Metabolic Syndrome

For those who don’t know, metabolic syndrome is the name for the shitstorm of physical ailments that come from long-term use of antipsychotics. Well, that’s not exactly right. Let me quote a real authority, the American Heart Assn.:

The metabolic syndrome is characterized by a group of metabolic risk factors in one person. They include:

* Abdominal obesity (excessive fat tissue in and around the abdomen)
* Atherogenic dyslipidemia (blood fat disorders — high triglycerides, low HDL cholesterol and high LDL cholesterol — that foster plaque buildups in artery walls)
* Elevated blood pressure
* Insulin resistance or glucose intolerance (the body can’t properly use insulin or blood sugar)
* Prothrombotic state (e.g., high fibrinogen or plasminogen activator inhibitor–1 in the blood)
* Proinflammatory state (e.g., elevated C-reactive protein in the blood)

People with the metabolic syndrome are at increased risk of coronary heart disease and other diseases related to plaque buildups in artery walls (e.g., stroke and peripheral vascular disease) and type 2 diabetes.

So yes, it’s not just from psychotropics, but people with severe mental illnesses who take atypicals for more than 10 years are in an extremely high risk group. I’ve seen it too many times to count, and that doesn’t even begin to take into account what happens to a person psychologically when they’re not only overweight, but unable to be active in order to lose that weight.

Today Joe sent me this:

Metabolic monitoring in patients prescribed antipsychotics abysmal

Abysmal. That’s a serious word. From the piece:

Among insured patients newly prescribed second-generation antipsychotics, monitoring of blood glucose and lipid levels falls far short of 2004 American Diabetes Association (ADA) guidelines, researchers report [1].

The guidelines are based on substantial evidence that these drugs can increase risk for cardiovascular disease by affecting lipid and glucose metabolism and body weight.

However, this study showed that by 2006, just over 10% of patients newly prescribed second-generation antipsychotics received lipid monitoring and just over 20% received glucose monitoring.

“These numbers are unacceptably low, given that the ideal level of monitoring should be 100%,” lead author Dr Dan W Haupt (Washington University School of Medicine, St Louis, MO) said.

Joe suggests the following announcement:

Dear Psychiatrist,

You may not be aware that claims that SGAs are safer and more effective then FGAs turned out to be horse hooey. If not, you may have noticed that some of your patients just don’t come around anymore and when you attempt to call them threatening injectables to guarantee medication compliance, you find their phones are no longer in service. Well some of these folks are never coming back …. if you get what I mean. It may have something to do with Metabolic Syndrome.

First, it wasn’t your fault. Heck, you were just relying on what a pharma rep told you over the lunch brought from Panera. (Isn’t their Tomato & Mozzarella on Ciabatta Panini just great?)

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Liz | 6:19 PM | BIG PHARMA, meds

It’s Official: Our Soldiers Need Help

Yesterday I wrote about suicides being on the rise in the military, but that was before the official numbers came in. Now they’re in, and as projected, the news is devastating:

Army Suicides In 2008 Hit Highest Level Ever Recorded [Hartford Courant]

Army suicides at record high, passing civilians [Associated Press]

Here’s an excerpt from the AP article:

At least 128 soldiers committed suicide in 2008, the Army said Thursday. And the final count is likely to be even higher because 15 more suspicious deaths are still being investigated.

“Why do the numbers keep going up? We cannot tell you,” said Army Secretary Pete Geren. “We can tell you that across the Army we’re committed to doing everything we can to address the problem.”

It’s all about pressure and the military approach, said Kim Ruocco, 45, whose Marine husband was an officer and Cobra helicopter pilot who hanged himself in a California hotel room in 2005. That was one month before he was to return to Iraq a second time.

She said her husband, John, had completed 75 missions in Iraq and was struggling with anxiety and depression but felt he’d be letting others down if he sought help and couldn’t return.

“He could be any Marine because he was highly decorated, stable, the guy everyone went to for help,” Ruocco said in a telephone interview. “But the thing is … the culture of the military is to be strong no matter what and not show any weakness.”

It is encouraging to know, however, that the Army plans to take action. From the Hartford Courant:

The first efforts will take place from mid-February to mid-March, when commanders throughout the Army conduct a two- to four-hour “stand down” at which every soldier will be trained to recognize a troubled colleague and effectively intervene.

Army officials said they would also continue efforts to reduce the stigma associated with seeking mental health care, and would work to ease the transition for soldiers returning from war zones. Col. Elspeth Ritchie, the Army’s top psychiatrist, also made an explicit plea for mental health workers to join the military. The Army has tried for more than a year to hire 300 new psychiatrists and psychologists and is still looking to fill about 50 positions.

“Anybody out there who’s interested: We are hiring and we need your help,” Ritchie said.

In a bad economy, it’s nice to know there’s someone hiring.

Liz | 11:08 AM | military

Hair and Gone

I just had to use that headline. Or how about, “Hair Today, Gone Tomorrow”? Or “Hair and Now”? Tara Murtha, I’m looking at you.

Joe writes to us about another pharma boon. He sent me this article, from Time.com. Here’s the part that matters to us:

Many psychiatric drugs have hair loss [side effects]. Prozac has that as a side effect. Almost every one of them, if you read the literature. Unfortunately, the amount of ignorance among physicians in dealing with hair loss is massive, so there are very few doctors who really understand the process and they tend to evade the questions that are posed to them.

Joe was very funny in response:

I guess some marketing wonk could spin this side effect into a benefit, “This medication also saves consumers, who are disproportionately poor, the costs normally associated with hair care thus freeing their funds to enjoy the full life that this medication has long engendered.”

I wish that were a stretch. I really do.

Liz | 3:02 PM | meds, side effects

Took a Day Off, But I’m Back and Pissed Off

The suicide rate among U.S. Army soldiers is at a three-decade high. It could be an all-time high, but stats have only been kept since 1980. The majority of the men and women don’t commit suicide while deployed, but after they come home. A spokesman quoted on NPR said the suicides were primarily the result of failed relationships post-deployment. I’ve never heard anything more ridiculous and ill-informed. By saying something so utterly banal and simplistic, it shields the public from stories of neglect by the V.A. There is an abhorrent inability to appropriately address PTSD in returning soldiers, whether their relationships — if they have them — remain intact or no.

Each suicide has its own contours. From CNN.com:

Suicides for Marines were also up in 2008 …

The numbers did not surprise Kevin Lucey, whose 23-year-old son, Jeffrey M. Lucey — a former Marine — hanged himself on June 22, 2004 — 11 months after returning from Iraq.

The night before, “Jeffrey asked if he could sit in my lap and if we could rock,” Lucey said. “It was about 11:30 at night. And I rocked him for about 45 minutes. Now here you have a 23-year-old, 150-pound Marine that I’m just rocking and his therapist said it was his last gasp. It was his last place for refuge, and then the next time I held him in my lap was when I was taking him down from the rafters. He had put the hose around his neck double-looped and he was dead.”

Lucey maintains his son tried to get help from the VA, but was unable to.

More on the subject from MSNBC:

Liz | 11:17 AM | military

R.I.P. John Updike

I can’t talk about this right now in any depth, because it’s too upsetting. But 76-year-old John Updike, one of the authors I most respect, passed away from lung cancer today. He utterly changed the way I understood language, writing and books when I was a kid. Very sad.

Click here for NYT obit and video interview.

Below is the first story I ever read by him, and the one that had such an impact on me. It’s called “A&P.”

In walks these three girls in nothing but bathing suits. I’m in the third check-out slot, with my back to the door, so I don’t see them until they’re over by the bread. The one that caught my eye first was the one in the plaid green two-piece. She was a chunky kid, with a good tan and a sweet broad soft-looking can with those two crescents of white just under it, where the sun never seems to hit, at the top of the backs of her legs. I stood there with my hand on a box of HiHo crackers trying to remember if I rang it up or not. I ring it up again and the customer starts giving me hell. She’s one of these cash-register-watchers, a witch about fifty with rouge on her cheekbones and no eyebrows, and I knowit made her day to trip me up. She’d been watching cash registers forty years and probably never seen a mistake before.

By the time I got her feathers smoothed and her goodies into a bag — she gives me alittle snort in passing, if she’d been born at the right time they would have burned her over in Salem — by the time I get her on her way the girls had circled around the bread and were coming back, without a pushcart, back my way along the counters, in the aisle between the check-outs and the Special bins. They didn’t even have shoes on. There was this chunky one, with the two-piece — it was bright green and the seams on the bra were still sharp and her belly was still pretty pale so I guessed she just got it (the suit) — there was this one, with one of those chubby berry-faces, the lips all bunched together under her nose, this one, and a tall one, with black hair that hadn’t quite frizzed right, and one of these sunburns right across under the eyes, and a chin that was too long — you know, the kind of girl other girls think is very “striking” and “attractive” but never quite makes it, as they very well know, which is why they like her so much — and then the third one, that wasn’t quite so tall. She was the queen. She kind of led them, the other two peeking around and making their shoulders round. She didn’t look around, not this queen, she just walked straight on slowly, on these long white prima donna legs. She came down a little hard on her heels, as if she didn’t walk in her bare feet that much, putting down her heels and then letting the weight move along to her toes as if she was testing the floor with every step, putting a little deliberate extra action into it. You never know for sure how girls’ minds work (do you really think it’s a mind in there or just a little buzz like a bee in a glassjar?) but you got the idea she had talked the other two into coming in here with her, and now she was showing them how to do it, walk slow and hold yourself straight.

She had on a kind of dirty-pink - - beige maybe, I don’t know — bathing suit with a little nubble all over it and, what got me, the straps were down. They were off her shoulders looped loose around the cool tops of her arms, and I guess as a result the suit had slipped a little on her, so all around the top of the cloth there was this shining rim. If it hadn’t been there you wouldn’t have known there could have been anything whiter than those shoulders. With the straps pushed off, there was nothing between the top of the suit and the top of her head except just her, this clean bare plane of the top of her chest down from the shoulder bones like a dented sheet of metal tilted in the light. I mean, it was more than pretty.

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Liz | 1:41 PM | random

International Holocaust Remembrance Day

And good morning to you, too! To explain why today matters:

In 2005, the United Nations General Assembly designated January 27 as an annual international day of commemoration to honor the victims of the Nazi era. This date marks the anniversary of the liberation of Auschwitz-Birkenau, the largest Nazi death camp. … The U.N. resolution rejects denial of the Holocaust, and condemns discrimination and violence based on religion or ethnicity.

This morning I heard a report on the radio that due to the economic crisis and lack of funds, Auschwitz, which is now an educational site, may have to close. That would be unfortunate.

Interestingly, on this day in 1973, the Vietnam peace pacts were signed. The New York Times‘ Flora Lewis wrote then:

The Vietnam cease-fire agreement was signed here today in eerie silence, without a word or a gesture to express the world’s relief that the years of war were officially ending.

The accord was effective at 7 P.M. Eastern standard time.

Secretary of State William P. Rogers wrote his name 62 times on the documents providing–after 12 years–a settlement of the longest, most divisive foreign war in America’s history.

I wonder what else happened on Jan. 27. We are but specks of dust.

Liz | 10:26 AM | Uncategorized

Irony Alert: “Did Pfizer Just Commit Suicide?”

That’s a headline on Motley Fool. Which is funny, ’cause, you know, Pfizer makes drugs that are supposed to make you happy.

For the post, go here.

Liz | 5:11 PM | BIG PHARMA

Part 1,674,000 on Why It’s Shite to Prescribe Psych Meds to Kids

Okay, I’m not immediately going to follow through on that headline, because I’m reassured by the Washington Post’s jaunty tone:

Hallucinations Are Rare Side Effects of ADHD Medications

The L.A. Times puts it a little differently:

ADHD drugs cause hallucinations in some kids, study says

Here’s Julie Steenhuysen’s Reuters breakdown:

CHICAGO (Reuters) - Drugs for attention deficit hyperactivity disorder can cause children to have hallucinations even when taken as directed, U.S. government researchers said on Monday.

U.S. Food and Drug Administration researchers analyzed data from 49 clinical studies conducted by makers of the drugs and found they can cause psychosis and mania in some patients, including some with no obvious risk factors. In some cases, children hallucinated that worms, bugs or snakes were crawling on them.

“Patients and physicians should be aware of the possibility that psychiatric symptoms consistent with psychosis or mania” might arise in the course of treatment, Dr. Andrew Mosholder and colleagues wrote in the journal Pediatrics.

Their analysis provides fresh detail about known risks of the drugs, which include Novartis AG’s Ritalin and Focalin XR, Shire Plc’s Adderall XR and Daytrana patch, Johnson & Johnson’s Concerta, Eli Lilly and Co’s Strattera and Celltech Pharmaceuticals Inc’s Metadate CD.

It also includes data on Cephalon Inc’s modafinil, sold as Provigil, a narcolepsy drug that was rejected as an ADHD treatment in children.

Liz | 2:07 PM | Uncategorized

Cute Fix: Streaming Kitten Cam

Liz | 12:44 PM | cute fix

D.I.D.: You’re Not Crazy and You’re Not Alone

Liz | 11:54 AM | D.I.D.