Study shows placebos as good as antipsychotics for the intellectually disabled.

Study shows placebos as good as antipsychotics for the intellectually disabled.

Joined: April 1st, 2004, 4:56 pm

January 3rd, 2008, 11:40 pm #1

<H1 class="heading entry-title"><FONT size=3>http://www.nature.com/news/2008/080103/full/news.2007.404.html</FONT></H1>
<H1 class="heading entry-title">&nbsp;</H1>
<H1 class="heading entry-title">&nbsp;</H1>
<H1 class="heading entry-title">Cheap drugs against aggression don't work</H1>
<P class=intro>Study shows placebos as good as antipsychotics for the intellectually disabled.

<P class=byline><SPAN class=vcard><SPAN class="author fn">Jennifer Wild </SPAN></SPAN>
<SPAN class=cleardiv><!-- --></SPAN>
<DIV class=entry-content>

Scientists have discovered that taking a sugar pill is more effective than routine medications in treating aggression in people with intellectual disabilities.

Until now, patients with intellectual disabilities have been prescribed antipsychotic drugs — normally given to people with a psychiatric disease like schizophrenia — to treat aggressive behaviour such as head banging. But evidence for the drugs' effectiveness has been thin.

“Antipsychotic drugs are widely used because they are cheap and at high doses they sedate people,” says Eric Emerson at Lancaster University, an expert in the behaviour of intellectually disabled people.

Peter Tyrer, based at Imperial College London, led an international research project looking at 86 people with intellectual disability at clinics across England, Wales and at one centre in Australia. Patients being treated for aggressive behaviour randomly received one of two antipsychotic drugs — respiridone or haloperidol — or a placebo.

These antipsychotics have been used for more than 40 years to treat aggression in people with intellectual disabilities. They block dopamine D2 receptors, which means that people who take them have less dopamine in the limbic pathway, depriving the part of the brain linked to addiction, reward and fear. Dopamine is a key neurotransmitter of arousal.

“The drugs dampen down all behaviours, not just aggression,” says John Taylor, president elect of the British Association for Behavioural and Cognitive Psychotherapies, “with no evidence that they specifically target aggression.” They have many other effects too. “Respiridone and haloperidol are dirty drugs,” says Tyrer, “with lots of side effects like drooling, shaking, seizures, dry mouth, weight gain, skin rashes and so on.”

<H2 class=inlineheading>The drugs don't work</H2>
A careworker who did not know which medication the patients had taken assessed their behaviour against a standard measure of aggression at 4 weeks, 12 weeks, and 26 weeks. Aggression decreased substantially at 4 weeks with all three treatments, with the placebo actually coming out top with a 79% success rate, compared to 58% for respiridone and 65% for haloperidol. At later stages all three treatments had similar effects, they report in the <SPAN class=i>Lancet </SPAN>1.

The results raise concern over the use of antipsychotic drugs in the treatment of aggressive behaviour. People of average intelligence who get aggressive, such as people who suffer extreme road rage or are violent towards their loved ones, receive psychological intervention for their aggression instead of medication. This kind of intervention is more expensive.

Not everyone is convinced the results will stand the test of time. Christopher McDougle, a psychopharmacologist based at the Indiana University School of Medicine, notes that the doses used in the study were very small. The researchers used the doses recommended for initial treatment, but these, McDougle says, are too small to be truly therapeutic for most. He also wants to see longer follow-up periods for the study.
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In the meantime, McDougle has concerns over tightly controlling antipsychotic medications in this group of people. “Good luck trying to treat these people without respiridone or haloperidol,” he says.

Tyrer is now chairing a group for the UK's National Institute of Clinical Excellence, with the aim of drawing up guidelines for treating aggressive behaviour in people with intellectual disability.

His team’s next step will be develop non-pharmacological therapies, which will involve changing the sufferer’s environment to avoid aggression triggers. “This kind of treatment is helpful with antisocial patients,” says Tyrer, “and we think it will be helpful in this group too.”

<UL class=xoxo id=article-refrences>
[*]
<H2 class=heading>References</H2>
<OL>
<LI id=B1><SPAN class=reference-author>Tyrer P.</SPAN> <SPAN class=i>et al. </SPAN>, <SPAN class=reference-publication>Lancet</SPAN>, 371, 57-63 (2008) </LI>[/list]</LI>[/list]</DIV><!-- end .entry-content -->
<H2 class=subheading id=comments>Comments</H2>
<P class=disclaimer>Reader comments are usually moderated after posting. If you find something offensive or inappropriate, you can speed this process by clicking <SPAN class=request-moderation>'Report this comment'</SPAN> (or, if that doesn't work for you, email redesign@nature.com). For more controversial topics, we reserve the right to moderate before comments are published.
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January 3rd, 2008, 11:44 pm #2

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January 3rd, 2008, 11:46 pm #3


Medication used in the study was provided by Janssen-Cilag. The study was supported by Mencap and the National Coordinating Center for Health Technology Assessment.<?XML:NAMESPACE PREFIX = O /><O:P></O:P>
<O:P></O:P>

<TABLE style="BORDER-RIGHT: #8dabbc 1px solid; PADDING-RIGHT: 5px; BORDER-TOP: #8dabbc 1px solid; PADDING-LEFT: 5px; FONT-SIZE: 12px; PADDING-BOTTOM: 5px; BORDER-LEFT: #8dabbc 1px solid; PADDING-TOP: 5px; BORDER-BOTTOM: #8dabbc 1px solid; FONT-FAMILY: arial; BACKGROUND-COLOR: #dbe9f2" cellSpacing=0 hspace="1">
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<TD>The researchers and editorialists reported no conflicts of interest.<O:P></O:P> </TD></TR></TBODY></TABLE>

&nbsp;

http://www.medpagetoday.com/Psychiatry/ ... ry/tb/7849
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January 3rd, 2008, 11:47 pm #4

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January 3rd, 2008, 11:49 pm #5

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January 3rd, 2008, 11:53 pm #6




 

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January 3rd, 2008, 11:56 pm #7

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January 4th, 2008, 9:59 am #8

<H1 class="heading entry-title"><FONT size=3>http://www.nature.com/news/2008/080103/full/news.2007.404.html</FONT></H1>
<H1 class="heading entry-title">&nbsp;</H1>
<H1 class="heading entry-title">&nbsp;</H1>
<H1 class="heading entry-title">Cheap drugs against aggression don't work</H1>
<P class=intro>Study shows placebos as good as antipsychotics for the intellectually disabled.

<P class=byline><SPAN class=vcard><SPAN class="author fn">Jennifer Wild </SPAN></SPAN>
<SPAN class=cleardiv><!-- --></SPAN>
<DIV class=entry-content>

Scientists have discovered that taking a sugar pill is more effective than routine medications in treating aggression in people with intellectual disabilities.

Until now, patients with intellectual disabilities have been prescribed antipsychotic drugs — normally given to people with a psychiatric disease like schizophrenia — to treat aggressive behaviour such as head banging. But evidence for the drugs' effectiveness has been thin.

“Antipsychotic drugs are widely used because they are cheap and at high doses they sedate people,” says Eric Emerson at Lancaster University, an expert in the behaviour of intellectually disabled people.

Peter Tyrer, based at Imperial College London, led an international research project looking at 86 people with intellectual disability at clinics across England, Wales and at one centre in Australia. Patients being treated for aggressive behaviour randomly received one of two antipsychotic drugs — respiridone or haloperidol — or a placebo.

These antipsychotics have been used for more than 40 years to treat aggression in people with intellectual disabilities. They block dopamine D2 receptors, which means that people who take them have less dopamine in the limbic pathway, depriving the part of the brain linked to addiction, reward and fear. Dopamine is a key neurotransmitter of arousal.

“The drugs dampen down all behaviours, not just aggression,” says John Taylor, president elect of the British Association for Behavioural and Cognitive Psychotherapies, “with no evidence that they specifically target aggression.” They have many other effects too. “Respiridone and haloperidol are dirty drugs,” says Tyrer, “with lots of side effects like drooling, shaking, seizures, dry mouth, weight gain, skin rashes and so on.”

<H2 class=inlineheading>The drugs don't work</H2>
A careworker who did not know which medication the patients had taken assessed their behaviour against a standard measure of aggression at 4 weeks, 12 weeks, and 26 weeks. Aggression decreased substantially at 4 weeks with all three treatments, with the placebo actually coming out top with a 79% success rate, compared to 58% for respiridone and 65% for haloperidol. At later stages all three treatments had similar effects, they report in the <SPAN class=i>Lancet </SPAN>1.

The results raise concern over the use of antipsychotic drugs in the treatment of aggressive behaviour. People of average intelligence who get aggressive, such as people who suffer extreme road rage or are violent towards their loved ones, receive psychological intervention for their aggression instead of medication. This kind of intervention is more expensive.

Not everyone is convinced the results will stand the test of time. Christopher McDougle, a psychopharmacologist based at the Indiana University School of Medicine, notes that the doses used in the study were very small. The researchers used the doses recommended for initial treatment, but these, McDougle says, are too small to be truly therapeutic for most. He also wants to see longer follow-up periods for the study.
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In the meantime, McDougle has concerns over tightly controlling antipsychotic medications in this group of people. “Good luck trying to treat these people without respiridone or haloperidol,” he says.

Tyrer is now chairing a group for the UK's National Institute of Clinical Excellence, with the aim of drawing up guidelines for treating aggressive behaviour in people with intellectual disability.

His team’s next step will be develop non-pharmacological therapies, which will involve changing the sufferer’s environment to avoid aggression triggers. “This kind of treatment is helpful with antisocial patients,” says Tyrer, “and we think it will be helpful in this group too.”

<UL class=xoxo id=article-refrences>
[*]
<H2 class=heading>References</H2>
<OL>
<LI id=B1><SPAN class=reference-author>Tyrer P.</SPAN> <SPAN class=i>et al. </SPAN>, <SPAN class=reference-publication>Lancet</SPAN>, 371, 57-63 (2008) </LI>[/list]</LI>[/list]</DIV><!-- end .entry-content -->
<H2 class=subheading id=comments>Comments</H2>
<P class=disclaimer>Reader comments are usually moderated after posting. If you find something offensive or inappropriate, you can speed this process by clicking <SPAN class=request-moderation>'Report this comment'</SPAN> (or, if that doesn't work for you, email redesign@nature.com). For more controversial topics, we reserve the right to moderate before comments are published.
<TABLE cellSpacing=0 cellPadding=0 width=629 border=0>
<TBODY>
<TR>
<TD colSpan=3>
<DIV class=mxb>
</DIV></TD></TR>
<TR>
<TD vAlign=top width=416><FONT size=2><!-- S BO --><!-- S IIMA -->
<TABLE cellSpacing=0 cellPadding=0 width=203 align=right border=0>
<TBODY>
<TR>
<TD>
<DIV><IMG height=152 alt="Mental healthcare patient" hspace=0 src="http://newsimg.bbc.co.uk/media/images/42445000/jpg/_42445517_woman_cred203.jpg" width=203 border=0>
</DIV></TD></TR></TBODY></TABLE><!-- E IIMA --><!-- S SF -->Doctors are being warned not to routinely give people with learning disabilities anti-psychotic drugs to curb aggressive behaviour.
An Imperial College London study of 86 patients found the drugs were no more effective than being given none at all.
Researchers said it was more important to address the underlying causes.
In the UK, 200,000 people with learning disabilities are given anti-psychotic drugs - even though there is a risk of side-effects, the Lancet reported. <!-- E SF -->
These can include risk of weight gain, impotence and strain to the cardiovascular system.
<!-- S IBOX -->
<TABLE cellSpacing=0 cellPadding=0 width=208 align=right border=0>
<TBODY>
<TR>
<TD width=5><IMG height=1 alt="" hspace=0 src="http://newsimg.bbc.co.uk/shared/img/o.gif" width=5 border=0></TD>
<TD class=sibtbg>
<DIV>
</DIV>
<DIV class=mva>
<DIV>Professor Peter Tyrer, lead researcher</DIV></DIV></TD></TR></TBODY></TABLE><!-- E IBOX -->
The team studied patients in 10 inpatient and community settings in England, Wales and Australia.
One group was given haloperidol, a first-generation antipsychotic drug, a second group got risperidone, a second-generation version, while a third received a dummy pill.
Clinical assessments of aggression, aberrant behaviour, quality of life, adverse drug effects and feelings towards their carer were recorded at four, 12 and 26 weeks.
The researchers found that aggression had decreased substantially with all three treatments by week four, but patients receiving the dummy pill had the greatest change.
Improvements were seen with the other measures, but these were similar for all three groups.
Evidence
Lead researcher Professor Peter Tyrer said: "The problem with patients with learning disabilities is that we haven't had the evidence on whether anti-psychotic drugs work.
"Therefore, these patients were assumed to be the same as other mental health patients.
"But what our research shows is that drugs are no better than not giving any drugs. It seems what is important is the care a person receives.
"When people with learning disabilities are aggressive it is important they are given support and people communicate with them."
But he added that there would still be exceptional circumstances where such drugs were necessary.
Dr Jim Kennedy, prescribing spokesman at the Royal College of GPs, agreed.
But he added: "All too often the drugs are used as a chemical restraint. This can be poor practice."
And David Congdon, from the Mencap charity, said: "Anti-psychotic drugs should be seen as a last resort.
"Challenging behaviour is caused by many different factors - an undiagnosed health condition causing extreme pain, frustration at not being able to communicate properly, or boredom due to a lack of meaningful activity.
"All of this can be dealt with without the use of anti-psychotic drugs."<!-- E BO --> </FONT>

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Joined: April 1st, 2004, 4:56 pm

January 4th, 2008, 10:02 am #9

<H1 class="heading entry-title"><FONT size=3>http://www.nature.com/news/2008/080103/full/news.2007.404.html</FONT></H1>
<H1 class="heading entry-title">&nbsp;</H1>
<H1 class="heading entry-title">&nbsp;</H1>
<H1 class="heading entry-title">Cheap drugs against aggression don't work</H1>
<P class=intro>Study shows placebos as good as antipsychotics for the intellectually disabled.

<P class=byline><SPAN class=vcard><SPAN class="author fn">Jennifer Wild </SPAN></SPAN>
<SPAN class=cleardiv><!-- --></SPAN>
<DIV class=entry-content>

Scientists have discovered that taking a sugar pill is more effective than routine medications in treating aggression in people with intellectual disabilities.

Until now, patients with intellectual disabilities have been prescribed antipsychotic drugs — normally given to people with a psychiatric disease like schizophrenia — to treat aggressive behaviour such as head banging. But evidence for the drugs' effectiveness has been thin.

“Antipsychotic drugs are widely used because they are cheap and at high doses they sedate people,” says Eric Emerson at Lancaster University, an expert in the behaviour of intellectually disabled people.

Peter Tyrer, based at Imperial College London, led an international research project looking at 86 people with intellectual disability at clinics across England, Wales and at one centre in Australia. Patients being treated for aggressive behaviour randomly received one of two antipsychotic drugs — respiridone or haloperidol — or a placebo.

These antipsychotics have been used for more than 40 years to treat aggression in people with intellectual disabilities. They block dopamine D2 receptors, which means that people who take them have less dopamine in the limbic pathway, depriving the part of the brain linked to addiction, reward and fear. Dopamine is a key neurotransmitter of arousal.

“The drugs dampen down all behaviours, not just aggression,” says John Taylor, president elect of the British Association for Behavioural and Cognitive Psychotherapies, “with no evidence that they specifically target aggression.” They have many other effects too. “Respiridone and haloperidol are dirty drugs,” says Tyrer, “with lots of side effects like drooling, shaking, seizures, dry mouth, weight gain, skin rashes and so on.”

<H2 class=inlineheading>The drugs don't work</H2>
A careworker who did not know which medication the patients had taken assessed their behaviour against a standard measure of aggression at 4 weeks, 12 weeks, and 26 weeks. Aggression decreased substantially at 4 weeks with all three treatments, with the placebo actually coming out top with a 79% success rate, compared to 58% for respiridone and 65% for haloperidol. At later stages all three treatments had similar effects, they report in the <SPAN class=i>Lancet </SPAN>1.

The results raise concern over the use of antipsychotic drugs in the treatment of aggressive behaviour. People of average intelligence who get aggressive, such as people who suffer extreme road rage or are violent towards their loved ones, receive psychological intervention for their aggression instead of medication. This kind of intervention is more expensive.

Not everyone is convinced the results will stand the test of time. Christopher McDougle, a psychopharmacologist based at the Indiana University School of Medicine, notes that the doses used in the study were very small. The researchers used the doses recommended for initial treatment, but these, McDougle says, are too small to be truly therapeutic for most. He also wants to see longer follow-up periods for the study.
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In the meantime, McDougle has concerns over tightly controlling antipsychotic medications in this group of people. “Good luck trying to treat these people without respiridone or haloperidol,” he says.

Tyrer is now chairing a group for the UK's National Institute of Clinical Excellence, with the aim of drawing up guidelines for treating aggressive behaviour in people with intellectual disability.

His team’s next step will be develop non-pharmacological therapies, which will involve changing the sufferer’s environment to avoid aggression triggers. “This kind of treatment is helpful with antisocial patients,” says Tyrer, “and we think it will be helpful in this group too.”

<UL class=xoxo id=article-refrences>
[*]
<H2 class=heading>References</H2>
<OL>
<LI id=B1><SPAN class=reference-author>Tyrer P.</SPAN> <SPAN class=i>et al. </SPAN>, <SPAN class=reference-publication>Lancet</SPAN>, 371, 57-63 (2008) </LI>[/list]</LI>[/list]</DIV><!-- end .entry-content -->
<H2 class=subheading id=comments>Comments</H2>
<P class=disclaimer>Reader comments are usually moderated after posting. If you find something offensive or inappropriate, you can speed this process by clicking <SPAN class=request-moderation>'Report this comment'</SPAN> (or, if that doesn't work for you, email redesign@nature.com). For more controversial topics, we reserve the right to moderate before comments are published.
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Joined: April 1st, 2004, 4:56 pm

January 4th, 2008, 10:03 am #10

6. HOW THE DRUGS PROBABLY WORK
Too much dopamine activity seems to produce the symptoms of schizophrenia and psychosis. Correcting the effect of having too much dopamine should thus help to reduce the symptoms. One way of doing this is the block the dopamine receptors i.e. jam some of them up so they don't work and can't pass too many messages. This is just what antipsychotics do. They block dopamine receptors, to a greater or lesser extent.

<TABLE cellSpacing=8 cellPadding=0 width="100%">
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"Normal" communication
<IMG height=264 src="http://www.nmhct.nhs.uk/pharmacy/images/NORMSCH.JPG" width=565>
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"Excess" communication e.g. as in psychosis
<IMG height=264 src="http://www.nmhct.nhs.uk/pharmacy/images/PSYCHOS1.JPG" width=565>
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"Excess" communication but with receptors blocked, and reduced messages passes
<IMG height=264 src="http://www.nmhct.nhs.uk/pharmacy/images/ANTIPSY.JPG" width=565>
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The important thing to remember is that antipsychotics probably mainly work by reducing the effect of having too much dopamine. They are NOT JUST TRANQUILLISERS, although they may help you to feel calmer. They have a much more specific way of working than just sedating you.

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