has the highest capability to treat behaviours that are highly
undesireable. The capability to 'treat' the suicide rate may be achieved
by it's anti-aggression properties. I think it treats all the other
psychopathological problems that can cause psychosocial problems better
than anything else, for example stuff like thought disorder, but I'm not
sure on that. I still don't know enough about the measures. It is the
most powerful chemical cosh. I haven't found the research done in the UK
to show this but I think there is a very high level of non-compliance
with clozapine. Patients don't like taking it. There is research on the
use of clozapine and lithium in the US in children (two subjects, one 7
and one 12). Lithium is not used for it's psychoactive properties but to
boost the immune system, though it will still have the effect of
reducing and/or removing emotional range in these children. It's use as
an adjunct is common (I think) as a way to boost the white blood cell
count.
The blood monitoring halved the number of people who died from taking
clozapine. Afro-Caribbeans are at greater risk from agranylocytosis and
neuroptenia (a milder version that doesn't kill but is still an illness
and makes people vulnerable to other illnesses) but this is reduced by
lower thresholds for discontinuation of clozapine used by the Clozapine
Patient Monitoring Service.
It may or may not be the best drug at reducing the delusions or voices.
It's use is spreading and this may be off license use. It is a very
powerful chemical of behavioral control that could be used
illegitimately e.g. in high security prisons instead of seclusion. In
the only RCT in a (US) review clozapine was shown to be the best at
treating suicidal behaviours but did not affect the completed suicide
rate which seems contrary to the Finnish observational study that was
published last year which had a whopping great sample size though was
totally quantitative and showed the most dangerous psychiatric drug also
offered the longest life expectancy for people with a diagnosis of
schizophrenia.
But there is no conclusion from me and I have found no alternative. I
need to keep reading and I will do.
I know it can't be used but there is no alternative according to the
biomedical model of treatment and the behavioural control one. There
isn't the qualitative research I can find yet in the UK that speaks of
the patient experience of being medicated with the strongest chemical
cosh. The paper I've found on UK patient experience (published in the
BJPsych) was, in my opinion, not very good and biased. Obviously most
patients have little say in their treatment. All of them should probably
be informed of the risks and their carers too.
Honestly I don't know enough about the psychosocial model nor
psychological therapies and other sorts of non-pharmacological
techniques however the stuff that NICE looks at shows that nothing works
better than the non-therapeutic controls except medication (which is
compared to pill placebo rather than therapeutic placebo) in high
quality research using psychopathological, biomedical model measures
that are designed to be medication sensitive.
This is hard. I may be wrong. I may have wasted my time. I'm going to
keep going though because I'm arrogant enough to know that I'm right
that clozapine just can't be used, especially in children. It is
arrogance though and it is not a fact.
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