From: Ian Goddard (Ian@goddard.net)
Date: Wed Dec 08 1999 - 03:42:53 MST
(http://users.erols.com/igoddard/polyrisk.htm)
LOOKING FOR "EARLY SCHIZOPHRENIA" IN CHILDREN
MAY INCREASE RISK OF IATROGENIC POLYPHARMACY
(c) 12/8/99 Ian Williams Goddard
The New York Times (12/7/99) [1] reports that a possible
new psychiatric diagnostic agenda for children may be to
identify "early warning signs" of schizophrenia that are
to be treated with antipsychotic drugs. Research funded
in part by the drug company Eli Lilly is attempting to
see if antipsychotic drugs can reduce the incidence of
full-blown schizophrenia if given to "high-risk" subjects
while they are still children. With the ability to cause
permanent brain damage and disfiguring conditions such as
tardive dyskinesia, antipsychotic drugs, also known as
neuroleptics, are the most harmful psychiatric drugs. [2]
Also of concern regarding an "early schizophrenic" focus
in childhood diagnosis is that the drug Ritalin, which
is being prescribed to millions of children, is known to
produce symptoms that mimic schizophrenia. [3] One drug
study even found that Ritalin "induces a psychopathology
that seems to mimic schizophrenic psychosis more closely
than that induced by amphetamines and cocaine." [4] About
the ability of psychostimulants such as Ritalin to mimic
symptoms of schizophrenia, Peter Breggin, M.D., states:
"All of the stimulants, including Cylert, can cause
psychoses that mimic schizophrenia... These drug-
induced psychoses look so much like schizophrenia
that a strong argument has been made that stimulant
abuse sometimes causes 'chronic schizophrenia.'(43)" [5]
Since doctors often prescribe multiple drugs (polypharmacy),
and since an illness treated by one drug may be caused by
another (iatrogenic polypharmacy), the potential exists that
Ritalin-induced schizophrenia might be treated with even more
dangerous mind-altering drugs. As Breggin observes: "Because
Ritalin is promoted as relatively free of adverse effects,
the development of a severe mental disturbance can be
mistaken for the surfacing of further 'mental illness.'" [6]
The potential for iatrogenic polypharmacy could arise as a
result of any "early schizophrenia treatment" agenda unless
all doctors are aware of all adverse effects of stimulants
and are willing to take a child off them to see if symptoms
subside before they risk prescribing potentially brain-
damaging neuroleptics, and yet psychosis has been reported
during withdrawal from long-term Ritalin use. [7] Chances
are some doctors will drug first and ask questions later.
Quoted below are excerpts from a study that found Ritalin
produced a dose-dependent dysfunction in nonschizophrenics
that "'mimics' schizophrenic psychopathology." The range of
doses in the study intersects Ritalin's therapeutic range.
The study used Ritalin to test a hypothesis about the nature
of an on-set schizophrenic dysfunction. The fact that Ritalin
(methylphenidate) was chosen reflects the fact that it is a
drug of choice for modeling schizophrenic psychopathology.
Here then are important excerpts from that study:
==================================================
Archives of General Psychiatry (1988;45(9):827-32)
==================================================
Methylphenidate-Induced Information Processing
Dysfunction in Nonschizophrenic Patients
David L. Braff, MD, Leighton Huey, MD
Department of Psychiatry, University
of California, San Diego, La Jolla 92093.
"Schizophrenic patients have significant deficits
in a wide range of attentional and information
processing tasks. It is hypothesized that
catecholamine (eg, dopamine) overactivity may
induce and that antipsychotic medications may
reverse these attentional deficits." ...
"This experiment was designed to test whether
systemic administration of the dopamine agonist
methylphenidate hydrochloride [Ritalin], in
nonschizophrenic patients, would induce an
information processing dysfunction similar to
the dysfunction typically seen in schizophrenic
patients in the visual backward masking task."[8]
"These results show that methylphenidate, which
increases central catecholaminergic activity,
induces dose-dependent deficits in information
processing similar to those seen in schizophrenic
patients. ...this experiment used a combination
of psychophysical tasks and pharmacological
probes and is a novel illustration of how
stimulant challenges can induce the type of
information processing dysfunction seen in
schizophrenic spectrum patients." ...
"...the higher dose of methylphenidate induced
significantly more information processing
disruption, indicating a dose-dependant effect
that needs further investigation." [IAN: The
low dose in this study was 0.5 mg/kg, the high
dose was 1 mg/kg, oral. Typical therapeutic
doses of Ritalin range from .3 to .7 mg/kg [9]]
"...we assume that normal humans operate at
a highly efficient threshold level for many
attentional operations, so that even modest
impairments of these critical functions can
result in cognitive or symptomatic impairment.
... In this context, our drug treatment effect
represents a striking, methylphenidate-induced
impairment of the normal mechanisms by which
information is processed in humans." ...
"[M]ethylphenidate, possibly through its aminergic-
enhancing properties, 'mimics' schizophrenic
psychopathology by inducing specific, time-
linked backward visual masking abnormalities."
===================================================
STUDY ABSTRACT: http://www.ncbi.nlm.nih.gov/htbin-
post/Entrez/query?uid=2901251&form=6&db=m&Dopt=b
===================================================
_______________________________________________________
[1] The New York Times: Doctors Try a Bold Move Against
Schizophrenia. By Erica Goode, December 7, 1999.
http://nytimes.com/library/national/science/health/120799hth-behavior-
[2] Should the use of neuroleptics be severely limited?
Peter Breggin, MD: http://breggin.com/neuroleptics.html
[3] Studies cited showing Ritalin can mimic and increase
schizophrenia: http://www.erols.com/igoddard/conyers.htm
[4] Journal of Pharmacology and Experiment Therapeutics:
Inhibition of methylphenidate-induced behaviors in rats:
differences among neuroleptics. Koek W, Colpaert FC 1993
Oct;267(1):181-91.
[5] Talking Back To Ritalin. By Peter R. Breggin, MD.
page 18. The reference cited in the Breggin quote is:
Flaum M., & Schultz S. K. (1996) When does amphetamine-
induced psychosis become schizophrenia? American Journal
of Psychiatry. 153(6), 812-5.
[6] Ibid., page 17. http://www.breggin.com/prbbooks.html
[7] American Journal of Psychiatry: Depression and psychotic
regression following prolonged methylphenidate use and
withdrawal: case report. Rosenfeld AA. 1979 Feb;136(2):226-8.
[8] On Visual Backwards Masking Paradigm Tasking:
http://www.sci.sdsu.edu/CAL/cab.html#BackMask
On Visual Masking Deficits In Schizophrenic Patients:
http://www.appi.org/ajp/dec96/ajp12toc.html#AJPdec96-9
[9] Typical Starting Dosage...of Some ADHD Medications
http://lib-sh.lsumc.edu/fammed/intern/adhdmeds.html
(Web posted: http://www.erols.com/igoddard/polyrisk.htm)
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GODDARD'S JOURNAL: http://users.erols.com/igoddard/journal.htm
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