March 15, 2007

Banging On The Bipolar Child Paradigm, And A Few Interesting Bits On Schizophrenia, Plus Lilly's CEO Says Reps Help Docs ID Zyprexa Candidates

I am glad to see that my colleague CL Psych is slapping around the silly diagnostic criteria of early-onset bipolar disorder, especially its vague cousin bipolar disorder NOS:

"Of course, the upshot to a bipolar diagnosis is that it requires treatment, so should we really be breaking out Zyprexa, Depakote, or Risperdal for Johnny? As the diagnostic criteria become increasingly liberal, medication will be dispensed more frequently to those who need it less or not at all. Yet this passes for scientific progress in some circles. Kids who are now "bipolar" were labeled as having conduct disorder and/or ADHD (or were not given a label--God forbid!) a few years ago, but the bipolar child/adolescent paradigm is now sweeping across parts of the nation despite the rather meager data that this disorder exists to any meaningful degree or that treatment yields much benefit, especially in the longer-term."

Yee haw.

Psych Central has this fascinating item looking into how the common scientific assumption around schizophrenia's prevalence worldwide is now being challenged. I only wish it were good news.

Here, a pharmacist writes about akathisia in patients treated with first and second-generation antipsychotics. Among the atypicals, she only singles out Abilify, but let's face facts: Geodon sucks for this reason. And agitation can happen from taking Risperdal and, less commonly, Seroquel (despite what the company claims in its "paid editorials" in clinical journals). This is one of the few times when Zyprexa doesn't come off badly.

Speaking of dear old olanzapine, Eli Lilly's CEO Sidney Taurel admitted that Zyprexa's sales will likely be flat this year at $4.4 billion or so. And, then, he said:

"'The positioning of the drug is for our sales reps to help physicians identify those patients for whom the efficacy of the drug offsets the potential concern for side effects, and those are, in particular, the urgent patients,' said Taurel."

Sales reps help identify patients? What the fuck? That's the most bizarre thing to say for so many reasons that I won't even get into it. And "urgent?" I've never heard the term used in psychiatry. Is Sid Vicious so out of touch that he's not heard the terms "acute" and "critical" before? Kind of makes me want to buy some Lilly stock so I can show up at a shareholder's meeting one day and heckle Taurel.

If any of my faithful readers at Lilly or at Lilly's two outside law firms want to clarify Sid's point on Lilly's reps, you know where to find me.

Posted by Philip Dawdy at March 15, 2007 12:01 AM
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Hey, I saw one of those phone booth Abilify ads on the Ave in the U District the other day. Sadly I was running late and didn't have time to snap a pic for you.

Posted by: MvB at March 15, 2007 10:01 AM

That's because the word "urgent" is often used in business matters; and "acute" is a psychiatric term.

The CEO clearly runs a business, and cares nothing about who the medication is treating. He has probably never used the term "Gravely disabled" either, in a boardroom meeting.

I have. In a psychiatric board room meeting. My daughter was determined to be "gravely disabled" in April 2006, while on 30 mg. a day of Zyprexa.

Posted by: Stephany at March 15, 2007 10:31 AM

.."pharmacist writes about akathisia in patients.." and from the article:

.."monitoring for unpleasant effects."

It really bugs me when they use the word unpleasant. Try life-altering, crippling, annoying;anything but "unpleasant".

Posted by: Stephany at March 15, 2007 11:20 AM

I agree with Stephany. I don't think the pharmacist really gets it about akathisia. It's a lot more than "unpleasant" -- let's try life threatening. IMO it represents the beginning of serotonin syndrome. The pharmacist says, "If possible" the patient should reduce or stop the offending medication -- and why in heaven's name would it not be possible to stop something that's poisoning you? And "keep taking it if there's no alternative and just medicate the agitation with something else or treat with education." (That's the gist of what she's saying.) Please -- this does not represent a very profound understanding of the seriousness of this phenomenon nor of the best ways to treat psychosis and mania.

Posted by: Sara at March 15, 2007 04:30 PM

I posted earlier, telling of the killing of my son from Zyprexa, and warning Lilly that they'd better not get near me, because I feel violent. Especially after the "secret documents" came out and proved what I knew all a long.

Philip, if I could bear to go to a Lilly meeting, I couldn't restrain myself at heckling. Pandemonium would break out.

Posted by: Martha at March 18, 2007 02:06 PM

Do I detect a value system that prefers "simple" physical restraint over chemical assistance to treatment?

I doubt anyone, including Lilly, would say their methods are highly effective in relieving all patient symptoms or without potential for significant side effects.

Of course we should forget those who suggest the issue lies not with any particular patient but with modern societies. They are correct that from the purely macroscopic statistical view things wouldn't be that different if we returned to the "ideal" days where "madness" was equated with "divine inspiration". Sure modern technology allows a single person having a episode to drive a car through a crowd. Offset that against the historical past where they could add hemlock to the community stew. But that is sociology not psychology.

Posted by: jarhead at March 19, 2007 04:23 PM

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