“If you have a drug that makes $5Billion dollars, but then are sued/fined for ammounts of an incredible $4Billion; You still have a Billion dollars…”
Do initial work up/rule out. Dont alter stable pts Rx. Then:
“Cochrane Schizophrenia Group’s register (May 2007) and MEDLINE (September 2007) were conducted for randomized, blinded studies comparing two or more of nine second-generation antipsychotics in the treatment of schizophrenia. 78 study Meta 13.5k patients combined result Tx Positive/Negative/Subscales/Dropout:
1.💊Olanzapine💊 proved superior to aripiprazole, quetiapine, risperidone, and ziprasidone.
2. 💊Risperidone💊 was more efficacious than quetiapine and ziprasidone.
3. 💊Clozapine💊 proved superior to zotepine and, in doses >400 mg/day, to risperidone. These differences were due to improvement in positive symptoms rather than negative symptoms. The results were rather robust with regard to the effects of industry sponsorship, study quality, dosages, and trial duration.” (AmJPsychi 2009)
All data were extracted by at least three reviewers independently. The primary outcome measure was change in total score on the Positive and Negative Syndrome Scale; secondary outcome measures were positive and negative symptom subscores and rate of dropout due to inefficacy. The results were combined in a meta-analysis. Various sensitivity analyses and metaregressions were used to examine bias.
2.1 Inject & Forget Neurolept Anti Psychotics:
2.2 Head To Head Neurolept Anti Psychotics
There were no significant differences between amisulpride and olanzapine (N=701), risperidone (N=291), and ziprasidone (N=122).
Aripiprazole was less efficacious than olanzapine in two studies sponsored by aripiprazole’s manufacturer (N=794, weighted mean difference=5.0, p=0.002). Two further studies found no significant difference compared with risperidone (N=372).
Clozapine was not significantly different from olanzapine (N=619), quetiapine (N=232), risperidone (N=466), and ziprasidone (N=146). Clozapine was significantly more efficacious than zotepine (N=59, weighted mean difference=–6.0, p=0.002). The comparison with risperidone was significantly heterogeneous due to one study sponsored by clozapine’s manufacturer (17) ; excluding the study did not change the overall results.
Olanzapine was significantly more efficacious than aripiprazole (N=794, weighted mean difference=–5.0, p=0.002), quetiapine (N=1,449, weighted mean difference=–3.7, p<0.001), risperidone (N=2,404, weighted mean difference=–1.9, p=0.006), and ziprasidone (N=1,291, weighted mean difference=–8.3, p<0.001). No significant difference between olanzapine and amisulpride (N=701) or clozapine (N=619) emerged.
Quetiapine was significantly less efficacious than olanzapine (N=1,449, weighted mean difference=3.7, p<0.001) and risperidone (N=1,953, weighted mean difference=3.2, p=0.003). There was no significant difference compared with clozapine (N=232) and ziprasidone (N=710).
Risperidone was significantly more efficacious than quetiapine (N=1,953, weighted mean difference=–3.2, p=0.003) and ziprasidone (N=1,016, weighted mean difference=–4.6, p=0.002). It was less efficacious than olanzapine (N=2,404, weighted mean difference=1.9, p=0.006). No difference compared with amisulpride (N=291), aripiprazole (N=372), clozapine (N=466), and sertindole (N=493) emerged.
There was no significant difference between sertindole and risperidone in two studies sponsored by sertindole’s manufacturer, one in treatment-resistant patients, which found results with risperidone to be 7 points better, the other without this criterion finding sertindole 3.5 points better (N=493), leading to significant heterogeneity.
Ziprasidone was less efficacious than olanzapine (N=1,291, weighted mean difference=8.3, p<0.001) and risperidone (N=1,016, weighted mean difference=4.6, p=0.002). No significant differences compared with amisulpride (N=122), clozapine (N=146), and quetiapine (N=710) were found.
Zotepine was less efficacious than clozapine (N=59, weighted mean difference=6.0, p=0.002).
Dosing reference to 10mg oral Dz.
Tramadol is a non poppy derived semi synthetic opioid-esk mu primary tg (tad more complex than that). Most opiates are antag at Mu (& delta/kapha – but also note Op1, Op2 & Op3 have started cropping up as novel receptor names. For whotf knows why). Naloxone is a primary ag at Mu [etal] (ANZCA a2018). GPro rec cAMP cascade interference is the text book key MOA for analgia. Quiet firing down k+ channel block w/some related CA++ voltage gate chnl restriction (inc cardiac AV node impacts…ish). To dose Heroin to equ is difficult because of purity problems, but if that is all you have to mix in for your tea, the schedules may assist. Not that Im advising that: but if pain is chronic and physicians are not assisting – a daily dose of something that does help, vs daily pain, is obviously the better choice. Pity there arent more physicians that first do no harm. I can not believe we are at a place where street dealers may be more reliable than physicians. (UNODC)(Opioid MOA QkRvw)
And this CERTA biz is just puritanical insanity. And of course beyond ridiculous for the out pt. The only sane part is that they all ultimately involve opiates. Of course, if we just started there, no one would be left in pain. The back-flips thru internal reason hoops these young clinicians are doing is just incredible. But multiple Rx via impractical methods, & then an anyxiolytic (& an opiate…just delayed), instead of both effects from just an opiate up-front is where we are at. Until a few physicians & VIPs find out they or their wife had to go through this, & call their cousin the Governor. & call their law firm they just retired from. Because this is truly disgusting.
& inane. Anyway. That emotion is how you know this is a blog. My fav part is “away from symptoms based approach to pain, to a mechanistic” ie instead of asking is the pt in pain, we are now to explain to them why they arent. With charts. Fantastic ignorance of real world science gaps, and more ‘treat theory & numbers, not pts! Never pts!‘. If you can help it – dont touch them, talk to them or look at them.
Just tell them why they are wrong. & that what you did worked – they just dont understand the mechanistic approach to pain. It is their fault, really. Them & their under educated body. I mean, my Gawd. The most charitable thing to say would be it is a cash grab on the back of the opioid deaths. & hope that they do not practice anymore (*fingers crossed). Doesn’t reduce the harm however. But, unless you are screaming in pain, the theory work is fun. & luckily, we just got a double boarded emergency/ emergency-acupuncturist on the code team. So it looks like it is all pain-free & discomfort-free days ahead for everyone being tubed or dying! Heck, everyone everywhere! Everyone has access to 24h acupuncture, surely!
Why did we ever use pills for pain, when we could have been using nerve blocks & acupuncture at the drop of a hat! & ketamine, tricyclics & benzos! Totally reasonable.
More drugs will never be better. We do not understand anything new. Does ANY of that look new? All it looks like is patently incorrect. & anyone who has ever been stung by a bee or stubbed a toe can see that. All we are going to see with this “targeted” gobbledegook are new interactions & more idiosyncratic reactions, fixing a problem that isnt there – I mean clearly, right? Da-doi.
Look at that BS – emergency department level abdo pain out-pt d/c break out pain control “***oral acetaminophen or oral ibuprofen or both***“.
Have a look! That is also what it says for burns; for backpain (youve seen true back pain, with the grown men crying – sound right to you?); neuropathy (!!) (& shill some gabapentin, which does not work); all MSK; renal pain; & SICKLE CELL CRISIS. What a clear break through in targeted pain management.
F**king genius. @ least 711 also has Slurpies.
Forensic Psychiatrist Dr Yolande Lucire, PhD MD: Moral Panic, Drug Reactions & Prescribing Behaviors (Au)
Ethics & Abuse In Human Pharmacological Research (U of Tulsa College of Law)
Joanna Moncrieff: The Chemical Cure Myth – Politics of Psychiatric Drug Treatment
Dr David Healy: The Pharmaceutical Python (Yale Psychiatry)
Ivan Oransky, MD: Fraud & Retractions In Medical Science – (NYU)
Prof of Medicine & Statistics Ioannidis: Medical Research Is Broken (Stanford)
Neuropsychopharmacology Prof David Nutt – The Inconvenient Truth About Drugs – (Imperial College London)
Diagnostic and Therapeutic Controversies – All Faculty (EmergencyMed)
UNM Psychiatry GR: Succeeding With Psychotic Illness Mark Vonnegut, M.D.:
Diagnostic & Medical/Research Error List.
*Ed Nb I
[If Your Pain Is Being Under Managed, Because Your Physician Is Treating You Like A “Drug Seeker” Since The “Opioid Crisis” – Especially In A Single Night Emergency – You May Want To Consider A Law Suit Against The Company+Clinic+Clinician(s): And I Would Never Say That Lightly. But Only Legal Action Early Can Keep This In Check.
95% Of All Patients Were Not “Drug Seekers”, With Doctors Doing Nothing About It Because They Had To Wait To Be Told. We Should Not Be Practicing Medicine, Based On Discrimination And Guesses, At Which 5% *May* Get High – As If True Drug Seekers Won’t Always Find A Way Anyway. The New Guidelines Hurt Only The People They Are Not Targeted At. And Generate Underground Markets That Did Not Previously Exist. Medicine Is Not Policing.
If You Have Launched Any Legal Action, Please Contact The Author With Your Story, Or For Further Information On Class Actions As They Develop. FEB2018].