March 4, 2026 • 30 mins
Empowering Mental Health: Dr. Robert Laitman's Journey with Psychotic Illnesses and Clozapine Therapy
In this episode Dr. Robert Laitman, an internal medicine specialist with substantial experience in treating serious mental illnesses such as schizophrenia and bipolar disorder.
Dr. Laitman shares his deeply personal journey of treating his son, Daniel, who developed schizophrenia 20 years ago.
He discusses the challenges of finding effective treatment, the benefits and intricacies of Clozapine therapy, and the need for a comprehensive, empathetic approach in mental healthcare.
His advocacy for early and assertive management of psychotic illnesses, combined with cognitive enhancement and family involvement, aims to transform the lives of those affected by serious mental conditions.
He emphasizes the importance of demanding the best treatment options for loved ones, which significantly improve long-term outcomes.
Meet Dr. Robert Layman
Personal Journey with Schizophrenia
Challenges in Treatment
Managing Side Effects
Cognitive and Behavioral Approaches
The Importance of Early and Effective Treatment
Overcoming Systemic Obstacles
Final Thoughts and Takeaways
INTRO/OUTRO: T. Wild
Mantor Music BMI
The content on Why Not Me: Embracing Autism amd Mental Health Worldwide, including discussions on mental health, autism, and related topics, is provided for informational and entertainment purposes only.
The views and opinions expressed by guests are their own and do not reflect those of the podcast, its hosts, or affiliates.
Why Not Me is not a medical or mental health professional and does not endorse or verify the accuracy, efficacy, safety of any treatments, programs, or advice discussed.
Listeners should consult qualified healthcare professionals, such as licensed therapists, psychologists, or physicians, before making decisions about mental health or autism- related care.
Reliance on this podcast's contents is at the listener's own risk.
Why Not Me is not liable for any outcomes, financial or otherwise, resulting from actions taken based on the information provided.
https://tonymantor.com
https://Facebook.com/tonymantor
https://instagram.com/tonymantor
https://twitter.com/tonymantor
https://youtube.com/tonymantormusic
intro/outro music bed written by T. Wild
Why Not Me the World music published by Mantor Music (BMI)
Listen
Watch
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_00 (00:06):
Welcome to Why Not Mini, embracing autism and
mental health worldwide.
Hosted by Tony Mentor.
Broadcasting from the heart ofMusic City, USA, Nashville,
Tennessee.
Join us as our guests sharetheir raw, powerful stories.
Some will spark laughter, otherswill move you to tears.
(00:30):
These real life journeysinspire, connect, and remind you
that you're never alone.
We're igniting a global movementto empower everyone to make a
lasting difference by fosteringdeep awareness, unwavering
acceptance, and profoundunderstanding of autism and
(00:52):
mental health.
Tune in, be inspired, and joinus in transforming the world one
story at a time.
Hi, I'm Tony Mantor.
Welcome to Why Not Me, EmbracingAutism and Mental Health
Worldwide.
Joining us today is Dr.
Robert Leitman, who is adistinguished physician with
(01:14):
extensive expertise in internalmedicine, where he has built a
strong foundation in diagnosingand treating a wide range of
complex medical conditions.
Specializing in serious mentalillness like schizophrenia and
bipolar disorder, he seamlesslyblends his medical precision
with compassion, making him atrusted leader in addressing
(01:36):
patients' complex needs.
He has a wealth of informationfor us, so before we dive into
our episode, we'll be back withan uninterrupted show right
after a word from our sponsors.
Thanks for coming on.
SPEAKER_01 (01:49):
Oh, sure.
No, it's my pleasure.
And you know, thanks for havingme.
I mean, this is something nearand dear to my heart.
SPEAKER_00 (01:55):
It's great to have you here.
Could you share with ourlisteners a bit more about what
you do?
SPEAKER_01 (02:00):
I am an internal medicine specialist.
I was trained in nephrology andgeriatrics, but for the last 20
or so years, I've devoted uh mypractice as well as my wife, who
just walked out the door, totaking care of people with
psychotic illnesses.
And the reason I'm doing that isbecause my son 20 years ago
developed schizophrenia, and wejust didn't find adequate care.
(02:22):
We thought there was tremendousnihilism in the psychiatric
community that we were told, forinstance, you know, more on the
loss of your son and yourexpectations.
And I just didn't find that tobe an acceptable solution.
SPEAKER_00 (02:35):
Yes, I think that's very understandable.
So when you decided to take thison, what confronted you?
What were some of the bumps inthe road, so to speak?
SPEAKER_01 (02:45):
Well, initially, the biggest bump was actually my
wife.
And she's right, because uh, youknow, again, we're both
physicians.
You're not really supposed totake care of your own.
But I pointed out to her thatI'm uh not traditional.
I've been taking care of mymother and father because I was,
as I said, a nephrologist andgerontologist.
And, you know, and I I've done apretty decent job of that.
(03:07):
In fact, my dad ended up livingto 101, as I already mentioned,
and my mom lived to 99.
And I said, look, I'll makeevery attempt to find good care
for Daniel.
But after we started to read theliterature and we kept going and
being referred to onepsychiatrist after another, we
never found anyone, first ofall, for the first uh year or
(03:27):
so, actually six months, thatwas willing to prescribe
clospine.
Finally, we met Lou Oakler, whowasn't taking new patients at
the time, and he referred us toanother physician.
But it was still going to beanother year for clospine.
This guy was reasonably, hesaid, yes, I'll consider it.
Let me fix Daniel's regimen,because by that time he was
already on three antipsychotics.
I was chomping at the bit for myopportunity to take care of him,
(03:51):
but I deferred because again,you're not supposed to take care
of your own traditionally.
Eventually, he got to the pointwhere it was, you know, just he
needed to be on clozepine.
And we finally prevailed on thetreating psychiatrist to start
him.
SPEAKER_00 (04:06):
When you finally had the psychiatrist change his
mind, what happened next?
Over time, it got to the pointwhere it was so difficult.
SPEAKER_01 (04:15):
And fortunately, we've made the prescribing of
clozapine easier, easier becausewe've gotten rid of the
requirement for the blood.
But back then, it would take mehours every week just to get
Daniel's supply of clozepine.
I'd have to call up, get itapproved by the insurance
company, make sure I had theblood work.
(04:36):
And I even had my own in-officelab.
And then I would send theresults to the psychiatrist
waiting for him to write theprescription because for the
first 26 weeks back then, it wasweekly.
And I just got tired of it, youknow, and I found it a situation
almost guaranteed to failbecause he wouldn't give more
than the absolute number ofpills that Daniel was on.
(04:57):
So I just eventually just tookover.
And it was much easier afterthat.
You know, I rode for an adequateamount of medication.
I did the required blood work.
It was much easier because I hadthe blood work right in front of
me.
I took steps out of the way.
SPEAKER_00 (05:12):
Yeah, that sounds like it was very much easier.
Were there any other issues thatyou had to deal with?
SPEAKER_01 (05:18):
Also, the lack of knowledge on how to prescribe
closapine correctly.
So six months into Daniel'sillness, he developed a sizable
aspiration pneumonia, an abscesson his lung, because no one had
really talked to us or explainedhow to take care of the excess
of salivation that comes withclospine.
So we ended up treating him withIV antibiotics at home.
(05:41):
My wife and I took turns puttingan intravenous in every single
day, sending him to school,taking the IV out, putting a new
IV in.
And 28 days later, we had himwith clear lungs.
And in the meantime, we startedto treat the salivation.
So it became very apparent to methat if you're going to use
clospine correctly, because Ikept reading and reading about
it and all the terrible sideeffects, which is why people
(06:01):
weren't using the drug.
SPEAKER_00 (06:03):
That is a big question.
How do you handle the sideeffects?
Because one thing can lead toanother, and then all of a
sudden it could get out ofcontrol.
Every one of these side effectsis predictable.
SPEAKER_01 (06:15):
You can get predictable pharma, you know,
pharmacology, just usingpharmacology, for instance, with
the excess of salivation.
We took care of that, doing thesimple things, propping his head
up, obviously, and making surethat we diminished the uh
salivation using just uh we usedsomething called a hippotroprium
(06:36):
nasal spray, and we would justsquirt it under his tongue at
bedtime.
That diminished the salivation,and aspiration no longer became
a problem.
SPEAKER_00 (06:44):
Yeah, that's great.
Were there any other sideeffects or anything else that
you were concerned about?
SPEAKER_01 (06:50):
Also, as you start on closine, the heart rate goes
up.
Again, normal physiology.
So we would put him on a verylow dose of a beta blocker, and
that took care of that.
And you just go down the sideeffects.
Weight gain, almost universalwith clospine.
Why allow it?
You know, unfortunately,clospine has effects on
appetite.
(07:10):
It's very something calledanti-histaminic and
anticholinergic.
So it actually stimulates,greatly stimulates appetite.
You know, it's not the kidsbeing a pig, the kid is almost
driven to eat.
So what do you do?
You give them metformin.
It's not that hard.
And these days we're really wellequipped because we do the
injectables, which Daniel didnot require.
(07:33):
And of course, the beauty ofthis, where Daniel was really
sick and at his worst was almostcatatonic, he got better in
terms of his ability tocomprehend, to think, to
participate in his own care.
Something that would make youhappy, Tony.
He started to actually watch hisdiet and now has become
basically a pescatarian, not avegetarian, but a pescatarian,
(07:55):
and he exercises regularly.
And that obviously, you know,helped his health almost as much
as all the other medicines thatwe typically add, uh, you know,
to assist kids.
SPEAKER_00 (08:06):
Yeah, that's great.
It's all about the end results.
Now, this was 20 years ago.
Has anything changed themedications, the way you look at
it, just the overall proceduresthat you use compared to 20
years ago?
SPEAKER_01 (08:22):
We've expanded as the medications and we've
expanded our approaches.
So we really emphasize the dietand the exercise right away.
And we do a lot of cognitiveenhancement treatment.
Anything you can do to improvetheir ability to think and to
participate in care makeseverything else get better.
(08:42):
So we always talk about top-downcontrol of your psychosis.
So psychosis is not onlydelusions and hallucinations,
but there's a very strongcomponent that is cognitive.
And that is also the negativesymptoms, the inability to get
started.
And working on those cognitivesymptoms allows the person to
(09:03):
become more aware.
So let's say they're stillhaving auditory hallucinations.
That's a processing problem.
They're actually hearing thosevoices in their brain.
But if you can improve theircognitive abilities, they can
recognize that as being internaland therefore not listening to
voices.
And also as their cognitionimproves and often, you know,
(09:24):
get more involved in socialsituations, because what it
takes, the most difficult thinganyone ever does in terms of
cognitive abilities is socialinteraction, especially with
multiple people.
You need a lot of processingspeed.
So that tends to be diminishedin these illnesses.
SPEAKER_00 (09:41):
These are all great points.
Now, what did you do with yourson?
How did you approach that withall these things that you've
just mentioned?
SPEAKER_01 (09:50):
So with Daniel, we did a lot of cognitive
enhancement treatment, did a lotof exercise, and all of these
things improve cognitiveability.
So there's a feedback.
As far as the medicines, andalso we did cognitive behavioral
therapy, because once you canthink about your own thoughts,
you have a thought that onetenant, and I'm sure you've
(10:10):
heard this before because you'vebeen doing serious mental
illness before, you say neverchallenge a delusion because a
delusion is a fixed falsebelief.
SPEAKER_00 (10:18):
Yes, I have definitely heard that.
SPEAKER_01 (10:20):
Well, actually, with psychosis informed cognitive
behavioral therapy, you canstart to edge onto the delusions
and start to challenge them.
As you're doing that, they'remore in touch with reality and
uh their uh abilities improve.
So that's what we're using moreof.
In terms of the medications, youknow, the medications for
(10:40):
clozapine side effects, they'reold.
Uh one of the modalities that weuse a lot of for the salivation
that's relatively new, is we usegood old uh Botox.
Really?
Yeah, botulinum toxin.
So you can go to an ear nose andthroat doctor or a neurologist
typically that specializes intaking care of Parkinson's
(11:00):
patients because they haveproblems with the salivation and
they'll often have aspiration.
You just inject the salivaryglands.
You start low dose, everyone'sindividual.
These doctors are really adeptat this.
Basically, Botox lasts as longas the salivary glands, and they
turn over about every 90 days orso.
So you go to your nose andthroat doctor, and you get
(11:22):
injected every three months.
And that's really important ifyou're doing clospine because,
as it turns out, aspiration andpneumonia is probably the most
dangerous thing about closopineand that you really have to pay
attention to.
SPEAKER_00 (11:36):
Did you have any issues at first with him
agreeing to do any of this?
One of the issues I've heardfrom several different people is
when someone is in psychosis,they are unwilling to take any
help, get any help, and theyjust don't want any help.
So, how did you deal with that?
Was that an issue at all?
SPEAKER_01 (11:55):
Anasognosia.
No, we were fortunate.
Daniel was 15 when he got sick,which is a bad prognosis, right?
The earlier you get sick,usually the worse the prognosis.
That's why we were told, youknow, mourn the loss of your
child's expectations.
Of course, that did not turn outto be true.
We'll talk a little bit moreabout that.
But fortunately, we were able toget guardianship, which we did,
(12:16):
which we maintain to this day,have never used it because
Daniel has always been aware ofhis illness.
He skipped clozapine once, onetime by mistake.
He just missed it and he felthorrible the next day.
That was enough for him.
So he's always been aware of hisillness.
Anasygnosia is a reallyinteresting condition.
So we always talk aboutunawareness of the illness, but
(12:38):
it's actually more complicatedthan that.
You know, so Daniel does havesome anasognosia because when
you're talking aboutanasognosia, it's actually also
refers to your ability toself-assess.
And people with psychosis arenotoriously bad at
self-assessment.
He underestimates some of thethings he can do and grossly
overestimates some of the thingsthat he can do.
(13:00):
And that remains a problem.
You always have to work on hisself-esteem.
And, you know, this affectseveryone.
It also affects their ability tointeract with other people
because they will not get a goodread, what we call theory of
mind.
They don't usually understandexactly what someone else is
(13:20):
thinking.
SPEAKER_00 (13:21):
Can you expand on how they view that and how they
interact that way?
SPEAKER_01 (13:26):
They will, if they're very psychotic at the
time and their self-esteem ispoor, you know, they're going to
look at someone and they'regoing to interpret, you know,
their interaction in a verynegative fashion.
Ideas of reference.
You know, they're going to hearsomething and that's walking by,
and the other person may havebeen in the conversation
completely unattached and noteven aware of the patient.
(13:47):
But the patient says, thatperson just said I'm fat and I'm
terrible.
It's a real cognitive problem,you know, anasygnosia.
It's interesting, it does getbetter over time.
So clozapine, the one nice thingabout it is it changes the
trajectory of the illness.
And a lot of kids who have hadreally terrible anasygnosia
(14:07):
where they've absolutely knownconcept that they're sick and
think everything is hunky-dory,and why would I ever take any
medicine have over the yearsgotten to accept clozapine.
So the beauty of clozapine is itquiets your mind as opposed to
deadening it.
And if you follow kids that havebeen on clozapine and you've got
(14:31):
them on established doses, theacceptance rate with clozepine
is in the high 80s.
Now, if you look at our data, wehave at one year, and we now
have over 200 patients, uh,clozapine, our acceptance rate
is in 94%.
Yeah, no, so it does, it doesget better over time.
And if it doesn't, and there area lot of kids that are so sick,
(14:54):
then we use uh court-mandatedtreatment.
So that's the ultimate way ofgetting past anasygnosia.
Not where I start.
I usually start with, you know,Javier Amador's approach,
reflective listening, you know,empathizing, trying to agree
with them, partnering with whatthey want.
But sometimes that doesn't work.
And you don't want to, you know,these are illnesses that need to
(15:18):
be treated.
It's a brain illness.
You know, if you had someonelike grandma with Alzheimer's
disease and she didn't want totake her insulin because she
said she doesn't need itanymore, there wouldn't be a
second thought.
Of course you'd give herinsulin.
And the same applies to thispopulation.
SPEAKER_00 (15:34):
Yes, absolutely.
We have to find a way to takecare of everyone.
Here's an unfortunate butinteresting fact.
I've spoken with those that areautistic and those that deal
with serious mental illness.
One common thing they both havetold me is some have taken up to
10 years to get their lifecompletely figured out.
SPEAKER_01 (15:54):
Yeah, that's what I'm trying to stop.
So we have an approach, youknow, called Ease.
I wrote a paper with a guy bythe name of Matri Keshevan who
loves acronyms.
E is early because all theseillnesses, all these psychotic
illnesses are, to a certainextent, genetically based,
neurodevelopmental, and when notappropriately treated,
(16:14):
neurodeturative.
We know that untreated psychosisor poorly treated psychosis
leads to loss of brain.
Henry Naserlow's former,whatchamacallit, chair, I guess.
Chair, president, probablypresident of the APA, always
likes to say that psychosis islike a slow-moving stroke, and
you lose about 1% of your brainper year.
(16:36):
Early treatment with the mosteffective medication, that's all
I'm proposing, is the way to go.
I mean, no other field wouldthis be controversial.
And ossipine is the only drugthat has the FDA indication for
resistant schizophrenia andloosely defined as, you know,
people that have failed twoother antipsychotics without
(16:58):
really getting even close totheir former status.
It's the only drug that willwork in any significant
percentage.
There's always the anecdoteswhere someone does get better
because there's literallytrillions of ways to get the
psychosis.
But if you look at statistics,it's well less than 5% will be
successful of any other drug.
Whereas with closamine, just byclospine alone, that group will
(17:21):
get 50 to 70%.
So a decade's ridiculous becausepeople have failed earlier than
that.
I can't argue, I don't have thedata to argue that if you get
started on another antipsychoticthat's not as difficult to
manage because clospine is a lotof work.
You do have to manage the sideeffects.
Some of these antipsychoticsreally don't have appreciable
(17:42):
side effects.
And if they return to theirformer status, they go back and
they are fine.
I can't argue with using that.
SPEAKER_00 (17:49):
That makes perfect sense.
You are a strong advocate forthis.
What are your thoughts?
SPEAKER_01 (17:54):
Would I do that?
No.
And the reason is becauseusually that same group will
respond to very low doses ofclospine, which then will have
less side effects.
And we know clozepine is, as Isaid, distinctly useful at
changing the trajectory of theillness.
And we don't know if these otherdrugs will hold them.
Because what you've also heard,I'm sure, is oh, that drug used
(18:17):
to work great and then itstopped working because it's a
partial response.
And I don't take this withtremendous data because the data
really doesn't exist.
The very first treatment, but Iwould use closapine, and I have
used clospine right at theinception of illness if I could.
Daniel, it turned out it was ayear and a half before he
started clozepine.
SPEAKER_00 (18:37):
So you have strong beliefs that it's just as good
to start out right from the verystart.
SPEAKER_01 (18:42):
We've had people start much earlier.
I just started a fellow withbipolar with psychosis within
two weeks of the start of hisillness a few months ago, and
he's on a tiny dose of clozepinewith no side effects.
And I've done this multipletimes with other people.
On the literature,unfortunately, not many other
(19:02):
people are doing it.
There's a study that's comingout that Dr.
McCabe in King's College inEngland that's going to repeat a
lot of this in first episodepsychosis programs.
But it's also very interestingyour point about the 10 years.
The most successful firstepisode psychosis programs are
the programs that quickly goonto Clospede.
(19:23):
And this is just a paper thatjust came out, also, King's
College in England.
You know, this is the wave, Ibelieve, of the future.
And we're starting to get moreand more inertia.
10 years is way too long.
SPEAKER_00 (19:34):
Yes, I definitely agree there.
SPEAKER_01 (19:36):
You lose brain.
And you know, the recovery, youcan still get really good
recovery, but it's never quite,I shouldn't say never, but it's
almost never quite as completebecause there's never an ever,
as I keep finding out.
SPEAKER_00 (19:50):
Okay, you've been doing this a long time.
No matter what's going on,there's always a bump in the
road.
What's one of the biggerchallenges you've had to face?
Then you've kind of finallyfigured it out and move forward.
Ah, you know what?
SPEAKER_01 (20:06):
I haven't figured it out yet because probably the
biggest challenge is uh engagingthe psychiatric community.
And that's something that we'restill working on.
And getting an adequateworkforce to basically take care
of these kids.
Probably the biggest obstaclebesides that is the finances of
it all.
It's a lot of work.
(20:27):
And I think that's also why it'sreally tough to engage people
because treatment of seriousmental illness is very
undervalued.
Again, I made I made a very goodlivelihood when I was a
nephrologist.
And, you know, I'm working justas hard doing uh taking care of
psychotic individuals as aninternist, but I'm actually
making about a third of theamount that I was making back
(20:49):
then.
And most of it isnon-insurance-based.
Insurance will not pay for that.
So at this point, yeah, I thinkour biggest obstacle is the
inability of uh the insurancesto recognize the value in
treating serious mental illnesswith a comprehensive wraparound
approach and pay for it becauseuh, you know, it's great.
(21:09):
So I live in Upper Westchester,northern Westchester, right on
the border with Connecticut inWestchester County, right next
to Fairfield in Greenwich,Connecticut.
You know, I'm in Bedford.
It's a beautiful area, it'sincredibly affluent.
I'm probably one of the poorerpeople that live there.
And I am not poor by anyestimation.
So we have that group that willpay.
And they paid literally hundredsof thousands of dollars for
(21:33):
inadequate care.
So we've started somethingcalled Dora Mind the last two
years to, you know, get this isthe biggest problem around
access to our treatment plans.
And how can I get access at areasonable cost?
Well, we decided we would usenurse practitioners because
they're a little more economicalthan physicians.
You know, the rates are lowerand uh their income expectations
(21:57):
are lower because they don'tcome with the half a million.
Dollar loan from medical schoolthat most of the early
psychiatrists come out with.
And so I don't blame thepsychiatrists for wanting to be
paid.
SPEAKER_00 (22:08):
No, absolutely.
They spent a lot of money incollege and they want to get
paid.
So how is it all working and howare you training them?
SPEAKER_01 (22:15):
So we've started with this group, and I've
trained uh four nursepractitioners.
Three are employed right now.
I supervise them regularly.
I've got um the two originalfounders who had worked for a
Firefly and Athena Health inroles of uh, I think, chief uh
technical officers and the chiefoperating officers in those
(22:39):
roles, but they had loved oneswith serious penal illness.
So this is more their passion.
They understand the finances,and we are slowly trying to get
and slowly getting insurancecompanies to value it.
And they're valuing it probablytoo low.
And we are far from a profitableenterprise.
In fact, we're still on thebleeding money side, but we're
(23:00):
starting to see more and more,and also because we have the
data.
And the reality is it all comesback to our healthcare system,
right?
So private insurance is if youdo poorly, you can't afford to
pay the premium.
You go to another insurancecompany.
If there was a universal care,you would see that just treating
people with clozepine.
And they've looked at this inthe VA system, they've looked at
(23:22):
this in a Medicare and Medicaidenvironment, they've looked at
this in England, is a tremendouscost savings because instead of
the revolving door ofhospitalizations, it costs more
to use clozepine.
It's true.
As an outpatient, the drugitself is dirt cheap and you
stop the hospital, and that'sthe usual cost.
So coming into my practice, theyear before, 94% of our
(23:46):
individuals, 94%, 93, actually.
Sorry, I don't want toexaggerate, were in the hospital
at least once.
And most of those were multipletimes.
After coming into the practice,we've only had 15% go back in
the hospital.
And that extends from one yearto as long as 15 years, so much
longer periods of time.
So the revolving door stops andexpenses go down.
SPEAKER_00 (24:07):
With the expenses going down, the revolving door
stopping, you would think thatwould be a situation everyone
would love.
SPEAKER_01 (24:15):
The problem is getting all the individual
payers on board.
That's our probably biggest bumpin the road, you know, because
it's the affordability issue.
People come to me, and you know,if you can afford it, great.
That's wonderful.
And then they can get care.
I've trained these NPs, Isupervise them, they do a great
job.
My wife and I are over 200patients.
(24:37):
We're personally, and I alwayslike to put this on every
podcast, not taking any newpatients because I'm 68 years
old.
And I think my mission right nowis to take care of who I've got
and train other people becausethis approach works.
Oh, let me finish my approach.
Ease.
So early use of CLOSP, A isassertive management and a
(24:57):
wraparound service, not onlygiving medicines, but what we
talked about before (25:01):
diet, exercise, cognitive behavioral
therapy, socialization.
I have these kids come to myhouse, normalizing
relationships, taking it out ofthe medical environment.
The worst part of it, peoplewill tell you is what's the
worst part of the psychosis isthe loneliness, the being alone,
the isolation.
(25:21):
So we really work on that.
And then slow.
When you introduce yourmedicines or you titrate off
another medicine, take yourtime.
It really does help tremendouslywith the side effects.
And also slow, because as youalready mentioned, right, it
takes 10 years sometimes forpeople to get to me.
Guess what?
It's gonna be a slow, long road.
(25:42):
I always tell people it's not asprint, it's a marathon.
And then E, engagement.
We engage everyone.
We don't only engage thepatient, we try to engage the
family.
Often the families are left outof the cure of serious mental
illness.
And that's that's just a sin.
Or as I like to say, you know,sorry about my Judaism, a
shonda, a shonda, which is evena bigger shame.
(26:05):
And, you know, you gotta engage,you gotta use all the resources
you possibly can.
And you should never let HIPAA,you know, something that gets in
the way.
Again, coming back to theAnasagnosia, I've had kids tell
me, don't talk to my parents,you know, I'm not permitting it.
HIPAA actually gives the doctorpermission to use his best
judgment when the patient is, aswe would say, not of their right
(26:28):
mind.
So if you think the patient isclearly in psychosis and you
have met the family and they'renot toxic, and some families
are, and sometimes I don't sayit.
I mean, again, there's noabsolute, but most families are
out there trying to help theirkid, and I engage the family.
SPEAKER_00 (26:45):
Yeah, that makes total sense.
In closing, what do you think isimportant that our listeners
hear on what you're doing andwhat they need to know?
SPEAKER_01 (26:54):
So, as I said, the nihilism in psychiatry, the
belief that you know your kid'slife is over.
Well, my son is, you know, astand-up comic, which of course
most people with schizophreniaare, you know, has a decent
career in New York City and hasfinally engaged the serious
mental illness community becausethey need to see.
So we were just at an event inuh Valleo in California, I think
(27:18):
south of San Francisco.
And Daniel would get up and dida 20-minute set of stand-up
comedy.
Then we showed our movie, whichis Into the Light Meaningful
Recovery, a little plug forthat.
And then I'd do my usual talk.
And the sponsor said, Now youknow what schizophrenia can look
like.
That's what people have tounderstand.
It's not easy, it really is noteasy, but again, any other
(27:42):
illness, you would use the mosteffective treatments.
You pull out all the stops.
Schizophrenia kills people,psychosis kills people.
The suicide rates are up around5%.
Ospian reduces that by 90% orso, 80 to 90 percent or so.
I don't want to exaggerateagain.
You know, long-term survival,the FIN20 study, the entire
(28:03):
Finnish population, where theythey have actually a national
healthcare system and a nationaldatabase.
So they have less than 6 millionpeople, they have 62,500 people
with psychosis, and theyfollowed them for 20 years.
People not on antipsychoticsthat have psychosis, 46% had
passed away, almost 50%mortality.
People on a non-clozepine-basedantipsychotic, almost 16%.
(28:27):
Or no, not 16%, 25.8% died.
And then with clozepine, it was15.8%.
Still not perfect by any stretchof the imagination, but a hell
of a lot better.
So my message is don't settle.
It's not good enough.
Demand if your kid is great onwhatever antipsychotic they're
on.
Fine, but keep an open mind.
(28:47):
As I said, these illnesses tendto progress.
Demand the best treatment.
That's all I'm asking.
And that is a closopene-basedregimen.
Coming out in the next fewmonths will be our fifth
edition, and it's going to be anextensive disposition.
I've gone through each book.
At first, I just wrote it forthe general public.
Each edition, I've kind ofincreased references and made it
(29:10):
not only for the general public,but also for the physician.
We've expanded the bookoriginally to this little thing
that was 100 pages.
Now it's about 500 pages,probably too long.
So it's meaningful recovery fromschizophrenia and serious mental
illness with clospine.
That'll be the fifth edition.
It'll be out before the end ofthe year.
And you you share that with yourtreating psychiatrist.
(29:33):
That's it.
Just demand the best for yourkids.
That's all I'm saying.
SPEAKER_00 (29:37):
Absolutely.
Well, this has been great.
Great conversation, greatinformation.
I really appreciate you takingthe time to join us today.
SPEAKER_01 (29:44):
Oh, Tony, thanks so much.
Thanks for taking the time withme.
SPEAKER_00 (29:47):
Oh, it's been my pleasure.
Thanks again.
Thanks for taking time out ofyour busy schedule to listen to
our show today.
We hope you enjoyed it as muchas we enjoyed bringing it to
you.
If you know someone who has astory to share, tell them to
(30:10):
contact us at why notme.world.
One last thing spread the wordabout why not me.
Our conversations, our inspiringguests that show you are not
alone in this world.
Welcome to Why Not Mini, embracing autism and
mental health worldwide.
Hosted by Tony Mentor.
Broadcasting from the heart ofMusic City, USA, Nashville,
Tennessee.
Join us as our guests sharetheir raw, powerful stories.
Some will spark laughter, otherswill move you to tears.
(00:30):
These real life journeysinspire, connect, and remind you
that you're never alone.
We're igniting a global movementto empower everyone to make a
lasting difference by fosteringdeep awareness, unwavering
acceptance, and profoundunderstanding of autism and
(00:52):
mental health.
Tune in, be inspired, and joinus in transforming the world one
story at a time.
Hi, I'm Tony Mantor.
Welcome to Why Not Me, EmbracingAutism and Mental Health
Worldwide.
Joining us today is Dr.
Robert Leitman, who is adistinguished physician with
(01:14):
extensive expertise in internalmedicine, where he has built a
strong foundation in diagnosingand treating a wide range of
complex medical conditions.
Specializing in serious mentalillness like schizophrenia and
bipolar disorder, he seamlesslyblends his medical precision
with compassion, making him atrusted leader in addressing
(01:36):
patients' complex needs.
He has a wealth of informationfor us, so before we dive into
our episode, we'll be back withan uninterrupted show right
after a word from our sponsors.
Thanks for coming on.
SPEAKER_01 (01:49):
Oh, sure.
No, it's my pleasure.
And you know, thanks for havingme.
I mean, this is something nearand dear to my heart.
SPEAKER_00 (01:55):
It's great to have you here.
Could you share with ourlisteners a bit more about what
you do?
SPEAKER_01 (02:00):
I am an internal medicine specialist.
I was trained in nephrology andgeriatrics, but for the last 20
or so years, I've devoted uh mypractice as well as my wife, who
just walked out the door, totaking care of people with
psychotic illnesses.
And the reason I'm doing that isbecause my son 20 years ago
developed schizophrenia, and wejust didn't find adequate care.
(02:22):
We thought there was tremendousnihilism in the psychiatric
community that we were told, forinstance, you know, more on the
loss of your son and yourexpectations.
And I just didn't find that tobe an acceptable solution.
SPEAKER_00 (02:35):
Yes, I think that's very understandable.
So when you decided to take thison, what confronted you?
What were some of the bumps inthe road, so to speak?
SPEAKER_01 (02:45):
Well, initially, the biggest bump was actually my
wife.
And she's right, because uh, youknow, again, we're both
physicians.
You're not really supposed totake care of your own.
But I pointed out to her thatI'm uh not traditional.
I've been taking care of mymother and father because I was,
as I said, a nephrologist andgerontologist.
And, you know, and I I've done apretty decent job of that.
(03:07):
In fact, my dad ended up livingto 101, as I already mentioned,
and my mom lived to 99.
And I said, look, I'll makeevery attempt to find good care
for Daniel.
But after we started to read theliterature and we kept going and
being referred to onepsychiatrist after another, we
never found anyone, first ofall, for the first uh year or
(03:27):
so, actually six months, thatwas willing to prescribe
clospine.
Finally, we met Lou Oakler, whowasn't taking new patients at
the time, and he referred us toanother physician.
But it was still going to beanother year for clospine.
This guy was reasonably, hesaid, yes, I'll consider it.
Let me fix Daniel's regimen,because by that time he was
already on three antipsychotics.
I was chomping at the bit for myopportunity to take care of him,
(03:51):
but I deferred because again,you're not supposed to take care
of your own traditionally.
Eventually, he got to the pointwhere it was, you know, just he
needed to be on clozepine.
And we finally prevailed on thetreating psychiatrist to start
him.
SPEAKER_00 (04:06):
When you finally had the psychiatrist change his
mind, what happened next?
Over time, it got to the pointwhere it was so difficult.
SPEAKER_01 (04:15):
And fortunately, we've made the prescribing of
clozapine easier, easier becausewe've gotten rid of the
requirement for the blood.
But back then, it would take mehours every week just to get
Daniel's supply of clozepine.
I'd have to call up, get itapproved by the insurance
company, make sure I had theblood work.
(04:36):
And I even had my own in-officelab.
And then I would send theresults to the psychiatrist
waiting for him to write theprescription because for the
first 26 weeks back then, it wasweekly.
And I just got tired of it, youknow, and I found it a situation
almost guaranteed to failbecause he wouldn't give more
than the absolute number ofpills that Daniel was on.
(04:57):
So I just eventually just tookover.
And it was much easier afterthat.
You know, I rode for an adequateamount of medication.
I did the required blood work.
It was much easier because I hadthe blood work right in front of
me.
I took steps out of the way.
SPEAKER_00 (05:12):
Yeah, that sounds like it was very much easier.
Were there any other issues thatyou had to deal with?
SPEAKER_01 (05:18):
Also, the lack of knowledge on how to prescribe
closapine correctly.
So six months into Daniel'sillness, he developed a sizable
aspiration pneumonia, an abscesson his lung, because no one had
really talked to us or explainedhow to take care of the excess
of salivation that comes withclospine.
So we ended up treating him withIV antibiotics at home.
(05:41):
My wife and I took turns puttingan intravenous in every single
day, sending him to school,taking the IV out, putting a new
IV in.
And 28 days later, we had himwith clear lungs.
And in the meantime, we startedto treat the salivation.
So it became very apparent to methat if you're going to use
clospine correctly, because Ikept reading and reading about
it and all the terrible sideeffects, which is why people
(06:01):
weren't using the drug.
SPEAKER_00 (06:03):
That is a big question.
How do you handle the sideeffects?
Because one thing can lead toanother, and then all of a
sudden it could get out ofcontrol.
Every one of these side effectsis predictable.
SPEAKER_01 (06:15):
You can get predictable pharma, you know,
pharmacology, just usingpharmacology, for instance, with
the excess of salivation.
We took care of that, doing thesimple things, propping his head
up, obviously, and making surethat we diminished the uh
salivation using just uh we usedsomething called a hippotroprium
(06:36):
nasal spray, and we would justsquirt it under his tongue at
bedtime.
That diminished the salivation,and aspiration no longer became
a problem.
SPEAKER_00 (06:44):
Yeah, that's great.
Were there any other sideeffects or anything else that
you were concerned about?
SPEAKER_01 (06:50):
Also, as you start on closine, the heart rate goes
up.
Again, normal physiology.
So we would put him on a verylow dose of a beta blocker, and
that took care of that.
And you just go down the sideeffects.
Weight gain, almost universalwith clospine.
Why allow it?
You know, unfortunately,clospine has effects on
appetite.
(07:10):
It's very something calledanti-histaminic and
anticholinergic.
So it actually stimulates,greatly stimulates appetite.
You know, it's not the kidsbeing a pig, the kid is almost
driven to eat.
So what do you do?
You give them metformin.
It's not that hard.
And these days we're really wellequipped because we do the
injectables, which Daniel didnot require.
(07:33):
And of course, the beauty ofthis, where Daniel was really
sick and at his worst was almostcatatonic, he got better in
terms of his ability tocomprehend, to think, to
participate in his own care.
Something that would make youhappy, Tony.
He started to actually watch hisdiet and now has become
basically a pescatarian, not avegetarian, but a pescatarian,
(07:55):
and he exercises regularly.
And that obviously, you know,helped his health almost as much
as all the other medicines thatwe typically add, uh, you know,
to assist kids.
SPEAKER_00 (08:06):
Yeah, that's great.
It's all about the end results.
Now, this was 20 years ago.
Has anything changed themedications, the way you look at
it, just the overall proceduresthat you use compared to 20
years ago?
SPEAKER_01 (08:22):
We've expanded as the medications and we've
expanded our approaches.
So we really emphasize the dietand the exercise right away.
And we do a lot of cognitiveenhancement treatment.
Anything you can do to improvetheir ability to think and to
participate in care makeseverything else get better.
(08:42):
So we always talk about top-downcontrol of your psychosis.
So psychosis is not onlydelusions and hallucinations,
but there's a very strongcomponent that is cognitive.
And that is also the negativesymptoms, the inability to get
started.
And working on those cognitivesymptoms allows the person to
(09:03):
become more aware.
So let's say they're stillhaving auditory hallucinations.
That's a processing problem.
They're actually hearing thosevoices in their brain.
But if you can improve theircognitive abilities, they can
recognize that as being internaland therefore not listening to
voices.
And also as their cognitionimproves and often, you know,
(09:24):
get more involved in socialsituations, because what it
takes, the most difficult thinganyone ever does in terms of
cognitive abilities is socialinteraction, especially with
multiple people.
You need a lot of processingspeed.
So that tends to be diminishedin these illnesses.
SPEAKER_00 (09:41):
These are all great points.
Now, what did you do with yourson?
How did you approach that withall these things that you've
just mentioned?
SPEAKER_01 (09:50):
So with Daniel, we did a lot of cognitive
enhancement treatment, did a lotof exercise, and all of these
things improve cognitiveability.
So there's a feedback.
As far as the medicines, andalso we did cognitive behavioral
therapy, because once you canthink about your own thoughts,
you have a thought that onetenant, and I'm sure you've
(10:10):
heard this before because you'vebeen doing serious mental
illness before, you say neverchallenge a delusion because a
delusion is a fixed falsebelief.
SPEAKER_00 (10:18):
Yes, I have definitely heard that.
SPEAKER_01 (10:20):
Well, actually, with psychosis informed cognitive
behavioral therapy, you canstart to edge onto the delusions
and start to challenge them.
As you're doing that, they'remore in touch with reality and
uh their uh abilities improve.
So that's what we're using moreof.
In terms of the medications, youknow, the medications for
(10:40):
clozapine side effects, they'reold.
Uh one of the modalities that weuse a lot of for the salivation
that's relatively new, is we usegood old uh Botox.
Really?
Yeah, botulinum toxin.
So you can go to an ear nose andthroat doctor or a neurologist
typically that specializes intaking care of Parkinson's
(11:00):
patients because they haveproblems with the salivation and
they'll often have aspiration.
You just inject the salivaryglands.
You start low dose, everyone'sindividual.
These doctors are really adeptat this.
Basically, Botox lasts as longas the salivary glands, and they
turn over about every 90 days orso.
So you go to your nose andthroat doctor, and you get
(11:22):
injected every three months.
And that's really important ifyou're doing clospine because,
as it turns out, aspiration andpneumonia is probably the most
dangerous thing about closopineand that you really have to pay
attention to.
SPEAKER_00 (11:36):
Did you have any issues at first with him
agreeing to do any of this?
One of the issues I've heardfrom several different people is
when someone is in psychosis,they are unwilling to take any
help, get any help, and theyjust don't want any help.
So, how did you deal with that?
Was that an issue at all?
SPEAKER_01 (11:55):
Anasognosia.
No, we were fortunate.
Daniel was 15 when he got sick,which is a bad prognosis, right?
The earlier you get sick,usually the worse the prognosis.
That's why we were told, youknow, mourn the loss of your
child's expectations.
Of course, that did not turn outto be true.
We'll talk a little bit moreabout that.
But fortunately, we were able toget guardianship, which we did,
(12:16):
which we maintain to this day,have never used it because
Daniel has always been aware ofhis illness.
He skipped clozapine once, onetime by mistake.
He just missed it and he felthorrible the next day.
That was enough for him.
So he's always been aware of hisillness.
Anasygnosia is a reallyinteresting condition.
So we always talk aboutunawareness of the illness, but
(12:38):
it's actually more complicatedthan that.
You know, so Daniel does havesome anasognosia because when
you're talking aboutanasognosia, it's actually also
refers to your ability toself-assess.
And people with psychosis arenotoriously bad at
self-assessment.
He underestimates some of thethings he can do and grossly
overestimates some of the thingsthat he can do.
(13:00):
And that remains a problem.
You always have to work on hisself-esteem.
And, you know, this affectseveryone.
It also affects their ability tointeract with other people
because they will not get a goodread, what we call theory of
mind.
They don't usually understandexactly what someone else is
(13:20):
thinking.
SPEAKER_00 (13:21):
Can you expand on how they view that and how they
interact that way?
SPEAKER_01 (13:26):
They will, if they're very psychotic at the
time and their self-esteem ispoor, you know, they're going to
look at someone and they'regoing to interpret, you know,
their interaction in a verynegative fashion.
Ideas of reference.
You know, they're going to hearsomething and that's walking by,
and the other person may havebeen in the conversation
completely unattached and noteven aware of the patient.
(13:47):
But the patient says, thatperson just said I'm fat and I'm
terrible.
It's a real cognitive problem,you know, anasygnosia.
It's interesting, it does getbetter over time.
So clozapine, the one nice thingabout it is it changes the
trajectory of the illness.
And a lot of kids who have hadreally terrible anasygnosia
(14:07):
where they've absolutely knownconcept that they're sick and
think everything is hunky-dory,and why would I ever take any
medicine have over the yearsgotten to accept clozapine.
So the beauty of clozapine is itquiets your mind as opposed to
deadening it.
And if you follow kids that havebeen on clozapine and you've got
(14:31):
them on established doses, theacceptance rate with clozepine
is in the high 80s.
Now, if you look at our data, wehave at one year, and we now
have over 200 patients, uh,clozapine, our acceptance rate
is in 94%.
Yeah, no, so it does, it doesget better over time.
And if it doesn't, and there area lot of kids that are so sick,
(14:54):
then we use uh court-mandatedtreatment.
So that's the ultimate way ofgetting past anasygnosia.
Not where I start.
I usually start with, you know,Javier Amador's approach,
reflective listening, you know,empathizing, trying to agree
with them, partnering with whatthey want.
But sometimes that doesn't work.
And you don't want to, you know,these are illnesses that need to
(15:18):
be treated.
It's a brain illness.
You know, if you had someonelike grandma with Alzheimer's
disease and she didn't want totake her insulin because she
said she doesn't need itanymore, there wouldn't be a
second thought.
Of course you'd give herinsulin.
And the same applies to thispopulation.
SPEAKER_00 (15:34):
Yes, absolutely.
We have to find a way to takecare of everyone.
Here's an unfortunate butinteresting fact.
I've spoken with those that areautistic and those that deal
with serious mental illness.
One common thing they both havetold me is some have taken up to
10 years to get their lifecompletely figured out.
SPEAKER_01 (15:54):
Yeah, that's what I'm trying to stop.
So we have an approach, youknow, called Ease.
I wrote a paper with a guy bythe name of Matri Keshevan who
loves acronyms.
E is early because all theseillnesses, all these psychotic
illnesses are, to a certainextent, genetically based,
neurodevelopmental, and when notappropriately treated,
(16:14):
neurodeturative.
We know that untreated psychosisor poorly treated psychosis
leads to loss of brain.
Henry Naserlow's former,whatchamacallit, chair, I guess.
Chair, president, probablypresident of the APA, always
likes to say that psychosis islike a slow-moving stroke, and
you lose about 1% of your brainper year.
(16:36):
Early treatment with the mosteffective medication, that's all
I'm proposing, is the way to go.
I mean, no other field wouldthis be controversial.
And ossipine is the only drugthat has the FDA indication for
resistant schizophrenia andloosely defined as, you know,
people that have failed twoother antipsychotics without
(16:58):
really getting even close totheir former status.
It's the only drug that willwork in any significant
percentage.
There's always the anecdoteswhere someone does get better
because there's literallytrillions of ways to get the
psychosis.
But if you look at statistics,it's well less than 5% will be
successful of any other drug.
Whereas with closamine, just byclospine alone, that group will
(17:21):
get 50 to 70%.
So a decade's ridiculous becausepeople have failed earlier than
that.
I can't argue, I don't have thedata to argue that if you get
started on another antipsychoticthat's not as difficult to
manage because clospine is a lotof work.
You do have to manage the sideeffects.
Some of these antipsychoticsreally don't have appreciable
(17:42):
side effects.
And if they return to theirformer status, they go back and
they are fine.
I can't argue with using that.
SPEAKER_00 (17:49):
That makes perfect sense.
You are a strong advocate forthis.
What are your thoughts?
SPEAKER_01 (17:54):
Would I do that?
No.
And the reason is becauseusually that same group will
respond to very low doses ofclospine, which then will have
less side effects.
And we know clozepine is, as Isaid, distinctly useful at
changing the trajectory of theillness.
And we don't know if these otherdrugs will hold them.
Because what you've also heard,I'm sure, is oh, that drug used
(18:17):
to work great and then itstopped working because it's a
partial response.
And I don't take this withtremendous data because the data
really doesn't exist.
The very first treatment, but Iwould use closapine, and I have
used clospine right at theinception of illness if I could.
Daniel, it turned out it was ayear and a half before he
started clozepine.
SPEAKER_00 (18:37):
So you have strong beliefs that it's just as good
to start out right from the verystart.
SPEAKER_01 (18:42):
We've had people start much earlier.
I just started a fellow withbipolar with psychosis within
two weeks of the start of hisillness a few months ago, and
he's on a tiny dose of clozepinewith no side effects.
And I've done this multipletimes with other people.
On the literature,unfortunately, not many other
(19:02):
people are doing it.
There's a study that's comingout that Dr.
McCabe in King's College inEngland that's going to repeat a
lot of this in first episodepsychosis programs.
But it's also very interestingyour point about the 10 years.
The most successful firstepisode psychosis programs are
the programs that quickly goonto Clospede.
(19:23):
And this is just a paper thatjust came out, also, King's
College in England.
You know, this is the wave, Ibelieve, of the future.
And we're starting to get moreand more inertia.
10 years is way too long.
SPEAKER_00 (19:34):
Yes, I definitely agree there.
SPEAKER_01 (19:36):
You lose brain.
And you know, the recovery, youcan still get really good
recovery, but it's never quite,I shouldn't say never, but it's
almost never quite as completebecause there's never an ever,
as I keep finding out.
SPEAKER_00 (19:50):
Okay, you've been doing this a long time.
No matter what's going on,there's always a bump in the
road.
What's one of the biggerchallenges you've had to face?
Then you've kind of finallyfigured it out and move forward.
Ah, you know what?
SPEAKER_01 (20:06):
I haven't figured it out yet because probably the
biggest challenge is uh engagingthe psychiatric community.
And that's something that we'restill working on.
And getting an adequateworkforce to basically take care
of these kids.
Probably the biggest obstaclebesides that is the finances of
it all.
It's a lot of work.
(20:27):
And I think that's also why it'sreally tough to engage people
because treatment of seriousmental illness is very
undervalued.
Again, I made I made a very goodlivelihood when I was a
nephrologist.
And, you know, I'm working justas hard doing uh taking care of
psychotic individuals as aninternist, but I'm actually
making about a third of theamount that I was making back
(20:49):
then.
And most of it isnon-insurance-based.
Insurance will not pay for that.
So at this point, yeah, I thinkour biggest obstacle is the
inability of uh the insurancesto recognize the value in
treating serious mental illnesswith a comprehensive wraparound
approach and pay for it becauseuh, you know, it's great.
(21:09):
So I live in Upper Westchester,northern Westchester, right on
the border with Connecticut inWestchester County, right next
to Fairfield in Greenwich,Connecticut.
You know, I'm in Bedford.
It's a beautiful area, it'sincredibly affluent.
I'm probably one of the poorerpeople that live there.
And I am not poor by anyestimation.
So we have that group that willpay.
And they paid literally hundredsof thousands of dollars for
(21:33):
inadequate care.
So we've started somethingcalled Dora Mind the last two
years to, you know, get this isthe biggest problem around
access to our treatment plans.
And how can I get access at areasonable cost?
Well, we decided we would usenurse practitioners because
they're a little more economicalthan physicians.
You know, the rates are lowerand uh their income expectations
(21:57):
are lower because they don'tcome with the half a million.
Dollar loan from medical schoolthat most of the early
psychiatrists come out with.
And so I don't blame thepsychiatrists for wanting to be
paid.
SPEAKER_00 (22:08):
No, absolutely.
They spent a lot of money incollege and they want to get
paid.
So how is it all working and howare you training them?
SPEAKER_01 (22:15):
So we've started with this group, and I've
trained uh four nursepractitioners.
Three are employed right now.
I supervise them regularly.
I've got um the two originalfounders who had worked for a
Firefly and Athena Health inroles of uh, I think, chief uh
technical officers and the chiefoperating officers in those
(22:39):
roles, but they had loved oneswith serious penal illness.
So this is more their passion.
They understand the finances,and we are slowly trying to get
and slowly getting insurancecompanies to value it.
And they're valuing it probablytoo low.
And we are far from a profitableenterprise.
In fact, we're still on thebleeding money side, but we're
(23:00):
starting to see more and more,and also because we have the
data.
And the reality is it all comesback to our healthcare system,
right?
So private insurance is if youdo poorly, you can't afford to
pay the premium.
You go to another insurancecompany.
If there was a universal care,you would see that just treating
people with clozepine.
And they've looked at this inthe VA system, they've looked at
(23:22):
this in a Medicare and Medicaidenvironment, they've looked at
this in England, is a tremendouscost savings because instead of
the revolving door ofhospitalizations, it costs more
to use clozepine.
It's true.
As an outpatient, the drugitself is dirt cheap and you
stop the hospital, and that'sthe usual cost.
So coming into my practice, theyear before, 94% of our
(23:46):
individuals, 94%, 93, actually.
Sorry, I don't want toexaggerate, were in the hospital
at least once.
And most of those were multipletimes.
After coming into the practice,we've only had 15% go back in
the hospital.
And that extends from one yearto as long as 15 years, so much
longer periods of time.
So the revolving door stops andexpenses go down.
SPEAKER_00 (24:07):
With the expenses going down, the revolving door
stopping, you would think thatwould be a situation everyone
would love.
SPEAKER_01 (24:15):
The problem is getting all the individual
payers on board.
That's our probably biggest bumpin the road, you know, because
it's the affordability issue.
People come to me, and you know,if you can afford it, great.
That's wonderful.
And then they can get care.
I've trained these NPs, Isupervise them, they do a great
job.
My wife and I are over 200patients.
(24:37):
We're personally, and I alwayslike to put this on every
podcast, not taking any newpatients because I'm 68 years
old.
And I think my mission right nowis to take care of who I've got
and train other people becausethis approach works.
Oh, let me finish my approach.
Ease.
So early use of CLOSP, A isassertive management and a
(24:57):
wraparound service, not onlygiving medicines, but what we
talked about before (25:01):
diet, exercise, cognitive behavioral
therapy, socialization.
I have these kids come to myhouse, normalizing
relationships, taking it out ofthe medical environment.
The worst part of it, peoplewill tell you is what's the
worst part of the psychosis isthe loneliness, the being alone,
the isolation.
(25:21):
So we really work on that.
And then slow.
When you introduce yourmedicines or you titrate off
another medicine, take yourtime.
It really does help tremendouslywith the side effects.
And also slow, because as youalready mentioned, right, it
takes 10 years sometimes forpeople to get to me.
Guess what?
It's gonna be a slow, long road.
(25:42):
I always tell people it's not asprint, it's a marathon.
And then E, engagement.
We engage everyone.
We don't only engage thepatient, we try to engage the
family.
Often the families are left outof the cure of serious mental
illness.
And that's that's just a sin.
Or as I like to say, you know,sorry about my Judaism, a
shonda, a shonda, which is evena bigger shame.
(26:05):
And, you know, you gotta engage,you gotta use all the resources
you possibly can.
And you should never let HIPAA,you know, something that gets in
the way.
Again, coming back to theAnasagnosia, I've had kids tell
me, don't talk to my parents,you know, I'm not permitting it.
HIPAA actually gives the doctorpermission to use his best
judgment when the patient is, aswe would say, not of their right
(26:28):
mind.
So if you think the patient isclearly in psychosis and you
have met the family and they'renot toxic, and some families
are, and sometimes I don't sayit.
I mean, again, there's noabsolute, but most families are
out there trying to help theirkid, and I engage the family.
SPEAKER_00 (26:45):
Yeah, that makes total sense.
In closing, what do you think isimportant that our listeners
hear on what you're doing andwhat they need to know?
SPEAKER_01 (26:54):
So, as I said, the nihilism in psychiatry, the
belief that you know your kid'slife is over.
Well, my son is, you know, astand-up comic, which of course
most people with schizophreniaare, you know, has a decent
career in New York City and hasfinally engaged the serious
mental illness community becausethey need to see.
So we were just at an event inuh Valleo in California, I think
(27:18):
south of San Francisco.
And Daniel would get up and dida 20-minute set of stand-up
comedy.
Then we showed our movie, whichis Into the Light Meaningful
Recovery, a little plug forthat.
And then I'd do my usual talk.
And the sponsor said, Now youknow what schizophrenia can look
like.
That's what people have tounderstand.
It's not easy, it really is noteasy, but again, any other
(27:42):
illness, you would use the mosteffective treatments.
You pull out all the stops.
Schizophrenia kills people,psychosis kills people.
The suicide rates are up around5%.
Ospian reduces that by 90% orso, 80 to 90 percent or so.
I don't want to exaggerateagain.
You know, long-term survival,the FIN20 study, the entire
(28:03):
Finnish population, where theythey have actually a national
healthcare system and a nationaldatabase.
So they have less than 6 millionpeople, they have 62,500 people
with psychosis, and theyfollowed them for 20 years.
People not on antipsychoticsthat have psychosis, 46% had
passed away, almost 50%mortality.
People on a non-clozepine-basedantipsychotic, almost 16%.
(28:27):
Or no, not 16%, 25.8% died.
And then with clozepine, it was15.8%.
Still not perfect by any stretchof the imagination, but a hell
of a lot better.
So my message is don't settle.
It's not good enough.
Demand if your kid is great onwhatever antipsychotic they're
on.
Fine, but keep an open mind.
(28:47):
As I said, these illnesses tendto progress.
Demand the best treatment.
That's all I'm asking.
And that is a closopene-basedregimen.
Coming out in the next fewmonths will be our fifth
edition, and it's going to be anextensive disposition.
I've gone through each book.
At first, I just wrote it forthe general public.
Each edition, I've kind ofincreased references and made it
(29:10):
not only for the general public,but also for the physician.
We've expanded the bookoriginally to this little thing
that was 100 pages.
Now it's about 500 pages,probably too long.
So it's meaningful recovery fromschizophrenia and serious mental
illness with clospine.
That'll be the fifth edition.
It'll be out before the end ofthe year.
And you you share that with yourtreating psychiatrist.
(29:33):
That's it.
Just demand the best for yourkids.
That's all I'm saying.
SPEAKER_00 (29:37):
Absolutely.
Well, this has been great.
Great conversation, greatinformation.
I really appreciate you takingthe time to join us today.
SPEAKER_01 (29:44):
Oh, Tony, thanks so much.
Thanks for taking the time withme.
SPEAKER_00 (29:47):
Oh, it's been my pleasure.
Thanks again.
Thanks for taking time out ofyour busy schedule to listen to
our show today.
We hope you enjoyed it as muchas we enjoyed bringing it to
you.
If you know someone who has astory to share, tell them to
(30:10):
contact us at why notme.world.
One last thing spread the wordabout why not me.
Our conversations, our inspiringguests that show you are not
alone in this world.
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
Kingdom of Fraud
It’s the unlikeliest of criminal partnerships: a devout polygamist from an insular Utah sect joining forces with a shadowy Armenian tycoon from LA. The result - a billion dollar fraud conspiracy. In Kingdom of Fraud, investigative reporter Michele McPhee traces the origins of the extraordinary alliance between Jacob Kingston and Levon Termendzhyan. Together, the two men trigger the largest tax investigation in American history and weave around themselves a web of dirty cops, influential political relationships and transnational money laundering. All this is set against the backdrop of Jacob Kingston’s clan – The Order. A powerful and secretive polygamist organization in Salt Lake City. To whom Jacob is desperate to prove his worth. Kingdom of Fraud is produced by Novel for iHeart Podcasts. For more from Novel, visit https://novel.audio/. You can listen to new episodes of Kingdom of Fraud completely ad-free and 1 week early with an iHeart True Crime+ subscription, available exclusively on Apple Podcasts. Open your Apple Podcasts app, search for “iHeart True Crime+, and subscribe today!