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  • Akineton defends its position

    Photo: Beckomberga Hospita

    Caption: Beckomberga Hospital in western Stockholm was founded in 1935. In the mid-1900s Beckomberga one of Europe’s – and Sweden’s biggest ever – mental hospitals with 2000 patients. In the 1950s, when modern psychotropic drugs started coming on the market, the large mental hospitals have phased out. When the Stockholm County Council, as part of the mental health reform, decided to close down the hospital in 1995 there were about 250 hospital beds remained.

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    Retired physician Gillis Johansson has a long experience in psychiatric treatment. He started as a nurse at one of Europe’s biggest mental hospitals, Beckomberga, in the mid-1950’s, studied medicine, went into psychiatry, became deputy physician at Östra hospital in Malmo in 1975 and named physician there ten years later.

       Now Gillis Johansson has retired from an active career as psychiatrist.

    – I had my last patient several years ago.

    Akineton defends its position

    Surely the latest marketed neuroleptics have a decreased risk for EPS, extrapyramidal symptoms, Gillis Johansson points out.

    – But the new generation of antipsychotic drugs (who are not neuroleptics) can have other side effects that you want to avoid. Some have a higher tendency to give side effects of a metabolic kind or agranolocytosis.

    – There is a group of psychotic patients who do not cooperate so well with the treatment team, patients with a poor grasp of their disease who are nonchalant about taking their tablets. These patients have benefit of depot injections plus Akineton tablets. You start with ½ – 1 mg biperiden and later increase to 4 mg or until effect is achieved.

    – If the patient is suffering from acute dystonia, something that looks very dramatic an acute intervention with Akineton injection is required.

    – EPS can show up some time after neuroleptica treatment has started. Then it is vital to note the side effects and slip in Akineton. When EPS later diminishes it is time to start phasing out Akineton. A slow reduction is recommended.

     

    Trends

    During his long tenure as psychiatrist Gillis Johansson has seen treatment philosophies come and go. When the antipsychiatric wave came in the 1970’s the relationship of psychotic patients to their parents (mostly the mother) was seen as the cause of disease.

    Gillis Johansson is critical of the forced closure of the large mental hospitals that was started in the 1980’s.

    Many patients were discharged and got their own apartments. But the support that was given was not enough. Loneliness and lack of social skills meant that some patients went out to the streets, sick, lost and without direction.

     

    Important tasks for better psychiatric care.

    Gillis Johansson has in the later years seen how psychiatry works under increasingly difficult conditions. Public spending reductions and subsequent changes affect the psychotic patient greatly.

    But he doesn’t believe that “everything used to be better”.

    – No one wants to have the large mental hospitals back. What is on the other hand required is an intermediate setup, a treatment home or building with access to staff who supervise and help.

    – Another important task is that the psychiatric care creates contact with relatives and has them understand the therapy measures that the doctor suggests.

    The third task that Gillis Johansson suggests is bodily examination. Does the patient have metabolic conditions? What does it mean for the choice of drugs?

    The fourth recommendation is that the treatment team initiates contact with the social authorities in order to ensure accommodation, social contact and job.

    – Of course a psychiatric team must have frequent contact with the patient, so that the patient’s needs are seen to, Gillis Johansson ends.

     

    COB

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