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Comment by refurb | Hacker News Reader

Not usually, but schizophrenia is a waxing and waning disease like MS - patients tend to get episodes of worsening symptoms then remission (partial) where symptoms get better. Then they’ll get another relapse and often it’s worse, eventually resulting in a state of chronic symptoms.

Treatment with antipsychotic medication can actually “pause” the cycles and prevent the disease from getting worse if started early. It’s definitely a progressive disease.

I always thought of schizophrenia as a disease you just got and always had.

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Schizophrenia is a degenerative condition where positive symptoms start to be replaced by negative symptoms over the course of years. I've worked in acute adult mental health, and did a few shifts in the long term wards and the difference between people earlier on in the course of their illness versus the end stages are stark.

I would so love to chat with someone with your experience. I developed tourettes / ticking a few years ago when I was around 32 and I wonder whether it could be related to the psychosis I once had. When I researched sudden onset ticking I couldn’t really find much about it! There hasn’t been a day in past 4 years I’ve not ticked and it is worse than ever.

https://en.wikipedia.org/wiki/Obsessive%E2%80%93compulsive_s...

Curious if you've heard about socially-induced Tourette-like behaviours? There was a HN post about it not too long ago, one of the signs was sudden onset later in life: https://news.ycombinator.com/item?id=33878155

Funny you mention this, because it was only when that story came out that I could even find info about sudden onset Tourette's in people. Mines is the full vocal and movement ticks. But ticks only happen when I get memory flashbacks, which are approximately 50-100 times a day.

I'm not fully convinced here, I bet those long term patients were on antipsychotics nearly all of which have extrapyramidal side effects, pretty identical to negative symptoms.

It’s worth mentioning here that antipsychotics have come a long way since lithium. (Posting from the US with our unfortunate (relative to the developed world) healthcare system.)

There’s a handful of antipsychotics and mood stabilizers that have been developed in the last couple of decades that have had unprecedented success with Schizophrenia and Bipolar Disorder. They typically cost $20,000.00 per year before insurance (mine is $0.00 per year after insurance and a coupon, and they get cheap when their patent expires (the patent-clock is 20 years and starts when development starts)). I get to lead a normal life thanks to my medication, and I have experienced no side effects besides the typical mild brainwashing (totally worth it when compared to the alternative). I have friends on other similar newfangled medication, and they have similarly wonderful results.

Please forgive the Lisp-ish parentheses. I figure it’s halfway acceptable on HN.

> Please forgive the Lisp-ish parentheses. I figure it’s halfway acceptable on HN.

Haha it did make me wander if there was an Emacs HN client with paren mode.

> It’s worth mentioning here that antipsychotics have come a long way since lithium.

It's not really related to your comment which is interesting and useful to hear in of its self.

But Lithium is not a antipsychotic it's a mood stabiliser and remains to this day a good one. It remains to this day the best evidenced for suicide reduction and intractable depression.

Mood stabilizers haven't progressed much (valproate a favoured one is now out for fertile women due to risk of ASD and birth defects).

Antipsychotics have shown astounding progress as you say, the reintroduction of clozapine in the 90, introduction of second generations, then Aripiprazole(as a partial D2 agonist was a warning shot we didn't know as much as we thought), quetiapine (made us reassess what a second generation even means as it has even less D2 affinity), pimavanserin (! No D2 but some 5HT-2a activity) And future like SEP-856(!! What the fuck is TAAR1?!).

Represent astounding progress. Should SEP-856 get a market authorization it'll turn decades of the dopamine hypothesis fully on its head.

I lump the two groups of medications together because I’m under the impression that lithium was the most popular option for schizophrenia/bipolar 50 years ago (typically associated with the diagnoses that result in the need of a mood stabilizer or antipsychotic today). Not to mention depression. Am I missing something here?

I also assumed that lithium would have been responsible for the comment to which I was replying talking about the side effects of the medications. (Lithium is known to significantly alter personality over the long term, yes? (Once again, often worth the alternative.)) The intended use of my comment was to clarify that the side effects of drugs prescribed for schizophrenia/bipolar have calmed down a lot.

You sound knowledgeable, and I’m expressing my curiosity. It’s such a soft science relative to something like cancer that I really have no idea what’s going on (I’m just a code monkey). I’m really not aware of any popular antipsychotics being prescribed 50 years ago, but I’m open to having my ignorance fixed.

Even if you did call my comment useless :(

Oh god so sorry! I meant useful. I found it useful to read of your personal journey.

Regarding Lithium for schizophrenia, I believe it's use only is to manage affective (mood) changes rather than psychosis.

Personality change is very hard to objectively consider. Personalities change with time, so it's harder to compare if a drug will alter someone's personality compared to being untreated for decades in an objective way.

All that said, it's commonly described that people feel different on some medications and I think that has to be accepted. Even if it's hard to objectively measure, and hard to quantify.

We often think of mental illness as distinct from personality (yet we also often see personality disorders as mental illness a paradox).

Of course then we should expect treatments will alter personality.

That said we seem to see personality changes claimed with a number of medications, from antiepileptics to statins used for cholesterol, and beta blockers.

Thanks for the clarification!

Putting people on drugs that disable their cognition and brain function and calling it progressively effective is nothing but a crime to me. Have a good day sir.

Isn't TAAR1 related to some of amphetamine's mechanism of action?

Do you enjoy being on a dopamine antagonist? Are you happy?

It was always my observation that the extrapyrimidal side effects of the meds didn't help but that the negative symptoms - burning out if you like - is also a real thing.

What do you make of the thus-far success of the Soteria Houses/paradigm?

I think the proponents of this method of treatment and practitioners involved would argue that schizophrenia is not a lifelong disease, and true improvement is possible without the standard treatment methodology commonly seen in psychiatric hospitals.

Here are some links of interest that I pulled up in a quick Google search - unfortunately research is lacking and widespread implementation is yet to happen in any meaningful amount outside of Europe -

https://www.psychologytoday.com/us/blog/psychiatry-through-t...

https://www.madinamerica.com/2020/10/original-soteria-member...

https://www.wikiwand.com/en/Soteria_(psychiatric_treatment)#...

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2632384/

Draw whatever conclusions you would like from those links and further research if you're interested, but here are my 2¢:

A for-profit psychiatric hospital, that is basically a prison (with locked doors, restrictions to personal freedom, restraints, forced medication - a place that strips its patients of rights, with almost no recourse for patients if they are unhappy with their standard of care), is incredibly harmful.

Imagine being released from a psychiatric hospital in the USA and having been told that you will be ill (suffer from schizophrenia) for the rest of your life.

You will have to take (sometimes expensive) medication(s) for the rest of your life (and to never skip a dose or it might cause relapse).

You get hit with an exorbitant bill that you likely can't pay. No concrete changes to your life (besides massive debt) were made by the psychiatrist/therapist/support staff. Your family is still the same, your living situation may be the same or it might have been turned upside down. You probably lost your job if you had one, depending on onset/etc.

I'd feel pretty helpless. I'd also be traumatized by the experience, especially if I were involuntarily hospitalized.

I think our current standard of "care" worsens mental illness - especially delusions and persecution complexes. It makes patients believe that they will never truly be better, unless they constantly "seek help" - taking away any shred of confidence, provides no real-life solutions (operates inside a vacuum), bills an extremely vulnerable person exorbitant amounts of money, and is designed to keep the patient coming back.

Medication can have paradoxical side effects which, depending on severity, can only be rectified under controlled circumstances (hospitalization), and as the OP's link points out, schizophrenia is probably a bit more complicated than simply being caused by genes and so-called chemical imbalances.

I believe trauma, lifestyle, diet/nutrition, environment, physical activity levels, isolation/lack of a support system, and medical problems (like heavy metal poisoning), vitamin deficiencies, bad gut biome/digestive issues/food allergies, and chronic, systemic inflammation are more likely the causative agents to point to (that psychiatrists tend to ignore/downplay in favor of medication above all else for whatever reason).

I think that capitalism and for-profit should never go near the word hospital, especially a hospital that focuses on helping people in crisis.

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