What are your burning issues for 2018?

My vision for 2018 and beyond is to influence the development of Safe Houses in Scotland for people who experience psychosis, alternatives to psychiatric inpatient treatment, offering a range of therapies and activities for mental wellbeing and recovery, including minimum prescribing of neuroleptics and help with tapering meds. Therefore I am researching safe haven crisis houses in other countries to evidence good practice, leadership and management, and to hear the stories from the people involved.

Now aged 65, I’ve experienced puerperal psychosis twice, in 1978 and 1984, a menopausal psychosis in 2002, voluntarily entering psychiatric wards on all 3 occasions to be coercively drugged, eventually tapering meds myself, making a full recovery. More of my story can be found in a Psychosis Journal Opinion Piece, October 2017: 'Risk of relapse in psychosis: facing the fear, resisting mental illness' (1) and other stories in my main blog (2).

I’ve supported my 3 sons, 41, 39 and 33, when they experienced psychosis/psychiatry, helped them taper meds as I did. Then in 2015 I transitioned a 4th psychosis after years of campaigning for justice after my son's negative treatment as a psychiatric patient in February 2012, this time avoiding psychiatric treatment (3). This was a much more positive and life affirming experience from which I emerged a stronger, more confident, person.

I believe that psychosis is transitional, can be a journey, an escape, a positive and uplifting experience if reasoned out, worked through and helped by companions, friends who are equals, without agendas. People who are willing to share in an Other's pain and imaginings, and in so doing may become part of the psychosis journey themselves.

(1) Risk of relapse in psychosis: facing the fear, resisting mental illness: https://doi.org/10.1080/17522439.2017.1381757
(2) Chrys Muirhead Writes blog: http://chrysmuirheadwrites.blogspot.co.uk/
(3) Hospital Horrors: Patient locked in cell with no toilet, food or water; Scottish Sunday Express, 5 October 2014: https://www.express.co.uk/news/uk/518869/Patient-locked-in-cell-with-no-...

Nowadays, CRISPR-cas9 gene editing has quickly and successfully managed to engineer Anopheles mosquitoes resistant to Plasmodium malaria parasites, stable transmission of mutant alleles to progenies, reduced fertility mosquitoes, etc. [1][2][3][4]
Even necessary funding for breeding and distribution of these genetically modified mosquitoes is provided by Charities. [5][6][7][8][9][10]
Only 3 billion pounds, paid in several years, are necessary in order to eliminate malaria deaths worldwide.
In the meantime, 72 billion pounds are gathered and collected, annually, from English and Welsh Charities alone, [11] and $390 billion from US Charities! [12][13]
Only political will, cooperation between various Countries, and elimination of corruption remain, in order to completely eradicate malaria from the Planet.
References
[1] http://www.nature.com/nbt/journal/v34/n1/full/nbt.3439.html
[2] http://www.nature.com/news/gene-drive-mosquitoes-engineered-to-fight-mal...
[3] http://www.pnas.org/content/112/49/E6736.full.pdf
[4] http://www.bmj.com/content/353/bmj.i2548
[5] https://www.gov.uk/government/news/3-billion-pledge-to-help-end-malaria-...
[7] https://www.theguardian.com/society/2016/jan/25/british-government-and-b...
[8] http://www.wired.co.uk/news/archive/2016-01/25/government-bill-gates-end...
[9] http://www.reuters.com/article/malaria-funding-idUSL8N1591PN
[10] http://www.telegraph.co.uk/news/12119166/Bill-Gates-and-George-Osborne-a...
[11] https://www.thetimes.co.uk/article/1-of-charities-get-most-of-the-cash-m...
[12] http://www.cnbc.com/2017/06/13/americans-gave-390-billion-to-charity-las...
[13] https://www.forbes.com/sites/niallmccarthy/2017/06/13/where-are-americas...

With its liberal use of psychiatric drugs, psychiatry - which includes the work of GPs with psychiatric patients - does far more harm than good (1). Yet, not a single country has taken the UN’s handicap convention seriously, although it is impossible to argue, ethically or scientifically, that it is in the patients’ best interest to be subjected to forced treatment with neuroleptics (1).

According to the prevailing paradigm, psychiatric drugs have specific effects against specific disorders; their actions provide more good than harm; and it is often necessary to take them for years or perhaps even lifelong. Furthermore, many psychiatrists still tell their patients that they suffer from a chemical imbalance, and that taking a psychiatric drug is similar to taking insulin for diabetes (1).

This has been the paradigm in psychiatry since chlorpromazine came on the market in 1954. However, when the research in support of the paradigm is critically appraised, it becomes clear that the paradigm is unsustainable.

Firstly, the effects of psychiatric drugs are not specific. They impair higher brain functions and cause similar effects in patients, healthy people and animals, which is far from causing specific effects in specific disorders (1,2).

Secondly, the research in support of the paradigm is flawed (1-3).

Thirdly, the widespread use of psychiatric drugs has been harmful for the patients. In every country where this relationship has been examined, the increased usage of psychiatric drugs has been accompanied by an increase in the number of chronically ill people and the number of people on disability pensions (3). This speaks strongly against the idea of having specific drugs for specific disorders.

Fourthly, all attempts at showing that psychiatric disorders cause brain damage that can be seen on brain scans have failed. This research area is intensely flawed and very often, the researchers have not even considered the possibility that any brain changes they observe could have been caused by the psychiatric drugs their patients have taken for years (1,2). In contrast, it has been shown in many reliable studies - most clearly for neuroleptic drugs - that psychiatric drugs can cause permanent brain damage (1-3).

There are four main problems with psychiatric drug trials:

1) Almost all placebo-controlled trials are flawed due to their cold turkey design (1) Patients who are already in treatment first go through a wash-out period, when everyone is removed from the drug they had been on, and they are then randomised to placebo or drug. The wash-out period is too short to avoid withdrawal symptoms in the placebo group(1,4). These withdrawal symptoms can be the same as those that define the disorder, e.g. depression in depression trials, and the withdrawal effects can be very pronounced. One-third of patients in long-term treatment with sertraline or paroxetine who had been well for 4 to 24 months after remission of their depression had an increase in their Hamilton score of at least 8 during a 5-8 day period where the drug was substituted with a placebo (5).

2) The trials are insufficiently blinded (1).The drugs have conspicuous side effects and many patients and doctors have therefore guessed whether the drug is active or placebo. This is an important problem when the outcomes are subjective (1), which they virtually always are in psychiatric drug trials.

3) Psychiatrists assess the effect using rating scales, the relevance of which for the patients is often uncertain (1).

4) Selective reporting of outcomes is very common and can be very serious (1). As just one example, only about half of the suicides and half of the total number of deaths are reported in published drug trials compared with available data in trial registers (6), and we have found in our research that trial registry data may also be incomplete.

Psychiatry needs a revolution. Reforms are not enough. We need to focus on psychotherapy and to hardly use any psychiatric drugs at all.

Disclaimer: these are my views, based on ten years of research on psychiatric drugs. But they are shared by many patients.

1. Gøtzsche PC. Deadly psychiatry and organised denial. Copenhagen: People’s Press; 2015.

2. Breggin PR. Brain-disabling treatments in psychiatry: drugs, electroshock, and the psychopharmaceutical complex. New York: Springer; 2008.

3. Whitaker R. Anatomy of an epidemic. New York: Broadway Books; 2015.

4. Fava GA, Gatti A, Belaise C, Guidi J, Offidani E. Withdrawal symptoms after selective serotonin reuptake inhibitor discontinuation: a systematic review. Psychother Psychosom 2015;84:72-81.

5. Rosenbaum JF, Fava M, Hoog SL, et al. Selective serotonin reuptake inhibitor discontinuation syndrome: a randomised clinical trial. Biol Psychiatry 1998;44:77-87.

6. Hughes S, Cohen D, Jaggi R. Differences in reporting serious adverse events in industry sponsored clinical trial registries and journal articles on antidepressant and antipsychotic drugs: a cross-sectional study. BMJ Open 2014;4:e005535.

1. Should mammography breast cancer screening be abolished?
It seems to me that when experts cannot agree (1), any benefits are likely to be small and therefore the costs of providing the service in the UK, including the costs to the participants, are likely to be poor value for money.

2. Gabapentin and Pregabalin.
I come from the pre-Pregabalin era and find it hard to remember patients whose quality of life would have been improved had these drugs been available then. Widely used in fibromyalgia, an unlicensed indication. Prescriptions and deaths associated with overdoses have increased exponentially in the past few years (2).
Does anyone know a doctor who has found these products personally helpful? Have they seen this BBC Video (3)?
I am reminded of the successful voluntary ban by family doctors on the prescription of barbiturate sleeping tablets in the 1960s.

3. Influenza Immunisation.
Does it work? The hardy campaigner JK Anand has reasonably asked the question which has fallen on deaf ears (4).

4) Antidepressants.
Antidepressants - including the drugs that “increase serotonin levels in the brain” (5) - are said by some to be ineffective if not positively harmful (6). Stavros Saripanidis – another correspondent who won’t go away - has pointed this out (7). Des Spence has proposed that prescribing of antidepressants in primary care should be stopped for the same reasons (8).

So, Madam Editor, if by the end of 2018 you have provided answers to one or two of these topics you may have at least a handful more happier readers.

References
1. http://www.bmj.com/content/359/bmj.j5224 and discussion.
2..https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarri...
3. http://www.bbc.co.uk/news/av/uk-england-devon-40937449/prescription-drug...
4. http://www.bmj.com/content/359/bmj.j5629/rr-1
5. https://www.nhs.uk/conditions/ssri-antidepressants/
6. http://www.bmj.com/content/358/bmj.j3697/rr-4
7. http://www.bmj.com/content/356/bmj.j336/rr
8. http://www.pulsetoday.co.uk/views/dr-des-spence/we-need-to-stop-prescrib...