Caution Doctor

This is a response to an unexpected article on Habré psychiatrist with thirty-five years of experience of Alexander Gennadyevich Danilin, also a rather famous youtube vloger. Prior to his article on Habr, I did not pay attention to his work, as it turned out, in vain.

But first, a short introduction.

For me, psychiatry is a painful and personal story. Unfortunately, this is a very specific area of ​​medicine in which esotericism and obscurantism very successfully resist scientific knowledge. The fact is that evidence-based medicine is generally a little over thirty years old. And the medical community is only now with bloody vomiting plucking out all kinds of homeopathy. In psychiatry, due to objective factors, the process is the hardest. This area is still a reserve for charlatans, ignoramuses, idiots and freaks from science with their special interpretations and truths gleaned from “philosophical reflections”. The revolution in neuroscience, in particular in psychology and psychiatry, is taking place right now. Alas, not for everyone.
By not too competent, but adhering to standard programs and treatment methods for psychiatrists, I am pretty cold. However, they do what they have been taught. As a rule, this allows them to lead the patient out of an acute psychotic state. Well, then he will at least have a chance. Perhaps in the future they will develop better methods, they will be better treated. But freaks, picking out their anti-scientific hypotheses from a known place and applying them in the treatment of severe patients, cause in me an acute intolerable desire to burn, burn, burn in a dragon flame. I know too well what their ignorance leads to.

I was in this hell, I was burning in it.

A. Danilin, who posted his article on Habré: “The response of the psychiatrist to the article“ Sick and Healthy ”, is a dangerous freak from science, and his article is gibberish. At the same time, he manages to give advice to a patient with a very serious pathology.

Its categoricalness from the first paragraph is striking:

Based on my experience, I want to say right away that the experiences described in the article are characteristic, first of all, for thyroiditis - an increased titer of antibodies to thyroid hormones.


Science doesn't work like that. Firstly, we live in the twenty-first century, we need to draw up our experience in the form of research or refer to the research of other scientific groups. Because in this case we can all verify the correctness of such conclusions.

Thyroiditis - a violation of the functions of the thyroid gland, can actually lead (and often leads) to a violation of the functions of the higher nervous system. May adversely affect the mechanisms of thinking and memory. A breakdown in the coherence of thinking can introduce a schizotypic pattern into this mechanism. But usually it does not lead to prolonged energetic mania (that is, in the part of publications I see a mention like: “In some cases, even psychotic symptoms are noted.”) Psychotic symptoms are not manic psychosis. I found just one weird pubmed article linking the acute manic in ONE patient with the extra high doses of LT4 that he received. And even the authors' wording: “We ultimately ascribed the mania as secondary to LT4, and the heart block to hypothyroidism” confuses me greatly. However, everything bothers me in this articleincluding a single patient.

On the contrary, everywhere it is noted that thyroiditis leads to depression. According to the keywords “Thyroiditis depression”, the publisher issues a little less than two hundred articles. Which, frankly, is not a lot, but among them there are two dozen rather large studies on decent samples. You can also find material for the same keywords in the drawing gate. I did not find any large studies confirming Danilin's categorical opinion.

You can also find studies on the relationship of lithium drugs used to treat bipolar drugs with thyroid dysfunctions on the pubmed. But the feedback is back! It is not thyroiditis that leads to manic syndrome, but pharmaceuticals based on lithium, which stop the manic syndrome, can cause thyroiditis as a side effect.

But on the other hand, many studies talk about the relationship between depression and thyroid dysfunction. Which is not surprising. Depression is not exactly the opposite of mania. Depression is a depressed state of mind. There can be many reasons for such oppression. From school beatings, chronic toothache and hormonal imbalances to immunity problems and neuroinflammation. When you are dealing with depression, the source of the problem can be anywhere, even in the little finger of the left foot. But the causes of energetic mania are most often localized inside the cranium.

But psychiatrist Danilin continues:

Such a condition is still referred to as “endogenous” (internal, without an objective reason) and treated as schizophrenia, as the author can be convinced by reading the instructions for the medications that he takes.

First, who told you that endogenous causes are not causes? Of course, such conditions are classified as having an objective cause. Mandatory. By all means. The establishment of these causes employs a huge number of scientific groups around the world.

Another question is that for practicing psychiatrists the choice of instrument is not great. This is one way or another, antipsychotics that affect the dopamine system, and several classes of normotimics that regulate the glutamate / GABA balance by different mechanisms. Like drugs of lithium, anticolvulsants, calcium antagonists and (attention!) Thyroid hormones for the relief of depressive states (not manic).

Moreover, the doctor pedals and continues to insist on his extramural, unfounded diagnosis:

Based on the description, I consider thyroiditis to be the most likely physiological cause of the author’s conditions.

And I believe that after such statements it is necessary to deprive the diploma and drive out of medicine with an eternal ban on the profession. Danilin makes a diagnosis (albeit with reservations) to a person whom he didn’t even hear on the phone, while choosing from the more than two dozen reasons for such a pathology the most unbelievable, based only on absurd, unconfirmed hypotheses.

Yes, I am an adherent of Saint Pabmed and evidence-based medicine. I am not interested in conclusions based on “transcendental experience.” Moreover, contrary to common sense and a common understanding of the hormonal system.

Danilin:

Increased emotional vulnerability, about which masterdak did not write anything, is most often associated with minimal organic disorders of the nervous system, which arise, as a rule, as a result of birth trauma or with hemodynamic disorders in the pregnant woman's body. Something like this happens:

Capillaries supplying blood to nerve cells are very narrow vessels. At the slightest malfunction in the labor of the mother or an increase in blood viscosity, they subside and die, and in their place the so-called gliosis - microscopic scars forms.

This mechanism leads to depression, impaired consciousness, impaired memory very often. Between thyroiditis, hypersensitivity and emotional lability, a connection seems to be found in studies. All my attempts to find somehow adequate studies of the relationship between glioma and emotional lability or hypersensitivity have been unsuccessful. Can you see studies linking gliosis and hypersensitivity?

Further, the doctor already completely switches to the generation of delirium:

If this happened in the skin tissue, then inflammation would first occur, and in its place - scar tissue. The brain is an aseptic environment, there are no bacteria, there is no inflammation in the strict sense of the word, but the body’s defense systems will still fight with a microrubic.

No inflammation in the brain? What? The inflammatory process, in the strictest sense, is of course possible in the brain. Moreover, in all types of tissues. Both with and without a bacterial agent. How can this be stated? Such a statement is too illiterate even for the paramedic!

Further Danilin nevertheless makes a reservation:

I do not make diagnoses without examination. Based on your posts, I’m just trying to explain what happens in such situations with the human nervous system. And I do this only because Russian psychiatry is not interested in all these processes.

With domestic psychiatry, everything is bad for the most part. Alexander Gennadievich is a vivid confirmation of this. Patients requiring special delicacy and a strictly scientific approach suffer from the dominance of freaks and ignoramuses. In psychiatry, the principle of no harm is especially relevant, but the freaks do not care.

Another paragraph:

alcohol stabilizes their (patients suffering from increased emotional vulnerability or sudden mood swings) mental state.

I just have nothing to say: alcohol is a well-known “stabilizer” of emotional states! I’m even lost how I can formulate a search query for pubmed.

And so, pushing through the nonsense, we get to the next section:

The diagnosis of bipolar affective disorder today is a form of demagogy for the patient. The doctor does not want to tell the patient that he suffers from schizophrenia, painfully this is a hopeless and difficult to explain diagnosis.

Here demagoguery, moreover, illiterate, demonstrating wild ignorance, is raised by Danilin. BAR is a really large group of pathologies of a manic and / or depressive nature with a wide variety of pathogenesis (causes). All this is known to every psychiatrist. At the same time, BAR is treated with the same drugs that are prescribed for patients with schizophrenia, if the manic syndrome is clearly Schizotypal in nature. No competent doctor will prescribe antipsychotics to a patient with BAR if normotimics stabilize the patient and no schizotypal disturbances in thinking are observed. Another question is if normotimics do not cope. Then the psychiatrist would be glad to appoint something more targeted, but he only had a saw and a hammer. Lithium or valporate preparations do not help - the wilderness dopamine from hopelessness.
As an example, my hypomaniac is most likely associated with anandamide suppression of GABA. At night I go into an extremely excited state. In the morning I could make up for a dream. But now I get up at 6:15 to work. My psychiatrist is concerned about my regimen, in which I sleep less than 3-4 hours a day for a week. Alas, he would be glad to appoint me one of the CB-1 receptor antagonists. But such drugs are not yet on the market. They are only in development and when they are approved, it is not known. Therefore, he gently insists on taking quetiapine for the night. I softly refuse, but his motives are clear to me. Suppressing dopamine by D2 in my case will be too expensive, with my attenuated focus of attention. I decided to deplete the central nervous system and accept all the negative consequences of such a step, but do not touch dopamine. However, if I were the attending physician of such a patient, I would also insist on taking a mild antipsychotic in the absence of alternatives. MindFulness meditation helps me a bit. However, I am still a beginner and do not have much training and practice of meditation. Therefore, while the result of such exercises is very modest.

Further, Dr. A. Danilin issues a long conspiracy theory about the formation of the Soviet school of psychiatry. I will skip this section. What happened 70 years ago does not interest me, even if every word and every interpretation in this story is pure truth. I am more interested in what is happening in psychiatry and neuroscience now. Today.

But further down the line, the delirium becomes fatter, and the partisans become even thicker:

“Unified psychosis” is implied now and everywhere - even when your children are diagnosed with “child hypermobility syndrome” or “early childhood autism” - they are treated for schizophrenia. Do not forget to carefully read the instructions for the drugs!
But it's not only that.

How long has childhood hyperactivity been treated with antipsychotics? What did I miss? Where is it from?
In Russia, Stratter is certified to correct ADHD. Horseradish drug that acts on the noradrenaline system, but has nothing to do with antipsychotics.

And in the West, methylphenidate and amphetamine are used to correct ADHD. How long have amphetamines been shown to schizophrenics? Antipsychotics are antagonists of D2 recipes in their mass. A amphetamine and methylphenidate agonists. Their action is DIAMETRALLY the opposite.

Going further:

While teaching self-hypnosis and self-hypnosis, I have great respect for meditation, but meditating while taking antipsychotics and antidepressants is, at least, pointless.

Danilin should stop self-hypnosis and self-hypnosis. And do self-education. I also look with some hope at meditation techniques. There are several reasons for this, which I will write in more detail about when I get to them in the series “PsyGuide: Attention Deficit.”

But when the chemistry of the brain is broken, you must first normalize the chemistry and then do meditation. In an acute psychotic state, there can be no talk of any meditation.

We go further in the text:

Disturbing thoughts are doubts about yourself and your ability to be responsible for everything that you do. The psyche knows the only way to get rid of disturbing thoughts - a feeling of one's own greatness.

Well, what kind of Freudian / Jungism? What is this statement based on? In addition, again, everything is exactly the opposite.

There are many mechanisms that provoke anxiety. From the high content of anandamide in GABAergic neurons to the low cohesion of insula and the cortex, as well as the imbalance of hormones beloved by Danilin's thyroid gland.

As for megalomania, here always the main player is dopamine along the mesolimbic pathway. And with dopamine hyperstimulation, all studies report a decrease in anxiety.

Tell you what anxiety disorder is. This is when you leave home, forgetting to take rights and money even for lunch, working documents and the necessary drawings for the day. But at the same time, carefully making sure that both phones and the power bank were fully charged, because every moment you listen to the instant messengers. Every second, waiting for a call that your loved one jumped out the window, disappeared, or died while you were making money on the other side of the earth to pay for his treatment with such psychiatrists. The entire focus of attention twenty hours a day is focused on the smartphone. Now, now they’ll call you and tell you that your parents have died, your friends have burned down, a nuclear apocalypse is coming, and you will die in it last, burying everything that is dear to you. Extremely unpleasant state of mind. I had nothing to do with megalomania at that time. By the way, Ritalin, which I try to avoid for reasons that I will also reveal in the series “PsyGuide: Attention Deficit”, at that time helped me not only focus on work tasks, but also alleviated the anxiety state. Dopamine stimulation of D2 receptors reduces anxiety. With hyperstimulation, it is also capable of causing megalomania.

How does Danilin manage to miss 180 degrees so accurately every time in his hypotheses sucked from a finger?

I will skip the arguments and comments of the doctor about the brain. I just don’t know what it is, where to look for it on an MRI.

You can further analyze these pearls:

All people taking antipsychotics and antidepressants participate in a protracted pharmacological experiment, the effectiveness of which has not been proven in reality ...

Or these:

On the contrary, German psychiatry has always believed that this disorder goes unnoticed. And there were no psychotropic drugs at the time of Kraepelin - they treated this psychosis with sanatorium conditions, water procedures, hypnosis and ... round-the-world travels.

What they thought before the advent of evidence-based medicine interests me a little. One hundred years ago, it could be believed that hemophilia is completely cured by bloodletting.

The forces are running out, so we will not be distracted by conspiracy theology and mythology, we go further:

Side effects of drugs are not complications. Side effect is part of the mandatory effect of the drug on the body, but is not desirable for the patient's health and treatment goals.

I broke my brain from this phrase. Side effects are side effects. Complications are complications. Yes, we live in an imperfect world. Antipsychotics, suppressing the dopamine system along the mesolimbic pathway, also lead to suppression along the mesocortical, which poorly affects the comprehension of thinking, and in the long term leads to inhibition of the prefrontal cortex and the degradation of its functions. We simply do not have such a highly selective drug that would block dopamine so selectively. The emergence of such drugs will mean a breakthrough in the treatment of schizophrenia. But for now, we have what we have. We pay the price we pay. What Danilin said, I did not understand.

Further, Alexander Gennadievich reveals to the patient the truth:

Ariprizol.
Antipsychotic (antipsychotic). The therapeutic effect of aripiprazole in schizophrenia is believed to be due to a combination of partial agonistic activity against dopamine D2 and serotonin 5-HT1 receptors and antagonistic activity against serotonin 5-HT2 receptors. Aripiprazole has a high affinity in vitro for dopamine D2 and D3 receptors, serotonin 5-HT1a- and 5-HT2a receptors ... Not clearly
?
Firstly, it becomes clear that you are being treated for schizophrenia.

Unclear. I already wrote that modern psychiatry does not have such a large set of tools. It does not matter what is being treated, ideally (I hope it was) after selection, the patient gave the best answer to these drugs. What they are treating from is completely unclear from the instructions. At least to me. Danilin, who, apparently, draws knowledge directly from space, in general, everything is clear.

Further, Alexander Danilin uses a forbidden technique, for the use of which I am immediately ready to grab hold of a can of gasoline. It scares a long list of side effects of a patient with manic psychoses:

Participating in this experiment, you use drugs that have the following required effects (indicated as side effects): ... a
long list

The fact is that people who are forced to take such medicines, and so acutely experience the side effects that antipsychotic drugs have. The main one is a general depressed state. Often this causes the refusal of drugs, which sharply exacerbates psychosis and can threaten the patient's life. All of us who have dealt with antipsychotics and normotimics, we know the high price that you have to pay to stay in the mind. Those of us who are able to get down from the psychopharma for many years of hard work on ourselves are truly lucky. Alas, not everyone is given this; not all of them are allowed by their neurochemistry.

Be careful. Take care of yourself.