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Global Recognition Campaign for Multiple Chemical Sensitivity |
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| Mark Thompson's Story |
| Toxic Psychiatry Pharmaceuticals | |
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Helen Thompson Dubbo 2830 NSW Australia Email: helent007@yahoo.com.au February 2007 My name is Helen Thompson. I live in Dubbo, a regional centre in country New South Wales, Australia. I have a 26 year old son, Mark, who has been diagnosed with schizophrenia. He is currently an involuntary patient in an acute in-patient facility in Dubbo. Mark's contact with the mental health system here goes back about 10 years. The reason I am writing to you is that I am currently, and have been for a long time, challenging the mental health system here. I have engaged the services of both sfsfsf a litigation lawyer in Australian Capital Territory, and hghghg a criminal barrister in New South Wales. I have read Dr Peter Breggin's books Toxic Psychiatry', The Anti-Depressant Fact Book' and 'Your Drug May Be Your Problem' and, unfortunately, I can attest to everything that Dr Breggin talks about in vivid and horrid reality. I am thankful for Dr Breggin's brilliant work and I would be especially grateful if he could assist me in my ongoing bid to help my son who has been caught up in what I believe (and indeed what others believe) is both an arcane and Dickensian mental health system. As an example, if you make any type of complaint about the psychiatric drugs being administered to your loved one, the system can take your loved one and place him under the authority of a state Guardianship Board where after you have no say whatsoever as to the type or nature of care or treatment to be administered. This, in fact, is what happened to my son Mark. In 2000, I approached the New South Wales Supreme Court, Sydney, in an attempt to halt the electric shock treatment that was being administered to Mark. Although I was refused any information relating to Mark's electric shock treatment, I eventually learned that, within a seven week period, Mark had undergone 21 bouts of electric shocks. Mark fled the in-patient facility where he was being held following this electric shock treatment, communicated in complete gibberish for about two months and it was as this time, the first time, that Mark did not acknowledge me as his mother because he believed (falsely) that he was adopted. As one of the physical effects of Mark's electric shock treatment, he was burnt through to the flesh on two of four burns on his abdomen. Despite my earnestness to stop the electric shock treatment, as I was novice to the legal system at that time, I was frightened out of the court with the risk of costs being ordered against me. Eventually hghghg the barrister, successfully extricated Mark from the Guardianship Board's control. However, by this time, Mark's mental, emotional, social and physical condition was absolutely devastated. In February 2003, I returned to the New South Wales Supreme Court to ask the judge for help. Because Mark had previously run away, as the doctors wanted to experiment with Clozapine (which Mark had previously had and which made him very physically ill), the judge requested, rather than ordered, that the hospital allow different doctors and alternative treatment to psychiatric drugs. Despite the judge's request, the New South Wales hospitals remained intractable and would not accede to the judge's request. So, in April 2004,1 filed a Prosecutor's Summons, No 10578/03 in the Criminal Court, against the Minister for Health but this was struck out as I was supposedly in the wrong court and this, despite three High Court judges approving of the filing of the Summons in that court. Mark has had three doctors' reports and, since then Mark has been also tested by Dr bwbwbw of USA when he was out in Australia. At the end of 2005 and again in January 2006, Mark ran away from Bloomfield Hospital, Orange (a large mental health hospital facility) for about the 15th time: This psychotic and confused young man boarded a train and traveled to Sydney for the first time. For the next few weeks, Mark then traveled on a daily, five hour round trip to see Dr ylylylyl a forensic psychiatrist, who tried to gradually take Mark off Seroquel. Whilst undergoing this process, Mark lived in a caravan park some hours away from Dr ylylylyl rooms. At this time family members were unable to help, for when Mark is on Seroquel, he believes he is a criminal and that his own family members are impostors. Of course, without the proper support and security that he needed at the time, Mark's own desperate but valiant attempt to come off Seroquel was unsuccessful. Dr ylylylyl is currently writing a report on Mark's situation and the Consultant Pharmacist, has also written up a report based on all the files from all hospitals to which Mark has been admitted over the time. With help, I have tried on at least 10 to 15 occasions to dry Mark out slowly. However, inadvertently, Mark ends up going 'cold turkey' because he would typically end up running away to withdraw from psychiatric drugs. However, this does not work either, as the damage appears to be so bad, at least not while walking the Australian roads, often in temperatures of 100-105 degrees F or 36-42 degrees C. During these times Mark has lived in the bush, rolled in the mud in dams, lived in hay sheds etc. and under the house, as he seems to hate his family. The longest we lasted was seven months when Mark was finally picked up by police wandering unsafely (they say) on the roads. I should point out that Mark was born toxic-sensitive and with many allergies to food, chemical pesticides and pollens. In his early years he was required to wear a mask with a filter on his back to filter air. He also had severe asthma and eczema. Before this horror journey began over 10 years ago, Mark was a brilliant athlete, top basketball player, very bright student (in the top 1%) and a happy go-lucky teenager when we simply asked for help with a bad reaction that Mark had to some street drugs which he was tricked into taking while on a school camp. When a Dr knknknkn gave him amitriptyline Mark could not even manage to get out of bed. I'd pull him up and he would simply fall back down. As we live in the country, we had our consultation by satellite dish with the doctor in Sydney. I rang this doctor 15 times and he never answered. He was then head of the Children's Hospital. So, since that time, Mark has been either locked up in psychiatric wards or trying desperately to dry out from psychiatric drugs while walking aimlessly along roadsides: In other words, Mark, a normally sensitive and gentle young man, has endured 10 years of mental, emotional and physical trauma and torture. I don't know if anyone has ever attempted - let alone attempted successfully - to sue pharmaceutical companies from Australia. But as I desperately need big help, and if there is even the slimmest chance in changing the status quo, then it is only with the brilliant expertise of Dr Breggin that this can happen. I recognize that the challenges loom large and that the outcomes may not fulfil my own wishes or expectations but I am resolved to doing everything within my power to help my son who has become a hapless victim of our parlous mental health system. To give you a bit more background to Mark's clinical history and profile, I attach separate sheets setting out that detail. PLEA FOR HELP: If there are any Queens Counsels, Barristers, Solicitors/Lawyers and anyone who can help also help financially, please contact me to commence a “Free & Detox Mark Campaign”. I want my son back after almost 11 years, please help me to free my son from the Psychiatry & Pharmaceutical Industry and detox him under Protocol of Environmental Medicine. Short extract of Mark's clinical history and profile: (Note, Mark never wanted these drugs. They were all administered against his will. The following are the side effects I observed, but because his doctors would never tell me what medication he was on when he did speak, Mark was able to tell me some of them) Always over-drugged in a zombie-like state Rag doll appearance Lock jaw Horrible shakes down one side Never talks except when he has to (this was one reason he was given electric shocks) A few exceptions - once when I believe he was on Seroquel and probably because he was so frightened that he told me he thought he was responsible for the deaths of people of whose funerals he was taken to when only four years old. At the same time he escaped hospital to go to the police to ask for his criminal record of which he has absolutely none. This was torture for me to watch someone so frightened. Once he was very badly contorted, worse than any spastic person I had ever seen. This same day at a Tribunal Hearing when I simply brought up the fact that Mark's nose and ear were moving involuntarily, I was threatened with removal. Falling backwards while walking (on Clozapine at the time) - also very sick in the stomach, lying on the ground. Very angry most times but unable to express this outwardly Agitated (on Clozapine) Eyes rolling back in head Smacking lips together Pulling out his hair Found him huddled in the corner of a locked room Swollen eyelids, changed shape of face, can't sleep, up walking around at night Paranoia (eg burned down a 3-car garage with his brother's car inside the garage. He thought that the car was chasing him.) Irrational thinking, extremely fearful Anti-social, sits alone in dark rooms The following are the neuroleptic drugs which Mark has been on and their side effects. 1996 Dec Amitriptyline • Sleepy • Could not get out of bed • Had to pull him up, but would fall back down • Rang doctor in Sydney 15 times to no avail • Took Mark off this drug, and after removing Mark from home, the Mental Health Services took over and put him back on it • Mark was unconscious which we thought was due to street drugs at the time 1997 Feb-Apr Mark agreed to go to dry out at South Pacific Hospital near Sydney. Not successful at this stage (didn't know about withdrawal). • Back home and back to school and his job at supermarket store 1997 Oct Taken by father to police station for slapping his father on face (this gave easy excuse for Mental Health Services to have Mark locked up) Mark taken to Bloomfield psychiatric hospital and very heavily drugged Zuclopenthixol injection (+ Diazepam, Haloperidol benztropine, Chlorp-romazine) • Horrific • Rag doll appearance • Lock jaw • Dribbling • Mark discharged on basis that his problem was only behavioural and that I (the mother) was the problem • Mark returned to school and promptly expelled because he looked totally scary to other kids. He was so frightened and could not sleep. He did not know what was wrong with him. Now under Guardianship 1998 Feb Westmead Children's Hospital Haloperidol, Flupenthixol (20mg every two weeks), Benztropine, Risperidone Zoloft: • No benefit • Horrific shakes down one side of body - unable to hold onto a pen to write with • Starving hungry when we got to see him; other times he is too unwell to eat properly and often only eats food from a sealed tin • Extremely stiff, rigid gait • Ran away, on withdrawal very angry and violent, runs away • When he runs away (often covering very long distances), he is regularly picked up by police in a disheveled state 1999 Jan Tried to commit suicide Olanzapine, Effexor (Venlafaxine), Clopixol accuphase, Seroquel, Solian: • No benefit • Put on 30kg • Slept most of the day and ate poorly (chips etc) 2007 *Clozapine in 2007 for second time - locked up. At times when Mark has been in various stages of withdrawal, he would: • Remove his clothing (this lasted different lengths of time depending on amount of medication) • Lock himself in a room • Light fires in rooms • Live in a room amongst his own faeces • Stand and stare blankly into space for long periods • Lie in the sun in extreme conditions (once for three hours) (Please see section from a Consultant Pharmacist, on her review of Mark's hospital files.) (name removed) (contact details) Consultant Pharmacist removed BiPhann, BHA, Giad Dip On F>hatm FSHPA, FACPP, Grad Conversion Cw»se June 26, 2006 Re:Mark Thompson (MT ) DOB 1980 Issue: Medications 1996 - present Amitriptyline is one of the more sedating tricyclics. It may be 2-4 weeks before any antidepressant effect is seen. Amitriptyline should be withdrawn gradually to reduce the risk of withdrawal symptoms. It is relevant to note that at this time MT was only 17 years of age. It is noted that that adolescents (and elderly patients) often have reduced tolerance to tricyclic antidepressants and initial doses of 25 -75mg daily are licensed in these groups (Martindale p285) The British National Formulary (BNF) suggests a minimum initial dose of 30mg daily.MT's initial dose of amitriptyline was 50mg daily. In 1998 MT was admitted to Westmead Hospital (25/2/19981 On this admission he was experiencing EPSE from high dose neuroleptic medication (Flupenthixol /!0mg every 2 weeks) Flupenthixol is conventional antipsychotic (like zuclopenthixol) and is used in the treatment of chronic psychoses. The typical dose ranges from 20-40mg every 2-4 weeks and the onset of action of flupenthixol are 1-3 days On this admission MT was experiencing significant EPSE however despite this haloperidol 10mg bd was added - haloperidol is the most EPSE producing neuroleptic and the addition of haloperidol would have greatly exacerbated the EPSE. The addition of haloperidol led to severe tremor and stiffness. 10mg twice daily (20mg daily) is a large dose. On 3/3/1998, the dose of haloperidol was decreased to 15mg. MT had neck stiffness rigidity and tremor.These symptoms are side effects from the conventional neuroleptics. During this admission, it appears that there was a lack of concern by the medical staff with respect to his blood sugar levels and allergy free diet as well as nutritional supplementation.Any consideration of" alternative " treatment i.e orthomolecular treatment was not entertained by medical staff. To minimise the effects of EPSE benztropine 2mg was added. On 17/03/1998 sertraline (Zoloffl was commenced by Dr L N -psychiatric registrar at Westmead Hospital. The dose was initially 50mg and then increased to 100mg in the morning approximately 1 week later -this was a dose escalation that was far too rapid and likely to have adverse effects for MT. At the time of the dose increase, it is documented that he assaulted a member of the nursing staff. This could have been as a result of the effects of serotonin i.e SS. Sertraline was prescribed in addition to haloperidol and benztropine. The combination of haloperidol with benztropine can result in heat stroke, which can be fatal, because the interference with the heat regulatory system of the body. Both haloperidol and benztropine have anticholinergic side effects. Therefore symptoms of central anticholinergic psychosis -namely short term memory problems, anxiety and visual and auditory hallucinations can develop with an anticholinergic combination. This can be confused with the basic psychotic symptoms of the patient. Later in March, the haloperidol was changed to risperidone an atypical antipsychotic (see below for more information about risperidone) Sertraline (Zoloft) is a Selective Serotonin Reuptake Inhibitor. (SSRI) He was also concurrently taking benztropine for EPSE and haloperidol Drugs which are metabolised in the liver by the Cytochrome P450 system are subject to considerable interactions. In addition the isoenzyme CYP2D6 shows genetic polymorphism and a small percentage of the population has absent or nonfunctional CYP2D6 (as well as 2B6, 2C9, 2C19) which means that toxicity develops. It is not known which individuals will show this genetic polymorphism but it can be postulated that those individuals who develop serious adverse effects from drugs may have this problem. From MT's medication history, it is apparent that various neuroleptic drugs were repeatedly trialled but were ceased because of adverse drug effects. On 25/3/1998 MT was on Sertraline 100mg m (a large dose) Benztropine 2mg twice daily (For EPSE) Haloperidol was changed to risperidone 2mg twice daily for 3 doses then 2mg in the morning and 3mg at night then 3mg twice daily It is unsure from he clinical history whether there was a washout period between the two-drug haloperidol and risperidone. Risperidone can also cause EPSE but generally not to the same extent as haloperidol. Bloomfield Hospital Admission 23/472000 - 8/6/2000 During this admission venlafaxine 75mg was again commenced in combination with olanzapine 10mg daily and with benztropine and zuclopenthixol 150mg (Clopixol accuphase) Presumably MT had been non compliant with his oral medications after the previous admission to Bloomfield (approximately a 6 week period) If these drugs had not been tapered very slowly during that period any abrupt stopping of olanzapine and venlafaxine would have caused abrupt withdrawal symptoms such as akathisia and toxic delirium. The treatment with zuclopenthixol (Clopixol Accuphase) during that period was: 23/4/2000 150mg 24/4/2000 150mg 26/4/2000 200mg 1/5/2000 100mg accuphase together with 200mg depot (which is standard treatment) The Australian Medicines Handbook (AMH) 2006 recommends for acute psychosis 50-150mg accuphase every 2-3 days up to 400mg per course (up to four doses)- MT had 500mg every 1-2 days. Sedation with Clopixol Accuphase is maximal 12 hours after injection and may last up to 3 days. During this admission, the dose of venlafaxine was commenced on 24/4/2000 on 75mg XR. This dose was doubled 48 hours later to 150mg daily. This is rapid dose escalation and this rapid dose escalation can result in the development of Serotonin Syndrome (see above). The combination of venlafaxine and olanzapine ( both serotonergic drugs ) was maintained throughout this admission until 8/6/2000. Bloomfield 27/6/2000-6/9/2000 Presumably MT was non-compliant with his medications after discharge and therefore again was suffering from the abrupt stopping of olanzapine and venlafaxine. Again zuclopenthixol (Ciopixol Accuphase was given) 1/7/2000 150mg 6/7/2000 200mg 12/7/2000 10Omg - a total course dose of 450mg of zuclopenthixol (more than the maximum 400mg recommended) Dr C prescribed haloperidol (Serenace) 20mg twice daily although MT had shown severe EPSE in the past to haloperidol and he was already on a conventional antipsychotic zuclopenthixol. MT refused the haloperidol. MT was discharged 6/9/2000 on nil regular oral medications but with the treatment order of zuclopenthixol (Clopixol) depot 400mg every 2 weeks. This according to the AMH 2006 is the maximum dose - AMH recommends for chronic psychoses 200-400mg every 2-4 weeks. Bloomfield 6/9/2000-16/11/2000 ECT was administered during this period. MT was 19 years old. The plan was for 12 ECTS over three weeks Gold Coast Admission 29/5/1998-31/7/1998 MT was given zuclopenthixol (Clopixol Depot) 200mg every 3 weeks because of refusal to take oral medications namely olanzapine (Zyprexa). EPSE was still a problem. During this period in the acute psychotic period a variety of different drugs were given to MT on a "prn" or as necessary basis including haloperidol, clonazepam - a benzodiazepine used to control agitation; benztropine (Cogentin) to control EPSE. This prn medication regimen is common in the acute psychotic phase. However, additional haloperidol would have exacerbated MT's EPSE Bloomfield 14/1/2000-8/3/2000 ^ Prior to this admission MT was non compliant with his medications and therefore probably going through withdrawal effects because of abrupt discontinuation. Then on 5/1/00 the olanzapine (Zyprexa) was increased to 20mg as well as concurrent flupenthixol depot 2 weekly. During this admission flupenthixol (Fluanxol Depot) was administered to MT. Flupenthixol is very similar to zuclopenthixol (Clopixol Depot). Fluanxol depot has an onset of action of 1 -3 days. Concurrently olanzapine (Zyprexa) was given. In addition, zuclopenthixol (Clopixol accuphase) was given on 15/1/2000. Also during this admission venlafaxine (Efexor) was commenced. *Page12 • June 26,2006 Olanzapine is metabolised by the liver through the Cytochrome P450 System CYP1A2 and to a lesser extent by CYP2D6. Doses for schizophrenia are usually in the order of 10-15mg daily The safety of doses above 20mg daily has not been evaluated in clinical trials. • Page 14 • June 26,2006 Lismore Base Hospital 12/12/2000-21/12/2000 MT was again given zuclopenthixol 400mg(Clopixol Depot) - it is noted that he was overdue for his Clopixol depot which was last given 26/10/2000. MT was discharged on zuclopenthixol Lismore Base Hospital 16/7/2001 -20/7/2001 MT had ECT during this admission From the records it is unclear what had happened to MT in the preceding 6 months. MT was commenced on olanzapine 10mg by injection and also given zuclopenthixol depot 400mg (Clopixol) on 17/7/2001 and zuclopenthixol ( Clopixol accuphase ) 150mg on 18/7/2001 During the admission quetiapine (Seroquel) another atypical antipsychotic was commenced (at a dose of 10Omg twice daily) Quetiapine is more sedating than the other atypical antipsychotics but generally has much the same adverse effects as risperidone and olanzapine. Weight gain is a common side effect often with the elevation of blood sugars. It must be given twice daily (half-life of 6-7 hours) so it poses a real problem with respect to compliance. Patients should have an eye examination to detect cataract formation when starting treatment with quetiapine and every 6 months during treatment. Again Cytochrome P450 - 3A4 is responsible for the metabolism of quetiapine. Gold Coast Hospital 21/7/2001 -17/8/2001 During this admission, MT was commenced on risperidone - although this had been trialled earlier. He was also given benztropine regularly (for EPSE) Risperidone does cause EPSE. The dose of risperidone was 4mg and MT was discharged on this dose During this admission, MT was tachycardic (Pulse rate 120) . Tachycardia is a symptom ofSS. St Vincent's Hospital Robina Admission 17/8/2001-25/10/2001 Zuclopenthixol 150mg (Clopixol Accuphase) was given on 20/8/2001. He was also taking risperidone 7mg daily'(a large dose) and haloperidol (Haldol) depot 150mg on 21/8/2001 -onset of action of Haldol depot is 2-4 days. The usual range of risperidone is 4-6mg - daily doses of > 4mg increase the risk of EPSE. MT already suffers from the effects of EPSE and haloperidol (the most EPSE producing conventional antipsychotic) will exacerbate EPSE Chlorpromazine 100mg three times daily was given to MT on 17/9/2001 and 19/9/2001 presumably for agitation. Chlorpromazine is an effective agent which is used to treat symptoms of SS (Dr Isbister-toxicologist - lecture to SHPA June 2006) On 11/11/2002, it is documented that MT was on 10mg risperidone daily - a very large dose and then MT stopped the risperidone and was not currently smoking. • Page 15 . June 26,2006 Bloomfield 14/11/2001-8/8/2002 Dr B commenced MT on risperidone ( despite the fact that it had been previously trialled) On 15/11/2001 risperidone 1mg at night. On16/112001 2mg at night. On17/11/2001 3mg at night and then MT refused to take risperidone - presumably because the risperidone made him feel worse rather than better. Zuclopenthixol (Clopixol Accuphase) was commenced and later 23/11/2001 zuclopenthixol (Clopixol depot) was commenced MT was kept in a Special Care Unit An attempt was made to commence clozapine but MT refused to take it. A Parkinsonian tremor was noted. On 27/12/2001, MT is taking zuclopenthixol (Clopixol Depot) SOOmg fortnightly as well as benztropine 2mg in the morning for EPSE. On 4/1/2002, MT is again recommenced on risperidone despite many initiations with risperidone which showed no improvement. The zuclopenthixol fortnightly depot dose was therefore decreased to 100mg. The risperidone was increased from 1mg (9/1/2002) to 4mg (21/1/2002) - however on 29/1/2002 clozapine was commenced. Clozapine was stopped on 31/3/2002 due to MT's refusal to take oral medication and he was recommenced on zuclopenthixol depot (200mg every 2 weeks). On 8/7/2002, the zuclopenthixol was changed to 150mg every 10 days together with a "prn " order for chlorpromazine 50-1 OOmg prn for agitation but not taken by MT as well as diazepam On 8/8/2002, the dose of zuclopenthixol was changed to 200mg every 2 weeks. It is clearly documented that he had EPSE during this admission. EPSE is a serious side effect and can make an individual extremely uncomfortable. Bloomfield 19/8/2002-24/8/2002 Zuclopenthixol (Clopixol Depot) 150mg every 10 days was restarted under a community treatment order (CTO). Bloomfield 17/10/2002-29/12/2002 MT presented on a breach of a CTO and given zuclopenthixol 150mg. MT is clearly experiencing EPSE Commenced on amisulpride (Solian) on 5/11/2002. It is documented that MT has a coarse tremor of his right arm. Amisulpride (Solian) is an atypical antipsychotic, which works as a dopamine antagonist (D2 and D3), predominantly in the limbic area. Amisulpride has low affinity for serotonin, alpha-adrenergic histaminic and muscarinic receptors. Amisulpride is different to other atypicals in that it does not act as a 5HT2 receptor antagonist. Adverse effects of amisulpride include : • Dose related EPSE • Insomnia • Anxiety • Page 16 June 26, 2006 • Agitation • Somnolence • Hypersaiivation • Constipation Records indicate that on 21/11/2002-zuclopenthixol decanoate 150mg (Clopixol Depot) was being given every 2 weeks. Benztropine (Cogentin) was being given regularly for EPSE. There was refusal for Clopixol depot on 6/12/2002 and for amisulpride on 11/12/2002 MT subsequently absconded. Bloomfield 27/2/2003- 29/6/2003 -24/9/2003 MT was given zuclopenthixol 150mg (Clopixol depot) and zuclopenthixol 50mg (Clopixol Accuphase). Mt was refusing all oral medication. Quetiapine (Seroquel) 50mg in the morning and 100mg at night was commenced. MT was requesting benztropine for the EPSE. Quetiapine was increased to 200mg twice daily together with zuclopenthixol SOOmg (Clopixol Depot) every 2 weeks. It is documented the MT feels tired and has the shakes (side effects from the combination. On 22/3/2003 given zuclopenthixol 150mg (Clopixol Accuphase) plus 150mg Clopixol Depot. However MT complains that he feels sick on those medications and is consistently refusing quetiapine due to the side effects .On 14/4/2003 MT was on zuclopenthixol SOOmg (Clopixol Depot) every 2 weeks. On 29/4/2003 amisulpride 100mg was added to the regimen and quetiapine was reduced to 100mg daily in the morning. Clopixol Depot was 300mg every 2 weeks .In the clinical notes it states MT" won't take medications because of side-effects" It is documented that there was physical and verbal attack on staff. Around 2/6/2003, MT was taking amisulpride (Solian) 100mg twice daily - quetiapine had been ceased. Clopixol SOOmg depot was 2 weekly. Bloomfield 4/2/2004 - 5/2/2004 Unsure what has happened in this period? Bloomfield 1/6/2004 Brought in because of suicidal ideation - MT was on the road and aggressive - was non-compliant with medications therefore in a withdrawal state- a toxic delirium Bloomfield 13/8/2004 MT claims that he was assaulted at Bloomfield Bloomfield 13/8/2005 MT was given amisulpride 400mg in the morning and 600mg (1g total daily) at night as well as benztropine. For acute psychosis the recommended dose of amisulpride is 400-800mg daily. Maintenance dose is 50 - SOOmg daily (AMH 2006)- it can be seen that the dose of amisulpride given to MT at this time was large. Risperidone injectable (Risperdal Consta) was commenced. After this MT exhibited signs of akathisia (walked 70km) and had odd and delusional behaviour? Toxic psychosis and delirium due to .the combination. • Page 17 .. June 26,2006 Quetiapine (Seroquel) 100mg twice daily was added on 1/9/2005 to amisulpride. On 7/9/2005, the dose of amisulpride was reduced to 400mg twice daily and then down to 400mg daily. Quetiapine was increased to 400mg then to 800mg. I am unsure how how fast this dose of quetiapine was increased . A rapid dose escalation can lead to a toxic delirium. It is documented that MT is feeling agitated and is requesting diazepam .On 11/10/2005 he is given olanzapine 10mg prn. MT is complaining of agitation and pacing (20/10/2005) In Summary • MT was treated with a combination of different antipsychotic drugs polypharmacology) with little research support for the efficacy of combining multiple neuroleptic medications. He appeared to be acutely sensitive to these medications and suffered from the adverse effects of these drugs a toxic delirium. He has been trialled on every type of neuroleptic and appears to have got worse on these drugs. Again and again the same drugs were re-introduced even though the side effects from previous administrations are clearly documented e.g. EPSE, akathisia. MT appears to exhibit many adverse effects from his neuroleptic medication and it appears that there may be some inability in his Cytochrome P450 system to metabolise these drugs properly thus leading to many and varied adverse drug effects. MT was non-compliant as soon as he was discharged or absconded from medical treatment which lead to severe withdrawal effects and subsequent multiple re-admissions. • Page 18 June 26, 2006 • He appears to be either a slow metaboliser or a non-metaboliser of these neuroleptic drugs, which are all cleared through the liver notably the Cytochrome P-450 system, Cannabis and amphetamine are also metabolised by the Cytochrome P450 system. MT's non-compliance with medication between admissions would result in severe withdrawal symptoms. These withdrawal symptoms appear to be unrecognised by clinicians involved with MT's treatment. These neuroleptics must be withdrawn very slowly under strict medical supervision. • MT has shown food intolerance to barley, cocoa, malt, egg, cow's milk, gluten containing grains, legumes, beans and yeast glycoproteins. MT is also sensitive to peanuts, coffee, cane sugar, beef and MSG MT is allergic to moulds, cephalosporium, grass mix, rye grass, plantain, oats, pine mix, tobacco, bahai grass, alfalfa, lovegrass, canary grass and orris root (Dr C R January 2000). Since MT exhibits these intolerances, it is highly likely that MT suffers from an inability to properly metabolise neuroleptic medications which can lead to the many varied adverse drug effects that MT has demonstrated over the years of treatment. • The references to MT's mother in the clinical notes show a patronising disregard for anyone who challenges the treatment. There is still very little information available on the workings of the brain and the role of neurotransmitters. • The multiple drug regimens made MT feel worse rather than better and that is why he was non-compliant. It can be postulated that if a medication is given to a patient and it makes them feel better then they would be keen to be compliant. • Smoking - Smoking does affect the metabolism of these neuroleptic drugs. Nicotine is metabolised in the liver by the Cytochrome P450 system notably CYP2A6 MT was smoking during most of his treatment (in November 2002 he gave up for a while) Smoking does ameliorate some of the effects of the toxic delirium. • Unfortunately drug companies have a huge influence on the treatment of psychoses and often clinical trials are brief and the results are sometimes lacking in evidence. Certainly, in acute situations drug treatment is needed for a short period. It must be remembered that all drugs are poisons and the dose is critical. There must be benefits associated with any medication given to a patient and if there are not benefits then treatment must and should be reviewed . Signature removed |
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