Thursday, April 19, 2007

Cho and Psychiatry, the issue of forced treatment

Dr. Helen has thought provoking comments and information about the mental health efforts made in regard to the VT killer. The facts given suggest that in January of 2005, a complaint was made that he had been spurned by 2 ladies that he appeared to be 'stalking' and that he seemed to have taken this very hard and might be dangerous. After review, a psychiatrist I presume seemed to be of the opinion that he had something of a depressive reaction to disappointment. He was given an antidepressant, probably an equivalent to Prozac as he 'got up in the morning and took his medication.' It appears as though a 'rambling composition (or speech)' was missed as a symptom of either a manic or schizophrenic illness, the speech process would likely be somewhat distinct characteristic of one or the other disorder. Also his sense of persecution and rage, exaggerating his ill treatment, were also missed and could have pointed to either illness. Thus he would seem to have been treated for Major Depression when his illness should have been categorized as a bipolar manic or schizophrenic illness.

No investigator, nor the manufacturers of Prozac or the like, have claimed that these drugs are effective in mania or schizophrenia. The serotonin reuptake inhibitors, Prozac etc., might be said to have the general psychological effect of helping a person 'let it go.' They are more effective than other antidepressants where self esteem is an issue because they help a person 'let go' of his self criticism. Mania and schizophrenia would likely have been benefited by the antipsychotic drugs or others with an FDA approved indication for these illnesses. The FDA indication means, at a minimum, that substantial and thorough testing has found the drugs to be effective for the indicated illness, here perhaps either a bipolar manic or schizophrenic illness.

One commenter raised the issue of 'enforcing the gun laws we have' and said that he should not have been able to buy a gun because of his having been committed. I believe that the question on the form is 'Have you ever been committed into a psychiatric hospital?' He would have answered truthfully, 'No' because he was ordered to outpatient treatment. If the symptoms reported after the mass murder had been present and recognized, the 'rambling speech' and unreasonable sense of persecution, during an earlier evaluation, dangerousness to others could have been seen as a potential consequence and a brief hospital stay with the appropriate medications ordered.

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