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Author Topic: Brian's mental history  (Read 28015 times)
Amy B.
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« Reply #100 on: August 11, 2008, 08:05:55 PM »


there is a lot of misinformed wild speculation going on here and I think it deserves a generalized response.

Heh heh. Misinformed wild speculation is the unofficial name of this and many other boards!  Cheesy

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Fun Is In
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« Reply #101 on: August 12, 2008, 07:25:32 PM »

"name me a psychiatric medication that can permanently "damage" your brain."

If someone takes enough Haldol (or certain other old antipsychotics) they *may* get permanent TD, no?

I'm not saying this relates to BW, not saying he has TD; it's just an answer to your challenge.





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Mark H.
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« Reply #102 on: August 13, 2008, 04:23:28 AM »

Cite me a case. 

Years ago when I was in training we used massive doses of Haldol.  You can't really "overdose" on it.  In some cases you can develop Neuroleptic Malignant Syndrome - usually you die if you get this disorder.  It is idiopathic and not dose dependant or dose related.  Tardive causes strange tremors, movements, vocalizations, etc.  - this is more common and fairly obvious when you see it.  I still use a fair amount of Haldol in patients with terminal delirium/psychosis and for nausea.

Some of the modern atypical antipsychotics have been linked to strokes in th elderly.  They are generally well tolerated and safe in younger patients.

On the other hand, massive doses of street drugs like cocaine and even alcohol have been known to cause brain damage, ie "organic brain syndrome".

Obviously I don't know anything about Brian Wilson's medical history.
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Andrew G. Doe
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« Reply #103 on: August 13, 2008, 10:58:01 AM »

Tardive causes strange tremors, movements, vocalizations, etc.  - this is more common and fairly obvious when you see it.

"Features of the disorder may include grimacing, tongue protrusion, lip smacking, puckering and pursing of the lips, and rapid eye blinking. Rapid movements of the arms, legs, and trunk may also occur. Impaired movements of the fingers may appear as though the patient is playing an invisible guitar or piano."

Sound like anyone most of us know ?
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Mark H.
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« Reply #104 on: August 13, 2008, 06:44:11 PM »

Tardive causes strange tremors, movements, vocalizations, etc.  - this is more common and fairly obvious when you see it.

"Features of the disorder may include grimacing, tongue protrusion, lip smacking, puckering and pursing of the lips, and rapid eye blinking. Rapid movements of the arms, legs, and trunk may also occur. Impaired movements of the fingers may appear as though the patient is playing an invisible guitar or piano."

Sound like anyone most of us know ?

Reading about it and seeing it are two very different animals.  Brian doesn't have TD.
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« Reply #105 on: August 13, 2008, 08:35:48 PM »

Tardive causes strange tremors, movements, vocalizations, etc.  - this is more common and fairly obvious when you see it.

"Features of the disorder may include grimacing, tongue protrusion, lip smacking, puckering and pursing of the lips, and rapid eye blinking. Rapid movements of the arms, legs, and trunk may also occur. Impaired movements of the fingers may appear as though the patient is playing an invisible guitar or piano."

Sound like anyone most of us know ?

Reading about it and seeing it are two very different animals.  Brian doesn't have TD.

But Brian does appear to have some odd movements/facial expressions/tics at times.  I noticed that when he did Larry King some time ago, and have noticed it since in other TV interviews.  Whatever is causing it might be relatively mild compared to what some people suffer from, but it's there, whatever the cause is. 
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« Reply #106 on: August 13, 2008, 08:38:37 PM »

So you're refuting Peter Reum's claims?
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STE
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« Reply #107 on: August 14, 2008, 12:38:15 AM »

Impaired movements of the fingers may appear as though the patient is playing an invisible guitar or piano."

Sound like anyone most of us know ?


Well, not Brian: the piano is there but he doesn't play it..    Grin


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Jay
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« Reply #108 on: August 14, 2008, 01:16:04 AM »

Impaired movements of the fingers may appear as though the patient is playing an invisible guitar or piano."

Sound like anyone most of us know ?


Well, not Brian: the piano is there but he doesn't play it..    Grin



Brian "played" the piano/keyboard on a few TV performances. I remember that Jay Leno was one of them.
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Jay
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« Reply #109 on: August 14, 2008, 01:19:14 AM »

On another note: Isn't a symptom of TD constant movment, and not being able to sit still? There are several examples on YouTube of Brian constantly rocking back and forth during interviews.
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« Reply #110 on: August 14, 2008, 10:23:29 AM »

Cite me a case. 

Cite you a case? I love a challenge and the literature is just LOADED with data.

Haldol has gone more or less generic and isn't given detailed coverage in the most common reference, so I'll direct your attention to the PDR entry for Thiothixene (another antipsychotic) instead. 

They don't list specific case studies or personal experiences of individual physicians but do say specifically, clearly and without reservation that TD caused by their product, Thiothixene, can be permanent, so feel free if need be to now suggest that the manufacturer has included a make-believe permanent serious side effect of their drug....but then you will have to explain away many studies and statments from the medical professionals at NIH and lay groups like NAMI.

This from the NIH: http://www.ninds.nih.gov/disorders/tardive/tardive.htm
What is the prognosis?

Symptoms of tardive dyskinesia may remain long after discontinuation of neuroleptic drugs; however, with careful management, some symptoms may improve and/or disappear with time.

Or that hoary old chestnut, the Merck Manual
http://www.merck.com/pubs/mmanual_ha/sec3/ch30/ch30d.html
Treatment begins with discontinuing the drug or lowering the dose if possible. Sometimes a different drug can be substituted. After the drug is discontinued, symptoms may lessen, sometimes after worsening temporarily. But they may persist.



Studies that include larger numbers of patients, including cases of treatment with Haldol

http://www.ncbi.nlm.nih.gov/pubmed/18332662?ordinalpos=36&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

FINDINGS: Across 12 trials (n = 28 051, age 39.7 years, 59.7% male, 70.9% white, followed for 463 925 person-years), the annualized tardive dyskinesia incidence was 3.9% for second-generation antipsychotics and 5.5% for first-generation antipsychotics. Stratified by age, annual tardive dyskinesia incidence rates were 0.35% with second-generation antipsychotics in children, 2.98% with second-generation antipsychotics versus 7.7% with first-generation antipsychotics (P < 0.0001) in adults, and 5.2% with second-generation antipsychotics versus 5.2% with first-generation antipsychotics (P = 0.865) in the elderly (based almost exclusively on one retrospective cohort study). In four adult studies (n = 2088, age 41.2 years, 71.2% male, 62.0% white), tardive dyskinesia prevalence rates were 13.1% for second-generation antipsychotics, 15.6% for antipsychotic-free patients, and 32.4% for first-generation antipsychotics (P < 0.0001). SUMMARY: Current evidence supports a lower tardive dyskinesia risk for second-generation antipsychotics than for first-generation antipsychotics. Tardive dyskinesia incidence was higher with second-generation antipsychotics than previously reported, possibly due to recent studies with relatively short mean durations and use of nonstandard tardive dyskinesia definitions.

Good enough?

No? OK.

How about this:

http://www.ncbi.nlm.nih.gov/pubmed/18591121?ordinalpos=11&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
where withdrawal of the offending drug resulted in the disappearance of tardive symptoms of 40/100 patients (in other words, tardive symptoms PERSISTED in 60/100 patients AFTER withdrawal of the offending drug).

Or this:
http://www.ncbi.nlm.nih.gov/pubmed/18588359?ordinalpos=12&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

Or this:
http://www.ncbi.nlm.nih.gov/pubmed/18583442?ordinalpos=13&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
where they switched them off Haldol and "improvement" by not remission of TD symptoms.

Or this:
http://www.ncbi.nlm.nih.gov/pubmed/18204344?ordinalpos=48&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

Or from the lay group NAMI
http://www.nami.org/Content/ContentGroups/Helpline1/Tardive_Dyskinesia.htm
TD is often mild and reversible. The percentage of patients who develop severe or irreversible TD is quite low as a proportion of those receiving long-term antipsychotic therapy.

There has never been a definitive, validated and widely accepted treatment for TD. Dozens of drugs have been tested over the past 30 years with mixed results at best. The atypical antipsychotic clozapine has been reported to reverse persistent TD after 6-12 months, possibly through gradual "down-regulation" of supersensitive dopamine D2 receptors. Some preliminary reports suggest that other atypical antipsychotics may also help reverse TD.



So, in summary: there is plenty of published evidence in the commercial literature, the peer reviewed literature and on the internet that contradicts your claim so I say cite me a study that says that NO first generation antipsychotic EVER induces chronic, persitent or permanent TD  and you will win the pissing contest.  Evil


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« Reply #111 on: August 14, 2008, 12:18:16 PM »

So you're refuting Peter Reum's claims?

And doesn't Peter work in the same field ?
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Aegir
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« Reply #112 on: August 14, 2008, 03:17:45 PM »

DoveNest, I find it so hard to understand which parts you wrote there and which parts Mark H. wrote, because they're both inside Mark's quote box.
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Mark H.
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« Reply #113 on: August 14, 2008, 05:00:13 PM »

So you're refuting Peter Reum's claims?

And doesn't Peter work in the same field ?

I'm not debating nor interested in debating Peter Reum.  He's forgotten more about the BB and Brian than I'll ever know.

I'm a physician, I prescribe these medicines all the time, I'm intimately familiar with their efficacy and side effects.  TD is not a subtle diagnosis.  Brian is 60+ years old.  Tremors, Parkinsonian tremors, etc. are very common in elderly who take psychotropics.  The guy is way too functional for someone with TD.  If making a diagnosis was as easy as looking it up on the internet, then I'd be out-of-business.

My last word on the topic.

thanks for your indulgence

http://www.springhillinternalmed.com/

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Fun Is In
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« Reply #114 on: August 14, 2008, 07:20:30 PM »

DoveNest, I find it so hard to understand which parts you wrote there and which parts Mark H. wrote, because they're both inside Mark's quote box.

Sorry, I don't know how that happened. I messed it up somehow. Just the top couple lines were a quote of Mark H.

The rest was my answer to his challenge. What it boils down to is that anecdote doesn't trump peer-reviewed science. Peer-reviewed science currently indicates that some first generation antipsychotics cause TD and in some cases it's permanent.  Dr. H apparently disagrees with the National Institutes of Health and National Institute of Mental Health on this issue. What can you say to that?


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« Reply #115 on: August 14, 2008, 07:25:57 PM »

DoveNest, I find it so hard to understand which parts you wrote there and which parts Mark H. wrote, because they're both inside Mark's quote box.

Sorry, I don't know how that happened. I messed it up somehow. Just the top couple lines were a quote of Mark H.

The rest was my answer to his challenge. What it boils down to is that anecdote doesn't trump peer-reviewed science. Peer-reviewed science currently indicates that some first generation antipsychotics cause TD and in some cases it's permanent.  Dr. H apparently disagrees with the National Institutes of Health and National Institute of Mental Health on this issue. What can you say to that?





Mark, congratulations on your recent Board Certification and thanks for your service to hospice patients. That's damned important work. I mean that sincerely.
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Jay
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« Reply #116 on: August 14, 2008, 08:27:14 PM »

I decided to look up TD on YouTube. I found this clip:
 
http://www.youtube.com/watch?v=rqsKGTBB8Ag&feature=related
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« Reply #117 on: August 14, 2008, 10:01:38 PM »

Aren't there different generational classes of anti-psychotics?  TD is usually associated with the earliest generation of drugs, but there were drugs developed afterwards that are not associated with TD, but do have side effects of their own that are more similar to Parkinsonism (tremors, but not the dramatic movement disorders that TD has).  I read that somewhere, but since I'm indeed not a doctor, I don't remember the details.  It seems more likely that Brian might have been prescribed the latter generation of drugs while with Landy.  By some accounts Landy did prescribe him meds that help control symptoms of Parkinsons at the same time he was taking the psychiatric drugs, and since Brian doesn't have that disease, that might be the reason.  So, Brian does not have TD, maybe instead the tremor-type thing that Mark is describing.  And not that bad; even Peter Reum has said Brian's own doctor's are happy that he has not had side effects that are too bad relative to what they believe he was taking.
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« Reply #118 on: August 14, 2008, 10:17:21 PM »

It's also possible the Brian was displaying TD-like symptoms in the late 80s early 90s but that the removal of Landy and that drug regimen also eliminated those symptoms (the documentation above suggests that TD can diminish once the drugs are gone). We have a lot less footage of Brian from that era then we do of him in the last 10 years.
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« Reply #119 on: August 19, 2008, 07:19:29 PM »

But Brian does appear to have some odd movements/facial expressions/tics at times.  I noticed that when he did Larry King some time ago, and have noticed it since in other TV interviews.  Whatever is causing it might be relatively mild compared to what some people suffer from, but it's there, whatever the cause is. 

Hmm, yeah, and I've always thought his movements in this video (from 1967) were a little odd, especially around the 2:00 mark or so:  http://www.youtube.com/watch?v=dmtHmzwmJf4
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The Heartical Don
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« Reply #120 on: August 20, 2008, 02:23:02 AM »

Call me Ishmael, but after reading this thread I feel like I am a psychiatrist myself.
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