Curing or alleviating psychiatric disease

[tortuga87]

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Does anyone have any ideas on how to cure or alleviate almost completely any of the hardest-to-treat psychiatric illnesses? E.g., schizophrenia, PTSD, autism. Perhaps some ideas you had in the back of your mind but never decided to follow up on.

Assume you have tons of resources and can pull off the most complex of research techniques. Just asking because maybe someone has some ingenious idea(s). In general terms if you dont understand specific techniques.

 

[Bartelby]

I would first try to better understand the disease pathogenesis. For schizophrenia an interesting retrovirus hypothesis has popped up recently, I would like to better study that if I had a lab:

http://www.pnas.org/content/98/8/4293.full
http://www.sciencedirect.com/science/article/pii/S0165017399000375

Trying to get a better grasp on what exactly causes the condition is a logical first step.

With unlimited resources, I would also try to educate families and friends about decreasing hostile expressed emotions toward the patient and increase the patient's social support for a transition back to the community. That would not cure the patient but it would increase the chances that he or she would make a successful transition back into society.

 

[whopper]

Schizophrenia: a cure? Agree with the above. It's hard to say because we don't yet have a completely definable explanation as to what is physiologically going on. IMHO, a lot of it is major problems with neuronal networking and interaction on multiple levels even after whatever possible inciting event caused it, and the complexity just makes it harder to figure it out.

It could be the type of thing where a cure is not found for the next several decades but perhaps a strong type of prevention could be done. While viruses are not similar in any way (edit: many ways) to mental illness, the idea could be the same. E.g. we dont' have a cure but we could develop ways to prevent it to the degree where it makes a significant difference such as a type of vaccine, genetic screening, etc.

Autism: same problem as above.

PTSD: I've seen people get significantly better, to the point where medications were not used or could be significantly decreased or even discontinued. Medication and/or psychotherapy is the treatment here. Is this a cure? Well one could argue it's simply a decrease in symptoms until the next relapse that could be years later. Some disorders such as depression and anxiety disorders could achieve a state of remission, but could possibly return later.

 

[nitemagi]

Aside from infections, there's almost no medical conditions we "cure." Either the body does the curing, or we help with chronic disease maintenance and ideally remission.

Agree with whopper that prevention is more likely than cure to be successful.

I also have thoughts about use of hypnosis (a positive dissociative state) to train people with maladaptive dissociative episodes to adapt to stress (PTSD, borderline PD, conversion d/o)

 

[Ibid]

transition back to the community. That would not cure the patient but it would increase the chances that he or she would make a successful transition back into society.

I appreciate the sentiment you are expressing and I do agree with it but there is one thing I would add or point I would make.

Seeing the hospital resident as "not still part of society" or the hospital as not a part of the community is part of the problem as well. Demystifying the hospital experience as well as the distress/illness would go a long way to facilitating good transitions back home.

A huge way to go on this front I fear.

 

[digitlnoize]

Aside from infections, there's almost no medical conditions we "cure." Either the body does the curing, or we help with chronic disease maintenance and ideally remission.

Even with infections, many antibiotics are bacteriostatic, not bactericidal, and the drugs just help keep the infection in check while the body takes care of it.

 

[Bartelby]

I appreciate the sentiment you are expressing and I do agree with it but there is one thing I would add or point I would make.

Seeing the hospital resident as "not still part of society" or the hospital as not a part of the community is part of the problem as well. Demystifying the hospital experience as well as the distress/illness would go a long way to facilitating good transitions back home.

A huge way to go on this front I fear.

I guess what I meant was closer to reintegrating the patient to his or her usual or planned role, just as you would do for a patient who had an extended stay for an MI or complications of multiple sclerosis. Agreed though, decreasing the mystery and stigma around what goes on in a mental hospital might make others less afraid or wary of people with mental illnesses and hopefully go a long way toward helping others accept the patient.

 

[Therapist4Chnge]

Prolonged Exposure therapy has produced some promising research support for significantly decreasing and sometimes eliminating PTSD symptoms. I don't believe you can medicate PTSD sufficiently, though medication can be helpful when used in conjunction with certain psychotherapy approaches.

 

[PETRAN]

Prolonged Exposure therapy has produced some promising research support for significantly decreasing and sometimes eliminating PTSD symptoms. I don't believe you can medicate PTSD sufficiently, though medication can be helpful when used in conjunction with certain psychotherapy approaches.

Yeah, and then there is this new finding in which memory recall is like a re-consolidation process that lives an "open window" for certain drugs like beta-blockers to act, weakening the association between the episodic memory trace and stress. So, imaginary exposure+ some anxiety reducing drug could be the best option. I guess that pharmaco+psycho therapy will "co-operate" more frequently in the future.



Alternatively, i've heard that XTC works miracles 😱

http://psychcentral.com/news/2010/07/20/mdma-may-have-role-in-treatment-of-ptsd/15778.html

 

[whopper]

Alternatively, i've heard that XTC works miracles

What do you do with a patient where you've tried all the conventional treatments and they don't work? How many of you would recommend XTC if nothing else worked.

I haven't had it with PTSD, but I have one particular guy with MDD, GAD, and Panic Disorder. While I haven't tried EVERYTHING, I have tried almost every single SSRI, SNRI, TCA, Buspirone, Seroquel, Zyprexa, Gabapentin, and even benzos. The only thing that worked are benzos but he doesn't like them because he feels drunk on it. All the other meds either didn't work or he couldn't tolerate the side effects. I started to consider that perhaps this was a case where medical marijuana was justified, but I haven't recommended it because it's not legal in my state.

 

[OldPsychDoc]

What do you do with a patient where you've tried all the conventional treatments and they don't work? How many of you would recommend XTC if nothing else worked.

I haven't had it with PTSD, but I have one particular guy with MDD, GAD, and Panic Disorder. While I haven't tried EVERYTHING, I have tried almost every single SSRI, SNRI, TCA, Buspirone, Seroquel, Zyprexa, Gabapentin, and even benzos. The only thing that worked are benzos but he doesn't like them because he feels drunk on it. All the other meds either didn't work or he couldn't tolerate the side effects. I started to consider that perhaps this was a case where medical marijuana was justified, but I haven't recommended it because it's not legal in my state.

I think that you could try an MAOi before you move toward something less than legal...

 

[whopper]

Sound advice. Trust me, I wouldn't go down the marijuana route given the law, but a part of me questions if I would if I were in a state where medical marijuana were legal.

 

[billypilgrim37]

What do you do with a patient where you've tried all the conventional treatments and they don't work?

There has been no electricity mentioned in this thread!

 

[whopper]

True.

Further elaborating on something I mentioned above, there was an article in the Carlat Report months ago where there has been advancement in a type of screening for prodromal schizophrenia. Per Carlat's article (and I forgot off the top of my head exactly which month it came out), the methods to detect someone going through the schizophrenia disease process before it can be diagnosed has so far been low in terms of statistical validity and reliability, with the exception of a particular type of newer method that's still being studied.

If that method could be further developed, perfected, and then finally used clinically, I can see an emerging area where people of already high risk (e.g. direct biological family members of someone with schizophrenia or schizoaffective disorder), being recommended to undergo that test perhaps every several months or once a year during the years where one is at the highest risk for developing a psychotic disorder, and then antipsychotic therapy (and other therapies) being utilized before the person actually develops a psychotic disorder.

Not a cure, but something that might possibly prevent, or at least delay and dampen the severity of the disorder.

 

[tortuga87]

so assuming you can develop a good prediction algorithm, how exactly would one go about testing drugs that can decrease the likelihood of developing an illness?

would the drug have to work on some iffy mouse models? then the normal human clinical trials?