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'Is there any relationship between the opioid addiction epidemic among working/middle class Americans, and the uneven gains from the economic recovery following the 2008-09 financial crisis?'.If the 2008-2009 financial crisis and its continuing fallout triggered and/or exacerbated the ongoing US opioid addiction crisis, a striking increase in opioid overdose deaths post-2008 would be expected. However, epidemiological data does not support such a premise. This answers summarizesData showing steady year-on-year increase in opioid overdose deaths from 1999 till date, overdose death rates varying widely from state to state, disproportionately affecting whites, and increasing in tandem as opioid prescribing rates rose from 1999-2010, deaths that the CDC already noted with alarm in 2006-07.How starting in the 1990s aggressive opioid marketing and lobbying gestated the roots of the ongoing opioid epidemic by changing how the US medical system treats pain.Steady Year-on-Year Increase In Opioid Overdose Deaths From 1999 Till DateOpioids prescribed in the US peaked in 2010, decreasing steadily since then (see below from 1) though they're still much higher than in the rest of the world.'CDC analyzed retail prescription data from QuintilesIMS to assess opioid prescribing in the United States from 2006 to 2015, including rates, amounts, dosages, and durations prescribed. CDC examined county-level prescribing patterns in 2010 and 2015. ..The amount of opioids prescribed in the United States peaked at 782 morphine milligram equivalents (MME) per capita in 2010 and then decreased to 640 MME per capita in 2015.’Drug overdose deaths have steadily increased since 1999, doubling already by 2006 in 45 to 54 year olds (see second figure below from 2).Drug overdose deaths vary widely from state to state, with states with rather different economic profiles such as West Virginia, New Hampshire, Ohio, Rhode Island, Pennsylvania, Massachusetts, Connecticut, Maine and Maryland experiencing substantial increases from 2010 to 2015 (see below from 3).Overdose deaths disproportionately affect whites (see below from 2) though overall, black males continue to have the lowest life expectancy (see below from 4).Opioid prescribing rates steadily increased 1999-2010 with overdose deaths rising in tandem (see below from 5).Already in 2006-7, CDC reported alarming increases in opioid-induced overdose deaths (see below from 6).Aggressive Opioid Marketing in the 1990s Changed How The US Medical System Treats PainA little known drugmaker best known in the 1980s for the painkiller MS Contin, Purdue Pharma morphed into a multi-billion dollar behemoth on the back of OxyContin, its 1990s upgrade, whose unprecedented marketing vaulted the Sackler family, owners of Purdue Pharma, into the ranks of the wealthiest Americans today.Well worth the reading, Mike Mariani at the Pacific Standard (7) and Patrick Radden Keefe at the New Yorker (8) methodically and comprehensively unravel the process Purdue Pharma used to relentlessly lobby all manner of doctors from general practitioners to pain physicians alike to expand opioid prescription to those with all manner of chronic pain. US doctors in the incalculably innocent pre-OxyContin era tended to view opioids as 'dangerously addictive', limiting their use to those terminally ill, usually terminal cancer patients.Mariani and Keefe recount how sheer money muscle was used to overturn this restriction in use of prescription opioids to instead render them acceptable to treat an expanding list of pain-related conditions.In practical terms, this meant serious boots on the ground in the form of intense lobbying by the likes of the now-defunct American Pain Foundation (9), and thousands of highly paid and hence extremely motivated sales reps to relentlessly push all manner of doctors to start applying the fifth Vital signs - Wikipedia during their routine examination of patients to elicit information about their pain levels and then palliatively treat them with powerful prescription opioids (10, 11), all while repeatedly assuring them opioids weren't addictive (see below from 12, emphasis mine).'Abbott’s relationship with Purdue and its part in building the OxyContin brand are detailed in previously secret court filings unsealed by a Welch, http://W.Va., state court judge at the request of STAT. The records were part of a case brought by the state of West Virginia against Purdue and Abbott that alleged they inappropriately marketed the drug, causing users to become addicted to the opioid. The case was settled in 2004 when Purdue agreed to pay $10 million to the state. Neither company admitted any wrongdoing.The documents include internal Abbott and Purdue memos, as well as sales documents and marketing materials. They show that Abbott sales reps were instructed to downplay the threat of addiction with OxyContin and make other claims to doctors that had no scientific basis. The sales reps from the two companies closely coordinated their efforts, met regularly to strategize, and shared marketing materials.'Opioid prescribing inducements included direct payments to doctors as well. One 2017 study estimated as many as 1 in 12 US physicians and ~1 in 5 family doctors accepted payments related to opioids during the course of the 29-month study (August 2013-December 2015) (13).Such change in prescribing was based not on carefully conducted scientific studies but one mediated by relentless lobbying and marketing, and came into place within the span of a decade from the mid-1990s to the mid-2000s so much so that in 2012, 13 states had more opioid prescriptions than even people (see below from 14, 15). Clearly, change in prescribing (demand) went hand in glove with carpeting of the entire country with a surfeit of opioids (supply).Investigative reporting suggests regulator-opioid maker revolving door also helped grease the wheels.A Los Angeles Times report by Harriet Ryan, Lisa Girion, Scott Glover (16) uncovers how Dr. Curtis Wright, the FDA bureaucrat who led its medical review of Purdue Pharma's OxyContin application in 1995 left the FDA shortly after it approved it and within 2 years began working for Purdue.A piece in the Milwaukee Journal Sentinel by John Fauber suggests (see below from 17, emphasis mine) beefing up pain advisory councils with opioid maker-friendly voices also helped smooth the way in expanding usage of opioids in pain treatment,'Federal health industry regulators and executives of companies that make pain drugs have held private meetings at expensive hotels at least once a year since 2002 through an organization funded by the drug companies, according to emails obtained through public records requests and provided to the Journal Sentinel/MedPage Today.Each year a handful of drug companies have paid up to $35,000 each to send a representative to meetings of IMMPACT, where they could discuss clinical trial testing procedures with officials from the U.S. Food and Drug Administration and other government agencies. IMMPACT's stated goal is to improve the design of clinical trials conducted to develop new pain treatments.’Such meetings appear to have favored opioid makers even as recently as 2013 (see below from 18, emphasis mine).'The Food and Drug Administration is under enormous pressure to change its mind about a powerful new prescription painkiller. Forty-two public health groups are urging the FDA to withdraw its support of Zohydro. The drug is similar to Oxycontin, except it comes in significantly higher doses. The FDA approved Zohydro last year, despite its own advisory panel voting against it. And critics are, among other things, raising questions about that approval process.’As late in the US opioid crisis as January 2016, a federal government pain advisory panel of 18 had at least 5 with financial ties to opioid makers, connections that came to light (see below from 19),'...after the committee last month bashed a federal plan to recommend doctors scale back on prescribing painkillers for chronic pain. The guidelines by the Centers for Disease Control and Prevention are intended to curb deadly overdoses tied to powerful but highly-addictive opioid drugs, including Percocet and Vicodin.'The Center for Public Integrity - Wikipedia also uncovered evidence of opioid maker lobbying of Congress and state legislatures (20), efforts estimated by Mother Jones to be 8X that of the gun lobby and 200X that of those advocating stricter opioid prescription rules (21).Raw numbers reflect the spectacular success of such unprecedented marketing and lobbying. In 1996, annual OxyContin sales were $48 million. For OxyContin's inaugural marketing alone, Purdue doubled its sales force to 600 and spent $207 million, so much so that already by 2000, OxyContin sales grew 23-fold to ~$1.1 billion (22).Already by 2001, OxyContin had become the most frequently prescribed brand name opioid for treating moderate to severe pain in the US, with so much overprescribing that the US GAO issued a 58-page report warning about it all the way back in December 2003 (23).In recent years, other opioid makers such as Insys Therapeutics Inc. (24) and Mallinckrodt Pharmaceuticals (25) have also come under the public spotlight for their aggressive sales practices, tactics that also applied to antidote makers such as Reckitt Benckiser (26).Like a burst dam, such intense marketing and lobbying ended up transforming how US doctors treat pain, replacing wholesale old true and tried methods that erred on the side of caution to an approach where it suddenly became acceptable to treat any and all pain with extremely powerful opioids (1, 5, 27, 28), a change that a 2016 study (29) suggests had US family doctors and general practitioners at the forefront.Could one seriously argue that from the years 1996 onwards, physical pain and/or existential angst increased so much among the US population as to justify such an increase in opioid sales and consumption? Obviously not. Instead, the US opioid epidemic is inextricably linked to an unprecedented medical culture change in how US doctors were carefully and relentlessly persuaded by opioid makers, their lobbyists and sales reps to treat all manner of pain, not just terminal, late stage cancer pain, with highly powerful opioids.Problem is so far opioid makers haven't been held accountable for their willful recklessness (slaps on the wrist in the form of relatively piddling monetary fines obviously don't count) even as they've saturated the US market. Rather, a report in the Los Angeles Times by by Harriet Ryan, Lisa Girion, Scott Glover suggests that as their profits in the US market start to dry up, their ongoing intense lobbying around the world may end up replicating the US opioid crisis in other countries as well (30). For governments, policy makers and regulators the world over, how to avoid 'globalization of the prescription opioid epidemic' (31) thus becomes a matter of urgency.Bibliography1. Guy, Gery P. "Vital signs: changes in opioid prescribing in the United States, 2006–2015." MMWR. Morbidity and mortality weekly report 66 (2017). https://www.cdc.gov/mmwr/volumes/66/wr/pdfs/mm6626a4.pdf2. Hedegaard, Holly, Margaret Warner, and Arialdi M. Miniño. "Drug overdose deaths in the United States, 1999-2015." NCHS data brief 273 (2017): 1-8. Welcome to CDC stacks3. Rudd, Rose A. "Increases in drug and opioid-involved overdose deaths—United States, 2010–2015." MMWR. Morbidity and mortality weekly report 65 (2016). https://www.cdc.gov/mmwr/volumes/65/wr/pdfs/mm655051e1.pdf4. https://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_02.pdf5. Centers for Disease Control and Prevention (CDC. "Vital signs: overdoses of prescription opioid pain relievers---United States, 1999--2008." MMWR. Morbidity and mortality weekly report 60.43 (2011): 1487. https://www.cdc.gov/mmwr/pdf/wk/mm6043.pdf6. CDC Publications7. Mike Mariani, February 23, 2015. Poison Pill8. New Yorker, Patrick Radden Keefe, October 30, 2017. The Family That Built an Empire of Pain9. Propublica, Charles Ornstein, Tracy Weber, December 23, 2011. The Champion of Painkillers — ProPublica10. Tompkins, D. Andrew, J. Greg Hobelmann, and Peggy Compton. "Providing chronic pain management in the “Fifth Vital Sign” Era: Historical and treatment perspectives on a modern-day medical dilemma." Drug and Alcohol Dependence 173 (2017): S11-S21. http://www.sciencedirect.com/science/article/pii/S0376871617300030/pdfft?md5=3f2ef3c4ddb2c940d6f48f623ef4cc45&pid=1-s2.0-S0376871617300030-main.pdf11. Harris, Matthew C., et al. "Prescription Opioids and Labor Market Pains." (2017). http://cber.haslam.utk.edu/staff/harris/Opioids_HKMG.pdf12. Stat News, David Armstrong, September 22, 2016. Secret trove reveals Abbott's bold 'crusade' to sell OxyContin13. Hadland, Scott E., Maxwell S. Krieger, and Brandon DL Marshall. "Industry Payments to Physicians for Opioid Products, 2013–2015." American journal of public health 107.9 (2017): 1493-1495. https://www.researchgate.net/profile/Brandon_Marshall/publication/319203662_Industry_Payments_to_Physicians_for_Opioid_Products_2013-2015/links/599acf44aca272e41d4089fa/Industry-Payments-to-Physicians-for-Opioid-Products-2013-2015.pdf14. Prescribing Data15. Protect patients from opioid overdose16. The Los Angeles Times, Harriet Ryan, Lisa Girion, Scott Glover, May 5, 2016. http://www.latimes.com/projects/oxycontin-part1/17. Milwaukee Journal Sentinel, John Fauber, October 6, 2013. Emails point to relationship between drug firms, regulators18. Critics Question FDA's Approval Of Zohydro19. Associated Press, Matthew Perrone, January 27, 2016. Federal pain panel rife with links to pharma companies20. Public Integrity, Liz Essley Whyte, Geoff Mulvhill, Ben Wieder, September 18, 2016. Politics of pain: Drugmakers fought state opioid limits amid crisis21. Mother Jones, Julia Lurie, September 21, 2016. Opioids are ravaging the country. These lobbyists want to keep the drugs flowing.22. Van Zee, Art. "The promotion and marketing of oxycontin: commercial triumph, public health tragedy." American Journal of Public Health 99.2 (2009): 221-227. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/pdf/221.pdf23. https://www.gao.gov/new.items/d04110.pdf24. Founder and Owner of Pharmaceutical Company Insys Arrested and Charged with Racketeering25. This company’s drugs helped fuel Florida’s opioid crisis. But the government struggled to hold them accountable.26. Reckitt Benckiser sued by 35 US states for 'profiteering' from opioid treatment27. Boudreau, Denise, et al. "Trends in long‐term opioid therapy for chronic non‐cancer pain." Pharmacoepidemiology and drug safety 18.12 (2009): 1166-1175. 6 (2017). https://www.cdc.gov/mmwr/volumes/66/wr/pdfs/mm6626a4.pdf28. Schuchat, Anne, Debra Houry, and Gery P. Guy. "New data on opioid use and prescribing in the United States." Jama 318.5 (2017): 425-426. https://www.issup.net/files/2017-07/New%20Data%20on%20Opioid%20Use%20and%20Prescribing%20in%20the%20United%20States.pdf29. Chen, Jonathan H., et al. "Distribution of opioids by different types of medicare prescribers." JAMA internal medicine 176.2 (2016): 259-261. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2474400?version=meter%20at%20null&module=meter-Links&pgtype=article&contentId=&mediaId=&referrer=&priority=true&action=click&contentCollection=meter-links-click30. Los Angeles Times, Harriet Ryan, Lisa Girion, Scott Glover, December 16, 2016. http://www.latimes.com/projects/la-me-oxycontin-part3/31. Humphreys, Keith. "Avoiding globalisation of the prescription opioid epidemic." The Lancet 390.10093 (2017): 437-439.

Risperdal is available as a generic drug. Common side effects of Risperdal include:extrapyramidal effects (sudden, often jerky, involuntary motions of the head, neck, arms, body, or eyes),dizziness,tiredness,drowsiness,fatigue,fever,weight gain,feeling hot or cold,headache,dry mouth,increased appetite,restlessness,anxiety,sleep problems (insomnia),nausea,vomiting,stomach pain,constipation,cough,sore throat,runny or stuffy nose,or skin rash.Tell your doctor if you experience serious side effects of Risperdal including difficulty swallowing, muscle spasms, shaking (tremor), mental/mood changes, or signs of infection (such as fever, persistent sore throat).Risperdal dose ranges from 0.5 mg to 8mg/day. Risperdal may interact with other medicines that make you sleepy (such as cold or allergy medicine, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures, depression, or anxiety), carbamazepine, cimetidine, ranitidine, clozapine, fluoxetine, paroxetine, phenytoin, valproic acid, phenobarbital, rifampin, or medicines used to treat Parkinson's Disease. Tell your doctor all medications and supplements you use. There are no adequate studies of risperidone in pregnant women so it should not be used unless the benefits outweigh the potential unknown risks. Risperidone is excreted in human breast milk and women receiving risperidone should not breastfeed.Our Risperdal Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication. articles.This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.Risperdal in Detail - Patient Information: Side EffectsGet emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.Stop taking risperidone and call your doctor at once if you have a serious side effect such as:fever, stiff muscles, confusion, sweating, fast or uneven heartbeats;restless muscle movements in your eyes, tongue, jaw, or neck;drooling, tremor (uncontrolled shaking);seizure (convulsions);fever, chills, body aches, flu symptoms;nosebleeds;white patches or sores inside your mouth or on your lips;trouble swallowing;feeling like you might pass out; orpenis erection that is painful or lasts 4 hours or longer.Less serious side effects may include:weight gain;feeling hot or cold;headache, dizziness;drowsiness, tired feeling;dry mouth, increased appetite;feeling restless or anxious;sleep problems (insomnia);nausea, vomiting, stomach pain, constipation;cough, sore throat, runny or stuffy nose; ormild skin rash.This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.Risperdal Overview - Patient Information Side EffectsSIDE EFFECTS: Drowsiness, dizziness, lightheadedness, drooling, nausea, weight gain, or tiredness may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: difficulty swallowing, muscle spasms, shaking (tremor), mental/mood changes (such as anxiety, restlessness), signs of infection (such as fever, persistent sore throat).This medication may infrequently make your blood sugar level rise, which can cause or worsen diabetes. Tell your doctor immediately if you develop symptoms of high blood sugar, such as increased thirst and urination. If you already have diabetes, be sure to check your blood sugars regularly. Your doctor may need to adjust your diabetes medication, exercise program, or diet.This drug may also cause significant weight gain and a rise in your blood cholesterol (or triglyceride) levels. These effects, along with diabetes, may increase your risk for developing heart disease. Discuss the risks and benefits of treatment with your doctor. (See also Notes section.)Risperidone may rarely cause a condition known as tardive dyskinesia. In some cases, this condition may be permanent. Tell your doctor immediately if you develop any unusual/uncontrolled movements (especially of the face, lips, mouth, tongue, arms or legs).This medication may increase a certain natural substance (prolactin) made by your body. For females, this increase in prolactin may result in unwanted breast milk, missed/stopped periods, or difficulty becoming pregnant. For males, it may result in decreased sexual ability, inability to produce sperm, or enlarged breasts. If you develop any of these symptoms, tell your doctor immediately.Get medical help right away if you have any very serious side effects, including: severe dizziness, fainting, seizures.This medication may rarely cause a very serious condition called neuroleptic malignant syndrome (NMS). Get medical help right away if you have any of the following symptoms: fever, muscle stiffness/pain/tenderness/weakness, severe tiredness, severe confusion, sweating, fast/irregular heartbeat, dark urine, change in the amount of urine.Rarely, males may have a painful or prolonged erection lasting 4 or more hours. If this occurs, stop using this drug and get medical help right away, or permanent problems could occur.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.Risperdal FDA Prescribing Information:Side Effects(Adverse Reactions)The following are discussed in more detail in other sections of the labeling:Increased mortality in elderly patients withdementia-related psychosis [see BOXED WARNING and WARNINGS ANDPRECAUTIONS]Cerebrovascular adverse events, including stroke, in elderly patients with dementia-related psychosis [see WARNINGS ANDPRECAUTIONS]Neuroleptic malignant syndrome [seeWARNINGS AND PRECAUTIONS]Tardive dyskinesia [see WARNINGS AND PRECAUTIONS]Metabolic Changes (Hyperglycemia and diabetes mellitus, Dyslipidemia, and Weight Gain) [see WARNINGS AND PRECAUTIONS]Hyperprolactinemia [see WARNINGS AND PRECAUTIONS]Orthostatic hypotension [see WARNINGS AND PRECAUTIONS]Leukopenia, neutropenia, and agranulocytosis [see WARNINGS AND PRECAUTIONS]Potential for cognitive and motor impairment [see WARNINGS AND PRECAUTIONS]Seizures [see WARNINGS AND PRECAUTIONS]Dysphagia [see WARNINGS AND PRECAUTIONS]Priapism [see WARNINGS AND PRECAUTIONS]Disruption of body temperature regulation [see WARNINGS AND PRECAUTIONS]Patients with Phenylketonuria [seeWARNINGS AND PRECAUTIONS].The most common adverse reactions in clinical trials ( > 5% and twice placebo) were parkinsonism, akathisia, dystonia, tremor, sedation, dizziness, anxiety, blurred vision, nausea, vomiting, upper abdominal pain, stomach discomfort, dyspepsia, diarrhea, salivary hypersecretion, constipation, dry mouth, increased appetite, increased weight, fatigue, rash, nasal congestion, upper respiratory tract infection, nasopharyngitis, and pharyngolaryngeal pain.The most common adverse reactions that were associated with discontinuation from clinical trials (causing discontinuation in > 1% of adults and/or > 2% of pediatrics) were nausea, somnolence, sedation, vomiting, dizziness, and akathisia [see Discontinuations Due to Adverse Reactions].The data described in this section are derived from a clinical trial database consisting of 9803 adult and pediatric patients exposed to one or more doses of RISPERDAL® for the treatment ofschizophrenia, bipolar mania, autistic disorder, and other psychiatric disorders in pediatrics and elderly patients with dementia. Of these 9803 patients, 2687 were patients who received RISPERDAL® while participating in double-blind, placebo-controlled trials. The conditions and duration of treatment with RISPERDAL® varied greatly and included (in overlapping categories) double-blind, fixed- and flexible-dose, placebo- or active-controlled studies and open-label phases of studies, inpatients and outpatients, and short-term (up to 12 weeks) and longer-term (up to 3 years) exposures. Safety was assessed by collecting adverse events and performing physical examinations, vital signs, body weights, laboratory analyses, and ECGs.Clinical Trials ExperienceBecause clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice.Commonly-Observed Adverse Reactions In Double-Blind, Placebo-Controlled Clinical Trials - SchizophreniaAdult Patients with SchizophreniaTable 8 lists the adverse reactions reported in 2% or more of RISPERDAL®-treated adult patients with schizophrenia in three 4- to 8-week, double-blind, placebo-controlled trials.Table 8: Adverse Reactions in ≥ 2% of RISPERDAL®-Treated Adult Patients (and greater than placebo) with Schizophrenia in Double-Blind, Placebo-Controlled TrialsSystem/Organ Class Adverse ReactionPercentage of Patients Reporting Reaction RISPERDAL®Placebo (N=225)2-8 mg per day(N=366)> 8-16 mg perday (N=198)Cardiac DisordersTachycardia130Eye DisordersVision blurred311Gastrointestinal DisordersNausea944Constipation896Dyspepsia865Dry mouth401Abdominal discomfort311Salivary hypersecretion21< 1Diarrhea211General DisordersFatigue310Chest pain221Asthenia21< 1Infections and InfestationsNasopharyngitis343Upper respiratory tract infection231Sinusitis121Urinary tract infection130InvestigationsBlood creatine phosphokinase increased12< 1Heart rate increased< 120Musculoskeletal and Connective Tissue DisordersBack pain411Arthralgia23< 1Pain in extremity211Nervous System DisordersParkinsonism*14178Akathisia*10103Sedation1052Dizziness742Dystonia*342Tremor*231Dizziness postural200Psychiatric DisordersInsomnia322527Anxiety161111Respiratory, Thoracic and Mediastinal DisordersNasal congestion462Dyspnea120Epistaxis< 120Skin and Subcutaneous Tissue DisordersRash141Dry skin130Vascular DisordersOrthostatic hypotension210* Parkinsonism includes extrapyramidal disorder, musculoskeletal stiffness, parkinsonism, cogwheel rigidity, akinesia, bradykinesia, hypokinesia, masked facies, muscle rigidity, and Parkinson's disease. Akathisia includes akathisia and restlessness. Dystonia includes dystonia, muscle spasms, muscle contractions involuntary, muscle contracture, oculogyration, tongue paralysis. Tremor includes tremor and parkinsonian rest tremor.Pediatric Patients with SchizophreniaTable 9 lists the adverse reactions reported in 5% or more of RISPERDAL®-treated pediatric patients with schizophrenia in a 6-week double-blind, placebo-controlled trial.Table 9: Adverse Reactions in ≥ 5% of RISPERDAL®-Treated Pediatric Patients (and greater than placebo) with Schizophrenia in a Double-Blind TrialSystem/Organ Class Adverse ReactionPercentage of Patients Reporting Reaction RISPERDAL®Placebo(N=54)1-3 mg per day(N=55)4-6 mg per day(N=51)Gastrointestinal DisordersSalivary hypersecretion0102Nervous System DisordersSedation24124Parkinsonism*162811Tremor11106Akathisia*9104Dizziness7142Dystonia*260Psychiatric DisordersAnxiety760* Parkinsonism includes extrapyramidal disorder, muscle rigidity, musculoskeletal stiffness, and hypokinesia. Akathisia includes akathisia and restlessness. Dystonia includes dystonia and oculogyration.Commonly-Observed Adverse Reactions In Double-Blind, Placebo-Controlled Clinical Trials - Bipolar ManiaAdult Patients with Bipolar ManiaTable 10 lists the adverse reactions reported in 2% or more of RISPERDAL®-treated adult patients with bipolar mania in four 3-week, double-blind, placebo-controlled monotherapy trials.Table 10: Adverse Reactions in ≥ 2% of RISPERDAL®-Treated Adult Patients (and greater than placebo) with Bipolar Mania in Double-Blind, Placebo-Controlled Monotherapy TrialsSystem/Organ ClassAdverse ReactionPercentage of Patients Reporting ReactionPlacebo(N=424)RISPERDAL® 1-6 mg per day(N=448)Eye DisordersVision blurred21Gastrointestinal DisordersNausea52Diarrhea32Salivary hypersecretion31Stomach discomfort2< 1General DisordersFatigue21Nervous System DisordersParkinsonism*259Sedation114Akathisia*93Tremor*63Dizziness65Dystonia*51Lethargy21* Parkinsonism includes extrapyramidal disorder, parkinsonism, musculoskeletal stiffness, hypokinesia, muscle rigidity, muscle tightness, bradykinesia, cogwheel rigidity. Akathisia includes akathisia and restlessness. Tremor includes tremor and parkinsonian rest tremor. Dystonia includes dystonia, muscle spasms, oculogyration, torticollis.Table 11 lists the adverse reactions reported in 2% or more of RISPERDAL®-treated adult patients with bipolar mania in two 3-week, double-blind, placebo-controlled adjuvant therapy trials.Table 11: Adverse Reactions in ≥ 2% of RISPERDAL®-Treated Adult Patients (and greater than placebo) with Bipolar Mania in Double-Blind, Placebo-Controlled Adjunctive Therapy TrialsSystem/Organ ClassAdverse ReactionPercentage of Patients Reporting ReactionRISPERDAL® + Mood Stabilizer(N=127)Placebo +Mood Stabilizer(N=126)Cardiac DisordersPalpitations20Gastrointestinal DisordersDyspepsia98Nausea64Diarrhea64Salivary hypersecretion20General DisordersChest pain21Infections and InfestationsUrinary tract infection21Nervous System DisordersParkinsonism*144Sedation94Akathisia*80Dizziness72Tremor62Lethargy21Psychiatric DisordersAnxiety32Respiratory, Thoracic and Mediastinal DisordersPharyngolaryngeal pain52Cough20* Parkinsonism includes extrapyramidal disorder, hypokinesia and bradykinesia. Akathisia includes hyperkinesia and akathisia.Pediatric Patients with Bipolar ManiaTable 12 lists the adverse reactions reported in 5% or more of RISPERDAL®-treated pediatric patients with bipolar mania in a 3-week double-blind, placebo-controlled trial.Table 12: Adverse Reactions in ≥ 5% of RISPERDAL®-Treated Pediatric Patients (and greater than placebo) with Bipolar Mania in Double-Blind, Placebo-Controlled TrialsSystem/Organ Class Adverse ReactionPercentage of Patients Reporting ReactionRISPERDAL ®Placebo(N=58)0.5-2.5 mg per day(N=50)3-6 mg per day(N=61)Eye DisordersVision blurred470Gastrointestinal DisordersAbdominal pain upper16135Nausea16137Vomiting10105Diarrhea872Dyspepsia1032Stomach discomfort602General DisordersFatigue18303Metabolism and Nutrition DisordersIncreased appetite472Nervous System DisordersSedation425619Dizziness16135Parkinsonism*6123Dystonia*650Akathisia*082Psychiatric DisordersAnxiety083Respiratory, Thoracic and Mediastinal DisordersPharyngolaryngeal pain1035Skin and Subcutaneous Tissue DisordersRash072* Parkinsonism includes musculoskeletal stiffness, extrapyramidal disorder, bradykinesia, and nuchal rigidity. Dystonia includes dystonia, laryngospasm, and muscle spasms. Akathisia includes restlessness and akathisia.Commonly-Observed Adverse Reactions In Double-Blind, Placebo-Controlled Clinical Trials - Autistic DisorderTable 13 lists the adverse reactions reported in 5% or more of RISPERDAL®-treated pediatric patients treated for irritability associated with autistic disorder in two 8-week, double-blind, placebo-controlled trials and one 6-week double-blind, placebo-controlled study.Table 13: Adverse Reactions in ≥ 5% of RISPERDAL®-Treated Pediatric Patients (and greater than placebo) Treated for Irritability Associated with Autistic Disorder in Double-Blind, Placebo-Controlled TrialsSystem/Organ ClassAdverse ReactionPercentage of Patients Reporting ReactionRISPERDAL® 0.5-4.0 mg/day(N=107)Placebo(N=115)Gastrointestinal DisordersVomiting2017Constipation176Dry mouth104Nausea85Salivary hypersecretion71General Disorders and Administration Site ConditionsFatigue319Pyrexia1613Thirst74Infections and InfestationsNasopharyngitis199Rhinitis97Upper respiratory tract infection83InvestigationsWeight increased82Metabolism and Nutrition DisordersIncreased appetite4415Nervous System DisordersSedation6315Drooling124Headache1210Tremor81Dizziness82Parkinsonism*81Renal and Urinary DisordersEnuresis1610Respiratory, Thoracic and Mediastinal DisordersCough1712Rhinorrhea1210Nasal congestion104Skin and Subcutaneous Tissue DisordersRash85*Parkinsonism includes musculoskeletal stiffness, extrapyramidal disorder, muscle rigidity, cogwheel rigidity, and muscle tightness.Other Adverse Reactions Observed During The Clinical Trial Evaluation Of RisperidoneThe following additional adverse reactions occurred across all placebo-controlled, active-controlled, and open-label studies of RISPERDAL® in adults and pediatric patients.Blood and Lymphatic System Disorders:anemia, granulocytopenia, neutropeniaCardiac Disorders: sinus bradycardia, sinustachycardia, atrioventricular block first degree, bundle branch block left, bundle branch block right, atrioventricular blockEar and Labyrinth Disorders: ear pain, tinnitusEndocrine Disorders: hyperprolactinemiaEye Disorders: ocular hyperemia, eye discharge,conjunctivitis, eye rolling, eyelid edema, eye swelling, eyelid margin crusting, dry eye, lacrimation increased, photophobia, glaucoma, visual acuity reducedGastrointestinal Disorders: dysphagia, fecaloma, fecal incontinence, gastritis, lip swelling, cheilitis, aptyalismGeneral Disorders: edema peripheral, thirst, gait disturbance, influenza-like illness, pitting edema, edema, chills, sluggishness, malaise, chest discomfort, face edema, discomfort, generalized edema, drug withdrawal syndrome, peripheral coldness, feeling abnormalImmune System Disorders: drug hypersensitivityInfections and Infestations: pneumonia, influenza, ear infection, viral infection, pharyngitis, tonsillitis, bronchitis, eye infection, localized infection, cystitis, cellulitis, otitis media, onychomycosis, acarodermatitis, bronchopneumonia, respiratory tract infection, tracheobronchitis, otitis media chronicInvestigations: body temperature increased, blood prolactin increased, alanine aminotransferase increased, electrocardiogramabnormal, eosinophil count increased, white blood cell count decreased, blood glucose increased, hemoglobin decreased, hematocritdecreased, body temperature decreased, blood pressure decreased, transaminases increasedMetabolism and Nutrition Disorders: decreased appetite, polydipsia, anorexiaMusculoskeletal and Connective Tissue Disorders: joint stiffness, joint swelling, musculoskeletal chest pain, posture abnormal,myalgia, neck pain, muscular weakness, rhabdomyolysisNervous System Disorders: balance disorder, disturbance in attention, dysarthria, unresponsive to stimuli, depressed level of consciousness, movement disorder, transient ischemic attack, coordination abnormal, cerebrovascular accident, speech disorder, syncope, loss of consciousness, hypoesthesia, tardive dyskinesia, dyskinesia, cerebral ischemia, cerebrovascular disorder, neuroleptic malignant syndrome, diabetic coma, head titubationPsychiatric Disorders: agitation, blunted affect, confusional state, middle insomnia, nervousness, sleep disorder, listlessness, libidodecreased, and anorgasmiaRenal and Urinary Disorders: enuresis, dysuria, pollakiuria, urinary incontinenceReproductive System and Breast Disorders:menstruation irregular, amenorrhea, gynecomastia, galactorrhea, vaginal discharge, menstrual disorder, erectile dysfunction, retrograde ejaculation, ejaculation disorder, sexual dysfunction, breast enlargementRespiratory, Thoracic, and Mediastinal Disorders: wheezing, pneumonia aspiration, sinus congestion, dysphonia, productive cough, pulmonary congestion, respiratory tract congestion, rales, respiratory disorder, hyperventilation, nasal edemaSkin and Subcutaneous Tissue Disorders:erythema, skin discoloration, skin lesion, pruritus, skin disorder, rash erythematous, rash papular, rash generalized, rash maculopapular, acne, hyperkeratosis, seborrheic dermatitisVascular Disorders: hypotension, flushingAdditional Adverse Reactions Reported With RISPERDAL® CONSTA®The following is a list of additional adverse reactions that have been reported during the premarketing evaluation of RISPERDAL® CONSTA®, regardless of frequency of occurrence:Cardiac Disorders: bradycardiaEar and Labyrinth Disorders: vertigoEye Disorders: blepharospasmGastrointestinal Disorders: toothache, tongue spasmGeneral Disorders and Administration Site Conditions: painInfections and Infestations: lower respiratory tract infection, infection, gastroenteritis, subcutaneous abscessInjury and Poisoning: fallInvestigations: weight decreased, gamma-glutamyltransferase increased, hepatic enzyme increasedMusculoskeletal, Connective Tissue, and Bone Disorders: buttock painNervous System Disorders: convulsion, paresthesiaPsychiatric Disorders: depressionSkin and Subcutaneous Tissue Disorders:eczemaVascular Disorders: hypertensionDiscontinuations Due To Adverse ReactionsSchizophrenia - AdultsApproximately 7% (39/564) of RISPERDAL®-treated patients in double-blind, placebo-controlled trials discontinued treatment due to an adverse reaction, compared with 4% (10/225) who were receiving placebo. The adverse reactions associated with discontinuation in 2 or more RISPERDAL®-treated patients were:Table 14: Adverse Reactions Associated With Discontinuation in 2 or More RISPERDAL®Treated Adult Patients in Schizophrenia TrialsAdverse ReactionRISPERDAL®Placebo(N=225)2-8 mg/day(N=366)> 8-16 mg/day(N=198)Dizziness1.4%1.0%0%Nausea1.4%0%0%Vomiting0.8%0%0%Parkinsonism0.8%0%0%Somnolence0.8%0%0%Dystonia0.5%0%0%Agitation0.5%0%0%Abdominal pain0.5%0%0%Orthostatic hypotension0.3%0.5%0%Akathisia0.3%2.0%0%Discontinuation for extrapyramidal symptoms (including Parkinsonism, akathisia, dystonia, and tardive dyskinesia) was 1% in placebo-treated patients, and 3.4% in active control-treated patients in a double-blind, placebo- and active-controlled trial.Schizophrenia - PediatricsApproximately 7% (7/106), of RISPERDAL®-treated patients discontinued treatment due to an adverse reaction in a double-blind, placebo-controlled trial, compared with 4% (2/54) placebo-treated patients. The adverse reactions associated with discontinuation for at least one RISPERDAL®-treated patient were dizziness (2%), somnolence (1%), sedation (1%), lethargy(1%), anxiety (1%), balance disorder (1%), hypotension (1%), and palpitation (1%).Bipolar Mania - AdultsIn double-blind, placebo-controlled trials with RISPERDAL® as monotherapy, approximately 6% (25/448) of RISPERDAL®-treated patients discontinued treatment due to an adverse event, compared with approximately 5% (19/424) of placebo-treated patients. The adverse reactions associated with discontinuation in RISPERDAL®-treated patients were:Table 15: Adverse Reactions Associated With Discontinuation in 2 or More RISPERDAL®Treated Adult Patients in Bipolar Mania Clinical TrialsAdverse ReactionRISPERDAL® 1-6 mg/day(N=448)Placebo(N=424)Parkinsonism0.4%0%Lethargy0.2%0%Dizziness0.2%0%Alanine aminotransferase increased0.2%0.2%Aspartate aminotransferase increased0.2%0.2%Bipolar Mania - PediatricsIn a double-blind, placebo-controlled trial 12% (13/111) of RISPERDAL®-treated patients discontinued due to an adverse reaction, compared with 7% (4/58) of placebo-treated patients. The adverse reactions associated with discontinuation in more than one RISPERDAL®-treated pediatric patient were nausea (3%), somnolence (2%), sedation (2%), and vomiting (2%).Autistic Disorder - PediatricsIn the two 8-week, placebo-controlled trials in pediatric patients treated for irritability associated with autistic disorder (n = 156), one RISPERDAL®-treated patient discontinued due to an adverse reaction (Parkinsonism), and one placebo-treated patient discontinued due to an adverse event.Dose Dependency Of Adverse Reactions In Clinical TrialsExtrapyramidal SymptomsData from two fixed-dose trials in adults with schizophrenia provided evidence of dose-relatedness for extrapyramidal symptoms associated with RISPERDAL® treatment.Two methods were used to measure extrapyramidal symptoms (EPS) in an 8-week trial comparing 4 fixed doses of RISPERDAL® (2, 6, 10, and 16 mg/day), including (1) a Parkinsonism score (mean change from baseline) from the Extrapyramidal Symptom Rating Scale, and (2) incidence of spontaneous complaints of EPS:Table 16Dose GroupsPlaceboRISPERDAL® 2 mgRISPERDAL® 6 mgRISPERDAL® 10 mgRISPERDAL® 16 mgParkinsonism1.20.91.82.42.6EPS Incidence13%17%21%21%35%Similar methods were used to measure extrapyramidal symptoms (EPS) in an 8-week trial comparing 5 fixed doses of RISPERDAL® (1, 4, 8, 12, and 16 mg/day):Table 17Dose GroupsRISPERDAL® 1 mgRISPERDAL® 4 mgRISPERDAL® 8 mgRISPERDAL® 12 mgRISPERDAL® 16 mgParkinsonism0.61.72.42.94.1EPS Incidence7%12%17%18%20%DystoniaClass Effect: Symptoms of dystonia, prolonged abnormal contractions of muscle groups, may occur in susceptible individuals during the first few days of treatment. Dystonic symptoms include: spasm of the neck muscles, sometimes progressing to tightness of the throat, swallowing difficulty, difficulty breathing, and/or protrusion of the tongue. While these symptoms can occur at low doses, they occur more frequently and with greater severity with high potency and at higher doses of first generationantipsychotic drugs. An elevated risk of acute dystonia is observed in males and younger age groups.Other Adverse ReactionsAdverse event data elicited by a checklist for side effects from a large study comparing 5 fixed doses of RISPERDAL® (1, 4, 8, 12, and 16 mg/day) were explored for dose-relatedness of adverse events. A Cochran-Armitage Test for trend in these data revealed a positive trend (p < 0.05) for the following adverse reactions: somnolence, vision abnormal, dizziness, palpitations, weight increase, erectile dysfunction, ejaculation disorder, sexual function abnormal, fatigue, and skin discoloration.Changes In Body WeightWeight gain was observed in short-term, controlled trials and longer-term uncontrolled studies in adult and pediatric patients [seeWARNINGS AND PRECAUTIONS, and Use In Specific Populations].Changes In ECG ParametersBetween-group comparisons for pooled placebo-controlled trials in adults revealed no statistically significant differences between risperidone and placebo in mean changes from baseline in ECG parameters, including QT, QTc, and PR intervals, and heart rate. When all RISPERDAL® doses were pooled from randomized controlled trials in several indications, there was a mean increase in heart rate of 1 beat per minute compared to no change for placebo patients. In short-term schizophrenia trials, higher doses of risperidone (8-16 mg/day) were associated with a higher mean increase in heart rate compared to placebo (4-6 beats per minute). In pooled placebo-controlled acute mania trials in adults, there were small decreases in mean heart rate, similar among all treatment groups.In the two placebo-controlled trials in children and adolescents with autistic disorder (aged 5 - 16 years) mean changes in heart rate were an increase of 8.4 beats per minute in the RISPERDAL® groups and 6.5 beats per minute in the placebo group. There were no other notable ECG changes.In a placebo-controlled acute mania trial in children and adolescents (aged 10 - 17 years), there were no significant changes in ECG parameters, other than the effect of RISPERDAL® to transiently increase pulse rate ( < 6 beats per minute). In two controlled schizophrenia trials in adolescents (aged 13 - 17 years), there were no clinically meaningful changes in ECG parameters including corrected QT intervals between treatment groups or within treatment groups over time.Postmarketing ExperienceThe following adverse reactions have been identified during postapproval use of risperidone. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. These adverse reactions include: alopecia, anaphylactic reaction, angioedema, atrial fibrillation, cardiopulmonary arrest, diabetic ketoacidosis in patients with impaired glucose metabolism, dysgeusia, hypoglycemia,hypothermia, ileus, inappropriate antidiuretic hormone secretion, intestinal obstruction, jaundice, mania, pancreatitis, pituitary adenoma, precocious puberty, pulmonary embolism, QT prolongation, sleep apnea syndrome, sudden death, thrombocytopenia, thrombotic thrombocytopenic purpura, urinary retention, and water intoxication.Read the entire FDA prescribing information for Risperdal (Risperidone) »Related Resources for RisperdalRelated HealthAutism Spectrum Disorder (In Children and Adults)Bipolar DisorderPrescription Anxiety MedicationsSchizophreniaRelated DrugsAbilifyAbilify MaintenaAdasuveAnafranilAriceptAristadaClozarilCompazineEquetroFanaptFazaCloGeodonHaldolInvegaInvega SustennaInvega TrinzaLatudaLithobidLoxitaneLuvox CRMobanNamenda XRNavaneOrapRisperdal ConstaSaphrisSeroquelSeroquel XRStavzorSymbyaxTegretolVersaclozZyprexaZyprexa Relprevv© Risperdal Patient Information is supplied by Cerner Multum, Inc. and Risperdal Consumer information is supplied by First Databank, Inc., used under license and subject to their respective copyrights.Last reviewed on RxList: 4/1/2016This monograph has been modified to include the generic and brand name in many instances.Page 0 of 12Table of Contents»Side Effects CenterDrug DescriptionIndicationsDosageSide EffectsDrug InteractionsWarningsPrecautionsOverdosageContraindicationsClinical PharmacologyMedication GuidePatient

First I will go through my answer, but then I will review the Mental Health Act and it’s statutes on “Sectioning”, explain “capacity to make decisions”, and give a few resources. BTW if I say “you” I don’t mean it specifically, it means “someone”.Note some sources may say The Mental Health Act 1983, but it was revised in 2007 with some fundamental changes. If you are unsure, the link above is a good one that explains the differences and changes.So, now my answer:No, in general, NHS MH staff are not pretty dangerous.To be sectioned, you need to do a lot more than just look at porn, or be morally liberal. Sectioning is covered under the Mental Health Act and the decision to section is not a simple one that can be made on a whim.I suspect the person who is so unhappy with this has a mental health need, and are showing behaviours they are happy with but that the mental health team or a close family member are not, and a lack of trust and disagreement is becoming an obstacle. This doesn’t mean it’s their fault they feel as they do- it could be a feature of their illness, or the result of a lack of social support, or lack of understanding about the impact of the behaviour.You don’t say what the “morally liberal” attitude is, but bear in mind in literature used by Mental Health professionals (and police, courts, probation officers…) there are clusters of symptoms/ behaviours that tend to occur in certain kinds of mental health problems that raise grave concerns.Using porn, certain kinds of porn, some sexual behaviours, illicit drug use, alcohol use and certain attitudes about relationships/people are included in some of these clusters- they are not in themselves bad, but with certain personality disorders or mental health problems they can be flags that something is going wrong or they can cause certain problems to become worse.Because they are flags, they might be included in a Community Treatment Order (CTO)- (explained in the area on sectioning below). A CTO might say:You must attend Therapy weeklyYou must take medication as prescribed and report any missed dosesYou must not drink alcohol or take medications/ drugs other than those specifically prescribedYou must reside at (address) and notify (who) in advance of any changes to residenceIf a person breaks the conditions of their CTO, they can be sectioned as it shows the care cannot be given safely in the community.Mental Health professionals must sometimes make decisions and offer advice that is unpopular. To be honest, the less reasonable the person is when these difficult times arise, the more it is felt that they lack understanding of the problems which can lead to sectioning.If you are talking about yourself, can I suggest a strategy or two?Try to be as reasonable and cooperative as possible. You don’t have to agree, just be calm, neutral and not reactive.If this is about a breach of a CTO, they are trying to keep you out of hospital by telling you off… do you want to go back to hospital? If not, do what your CTO requires as you are legally bound to that CTO.If you disagree with a NON CTO related request, ask “why do you think this is a problem?” and “what risk does this pose if I do other than you recommend?” This is a reasonable way of learning why the person is telling you what they think you should do.If sectioning is mentioned, ask “If you are threatening to section me, can you please explain how I pose a risk to myself, to others, and what treatment or assessment I need that can only be provided in hospital?”Its always ok to say “I find it hard when you keep talking about sectioning. Can we just discuss is without threats? I will listen, just help me understand”Learn about your mental health condition and what it means. Learn the flags, and learn how to work with people who only care about keeping you and others around you safe. You can look up your disorder in the DSM-V (the book with all the criteria for the diagnosis of mental disorders) but its not meant for “civilians” although it can help you ask the right questions like “what is a paraphilia?” or “what does hypomania mean?” if you are trying to understand your disorder and the reasons certain conditions or expectations are in place.Want to be treated (legally as well as interpersonally) as an adult who can make their own decisions? Act like one, and I mean that in the psychological sense, not as a judgement. When it comes to health, we may feel like a powerless child dominated by powerful parental figures who try to tell us what to do, but we must be adult to be taken seriously: children lack capacity to make decisions until they show the maturity of adults, and acting a a child has the same consequences.According to Berne, an “Adult” considers facts, reasons, thinks about the “big picture” and makes decisions using a rational, reasoned approach informed by experience and incorporating evidence from various sources including the input of others.A “child” reacts based on feelings just as in childhood, with limited awareness of the big picture and with limited accountability for their actions, limited regard for evidence or input from others, and rather than communicating rationally may pout, scream, avoid, stomp their feet and assume an oppositional/obstreperous stance to avoid things they dislike or do no want.I understand its more threatening to be told something you believe or think is wrong rather than to be told your liver for example is acting up. We often feel personally threatened and judged when we are told our minds are damaged, but in reality, the mind is a function of the brain, which is an organ like the liver, the skin and the kidney…. a very special and complex organ, but a physical one nonetheless. We also as adults like to do what we enjoy and having someone act like a parent eg“Stop doing that or I will punish you!” tends to bring out the child response in us eg “Oh Yeah? Well I hate you!”… to be treated like an adult brings out a reasonable adult response, but sometimes and especially under stress or when impaired by a mental disorder, a person can perceive that the carer (informal or professional) is being parental even when that’s not their intention.Mental Health is as much a physical health problem as any other… whereas you fix a sprained knee with physiotherapy because that aligns with how it’s used, you fix mental health needs with talk, because that’s how we access the mind… although in both cases sometimes medication or other treatment is needed to make that care work faster, better, or to support a person to cope with a need that is so great that the body cannot be restored but instead must be managed.Don’t judge because people don’t agree with you…. do I seem pretty dangerous to you? Your question sounded a bit aggressive and biased, but I have still answered you respectfully and fully, reasonably and with empathy. Right?But, if you had a CTO that says no booze and no porn because those are flags or triggers for you to engage in behaviour that puts you or others at risk, and you had them when I saw you, I’d tell you that you were headed for sectioning too not because I am dangerous, but because you are even if you can’t or won’t see it. Sectioning someone is not a power trip, its not simple, its a lot of boring and complicated paperwork, and it makes us feel like failures, but it’s also not being vindictive- its trying to save you (and other people) from yourself.If you want to message me with any specifics I will try to help you understand. Please trust me based not just on my professional but personal experiences: being oppositional, angry and confrontational with your healthcare team never has the result you hope it will. You will be labelled, and your opinion will lose value, you will be seen as being unreasonable and lacking capacity.Further reading if desired((followed by links to more info))SectioningIt is called “sectioning” because it uses a section of the Mental Health Act.Under the Mental Health Act of 1983, there are different “Sections” (eg, t##sections of the act) that speak of involuntary detention.In general, sectioning can be possible if a person has, or is thought to have,A mental illness which needs assessment or treatmentwhich is sufficiently seriousthat it is necessary for the health and safety of the person or for the protection of other people,and hospitalisation is necessary for the assessment or treatmentAND the person is unwilling or unable to agree to admission.Section 2 is for assessment if a person has not yet been assessed as an inpatient in hospital, or it has been a long time since that assessment, AND for any necessary treatment as a result of that assessment but does not exceed a total of 28 days.Section 3 is a bit different.It is for those who are well known to their healthcare professionalsIt can last up to 60 days, but is renewable and can result in a much longer detention than any other sectionTo be sectioned under 2 or 3, the following take placean application must be made by an approved mental health professional, or by a close relativethat person applying must have seen the person they believe needs sectioning within 14 days of the applicationTwo separate doctors, one with specialist training in the Mental Health Act, must see the person within 5 days of each other, and report on their opinion on the person’s needsAdmission must be completed within 14 days of the last of the assessments from those two doctorSection 4 is for emergency assessment and treatment of a person whose needs cannot wait for a section 2 or 3 to be undertaken. It is a “72 hour hold” whose real purpose is not treatment (as the person can refuse) but to remove the person from the possibility of harm (to themselves or others) whilst assessment to consider if a longer detention, further assessment or further treatment is needed (and to meet the criteria for another Section if needed).To be sectioned under 4, the following take placean application must be made by an approved mental health professional, or by a close relativeThe person must be seen by a doctor who knows them or who is qualified to section under the Mental Health Act, and both the person(s) making the application and the Doctor assessing must see the person within the past 24 hoursThe person must be admitted within 24 hoursSection 5 is when an appropriately trained (eg, mental health) nurse or a doctor prevents a person from leaving a facility. If done by a nurse, it lasts 6 hours or less, and stops when a Doctor arrives to assess. The Doctor can prevent the person from leaving the hospital for 72 hours and unlike section 4, treatment might be provided without the person’s consent. This occurs when the doctor thinks the person is either trying to leave without understanding the consequences and/or that they lack the capacity to make the decision to leave and/or that their or others health and safety are at risk if they leave. Further sectioning is required if the detention is extended.Anyone sectioned under any part of the mental health act has rights under the act: the person should be informed of the decision, how and why it was made, given written information about the act and the detention. Rights are greater under sections 2 and 3, including appealing and seeking help from an Independent Mental Health Advocate.Summary: No one professional can cause you to be sectioned unless you are already in hospital being treated, there is a very proscribed process, and you have clear rights under the mental health act.There is another form of section called a Community Treatment Order (CTO)If a person is hospitalised under the Mental Health Act, treatment can be provided in community instead if it is available there, (the act basically says it is inpatient only if its the only safe place to provide it) but the person must adhere to certain conditions or they risk being returned to hospital.—-Capacity (to consent)Sectioning only occurs when people lack capacity to make a decision for themselves or when they refuse to consent to care when it is believed failure to provide that care risks their or another person’s health and safety.Capacity in regards to consent to care and treatment is a legal term meaning you understand and can assess the risks. It means you can weigh the pros and cons, can consider information given you by healthcare professionals and explain why you make your decisions. People with capacity can disagree and should have their disagreement respected by healthcare professionals. If you have capacity, you consider your health and safety as well as that of others. Capacity can be impaired by alcohol, drugs, and both physical and mental illness, by the person’s emotional and mental maturity, or by coercion (eg, a battered person being convinced by their batterer to refuse care so they avoid detection).Capacity also related to the level of risk and complexity of the decision. A person for example is very drunk might not want to wash themselves and that decision needs to be considered differently than if they needed emergency brain surgery. Health care professionals must assess the risk and ask “If this was the average person, a reasonable and ordinary person, what would they do?” (this is/was called “The Man on the Clapham Bus The man on the Clapham omnibus - Wikipedia”This means always considering the impact (and its duration) of any known impairments. If a person is drunk or high, and a decision can wait until they are sober, it should.When a person lacks capacity for small decisions, eg washing or changing clothes, and their needs are clear (eg, a drunk person covered with body fluids who is at risk from their soiled clothing) “acting in best interest” means acting for them without their complete consent (“Come on Joe, Yeah just do this, stop pulling away Joe I need to get you washed up, Joe, I know you don’t want to but you can’t leave this dirty shirt on, come on, let me get you a clean shirt….”), but when those decisions have greater risk and impact, greater intervention is needed and can include sectioning or court ordered care.ALL decisions about capacity, consent, best interest decisions etc must be comprehensively documented.This sources might help further.Rethink Mental Illness - Mental Health Act/ SectioningRethink Mental Illness - Mental Health Act FAQAbout sectioning - http://Mind.orgThe Mental Health Act - NHS EnglandIndependent Mental Health Advocacy (IMHA)About Independent Mental Health Advocacy - .:: SEAP INC ::.Rethink Mental Illness - CTOInformation for people subject to community treatment orders (CTOs) - cqcCommunity Treatment Order - http://mentalhealthlaw.co.ukThe Brain’s of Porn Addicts -[sic]Signs and Symptoms of Sexual Addictionhttp://digitalcommons.liberty.edu/cgi/viewcontent.cgi?article=1393&context=honorsTransactional analysis - WikipediaEgo States and Types of Transactions in Transactional Analysis Theory - Video & Lesson Transcript | Study.comSmall print: this answer is UK based, and I am explaining the law as I believe it is manifest in practice but am not attempting to give legal advice. Any health advice is within my scope of practice, but is intended to generally inform, not to direct individual patient care.