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The Toybox

people for the conservation of limited amounts of indignation


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children of dune - leto 1
seperis
So.

To my flist, which by the way, let me say hello to everyone who has friended me recently. Hi! Cause wow.

Anyway.

Question:

Where would I find out about the aftereffects of thorazine or any of the anti-psychotics? I'm using google checking Rx sites, but one, I don't know enough about the treatment of presumed schizophrenia paranoia to really know what would work best for this.

Um. Yeah, that's it.


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You know you excite me when you ask questions like that, right?

I wish I had an answer. I can tell you about the after-effects of eating an entire box of Godiva chocolates, however.

I should probably mention my assumption that you were asking this for the purposes of writing a story. Otherwise, that was probably a very disturbing thing for me to say...yeah.

I should just attach my palm to my face permanently.

Yes, darlinng, it's for a story. At least, I hope it is. As I stare at Word and three open webpages and *will* the words to fall into place.

Yes, darlinng, it's for a story.

Oh thank god. Because if you were spasming after your thorazine drip, I was going to feel really bad.

In the rec room, there's chalk and crayons, and he draws impossible, secret equations with letters that aren't in any human alphabet. It's a secure military hospital and he's crazy anyway, so no one cares when he shows them the power curves of naqada, the secret death throes of stars, the prototype design of a zat, the way a Stargate folds space and bends time in the blank space between the theoretical and the practical. He builds white, spiraling cities from sugar cubes and Elmer's glue, glittering in the sun, tiny puddlejumpers folded from origami paper, charts out the Pegasus Galaxy from memory with a stolen pencil and the blanks space of his wall.

They still take his work, photographed from walls, whisked into boxes, secreted into blank-faced folders by blank faced orderlies, though where he doesn't know.

"We can't dial another galaxy, Rodney," Heightmeyer told him in the second session since he'd woken up. "Do you remember what happened to you?"

"How long have I been here?" He has jerky motor control, cuffed hands shaking against the cool metal of the chair. There are long scars that run across the tendons in his forearms and wrists, white and thick, scar tissue grown over a dozen times. Track marks line his arm from elbow to wrist in a diagonal line, the results, he supposes, of a patient who won't take his meds orally. Nerve damage, maybe, side-effects of anti-psychotics, probably, endless tics that make him feel like he's on a slow wooden roller coaster, twitches that make his words come out jerky and half-understandable. He thinks if he could tell the story right, they'd believe him.

It just goes to show that even geniuses can be stupid.

"Three years," she says calmly, fingers calm and relaxed on the cool surface of the desk, elegant, and she smells good, not like alcohol and pills and thrown food and variations of vomit from a hundred throats. "What do you remember?"

The first time since waking, he'd told her about Atlantis.

After, they'd held him down while she'd huddled in a corner of the office, cradling her broken wrist in one hand, and it wasn't his *fault*, the drugs made him twitch, made muscles move when he didn't mean them to, but she hadn't been listening and he's not really all that sorry. She *knew*, she had to, she'd woken up here like he did, with straight white walls and no smell of the sea, no soft light at the brush of a thought. No Wraith.

"There is no Atlantis," she says calmly, looking at him now with wide, clear, terrified eyes.

"You were my psychiatrist there, too. Though my only problems were minor. Insomnia, speed addiction, Wraith, inappropriate feelings for a fellow teammate. Wraith. Katie." He closes his eyes, opening them again to an empty room. "I'm not actually in therapy right now, am I?"

He had dinner but doesn't remember anything, but there's bits of something beneath the brutally short nails, green stains on his forearm that he doesn't recognize. He remembers--sleeping. Or waking up. A hand on his chest. And just barely, copper-iron, like scraping the tines of an old tin fork against his teeth.

*happy sigh*

You hurt them so pretty, Jenn.

eeeeeeeeeeee!! *is reduced to sounds*
*goes back to trying to write just one tiny stupid little Rodney/Jace smutlet*

Owww. You've really got the folding, spindling and mutilating thing going well. Pooooor Rodney. Puts me in mind of that Buffy episode where she wakes up in a padded cell, which I totally can't remember the name of right now.

*chews fingernails wondering where this is going*

This just turned up recently and I...guh. Tell me you are writing this.

*bites nails*

wikipedia is a great place to start. Start with the entry on Schizophrenia.

Ooh, thanks!

I love the internet.

by aftereffects are you talking about tardive dyskinesia? That's a syndrome many people who are on anti-psychotics eventually end up with. Here's a fairly readable article from e-medicine:

http://www.emedicine.com/neuro/topic362.htm

here's another article on toxicity due to long term treatment with neuroleptics: http://www.emedicine.com/emerg/topic338.htm

I like WebMD or you could try the American Psychiatric Association.

Mm.WebMD. I forgot about them.

Thanks!

Toxic Psychiatry by Peter R. Breggin is all about the adverse side effects of psychiatric drugs. The guy has a definite bias, but he's very readable and seems to do a pretty good job of backing his opinions up. Your local library will probably have something of his.

Hi, I'm a new person. :)

Here is some info [NIMH] It's kind of sketchy though.

Hm, I've not got too much info to share that's very medical, but I've got a bit of personal experience with some of those that I don't mind sharing.

Stuff like thorazine and haldol are old school antipsychotics. I know someone who took haldol and thorazine for years and it sucks. She's got restless leg syndrome, really bad muscle twitches.. like a bad tic on her face - it's very easy for anyone to notice after a while, muscle cramps, and just things like that.

The newer antipsychotics are started to be used more often now. They don't cause as much nervous system damage. I've taken Seroquel and Risperdal for a couple of years now and my hands tremble a bit (easily remedied by taking a mild prescription for Parkinson's, like Cogentin - it sounds bad, but it's not really), but it's nothing like what the older ones will do to someone. They cause weight gain though and there is a possibiliy of being more succeptible to diabetes. I've experienced the weight gain problem.. it sucks because it was quick and I was so healthy before. Nothing I do will keep it off. At least it finally tapered off and seems to have hit a plateau.

They cause most people to feel drowsiness. I took Seroquel to help with hallucinations, but the main reason was because nothing else would knock me out. I would stay up for days and days and couldn't fall asleep. I stayed up for weeks at a time with only an hour or two per day of sleep. Oh, another really crappy side effect is that it causes confusion. I hate that. Words and things I've known for years take forever to come to mind. It makes you feel stupid. It's really horrible for someone that's pretty intelligent. I've screwed up on plenty of tests because I couldn't recall something simple that I've known for years. It kind of shakes your confidence in yourself. It's bad when you are in a conversation with someone and you just have to break it off because you forgot what you were saying.. you forget your entire train of thought. You just stop talking mid-sentence and get this blank, confused look on your face.. and then you get angry because you know this, and it's just not there anymore.

Oh, and no citrus for people on Seroquel and maybe some other stuff too. It causes the meds to break down faster than they are supposed to. I think that's how it works. Anyway, I was told to stay far away from grapefruit juice.. I didn't like it much anyway.

Hah, hope that helps some.



Oh yeah, and the not sleeping thing is really bad. It just makes hallucinations worse and they come more often. It also makes you extremely irritable because after a while everything gives you a massive headache. I get snappy with everyone and tend to completely withdraw from my surroundings. It makes your irrational and angry. I've never wanted to actually hurt someone, but I've wanted to punch a few walls for no reason. It also causes paranoia or makes it a lot worse. You can't really think straight when you haven't slept for several days and so you get nervous and paranoid. You start seeing things. You take anything that anyone says to you completely out of context. You fixate and think too much on it.

So despite the drawbacks, antipsychotics are like a godsend, if only to knock your ass out for a while.

Tahnk you so much for the personal experience. That *really* helps a lot to give it context.

*hugs*

Seconded on the trembling (especially slight ones in the hands), weight gain, words/concepts/stuff escaping, and drowsiness. Especially on the drowsiness, but sometimes it depends on the medication and the individual-- Zyprexa knocked me down for days, but Seroquel wasn't so bad as long as it was cut into quarters. I'm not sure how treatment with schizophrenia goes, but when I was first being medicated my doctors put me on an absurd number of different combinations of anti-depressants, anti-psychotics, and mood stabilizers.

Oh, and the tremors and sudden-blanks combined to give me a stutter, which was extra humiliating.

I'm not a psychiatrist and it's been awhile since I did my psych rotation, so take anything I say with a grain of salt. Thorazine is one of the older traditional antipsychotics and not used much any more -- I have seen it used in schizophrenics that have failed to respond to the newer atypical agents or some of the other older agents like Haldol. Bascially first line treatment these days is with the atypical agents like Risperdal, Zyprexa, Geodon, Abilify and Seroquel. In general they have fewer extrapyramidal side effects (which I'll explain in a sec) and they are better at dealing with the "negative" symptoms of schizophrenia.

The "positive" symptoms of schizophrenia can be thought of in terms of disorder in thought and behavior, the stuff that makes it obvious the person is psychotic -- things like hallucinations (auditory hallucinations are by far most common), agitation, delusions, strange behavior, etc. The older antipsychotics were good for treating these but not good with negative symptoms. The negative symptoms can be thought of as deficits in functioning -- "flat" affect (i.e. lack of normal emotional expressiveness), thought blocking (abrupt halts in one's train of thinking, often because of hallucinations), poor grooming, lack of motiviation, social withdrawal -- the newer agents are good at treating these in addition to positive symptoms.

On the the psych ward when a patient is in florid psychosis that needs to be calmed down immediately, usually Haldol and Ativan (a benzodiazpine or anti-anxiety drug) are used. One advantage is that they can be given as intramuscular injections, since patients in the middle of a psychotic freak out probably won't cooperate to take a pill. (At one VA psych ward I was one, they sometimes had to rush a psychotic person with a mattress and pin them to the wall).

Okay, side effects. The most concerning side effects of antipsychotics are the extrapyramidal side effects (which means they are related to abnormal function in certain areas of the brain), of which there are four. These are the ones seen more with the old antipsychotics:

1)Parkonsinism -- same stuff you see in Parkonsin's disase -- pill-rolling tremor in hands at rest, akinesia (loss of the power of voluntary movement), cogwheel rigidity, shuffling gait.
2)Acute dystonic reaction -- slow, prolonged muscle contractions or spasms. Can be pretty dramatic, including torticollis, which involves contractions in the muscles of the neck, or oculogyric crisis, which involves rotation of the eyes). This is most common in men under forty and occurs hours after starting the medication. Given them benadryl or cogentin to reverse the effects.
3)Akathisia - restlessness. Tends to develop about a month after starting the medication.
4)Tardive dyskinesia -- involuntary movements, typically of the tongue, lips, face and head, which can become permanent. It's usually not seen until after 6 months of treament, also is more common in older women.

Neuroleptic malignant syndrome is a medical emergency that can occur in people on antipsychotics (especially the older ones), and involves very high fever, high blood pressure, sweating, confusion, fast heart rate, muscular rigidity. The muscles release high amounts of a protein called creatine phosphokinase (CPK), and it negatively impacts the kidneys, which can lead to kidney failure. This syndrome is more common in men, more common early in treatment, and has a 20% death rate. Bascially you have to stop the antipsychotic immediately, give IV fluids, cool the person down, and give a drug called dantrolene.

In terms of just immediate side effects -- antipsychotics are often sedating. Some of them cause orthostatic hypotension (drop in blood pressure when going from lying to standing position that causes lightheadness, person may pass out).

Thorazine also can cause blue-grey skin discoloration in people who've been taking it awhile.

I'm not sure if this helps at all, but good luck with your fic.

To my flist, which by the way, let me say hello to everyone who has friended me recently. Hi! Cause wow.

*waves admiringly*

hello! went out and asked around about your question--i.e. mild research... (because, ::loves you!::...but *so* not in a stalkery way...ahem) Anyway, my sources said:

They don’t use thorazine any more! Thorazine zombifies. The drugs of choice are atypical antipsychotics – seroquel, Risperdal, zyprexa, Geodon, or abilify. Sometimes older typical antipsychotics are used – haldol comes to mind. A good site is www.schizophrenia.com

I can see in the comments that some folks went into lots more helpful detail, but perhaps the url will be of use...

wags, springwoof

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