're certain other patterns, similar kind of patterns of growth that occur in parts of the brain during your teenage years as you're are getting into your twenties. Dr. Walter Kaye (14m 48s): And now we're beginning to wonder whether there may be permanent changes to some parts of the brain if people remain malnourished for many years. There are long term consequences that can happen. And even people that have Bulimia Nervosa that don't lose a lot of weight can also show some of these more chronic permanent changes. Dr. Bridget Nash (15m 10s): I liked the way you talk about the family as part of the treatment team. And I think that a multidisciplinary approach is key to treating someone with an eating disorder, even including like when we think about it, the medical, the dental, the psychiatric in the psychotherapy piece, I think they're all critical don't you think? Dr. Walter Kaye (15m 30s): It takes the team to treat somebody with Anorexia. A dietician, a various kind of therapy, sometimes medication. Family is just maybe the most critical element of that whole team. Dr. Bridget Nash (15m 43s): What are some of the most common obstacles that prevent people from achieving a full recovery? Dr. Walter Kaye (15m 49s): I don't think we really know that. And that's where you start to get into biology. One of the questions that we've really struggle with, and typically are doing research on his, this question about eating behavior. Let me ask you, how, how do you feel when you go without eating for a day or two? Dr. Bridget Nash (16m 7s): Angry! Dr. Walter Kaye (16m 7s): Yeah. Most people will say there's something unpleasant about it. It's irritable. It's uncomfortable. It just doesn't feel good and what people will find, if you go without eating for a day or two, you you get hungry, that first bite of food really is more pleasurable. It will still be pleasurable. But when you are really hungry, food tastes better doesn't it? Dr. Bridget Nash (16m 28s): Yes. Dr. Walter Kaye (16m 30s): Okay. So, if you ask somebody with Anorexia, what do they feel like when they have to eat or they think about food, you know, what they almost always tell you is there's something about that that makes them anxious and uncomfortable. And when they don't eat, they feel the anxiety isn't increased, or sometimes they feel even better, empowered. So, just from that standpoint, it makes you think that there's something that is wired very differently in people's brain with Anorexia because the primary job of animals is to find food and feed themselves every day. Dr. Walter Kaye (17m 4s): And we know from animals’ studies there is very powerful systems that are built into the brain to do that. So, what happens is, when animals go without eating for a while, their body says to sense that they need energy stores, their energy stores are diminished, their gas tank is less full. And that, there's a number of different pathways from the brain that send the messages signals to the, to the brain that say "Gosh, you need more energy." And what that does is that really, you know, in humans that is interpreted as an uncomfortable feeling like: “Hey, there's something wrong, you got to go out and eat.” And in animals, what that particularly does is that works on a part of the brain that is very important for reward and motivation, and it actually sends a signal to that part of their brain that motivates you to go out and search for food. So, we know a lot about that part of their brain. It's very deep in the brain and is shared with animals. It's actually below our consciousness. It's a part of the brain that sits on top of the brainstem, but under the cortex and is called the striatum or the basal ganglia. Dr. Walter Kaye (18m 9s): And it’s very important for motivating all kinds of behavior, whether it's food or drugs or sex or anything that people or animals are motivated to do. And you can do brain imaging studies now that, at least, ask the question of – “What happens in that part of the brain, there's the activity in that part of the brain, that's important for motivation get turned on when you are hungry.” And so, we did a study in, and this is just published a couple of months ago in the American Journal of Psychiatry, where we had people with Anorexia come into a laboratory that we have on campus, building a setting. Dr. Walter Kaye (18m 45s): And they lived there for three days. One day we had them go without eating for 16 hours. On the other day we had to meet normally. And what we wanted to do is measure the activity in this motivational part of the brain. And so, we had them come in. Then after that the, they came into an imaging center and we imaged to their brain and we had them, we put a little plastic tube in their mouth we had them taste, repeat a taste of sugar water, which we know kind of turns on this system. And what we found is that, in the control women, the women that didn't have Anorexia, we found exactly what others have found. Dr. Walter Kaye (19m 20s): On the day that they were hungry, there was much more activity in this motivational center of the brain then there was on the day they were full. No surprise. And we did the same thing in people with anorexia, you know, what we found is that, on the day that if they were fed, they look just like the controls. On the day they were hungry, it was decreased activity in the motivation center. So. this makes perfect sense. It what is really saying is that people with Anorexia, the reason they can starve themselves is that they're just not getting a signal that's compelling them to go out and eat food. Dr. Walter Kaye (19m 59s): Does that kind of makes sense? Dr. Bridget Nash (20m 2s): It does. Now are they motivated to do anything else? Like to do other things like compulsive behaviors? Dr. Walter Kaye (20m 6s): We have looked at other kinds of motivation, which is things like response to money, and they had the same diminished signal in that part of the brain. So, you know, people with Anorexia like to save money, they don't spend money. And so, they are not really motivated to for any kind of reward, and that actually we think as part of the problem with treatment is that they really have a hard time sensing the reward of it. You know, parents try to motivate their kid's all the time to eat and maintain their weight by a promising "I'll buy you a new Porsche." Dr. Walter Kaye (20m 39s): Because treatment is so expensive, it's probably cheaper to buy them a Porsche and it doesn't work because the people with Anorexia tend to be very insensitive to reward. But the converse side of it is there over-sensitive to things going wrong, to what we call punishment or some kind of aversive risk state. In fact, it, the other thing that we found in this study is that the more anxious than people with... Anorexia were, the more activity they showed in this part of their brain that's very sensitive to things going wrong and inhibit behavior. Dr. Walter Kaye (21m 15s): And actually what we think is going on is that if you're an animal out there in the wild, you're a rabbit, your living out there in their field, you are living here in your little hole on the ground, is relatively safe, you start to get hungry, that hunger is going to motivate you to go out and look for food, right? But animals have to have a system built into their brain that inhibits that behavior if there's something dangerous going on like a predator that might eat it. And so even though that rabbit is very hungry, that rabbit has to inhibit that hunger and motivation to eat and run away if there's some kind of risk going on, some kind of danger. Dr. Walter Kaye (21m 54s): And what I think is going on with the people with Anorexia is they are getting kind of a biased signal here. They're over sensitive to things going wrong, danger, anxiety, adversity, change, uncertainty. All those things that give you a signal there's some kind of risk, and they're actually getting a signal in their brain. They're somehow miscoding food and their miscoding food is being dangerous and risky. And that doesn't exist for the rest of us because nobody is wired that way, but there's something very different about the brain that people with Anorexia. Dr. Walter Kaye (22m 28s): Does that kind of make sense. Dr. Bridget Nash (22m 31s): It makes a lot of sense. I just wonder what the cause is. Do you have any theories of the cause of where that began? Dr. Walter Kaye (22m 38s): Well, now that we're beginning to understand what system is involved in the brain, we think that there's something wrong in this mechanism that balances reward and punishment, and people with Anorexia tend to be very sensitive to punishment and risk and things like that. So, then what exactly is it a chemical mechanism of that is still a mystery, but I think we've started to understand were to look now. Dr. Bridget Nash (22m 60s): That's really hopeful and promising. So, is there anything that improves treatment outcomes? Dr. Walter Kaye (23m 6s): We're finding that some people, and there have been some articles now in the literature, part of this system, it relies on a chemical called dopamine, which actually, people think of it as a reward chemical, but it’s actually a very important for this balance between reward and punishment. And that there's some studies suggesting at at least some people with Anorexia, may respond to some drugs that work on the dopamine system. It was a paper on American Journal last year is showing that Zyprexa also called Olanzapine showed improved weight gain to some extent in people with Anorexia. Dr. Walter Kaye (23m 42s): And there's been several other studies showing that a drug called Abilify which kind of has a similar mechanism or Aripiprazole also might work on some people, it doesn't work in everybody, it's not a magic bullet, but it may be helpful to some people. We really need to do now more controlled studies of that. But at least it’s starting to open the door to ask questions about mechanisms, Oh, by the way, I wanted to mention one other thing. The thing that's really important about this study I just told you about is we studied people who had recovered from Anorexia and not people that were ill. Dr. Walter Kaye (24m 16s): And the reason that we did that is this problem with teasing apart cause and effect. If you study people are ill or malnourished with Anorexia, it wouldn't be surprising you'd get altered signals in his system, and we wanted to look at people that are normal weight, not on a medication, normal menstrual function, doing really well in life and we found that they still had a disturbance in this system and suggesting that this may be the trait that leads to Anorexia in the first place. Dr. Bridget Nash (24m 48s): Are there other mental disorders that often co-occur with eating disorders? Dr. Walter Kaye (24m 52s): Sure. One of the, it seems to be the most common is anxiety or Obsessive Compulsive Disorder, but people also have depression and they may have a number of other disorders too. Dr. Bridget Nash (25m 5s): So, do people with eating disorders have a higher rate of suicide? Dr. Walter Kaye (25m 8s): Unfortunately, they do. I mean that's part of the increase death rate and mortality rate in Anorexia is some people starve themselves to death, but some people commit suicide and another reason why we need more effective treatments. Dr. Bridget Nash (25m 24s): Why is it important that clinicians who are treating people with eating disorders are trained in the most up-to-date research and treatments? Dr. Walter Kaye (25m 32s): Just because of the difficulty of treating this disorder and the difficulty of even getting people to participate and engaged in treatment. The more we learned about the Anorexia and the symptoms that people have, I think the better we can speak peoples, the language in the way, you know, understand the way people are thinking and reach out to them and get them to be motivated and engage in treatment, and I think one of the problems that we've had with Anorexia and often psychiatric disorders, is that, do you try, and there's theories about behavior... Dr. Walter Kaye (26m 7s): and maybe they make a lot of sense, but maybe they don't, and if you try and use a theory, that really has no particular, it doesn't fit or explain why somebody has a disorder, it is less likely to result in any kind of effective therapy. So, for example, now that we understand this altered balance between reward and punishment, we can work with families on that strategy, and we explain this to families and say: "Look, rewarding your child isn't going to be that effective." But there are these are kids that worry about consequences and don't want to do things wrong or make mistakes or... Dr. Walter Kaye (26m 44s): and we can help families develop strategies to use consequences. Now we're not trying to punish their kids, it's just that, ya know, sometimes they pay much more attention to that and to realize that, if they don't eat and maintain their weight, there is going to be consequences they consider even worse, then it becomes very individualized cause you want to figure out what consequences bother that child the most. What we are finding that can be somewhat a more successful kind of strategy. Dr. Bridget Nash (27m 13s): That's incredible. So, to use consequences to get the attention and to sort of start the conversation with the young person or whoever you're treating, that's excellent. Dr. Walter Kaye (27m 23s): For example, kids with Anorexia, you know, they really don't want to go back into treatment, they don't want to go into the hospital, they don't want to go into, you know, a residential program and sometimes that's the only leverage that you have. Not great, but you have to work with what you got it. Dr. Bridget Nash (27m 38s): And I think if you're not trained in understanding eating disorders, I want to ask you to explain to our audience, eating disorders are different. They're almost like distinct disorders, like Bulimia is a distinct disorder and Anorexia nervosa are distinct disorders, I mean we call them all feeding disorders, but their complex and they're different. Dr. Walter Kaye (27m 57s): They're both very different and they actually, sometimes have some similarities and one of the puzzling things is that both the Anorexia and Bulimia run in families, so one person can have Anorexia and another can have Bulimia you know, I don't think we really, you understand this. Dr. Bridget Nash (28m 14s): And if you're a clinician who's working in the field, who's been certified and I think you also understand that some people need multiple treatment, multiple treatment center or multiple residential treatment... Dr. Walter Kaye (28m 25s): Yeah. Dr. Bridget Nash (28m 26s): ... to get better. Whereas the person who's not experienced might see that as they're failing or they're not getting it the first time. Can you speak to that a little bit? Dr. Walter Kaye (28m 35s): Yeah. Well, you know, one of the things that's very important is that when people get malnourished, they actually, their symptoms tend to get worse and they spiral out of control and they have difficulty. The brain gets starved. They have difficulty learning things or using therapy, and, and so for both mental as well as physical reasons, they need to get back to a healthy body weight and that can really be an enormous challenge for people with Anorexia, and so being an a, you know, they often end up a higher level of care because it’s just so, if you don't get them until a more healthy nutritional state, they may die from their Anorexia. Dr. Walter Kaye (29m 13s): And also, the other thing that's going on here is that some people with Anorexia get very energy inefficient. And by that, I mean there's been studies showing, for example, people with obesity, have a hard time losing weight and they seem to have an easy time gaining the weight back after they lose weight. The opposite tends to seem to occur with a lot of people with Anorexia. They lose weight very easily, and it's hard for them to gain weight. Dr. Walter Kaye (29m 43s): And sometimes they need thousands of calories a day to gain that weight back. And if you're somebody with Anorexia and you want to eat 500 calories a day and you need three or four thousand to gain weight, you know, two, three pounds a week, food is making you anxious, what's the chance they're going to be able to do that at home? Not great. And they may have to eat that amount of food for two, three, four months to get back to a healthy body weight. Dr. Walter Kaye (30m 13s): So sometimes higher levels of care are just so critical to save their life. Dr. Bridget Nash (30m 19s): Exactly. Now aren't people with Anorexia nervosa interested in food? I mean, I think there's a misconception that they're not interested in food, but do you think that they might have a preoccupation with food perhaps? Dr. Walter Kaye (30m 32s): Absolutely. I mean, they collect calories. They cook for others. They window shop for food. They work in food industries. And I think this has been one of the puzzling parts. So, this network, you can have a brain circuit that is very important for recognizing you're hungry and driving the motivation to eat. And there's a series of kind of steps along the way that do that. And it's possible that you could have a blockage in one part of that which is... Dr. Walter Kaye (31m 2s): So, people with Anorexia seem to recognize that they're hungry, they're getting the signal, they can't turn that signal into motivation to eat, to initiate eating. But they're still, their part of their brain is still recognizing they're hungry. And this is a strange signal that nobody else has, and I suspect that really explains why they're obsessed with food and they cook for others, yet they can't eat. Dr. Bridget Nash (31m 31s): And can you speak a little bit about Binge Eating Disorder. It's a new disorder in the DSM-5, but I think it's one that has a lot of medical consequences. Dr. Walter Kaye (31m 39s): Yeah. Binge Eating Disorder tends to occur more frequently in males. It's a somewhat later age of onset and people have, they tend to often have mood and anxiety disturbances and respond somewhat differently to treatment and other treatments compared to Anorexia, but ideologically they're really not the same disorder whereas you see, Bulimia nervosa and Anorexia nervosa kind of run together in families, you don't really see that; Binge Eating Disorder has a separate kind of family and inheritance structure. Dr. Walter Kaye (32m 13s): There's one other disorder that we've recognized now that it's ARFID, or Avoided Restricted Food Eating Disorder, which is very extreme, picky. It tends to occur in children, that's something that we treat a lot also. And these are kids, there is a whole host of different symptoms they have. Some have pain in their stomach and can't eat because it causes pain and some are very anxious, some have obsession, they only can eat four different white foods, some disturbed by certain textures and tastes of food. Dr. Walter Kaye (32m 43s): So, it's not just one symptom complex - it's something that we've more recently kind of recognized, and some of these children really have a hard time eating and lose a lot of weight and so it's one of the disorders that we treat. And there's some from these children who end up developing Anorexia and some just have an ARFID disorder, so it's things that we're learning about, but it's also a disorder where Family Based Treatment is often very useful. Dr. Bridget Nash (33m 10s): And early intervention as well. Dr. Walter Kaye (33m 12s): Yeah. Yeah, exactly. Yeah. Dr. Bridget Nash (33m 14s): What are you most excited about mental health treatment today? Dr. Walter Kaye (33m 18s): Well, you know, I think we're finally becoming a science. The progress that's been made in the last 10, 20 years has just been enormous. And of course, the reason was that the brain is encased in your skull there, as opposed to having diabetes or heart disease where you can measure things. We haven't been able to measure what's going on in the brain and it's only been the last decade or so we've had powerful brain imaging and genetics kinds of studies that are allowing us to really look inside the brain and begin to understand brain circuits and pathways and mechanisms of behavior and how behavior is encoded in the brain... Dr. Walter Kaye (33m 54s): that have just made a difference. I am just kind of astounded how far we've gotten in my professional career, where you can begin to look at these behaviors and go like "Oh, well I think this part of the brain is involved and now I understand the mechanism, and I can predict what we are going to find and we can replicate those kinds of findings." And that's starting to lead to more effective treatments as we begin to translate that science into therapy. Dr. Bridget Nash (34m 18s): Effective and targeted treatments as well. Dr. Walter Kaye (34m 24s): Yeah. And that's one of the things that we do here. I like to look at our program not only as a, a treatment program, but also a laboratory for developing treatments. So we've very interested in this whole question of temperament in people with Anorexia and you know, these temperaments don't go away, but people with Anorexia when they recover, tend to do really well in life and they learn to use some of these temperaments in really kind of advantageous ways. This is a group of people who were very achievement oriented. Dr. Walter Kaye (34m 53s): They self-discipline, they pay attention to detail. They work hard. They wanted to do the right thing and they often have not just great but have actually spectacular careers. And so, this actually turns out to be a benefit to having some of these traits once people learn to use them in advantageous constructive ways. So, we think that that may be actually an important insight into developing more effective treatment approaches. Dr. Bridget Nash (35m 25s): That is very exciting. If you had a magic wand and could improve one thing about mental health treatment today, what would it be? Dr. Walter Kaye (35m 31s): Being able to understand each person's unique vulnerabilities and mechanisms because when you really come down to it, people are pretty complicated and everybody has probably in some ways unique mechanisms that are causing, and environmental influences and so that starts to explain why, whatever treatment we have works for some people, but not others. And so, if we could better understand, you know, it's called precision medicine. If you can better understand each person's unique with a series of factors, you could really more precisely prescribe treatment. Dr. Walter Kaye (36m 6s): We're not there yet. It's going to be a while. Yeah. We'll probably get there. Dr. Bridget Nash (36m 12s): No, we're going to get there because people are going to be asking for it now. Like when we hear from you and hear all of these exciting targeted treatments, it's going to kind of create a demand. Do you think? Dr. Walter Kaye (36m 25s): Yeah, yeah, absolutely. Dr. Bridget Nash (36m 28s): Dr. Kaye on behalf of myself, my listeners, and all of the people that you've helped through your work. I want to thank you for your contributions to mental health treatment and for taking the time out of your busy schedule to help me and my audience better understand the field of eating disorders. And to my listeners, be sure to check out my website TherapyShow.com, which has many resources about mental health. There, you will also find how to submit questions, stories, or insights that you have about the mental health system or suggestions about who else I interview can and how I can improve the show. Dr. Bridget Nash (37m 1s): I'd like to close by reminding our listeners to please subscribe, share, and review this podcast. So you, someone you love, and people around the world can gain more benefit for therapy. There is no need to suffer in silence. Get the help that you need to create the life that you want.

Jim Gottstein's legal education was interrupted by a psychological breakdown, but he managed to get back on his feet without becoming a lifetime drug consumer, completed his legal education at Harvard Law School, and turned his attention to helping others. So it was no surprise when internal Eli Lilly documents on the antipsychotic Zyprexa (Olanzapine) were sent to him. But the drug company did not like this and dragged him into a long drawn-out court battle to get him to close the barn door after the horses had fled (Jim had forwarded the documents to others, and not all of them returned and destroyed them). In this discussion, and in his book, “The Zyprexa Papers”, Jim also describes how he fought against the forced drugging of psychiatric patients in his home state of Alaska. Another long, drawn-out battle, with some successes, some failures.   For more on Jim's work see: http://gottsteinlaw.com   and http://psychrights.org

Contributor: Sam Killian, MD Educational Pearls: Agitation can be due to a number of causes, but regardless of the cause, sedation often plays a key role in patient and provider safety. But what is the best sedative agent? A study looked at control of agitation with intramuscular medication. Specifically, 5 different IM sedative agents were compared to see which one best provides “adequate” sedation in 15 minutes or less. Haldol 5mg, Haldol 10mg, Versed 5mg, Zyprexa 10mg, and Geodon 20mg were all compared, and by far Versed provided the best sedative results. All medications had approximately the same amount of adverse effects. There are so many sedative options, but time and time again large dose benzodiazepines have demonstrated great effectiveness in treating acute agitation References 1) Klein, Lauren R. et al. Intramuscular Midazolam, Olanzapine, Ziprasidone, or Haloperidol for Treating Acute Agitation in the Emergency Department. Annals of Emergency Medicine. 2018. 72(4), 374 - 385   Summarized by Jackson Roos, MS3 | Edited by Erik Verzemnieks, MD

Big pharmaceutical company Eli Lily was hiding the truth about the harms caused by their antipsychotic medication called Zyprexa -- until lawyer Jim Gottstein got a hold of the evidence and shared it with the New York Times.  You will not be surprised to hear that Eli Lily’s lawyers went after Jim hard with criminal charges to destroy his career, his livelihood and his freedom. In my interview with Jim about his personal experience with the mental health system, and his legal career focused on mental health, I ask him why he’s exposing big pharma deceit now in his new book The Zyprexa Papers.  Jim also tells about his personal experience with psychosis when he was over worked and under slept, and woke suddenly one night and thought he was being chased by the devil. Jim threw himself out a 2nd story window to escape. Fortunately, Jim is also skydiver, and knew how to roll his landing without injury. But it was Jim’s lived experience in the mental health system that prepared him for legal battles representing clients about mental health issues. Jim’s lived experience with the mental health system is priceless, adds value to a good legal defense, and cannot be taught in law school.  Jim also tells the story of how he became the lawyer to expose Eli Lily’s lies about the safety of their Zyprexa medication and the impact that had on his life and career. Jim became a leader in the psychiatric survivor community, founding patient organizations including PsychRights.org - and providing his legal services pro bono to clients who didn’t want to be forced to take medications. In The Zyprexa Papers, Jim gives a riveting first-hand account of what really happened, including new details about how a small group of psychiatric survivors spread the Zyprexa Papers on the Internet untraceably. All of this within a gripping, plain-language explanation of complex legal maneuvering and his battles on behalf of Bill Bigley, the psychiatric patient whose ordeal made possible the exposure of the Zyprexa Papers. The Zyprexa Papers included hundreds of internal Eli Lilly documents and emails that showed company officials knew their best-selling drug was severely harming people while scarcely helping anyone. Release of the papers exposed the abuses of the drug industry besides the harm that Zyprexa was doing. The series of front page stories in "The New York Times" could have saved tens of thousands of lives according to Jim's estimate. The public benefits greatly from Jim’s efforts, not only because of the life-saving information he released, but also because he’s a courageous model for other people to follow in exposing the predatory practices in the pharmaceutical industry. SHOW NOTES: 0:06:00 Jim was born in Anchorage Alaska in 1953 - it was a nice place to grow up - he was a pretty normal boy, he got to play little league, walk around town, ride bikes - when Jim was born Anchorage only had about 25,000 people, but now it is close to 400,000 0:07:00 Jim went to the University of Oregon to study business and to get a degree in finance, but one of the required courses was business law, and he didn't miss a question the entire term - he thought it may be a bette fit for him, so he took advanced business law and then decided to go to law school 0:08:00 Jim didn't do well enought in high school to get into any 'good' schools, and wanted to keep his options open by doing well in college - his 1st term was okay with a lot of Bs - Jim decided he had too much free time so increased his number of courses - the next term he got all As with one B 0:09:00 By over loading his courses, he graduated in 3 years - in his last term he needed 10 hours of anything to graduate, so he took 10 hours of teaching sky diving 0:10:00 Jim got his pilot's license when he was 17 - and then went to Harvard for law school 0:11:00 Jim's mom got him a job for lawyer Bob Goldberg, son of Justice Arthur Goldberg who was on the US Supreme Court - Bob had to move to Alaska to escape his father's shadow - Bob represented some of the Native groups 0:12:00 After a few years, Jim opened his own law practice and also decided to run for the State Senate, had traveled to Europe and Israel so was jet lagged and not getting enough sleep and Jim had a psychotic break - Jim had gone to his father's place to sleep but woke at 1am and thought the devil was coming for him - he was on the 2nd floor of the house and looked out the window 0:13:00 Jim thought he could jump far enough to miss the pavement and land on the grass - he jumped out the window and did a rolling landing parachute jump and ran across the street to the school parking lot but thought the devil was still chasing so kept looking over his shoulder - he was put in a straight jacket and hauled off to the Alasks Psychiatric Institute and they pumped him full of something that put him to sleep 0:14:00 Jim has always counted on his mind to accomplish what he set out to do and what was going on - so it was a shock that his mind could become completely unreliable - JIm remembers waking in the hospital and the male nurse asking Jim what day it was 0:15:00 Jim asked how long he'd been asleep - so the nurse noted that Jim wasn't oriented to time - so that was the start of the Alice in Wonderland experience of being in a psychiatric hospital - Jim was given Melaril , he told them he didn't want the psych med thorazine - thorazine was the first of the neuropleptic drugs for people with schizophrenia - it blocks about 80% of the dopamine, so they are basically chemical lobotomies 0:16:00 Jim knew he didn't want to have a 'committed involuntarily' label, so he signed himself in for treatment, but it was hardly voluntary - Jim's fiancee said he was still campaigning in the psych ward, handing out baseball caps, so Jim was pretty out of it - but was doing better and released after 30 days - Jim's not sure the medication did much for him 0:17:00 Jim's father connected Jim with a psychiatrist in New Rochelle, New York and he diagnosed Jim with biploar disorder - but the psych hospital had diagnosed him with atypical psychosis - Jim didn't find that psychiatrist very helpful - then Jim's mother connected him with another psychiatrist, Robert Alberts, who had been a Japanese prisoner of war - Jim says Robert was a wonderful person and told Jim that any one who misses enough sleep will become psychotic - and that Jim needed to manage that - Jim credits Robert with saving Jim from being made permanently mentally health by the mental health system because Jim had that he would never practice law again 0:18:00 When he told hospital staff he'd gone to Harvard law school, that confirmed to them Jim was delusional - Jim didn't accept their conclusion he'd never be able to practice law again, they'd call it 'denial' - Jim says 'denial' of being mental ill is one of the most positive things you can do - because the message of the mental health system is 'abandon all hope ye who enter here' 0:19:00 When in the hospital, they wanted to put Jim on lithium - he said he was a pilot and he couldn't fly if he was taking lithium, but they didn't care about that - so they creatine clearance test to his kidney function because lithium is hard on the liver and Jim's known a number of people killed by lithium - to do the test, they needed a kidnay biopsy, but the doctor couldn't find Jim's kidney's to do the test 0:20:00 Jim finds that work pressure with deadlines - and the habit is to always make the document better and file at the last minute - so Jim tries to file the day before so he doesn't have that sleep problem 0:21:00 Jim knows that if he's not getting enough sleep he can get into trouble, he knows the signs - the first sign is that Jim gets more witty with rejoinders, but nobogy notices except himself - then he'll have 'thought blocking' when he just stops for a few seconds when he's talking (his thoughts are blocked) - the next stage is that Jim thinks people are looking at him funny - he deals with that by telling himself that he's probably not acting funny 0:22:00 Then he'll also try to look at himself from 'above' to see if he's doing anything weird - at that point Jim may take a benzodiazipine (Halcyon) - just to break the cycle and get a nights sleep - it usually only takes 1 pill and then it'll be a year before he needs it again - benzos are highly addictive so its important not to take them daily 0:23:00 The FAA (Federal Aviation Administration) said Jim couldn't fly for 2 days after taking a benzo 0:24:00 Jim got involved in the legal side of mental health simultaneiously with his own psychotic break - in 1956 Congress enacted the Alaska Mental Health Enabling Act and gave a bunch of land for that purpose - later another Act redisgated that land for the state and said they'd maybe pay for it 0:25:00 Jim's mother was head of the Alaska Mental Health at the time and went to Congress and said you can't take this land, that's not legal - they said we don't care - so they sued them and won a billion dollar settlement 0:26:00 Jim found a couple of mental health 'consumer' groups - he was also on the Board of the Alaska Mental Health - then in 2002, Jim read Mad in America, Bad Science, Bad Medicine and the Enduring Mistreatment of the Mentally Ill by Robert Whittaker - to Jim it was a raodmap to challenging forced psychiatric drugging - JIm founded the Law Project for Psychiatric Rights (PsychRights.org) - and it challenged that and shock therapy 0:27:00 PsychRights also educates the public about these medications and shock therapy and their risks - Jim says we shouldn't call ECT (electro convulsive therapy) 'therapy' because it is not 0:28:00 The shock machines were invented in the 50s and have been modified since then - but before the FDA was responsible for regulating medical devices - but they didn't do that for 20 - 30 years - then in the last year they basically said that shock treatment is not harmful and we're not going to regulate them - Jim's says that is outrageous 0:29:00 Just shows how people in psychiatry just don't think - they're running electricity through the brain to cause a grand mal seizure, where neurologists do everything they can to prevent grand mal seizures - the convulsions were so intense people would break bones, bite through their tongue - now they anaesthetize them, but that requires more electricity to cause the convulsion 0:30:00 Dr Peter Breggin has written great psychiatry books - and he says electro shock is really a closed head injury - some people when they get a head injury, become euphoric for a while - but people have horrendous memory loss they don't get back - Jim thinks electro shock should be banned - its barbaric 0:31:00 A court in Conneticut has ordered a woman to be shocked against her will 500 times - that's the thing about psychiatry, 'if something doesn't work, do more of it' - 0:32:00 In November 2006 Jim received a call an expert witness in a massive lawsuit over side effects from the psych med Zyprexa - like diabetes and other metabolic problmes Eli Lily had not owned up to - he said he had documents showing Eli Lily knew from the beginning, hid it from the doctors and they were illegally marketing it to children and the elderly - but he was under a secrecy order - however if he was subpoanaed in another case - he wanted to know if Jim would do that - there's more to the story and that's what is book The Zyprexa Papers is about the New York Times published some articles 0:33:00 The expert witness had also been working with a writer from the New York Times, Alex Berenson - the expert witness gave the documents to Jim - there were a series of front page stories in the NYT and then Eli Lily came after Jim with criminal charges and to the Alaska Bar Association to try to get Jim disbarred 0:34:00 Zyprexa is a 2nd generation neuroleptic medication, also called antipsychotic, but that's just a marketing term - 'neuroleptic' means 'seize the brain' and that is what they do - in the 90s they started atypical neuroleptics which supposedly didn't have negative effects like tardive dyskinesia (results in involuntary, repetitive body movements, which may include grimacing, sticking out the tongue, or smacking the lips) - basically drug induced Parkinson's Disease 0:35:00 It blocks 70 - 90% of dopamine in the basal ganglia, same thing with Parkinson's patients - licking their lips, strange movements - and doctors interpret that in Zyprexa patients as mental illness, not as negative effects of Zyprexa - Eli Lily said this new generation of atypical meds didn't have tardive dyskenesia and that was a lie - another negative effect was neuroliptic malignant syndrome and it is often fatal, and Eli Lily lied about that too 0:36:00 Risperdal causes little boys to grow breasts, called gynecomastia - Seroquel causes problems, like elongates the heart rhythm and that can cause death - they are putting Veterans on Seroquel and another medication and they are dying in their sleep from this drug cocktail - they were prescribed originally for schizophrenia and the manic phase of bipolar disorder - cut in the US a doctor can prescribe any drug for any thing 0:37:00 Pharmaceuticals can only market a drug for a specific illness, but they do it anyway through various guises and artifices, like ghost writing articles, basically huge fraud perpetrated on the public - Dr David Eagleman was the expert witness and had these documents proving Eli Lily's lies and thought the public should know, but he was under a secrecy order 0:38:00 Dr Eagleman was looking for someone to subpeona him and Jim had just won a case for Faith Myers where they wanted to force her to take Zyprexa - Jim had a great witness, Dr Grace Jackson, and she analyzed the papers on which Zyprexa was given approval by the FDA, and she could see it caused diabetes just from that - but not just diabetes 0:39:00 People would gain a 100 pounds in a year - Dr Jackson found the studies were fraudulent - because the meds block dopamine, the first thing the brain does is try to pump out more dopamine - then after a few weeks it grows more dopamine receptors 0:40:00 So abrupt withdrawal causes some people to experience psychosis - but the doctor will say 'see what happens when you're not on medication' - but some people did quite well with the sudden withdrawal, but those people were thrown out of the study 0:41:00 About 2/3 of people in the study dropped out because of the negative effects - so Dr Jackson put all this in a report 0:42:00 Jim shared the documents with the NYT in 2006 and found someone to put them on the internet 0:43:00 Then a group called Psychiatric Survivors got involved - another group Mind Freedom.org with David Oakes, and they also helped get it out - Jim says it was amazing how Eli Lily could whip up Federal Judges to issues orders against Jim without him even being given notice 0:44:00 Psychiatric survivor Eric Weiland had posted them on his website and Eli Lily harassed and threatened him so he took them down - Pat Riser passed away a few years ago probably a result of psych drugging, he wrote the Eli Lilly and said 'geez, I saw these in the NYT and downloaded them and made a few CDs of them and sent them to newspapers and family and friends and went to... 0:45:00 ...handed them out in a shopping plaza parking lot - I didn't know they were illegal and sorry, I'm not going to be able to get them all back' - that's one of Jim's favorite vignettes - but Eli Lily had endless money to fight Jim 0:46:00 Jim testified and the judge ruled Jim conspired to steal the documents and a 'criminal act' and that set up Jim for criminal contempt charges 0:47:00 One of the clients in the case had a Gaurdian, and it was only the Gaurdian who could sign release papers so Jim could look at the client's medical records 0:48:00 Jim did get the medical records and the client had been drugged with Zyuprexa against his will - he was held down and injected with it 0:49:00 Eli Lily had portrayed themselves as the 'victim' in the lawsuit, so going after Jim, and the ensuing publicity, would've make Eli Lily look bad - they could have crushed Jim financially - so it was scary because the consequences could have been severe, including jail time 0:50:00 Zyprexa is still available and still forced - about 3 years ago Jim had financial troubles and had to give up most of the pro bono Pysch Rights work he'd been doing for 14 years and boost his law practice 0:51:00 After a year he had some clients but not a lot, so used his time to write the book - Jim would like the public to be aware because he thinks they'll be shocked by Jim's representation of Bill Bickley and to stop him from being drugged against his will 0:52:00 Jim represented him for 4 years, 10 trials and 5 trips to the Alaska Supreme Court - one of those decisions was an important precedent 0:53:00 Jim's says people are really taken with the 2 chapters on his defence of Bill Bickley and how the system is set up against patients, it is basically a kangaroo court - Bill's wife had divorced him and took custody of the 2 kids and sued him for child support which he couldn't afford - he had a good job as a heavy equipment operator and had a nervous breakdown - so Jim tries to convey how people's lives are ruined by what psychiatry does to them 0:54:00 In 2007, Dr Jackson testified that if Bill was continued to be drugged, he'd be dead within 5 years, and she was off by 6 months - Bill's Gaurdian didn't want Jim representing Bill, because they wanted him drugged - Jim won about half the cases for Bill - the Gaurdian told Jim that Bill didn't want Jim to represent him anymore, and Jim said that he'd never heard Bill say that 0:55:00 The judge asked Bill if he wanted Jim to represent him, and Bill said 'Jim knows a lot about me. And I'm the president." - the Gaurdian changed their tune after that, and said that Bill was not competent to make the decision - while Jim won half of Bill'ls cases, the Public Defendor who lost all but one of the cases - but the Alaska Supreme Court decided that Bill could not choose Jim as his lawyer, and that is a very frightening thing - so they got to drug him without constraint and he died within a couple of years 0:56:00 Jim pointed out to the Gaurdian that these drugs shorten lives, and the Gaurdian argued that quality of life is important - but they didn't care what Bill thought of his quality of life, and it was better without the drugs 0:57:00 One of the reasons Jim wrote the Zyprexa Papers is to bring people's attention - it is available on Amazon in Kindle or paperback 0:58:00 To connect with Jim, go to PsychRights.org and email him through that site 0:59:00 Jim talks to people all the time who had no idea this was going on - 'you can learn from your mistakes, but its better to learn from other people's mistakes' - hopefully he can prevent other people from having this sort of terrible thing happen to them   Twitter: https://twitter.com/jimgottstein   Connect with Jim Gottstein on Facebook: https://www.facebook.com/jim.gottstein   http://psychrights.org/http://gottsteinlaw.com/Author of The Zyprexa Papershttps://www.amazon.com/dp/B0838YYYWV   Be a podcast patron Support Medical Error Interviews on Patreon by becoming a Patron for $2 / month for audio versions.  Premium Patrons get access to video versions of podcasts for $5 / month.   Be my Guest I am always looking for guests to share their medical error experiences so we help bring awareness and make patients safer. If you are a survivor, a victim’s surviving family member, a health care worker, advocate, researcher or policy maker and you would like to share your experiences, please send me an email with a brief description:  RemediesPodcast@gmail.com    Need a Counsellor? Like me, many of my clients at Remedies Counseling have experienced the often devastating effects of medical error. If you need a counsellor for your experience with medical error, or living with a chronic illness(es), I offer online video counseling appointments. **For my health and life balance, I limit my number of counseling clients.**  Email me to learn more or book an appointment:  RemediesOnlineCounseling@gmail.com   Scott Simpson:  Counsellor + Patient Advocate + (former) Triathlete I am a counsellor, patient advocate, and - before I became sick and disabled - a passionate triathlete. Work hard. Train hard. Rest hard. I have been living with HIV since 1998. I was the first person living with HIV to compete at the triathlon world championships. Thanks to research and access to medications, HIV is not a problem in my life. I have been living with ME (myalgic encephalomyelitis) since 2012, and thanks in part to medical error, it is a big problem in my life.   Counseling / Research I first became aware of the ubiquitousness of medical error during a decade of community based research working with the HIV Prevention Lab at Ryerson University, where I co-authored two research papers on a counseling intervention for people living with HIV, here and here.  Patient participants would often report varying degrees of medical neglect, error and harms as part of their counseling sessions.   Patient Advocacy I am co-founder of the ME patient advocacy non-profit Millions Missing Canada, and on the Executive Committee of the Interdisciplinary Canadian Collaborative Myalgic Encephalomyelitis Research Network. I am also a patient advisor for Health Quality Ontario’s Patient and Family Advisory Council, and member of Patients for Patient Safety Canada. Medical Error Interviews podcast and vidcast emerged to give voice to victims, witnesses and participants in this hidden epidemic so we can create change toward a safer health care system.   My golden retriever Gladys is a constant source of love and joy. I hope to be well enough again one day to race triathlons again. Or even shovel the snow off the sidewalk.

A discussion with Attorney Jim Gottstein about the release of the Zyprexa papers which revealed to the public the terrible physical effects of Zyprexa, an antipsychotic medication created and sold by pharmaceutical giant Eli Lilly. The papers revealed that thousands of individuals developed diabetes, gained unusal amounts of weight and/or died and that Lilly knew, suppressed and lied about these so-called side effects of the drug. We will also discuss Jim's efforts to help those individuals diagnosed as mentally ill to fight against forced hospitalizations and treatments that violated their civil and human rights.  Jim's excellent book can be purchased at both Amazon.com and BN.com

Zyprexa, also known as Olanzapine, is a drug typically used to treat mental illnesses such as schizophrenia and bipolar disorder.  I have been on it since I first was put on medication.

EPISODE #327 Anti-Depressants and Mass Shootings Pt. 2 Richard welcomes an expert in serotonergic medications to talk about the possible violent side effects of anti-depressant medications. GUEST: Dr. Ann Blake Tracy is the director of the International Coalition for Drug Awareness. She has specialized for 22 years in adverse reactions to serotonergic medications (Antidepressants such as Prozac, Zoloft, Paxil, Luvox, Effexor, Celexa, Lexapro, Cymbalta, Pristiq, Serzone, Anafranil, etc. and the diet pills Fen-Phen, and Redux and the newer Atypical Anti-psychotic medications such as Zyprexa, Geodon, Abilify, Risperdal, Seroquel, etc.) and has testified before the FDA and congressional subcommittee members on Prozac. She has testified since 1992 as an expert witness in Prozac and other SSRI related court cases around the world. Her first book on the issue was published in 1991. During the last twenty years she has participated in innumerable radio, television, newspaper and magazine interviews on this subject. She is the author of Prozac: Panacea or Pandora?   PLEASE SUPPORT OUR SPONSORS!! C60EVO.COMThe Secret is out about this powerful anti-oxidant. The Purest C60 available is ESS60.  Buy Direct from the SourceUse the Code RS1SPEC for special discount. Ancient Life Oil Organic, Non GMO CBD Oil.  Big Relief in a Little Bottle! The Ferrari of CBD products. Strange Planet's Fullscript Dispensary - an online service offering hundreds of professional supplement brands, personal care items, essential oils, pet care products and much more. Nature Grade, Science Made!   Life Change and Formula 13 Teas  All Organic, No Caffeine, Non GMO!  More Energy!  Order now, use the code 'unlimited' and your first purchase ships for free.

EPISODE #325 Anti-Depressants and Mass Shootings Richard welcomes an expert in serotonergic medications to talk about the possible violent side effects of anti-depressant medications. GUEST: Dr. Ann Blake Tracy is the director of the International Coalition for Drug Awareness. She has specialized for 22 years in adverse reactions to serotonergic medications (Antidepressants such as Prozac, Zoloft, Paxil, Luvox, Effexor, Celexa, Lexapro, Cymbalta, Pristiq, Serzone, Anafranil, etc. and the diet pills Fen-Phen, and Redux and the newer Atypical Anti-psychotic medications such as Zyprexa, Geodon, Abilify, Risperdal, Seroquel, etc.) and has testified before the FDA and congressional subcommittee members on Prozac. She has testified since 1992 as an expert witness in Prozac and other SSRI related court cases around the world. Her first book on the issue was published in 1991. During the last twenty years she has participated in innumerable radio, television, newspaper and magazine interviews on this subject. She is the author of Prozac: Panacea or Pandora? WEBSITES:   PLEASE SUPPORT OUR SPONSORS!! Ancient Life Oil Organic, Non GMO CBD Oil.  Big Relief in a Little Bottle! The Ferrari of CBD products. C60EVO.COM The Secret is out about this powerful anti-oxidant. The Purest C60 available is ESS60.  Buy Direct from the SourceUse the Code RS1SPEC for special discount. Strange Planet's Fullscript Dispensary - an online service offering hundreds of professional supplement brands, personal care items, essential oils, pet care products and much more. Nature Grade, Science Made!   Life Change and Formula 13 Teas  All Organic, No Caffeine, Non GMO!  More Energy!  Order now, use the code 'unlimited' and your first purchase ships for free.

Richard speaks with a court expert witness about the frightening connection between mass shootings and anti-depressant drugs.  In virtually all mass-shootings, the shooters were taking some type of anti-depressant or anti-psychotic medication. GUEST: Ann Blake-Tracy is the director of the International Coalition for Drug Awareness. She has specialized for 22 years in adverse reactions to serotonergic medications (Antidepressants such as Prozac, Zoloft, Paxil, Luvox, Effexor, Celexa, Lexapro, Cymbalta, Pristiq, Serzone, Anafranil, etc. and the diet pills Fen-Phen, and Redux and the newer Atypical Anti-psychotic medications such as Zyprexa, Geodon, Abilify, Risperdal, Seroquel, etc.) and has testified before the FDA and congressional subcommittee members on Prozac. Her first book on the issue, Prozac: Panacea or Pandora? was published in 1991

Alice Washington is an associate at the California Institute for Behavioral Health Solutions. Ms. Washington was awarded a Bachelor’s of Art degree from Stanford University during March of 1988.  Her major was Sociology:  Social Sciences. In the past few years, Ms. Washington has received a Train-the-Trainer Certificate from California State University, Sacramento.  In 2013, Alice completed an A.S. in Graphic Design. She also completed a Diploma in Web Design and Interactive Media in December 2015. Finally, Alice has skills in developing technology-based trainings. Alice has been living with schizophrenia, depression and anxiety since age 27. She has had diabetes for about 6 years during to Zyprexa and obesity.www.facebook.com/alice.washington.125LinkedIn.com/in/alicejographics

FDA Drug Safety Podcast: FDA warns about rare but serious skin reactions with mental health drug olanzapine (Zyprexa, Zyprexa Zydis, Zyprexa Relprevv, and Symbyax)

The post Olanzapine (Zyprexa ) appeared first on NURSING.com.

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Did you or a family member take Risperdal and suffer from diabetes or another blood sugar disorder? If so, you have legal rights and are encouraged to contact Mark & Associates, P.C. today for a FREE legal consultation about your potential case.Eli Lilly, the manufacturer of Zyprexa, another atypical antipsychotic, has already settled with patients due to the risk of diabetes associated with its schizophrenia drug. Mark & Associates, P.C. takes all Risperdal cases on contingency, meaning that there will be NO legal fees unless we win or settle your case. Call 1-866-50-RIGHTS (1-866-507-4448) to speak with a defective drug lawyer at our firm today, or fill out our online case form on youhaverights.com.

Did you or a family member take Risperdal and suffer from diabetes or another blood sugar disorder? If so, you have legal rights and are encouraged to contact Mark & Associates, P.C. today for a FREE legal consultation about your potential case.Eli Lilly, the manufacturer of Zyprexa, another atypical antipsychotic, has already settled with patients due to the risk of diabetes associated with its schizophrenia drug. Mark & Associates, P.C. takes all Risperdal cases on contingency, meaning that there will be NO legal fees unless we win or settle your case. Call 1-866-50-RIGHTS (1-866-507-4448) to speak with a defective drug lawyer at our firm today, or fill out our online case form on youhaverights.com.

Dr. Jeff Brown is a practicing psychiatrist who regularly prescribes Zyprexa. Using the Just Say Know to Prescription Drugs Form we contacted Dr.Brown and asked about the benefits, risks and alternatives of the drug.This segment is both informative as well as a model for how to talk to your doctor about Zxprexa.

The Zyprexa Series began with a simple question. How is it that Zyprexa, which has been linked to more than several deaths, and has paid out settlements of over one billion dollars to people affected by the drug, is still selling briskly and being prescribed everyday? Part one of the Zyprexa series begins with an interview with Ellen Liversidge , who claims that Zyprexa Killed her son.

Anchorage lawyer Jim Gottstein has emerged as a player in a national controversy over the psychiatric medication Zyprexa, which is Eli Lilly's best-selling drug. Jim was an early supporter of the Just Say Know to Prescription Drugs Campaign and he joins us today to explain the legal process that allows the conflict of private and public interests to compromise public safety.

Dr. Simon and Dr. Riccio, summarize the key insights gleaned from the Just Say "Know" to Zyprexa Series and add their commentary and analysis.

Pushing Limits airs the first of a two part series on the mental health care system. Co hosts Leah Gardner and Eddie Ytuarte interview David Oaks, director of Mind Freedom, a national organization dedicated to ending psychiatric abuse and to promoting humane alternatives in mental health care. Mr. Oaks talks about Mind Freedom's legal battle against drug manufacturer Eli Lilly's efforts to block the dissemination of documents about its drug Zyprexa.. Other topics to be discussed will be the globalization of the mental health system, race and gender issues, and beneficial options present in current mental health care. The post Pushing Limits – February 16, 2007 appeared first on KPFA.

Zyprexa manufacturer Eli-Lilly covered up criminal conduct and drug risks, leaked documents show, and is using a court gag order to keep survivor activists, including Freedom Center organizer Will Hall, quiet.   [Read more...]