Saturday, 24 December 2011

interpreting the results of a study which hasn't happened yet. (the research into the next generation of antipsychotic drugs)

If all major tranquilisers had approximately equal effect sizes on
delusions and hallucinations...then what would this mean?

I'm imagining the results of a hypothetical retrospective meta-analysis
of major tranquiliser treatments solely looking at the effect on
delusions and hallucinations.

I'm also thinking about the placebo effect. There are few if any modern
placebo controlled trials of antipsychotic treatment as usual. Would a
result where all drugs performed approximately the same (once
publication bias had been taken into account and other techniques such
as large sample sizes are used to ensure the result is as close to the
best truth as possible. I wonder if it's worth excluding early trails
because these usually show favourable results and later trials show less
positive and more strong negative results?) indicate that none of the
drugs have a direct pharmacological action which actively works to
reduce the delusions and hallucinations.

The opposite of what I'm taking about is one drug being significantly
more effective than all the others. This is the key result for patients.
This is the drug which doctors should prescribe to patients who expect
an antipsychotic effect from their drug treatment. It is also a first
step to a new direction in drug research. Though they all work on
dopamine receptors each drug works on a different profile and not all
limit their neurobiological action to D receptors, for example clozapine
also works on 5HT receptors if memory serves me. There are 2 main D
receptors and 3 others which are like them and I guess each drug has a
different rpofile when targetting these receptors. Each chemical is
slightly different too and there are three generations of
antipsychotics: first generation or typical and atypical ones of which
there is now a new generation heralded by Abilify. Perhaps one drug in
the last half century holds the key to the effect of medication which
patients want and expect, and which may also significantly contribute to
diminishing what I guess is the core of a lot of the pathology and distress.

Of course there may be other results. What would be ideal is a normal
distribution of effect with one drug clearly peaking. The drugs around
it would be pharmacologically similar and the outlier wouldn't be a normal distribution. It
would be a standard x-y curve or something like that. Bugger. What I
mean is what would be ideal is a curve of performance which related to
phamocological/neurobiological action in a clear way. This would point
to the possibility of a chemical solution for the suppression of the
delusions and hallucinations for those patients who want this effect.

On another note.

Off the evidence from one qualitative paper on clozapine I'm making a
guess that clozapine patients are poor placebo responders to the
antipsychotic effect of major tranquilisers. Few patients got an
antipsychotic effect and those that did didn't report the cessation of
the delusions and hallucinations. Clozapine is meant to be the most
effect drug and it is very dangerous to the individual.

I don't know enough about psychiatric cilinical practice to know if some
psychiatrists would put a patient on clozapine if there was no effect on
the delusions and hallucinations from 2 trials of antipsychotics at
standard doses. If they did this would be fucking stupid. They would be
unnecessarily killing the patient for a small or non-existent treatment

Please can I ask for a few second of your time to click this link and like my suggestion.

I need the data about health outcomes sorted by race, gender, age and other characteristics so I can see if disadvantaged groups are being further disdavantaged by London GPs.

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We It comes in part from an appreciation that no one can truly sign their own work. Everything is many influences coming together to the one moment where a work exists. The other is a begrudging acceptance that my work was never my own. There is another consciousness or non-corporeal entity that helps and harms me in everything I do. I am not I because of this force or entity. I am "we"