Dr Laitman: A Fathers Journey to Transform Schizophrenia Recovery

Welcome to Why Not Me? Embracing Autism and Mental Health Worldwide?
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world one story at a time. Hi, I'm Tony Mantur.
Welcome to Why Not Me? Embracing Autism and Mental Health Worldwide.
Joining us today is doctor Robert Lateman, who is a
distinguished physician with extensive expertise and internal medicine, where he
has built a strong foundation in diagnosing and treating a
wide range of complex medical conditions, specializing in serious mental
illness like schizophrenia and bipolar disorder. He seamlessly blends his
medical precision with compassion, making him a trusted leader in
addressing patients complex needs. He has a wealth of information
for us. So before we dive into our episode, we'll
be back with an uninterrupted show right after a word
from our sponsors. Thanks for coming on.
Oh sure, no, it's my pleasure, ed you know, thanks
for having me. I mean, this is something near and
dear Tomorrow Art.
It's great to have you here. Could you share with
our listeners a bit more about what you do.
I am a internal medicine specialist. I was trained in
nephrology and geriatric but for the last twenty or so years,
I've devoted my practice as well as my wife, who
just walked out the door, to taking care of people
with psychotic illnesses. And the reason I'm doing that is
because my son twenty years ago developed schizophrenia and we
just didn't find adequate care. We thought there's tremendous nihilism
in the psychiatric community that we were told for instance,
you know more in the loss of your son and
your expectations, and I just didn't find that to be
an acceptable solution.
Yes, I think that's very understandable. So when you decided
to take this on, what confronted you? What were some
of the bumps in the road, so to speak?
Well, Initially, the biggest bump was actually my wife, and
she's right, because you know, again we're both physicians. You're
not really supposed to take care of your own. But
I pointed out to her that I'm not traditional. I've
been taking care of my mother and father because I was,
as I said, defrologists and gerontologists, and you know, and
I've done a pretty decent job of that. In fact,
my dad ended up living one hundred and one, as
I ready mentioned, and my mom lived in ninety nine.
And I said, look, I'll make every attempt to find
good care for Daniel. But after we started to read
the literature and we kept going and being referred to
one psychiatrist after another, we never found anyone.
First of all, for the first.
Year or so, actually six months that was willing to
prescribe Closby. Finally we met lou Oapler, who wasn't taking
new patients at the time, and he referred us to
another physician, but it was still going to be another
year for Closeby. This guy was reasonably said, 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 my opportunity to take care of him,
but I deferred, because again, you're not supposed to take
care of your own traditionally. Eventually he got to the
point where it was, you know, just he needed to
be on closebine, and we finally prevail on the treating
psychiatrists to startom.
When you finally had the psychiatrist change his mind, what
happened next?
Over time, it got to the point where it was
so difficult. And fortunately we've made the prescribing of closebine
easier easier because we've gotten rid of.
The requirement for the blood.
But back then it would take me hours every week
just get Daniel's supply of closebine. I'd have to pull up,
get it approved by the insurance company, make sure I
had the blood work, and I even had my own
in office lab, and then I would send the results
to the psychiatrist waiting for him to write the prescription,
because for the first twenty six weeks back then, it
was weekly, and I just I got tired of it,
you know, And I found it a situation almost guaranteed
to fail, because he wouldn't give more than the absolute
number of pills that Daniel was on. So I just
eventually just took over and it was much easier after that.
You know, I wrote for adequate amount of medication, I
did the required blood work. It was much easier because
I had the blood work right in front of me.
I took steps out of the way.
Yeah, that sounds like it was very much easier. Were
there any other issues that you had to deal with?
Also?
The lack of knowledge on how to prescribe claspine correctly.
So six months into Daniel's illness, he developed a sizeable aspiration,
pneumonia and absess on his lung because no one had
really talked to us or explained how to take care
of the excess of salivation that comes with closbin so
we ended up treating them with ivy antibiotics at home.
My wife and I.
Took turns putting an intravenous in every single day, sending
them to school, taking the IVY out, putting a new
iv and twenty eight days later we had him with
clearer lungs and in the meantime we started to treat
this salivation. So it became very apparent to me that
if you're going to use clos being correctly because I
kept reading and reading about it and all the terrible
side effects, which is why people weren't using the drug.
That is a big question. How do you handle the
side effects? Because one thing can lead to another and
then all of a sudden it could get out of control.
Every one of these side effects is predictable. You can
get predictable pharma, you know, pharmacology, just using pharmacology. For instance,
with the excess of salvation, we took care of that
doing the simple things, propping his head up obviously and
making sure that we diminished the salvation using just we
used something called a epitroprium measle spray and we would
just scort it under his tongue at bedtime. That diminished
the salvation and aspiration the longer became a problem.
Yeah, that's great. Were there any other side effects or
anything else that you was concerned about.
Also, as you start on closbying, the heart rate goes
up again, normal physiology, So we would put him on
a very low dose of a beta blocker and that
took care of them, and you just go down. The
side effects weighting almost universal with closby. Why allow it,
you know, Unfortunately, close bean has effects on appetite. It's
very something called anti histaminic and anti col energic, so
it actually stimulates greatly stimulates appetite. You know, it's not
the kids being a pig. The kid is almost driven
to eat, So what do you do? You give him that? Foreman,
it's not that hard. And these days we're really well
equipped because we do the injectibles, which Daniel did not require.
And of course the beauty of this, where Daniel was
really sick and at his worst was almost catatonic, he
got better in terms of his ability to comprehend, to think,
to participate in his own care. Something that would make
you happy, Tony. He started to actually watch his diet
and now has become basically a pescatarian, not a vegetarian,
but a pescatarian, and he exercises regularly, and that, obviously,
you know, helped his health almost as much as all
the other medicines that we typically add to assist kids.
Yeah, that's great, it's all about the end results. Now,
this was twenty years ago. Has anything changed the medication
the way you look at it, just the overall procedures
that you use compared to twenty years ago.
We've expanded as the medications and we've expanded our approaches,
so we really emphasize the diet and the exercise right away,
and we do a lot of cognitive enhancement treatment. Anything
you can do to improve their ability to think and
to participate in care makes everything else get better. So
we always talk about pop down control of your psychosis.
So psychosis is.
Not only delusions and hallucinations, but there's a very strong
component that is cognitive, and that is also the negative symptoms.
The inability to get started and.
Working on those cognitive symptoms allows the person become more aware.
So let's say they're still having auditory hallucinations. That's a
processing problem. They're actually hearing those voices in their brain.
But if you can improve their cognitive abilities, they can
recognize that as being internal and therefore not listening to voices,
and also as their cognition improves, and often, you know,
get more involved in social situations because what it takes
the most difficult thing anyone ever does in terms of
cognitive abilities is social interaction, especially with multiple people. You
need a lot of processing speed, so that tends to
be diminished in these illnesses.
These are all great points. Now what did you do
with your son? How did you approach that with all
these things that you've just mentioned.
So with Daniel, we did a lot of cognitive enhancement treatment,
did a lot of exercises. All of these things improve
cognitive ability. So there's a feedback as far as the medicines.
And also we did cognitive behavioral therapy because once you
can think about your own thoughts, you have a thought
that one tenant, and I'm sure you've heard this before
because you've been doing serious mental illness before, you say,
never challenge a delusion, because the delusion is a fixed
false belief.
Yes, I have definitely heard that.
Well, Actually, with psychosis and forum cognitive behavioral therapy, you
can start to edge onto the delusions and start to
challenge them. As you're doing that, they're more in touch
with reality and their ability is improve.
So that's what we're using more of.
In terms of the medications, you know, the medications for
PLASA being side effects, they're old. One of the modalities
that we use a lot of for the salvation that's
relatively new is we use good old botox. Really yeah,
botch alnom toxin. So you can go to in your
nose and throat doctor or a neurologist typically that specializes
in danger of Parkinson's patients because they had problems with
the salivation and they'll often have aspiration. You just inject
the salivary glands. You start low dose. Everyone's individual. These
doctors are really adept at this. Basically, boatox lasts as
long as the salivary clans, and they turn over about
every ninety days or so. So you go to your area,
your nose and throat doctor, and you get injected every
three months. And that's really important if you're doing closby because,
as it turns out, aspiration and pneumonia is probably the
most dangerous thing about closbanan that you really have to
pay attention to.
Did you have any issues at first with him agreeing
to do any of this? One of the issues I've
heard from several different people is when someone is in psychosis,
they are unwilling to take any help, get any help,
and they just don't want any help. So how did
you deal with that? Was that an issue at all?
And a sugnosia that we were fortunate Daniel was fifteen
when he got sick, which is a bad prognosis, right,
the earlier you get sick usually the worst of prognosis.
That's why we were told, you know, more than the
loss of your child's expectations. Of course, that did not
turn out to be true. We'll talk a little bit
more about that. But fortunately we were able to get guardianship,
which we did, which we maintained to this day.
Have never used it.
Because Daniel has always been aware of his illness. He
skipped closepede once one time by mistake. He just missed
it and he felt horrible the next day. That was
enough for him, So he's always been aware of his illness.
Anapsygnosia is a really interesting condition, so we always talk
about unawareness of the illness, but it's actually more complicated
than that, you know, So Daniel does have some anapgnosia
because when you're talking about anapseagnosia, it's actually also refers
to your ability to self assess, and people with psychosis
are notoriously bad at self assessment. He underestimates some of
the things he can do and grossly overestimates some of
the things that he can do, and that remains a problem.
You always have to work on his self esteem, and
you know, this affects everyone, and it also affects their
ability to interact with other people because they will not
get a good.
Read what we call theory of mind.
They don't usually understand exactly what someone else is thinking.
Can you expand on how they view that and how
they interact that way?
They will if they're very psychotic at the time and
their self esteem is poor. You know, they're going to
look at someone and they're going to interpret, you know,
their interaction in a very negative fashion ideas of reference.
They're going to hear something and that's walking by the
other person may have been in the conversation completely unattached
and not even aware of the patient, but the pat
you say, that person just said I'm fat and I'm terrible.
It's a real cognitive problem, you know, annas Ignos you
it's interesting. It does get better over time, so close
being The one nice thing about it is it changes
the trajectory of the illness. And a lot of kids
who have had really terrible antipsychdicitia where they've absolutely no
concept that they're sick and think everything is hunky Dorian,
why would I ever.
Take any medicine?
Have over the years gotten to accept close beIN. So
the beauty of closebine is it quiets your mind as
opposed to dending it. And if you follow kids that
have been on closepine and you've got them unestablished nosis,
the acceptance rate with closebine.
Is in the high eighties.
Now if you look at our data we have at
one year and we now have over two hundred patients closebine,
our acceptance rate is in ninety four percent. Yeah, no,
so it does. It does get better over time. And
if it doesn't, and there are a lot of kids
that are so sick, then we use court mandated treatment.
So that's the ultimate way of going to past and
a psychnosia not where I start. I usually start with,
you know, Javier Amadur's approach, reflective listening, you know, empathizing,
trying to agree with them, partnering with what they want.
But sometimes that doesn't.
Work and you don't want to you know, these are
illnesses that need to be treated.
It's a brain illness. You know, if you had someone like.
Grandma with Alzheimer's disease and she didn't want to take
her insulin because she said she doesn't need it, anymore,
there wouldn't be a second thought. Of course, you'd give
her insulin. And the same applies to this population.
Yes, absolutely, we have to find a way to take
care of everyone. Here's an unfortunate but interesting fact. I've
spoken with those that are autistic and those that deal
with serious mental illness. One common thing they both have
told me is some have taken up to ten years
to get their life completely figured out.
Yeah, that's what I'm trying to stop. So we have
an approach, you know, called EASE. I wrote a paper
with a guy by the name of matri Keshevon who
loves acronyms. E is early because all these illnesses, so
all these psychotic illnesses are to a certain extent, genetically
based neurodevelopmental and when not appropriately treated, neurodeteriorative. We know
that untreated psychosis or poorly treated psychosis, leads to.
Loss of brain.
Henry Nazulo's for what' you MC called chair, I guess
chair president probably President of the APA, always likes to
say that psychosis is like a slow moving strop and
you lose about one percent of your brain per year.
Early treatment with the most effective medication, that's all I'm
proposing is.
The way to go.
I mean, no other field would this be controversial. And
loscipine is the only drug that has the FDA indication
for resistant schizophrenia and loosely defined as you know, people
that have failed to other antipsychotics without really getting even close.
To their former status.
It's the only drug that will work in any significant percentage.
There's always the anecdotes where someone does get better, because
there's literally trillions of ways to get the psychosis, but
if you look at statistics, it's well less than five
percent will be successful to any other drug, whereas with
klasbin just by clsbein alone, that group will get fifty
to seventy percent. So a decade's ridiculous because people have
failed earlier than that.
I can't argue. I don't have the data or argue.
Then if you get started on another antipsychotic that's not
as difficult to manage because clsbean is a lot of work.
Yeah, do you have to manage the side effects.
Some of the antipsychotics really don't have appreciable side effects,
and if they return to their former status, they go
back and there are fine.
I can't argue with using that that makes perfect sense.
You are a strong advocate for this. What are your thoughts?
Would I do that?
No? And the reason is is because usually that's same
group will respond to very low doses of closbein, which
then we'll have less side effect. And we know clasipine is,
as I said, distinctly useful at.
Changing the trajectory of the illness.
And we don't know if these other drugs will hold
them because what you've also heard, i'm sure is oh
that drug used to work great and then it stopped
working because it's a partial response. And I don't take
this with tremendous data because the data really doesn't exist
the very first treatment. But I would use closipine, and
I have used closbean right at the inception of illness
if I could. Daniel it turned out it was a
year and a half before he started plasipine.
So you have strong beliefs that is just as good
to start out right from the very start.
We've had people start much earlier. I just started a
fellow with bipolar with psychosis within two weeks the start
of illness a few months ago, and he's on a
tiny dose of closipine with no side effects. And I've
done this multiple times with other people. I'm the literature. Unfortunately,
not many other people are doing it. There's a study
that's coming out that doctor McCabe in King's College in
England that's going to repeat a lot of this in
first episode psychosis programs. But it's also very interesting your
point about the ten years the most successful first episode
psychosis programs are the programs that quickly go on to clospeed.
And this is just a paper that just came out
also King's College in England. You know, this is the
way I believe of the future, and we're starting to
get more and more inertia.
Ten years is way too long.
Yes, I definitely agree.
There you lose brain and you know the recovery you
could still get really good recovery, but it's never quite
I shouldn't say never, but it's almost never. Wait, that's
complete because there's never an effort. As I keep finding out.
Okay, you've been doing this a long time. No matter
what's going on, is always a bump in the road.
What's one of the bigger challenge is you've had to
face then you've kind of finally figured it out and
move forward.
You know, I haven't figured it out yet because probably
the biggest challenge is engaging the psychiatric community, and that's
something that we're still working on and getting an adequate
workforce to basically take care of these kids. Probably the
biggest obstacle besides that is the finances of it all.
It's a lot of work, and I think that's also
why it's really tough to engage people, because treatment of
serious mental illness is very undervalued. Again, I made a
very good livelihood when I was in a prologist and
you know, I'm working just as hard doing taking care
of psychotic individuals as an interest. But I'm actually making
about a third of the amount that I was making
back then, and most of it is non insurance based.
Insurance will not pay for that. So at this point, yeah,
I think our biggest obstacle is the inability of the
insurance is to recognize the value in treating serious mental
illness with a comprehensive wraparound approach and pay for it.
Because you know, it's great.
So I live in Upper Westchester, Northern Westchester rate on
the border with Connecticut in Westchester County, right next to
Fairfield and Greenwich, Connecticut. You know, in Bedford, it's a
beautiful area, it's incredibly affluent. I'm probably one of the
poorer people that live there, and I am not poor
by any estimation. So we have that group that will pay,
and they've paid literally hundreds of thousands of dollars for
inadequate care. So we've started something called Dora Mine the
last two years to you know, get this is the
biggest around access to our treatment plans and how can
I get access at a reasonable cost. Well, we decided
we would use nurse practitioners because they're a little more
economical than physicians. You know, the rates are lower and
their income expectations are lower because they don't come with
the half a million dollar loan from medical school that
most of the early psychiatrists come out with. And so
I don't blame the psychiatrists for wanting to be paid.
No, absolutely, they spent a lot of money in college
and they want to get paid. So how is it
all working and how are you training them?
So we've started with this group and I've trained for
nurse practitioners. Three are employed right now. I supervise them regularly.
I've got the two original founders who had work for
a Firefly and Athena Health and roles of I think
chief technical officers and the cheap operating officers in those roles.
But they had loved ones with heriuspent on this, so
this is more of their passion. They understand the finances
and we are slowly trying to get and slowly getting
insurance companies to value it, and they're valuing it probably
too low, and we are far from a profitable enterprise effect.
We're still on the bleeding money side, but we're starting
to see more and more and also because we have
the data and the reality is it all comes back
to our healthcare system, right, so private insurances, if you
do poorly you can't afford to pay the premium, you
go to another insurance company. If there was a universal care,
you would see that just treating people with closebine and
they've looked at this in the VA system, They've looked
at this in a Medicare and Medicaid environment, they've looked.
At this in England.
Is a tremendous cost savings because instead of the revolving
door of hospitalizations, it costs more to use close beed
it's true. As an outpatient, the drug itself is dirt cheap,
and you stop the hospital and that's.
The usual cost.
So coming into my practice the year before, ninety four
percent of our.
Individuals ninety four ninety three. Actually sorry, I don't exaggerate.
We're in the hospital at least once, and most of
those were multiple times. After coming into the practice, we've
only had fifteen percent go back in the hospital. And
that extends from one year to as long as fifteen years,
so much longer periods of time. So the revolving door
stops and expenses go down.
With the expenses going down, the revolving door stopping, you
would think that would be a situation everyone would love.
The problem is getting all the individual payers on board.
That's our probably biggest bump on 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 framed these nps. I supervise them. They do a
great job.
My wife and I are over two hundred patients where personally,
and I always like to put this on every podcast,
not taking any new patients because I'm sixty eight years old,
and I think my mission right now is to take
care of who I've got and train other people because
this approach works. Oh, let me finish my approach ease.
So early use of cosby A is assertive management and
a wrap around service, not only giving me medicine, but
what we talked about before, diet, exercise, cognitive behavioral therapy, socialization.
I have these kids come to my house, normalizing relationships,
taking it out of the medical environment. The worst part
of the people, they'll tell you is what's the worst
part of the psychosis is the loneliness, the being alone,
the isolation. So we really work on that. And then
slow when you introduce your medicines, where you titrate off
another medicine, take your time. It really does help tremendously
with the side effects. And also slow because as you
already mentioned, right, it takes ten years sometimes for people
to get to me. Guess what it's going to be
a slow, long road. I always tell people it's not
a sprint, it's a marathon. And then e engagement. We
engage everyone. We don't only engage the patient. We try
to engage the family. Often the families are left out
of the cure of serious mental illness and that's just
a sin. Whereas I like to say, you know, sorry
about my judas am Mashanda Ashonda, which is even.
A bigger shame.
And you know, you got to engage, You got to
use all the resources you possibly can, and you should
never let hippop you know something that gets in the way. Again,
coming back to the antapagnosia. I've had kids tell me,
don't talk to my parents. You know I'm not permitting it.
Hippa actually gives the doctor the permission to use his
best judgment when the patient is, as we would say,
not of their right mind. So you think the patient
is clearly in psychosis and you have met the family
and they're not toxic, and some families are, then sometimes
I don't say it.
I mean again, there's.
No absolute but most families are out there to help
their kid, and I engage the family.
Yeah, that makes total sense. In closing, what do you
think is important that our listeners here on what you're
doing in what they need to know.
So, as I said, the nihilism and psychiatry, the belief
that you know your kid's life is over. My son
is you know, a stand up comic, which of course
most people with schizophrenia are, you know, as a decent
career in New York City and has finally engaged the
serious mental illness community because they need to see. So
we were just at an event in the Leo in California,
I think south of San Francisco, and Daniel would get
up and did a twenty minute set of stand up comedy.
Then we showed our movie, which is Into the Light
Meaningful Recovery, a little plug for that, and then I
do my usual tal and the sponsors said, now you
know what schizophrenia can look like. That's what people have
to understand. It's not easy. It really is not easy.
But again, any other illness, you would use the most
effective treatments. You pull out all the stuff. Schizophrenia kills people.
Psychosis kills people. The suicide rates are up around five percent,
us being reduces up by ninety percent or eighty to
ninety percent or so, I don't want to exaggerate again,
you know.
Long term survival.
The finn twenty study the entire finish population where they
have actually a national healthcare system and a national database,
so they have less than six million people. They have
sixty two thousand, five hundred people psychosis, and they followed
them for twenty years.
People not on.
Antipsychotics that have psychosis, forty six percent had passed away,
almost fifty percent mortality. People on a non closepine based
antipsychotic almost sixteen percent or no sixteen percent, twenty five
point eighty percent died, and then with closebine it was
fifteen point eight percent. Still not perfect by any stretch
of 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 on whatever antipsychotic they're on, fine,
but keep an open mind. As I said, these illnesses
tend due progress, demand the best treatment that's all on
asking and that is a closepine based regimen. Coming out
in the next few months will be our fifth edition,
and it's going to be an extensive disposition. I've gone
through each book, and first I just wrote it for
the general public. Each edition, I've kind of increased references
and made it not only for the general public but.
Also for the physician.
We've expanded the book originally to this little thing that
was one hundred pages. Now it's about five hundred pages,
probably too long. So it's meaningful Recovery from schizophrenia and
serious mental illness with Clsby. That'll be the fifth edition,
it'll be out before the end of the year. And
you share that with your treating psychiatrist. That's just demand
the best for your kids. That's all I'm saying.
Absolutely, well, this has been great, great conversation, great information.
I really appreciate you taking the time to join us today.
Oh, Tony, thanks so much. Thanks for taking the time
with me.
Oh it's been my pleasure. Thanks again. Thanks for taking
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