Dr Laitman: A Fathers Journey to Transform Schizophrenia Recovery

Miatore, broadcasting from the heart of Music City, USA, Nashville, Tennessee.

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We're igniting a global movement to empower everyone to make a lasting difference by fostering deep awareness, unwavering acceptance and profound understanding of autism and mental health, tune in, be inspired, and join us in transforming the world one story at a time. Hi, I'm Tony Miatore, welcome to Why Not Me, Embracing Autism and Mental Health worldwide. Joining us today is Dr. Robert Latelyn, 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 he word for my sponsors. "Thanks for coming on." "Oh sure, no, it's my pleasure, you know, thanks for having me.

I mean, this is something near and dear to my heart." "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 forology and geriatric, but for the last one year 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 20 years ago, to the Alps, schizophrenia, and we just didn't find adequate care. We thought there was tremendous nihilism in the psychiatric community. 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 have been taking care of my mother and father, because I was as I said it, and for all just in gerontologists. And, you know,

and I've done a pretty decent job of that. In fact, my dad ended up living 100. One is already mentioned, and my mom lived in 1999. And I said, "Look, I'll make every attend 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 clause P. Finally, we met Lu Oakler, who wasn't the new patients at the time and he referred us to another physician. But it was still going to be another year. There's more clause P. This guy was reasonably said, "Yes, I'll consider it. Let me fix Daniel's regiment, because by that time he was already on three anti-cycotics. I was chomping at the bit for my opportunity to take care of him. But I defer, 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 clause P. And we finally prevail on the treating psychiatrist to start him. 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 fortunate that we've made the prescribing of clause P. easier, easier, because we've gotten rid of the requirement for the blood. But back then, it would take me hours

every week just to get Daniel's supply of clause P. And 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 from the first 26 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.

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 clause P. correctly. So six months into Daniel's illness, he developed a sizable aspiration pneumonia and access on his lung, because no one didn't really talk to us or explained how to take care of the excessive salivation that comes with clause P. So we ended up treating them with IV antibiotics at home. My wife and I took turns putting an intravenous in every single day,

sending them to school, taking the IV out, putting a new IV in. In 28 days later, we had him

with clear lungs. And in the meantime, we started to treat the salivations. So it became very

apparent to me that if you're going to use clause 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 give predictable, you know, pharmacology, just using pharmacology, for instance, with the excessive salivation. We took care of that doing the simple things, cropping his head up, obviously, and making sure that we diminished the salivation using just, uh, we used this something called a epitroprium nasal spray and we would just score to the under his tongue at

that time. That diminished the salivation 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 clause being the heart rate goes up. Again, normal physiology. So we would put them on a very low dose of a beta blocker and that took care of that. And you just go down the side effects,

“weight gain, almost universal with clause B. Why allow it? You know, unfortunately, clause B has”

effects on appetite. It's very, it's something called anti-histamistic and anti-colonargic. 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 a metformin. It's not that hard. And these days we're really well equipped because we do the injectables which Daniel did not require. And of course, the beauty of this, where Daniel was really sick and that 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 had, you know, to assist kids. Yeah, that's great. It's all about the end results. Now,

this was 20 years ago. Has anything changed the medication the way you look at it. Just the overall procedures that you use compared to 20 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

top-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 gets 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 dead 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. It did a lot of exercise at all of these things improved cognitive abilities. So there's a feedback as far as the the medicines and also we did

that one tendon, 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 foreign cognitive behavioral therapy, you can start to edge onto the delusions and start to challenge them. As you're doing that,

“there are more in touch with reality. And their abilities improved. So that's what we're using”

more in terms of the medications. You know, the medications for a clasping side effects. They're old. One of the modalities that we use a lot of for the salivation that's relatively new is we use good old Botox. Really? Yep, Botox line of toxin. So you can go to a near-nonsense road doctor or a neurologist, typically, that specializes in taking care of Parkinson's patients. Because they have 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 adapted to this. Basically, Botox lasts as long as the salivary glands and they turn over about every 90 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 do a clasping because as it turns out, aspiration and pneumonia is probably the most dangerous thing about clasping and 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? Anosognosia. Now, we were fortunate. Daniel was 15 when he got sick. Which is the bad

“prognosis, right? The earlier he gets sick. Usually, the worst of the prognosis. That's why we were told,”

you know, more than the loss of your child's expectations. Or said, 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. I've never used it because Daniel has always been

aware of his illness. He skipped clasping once one time by mistake. He just missed it and he fell horrible the next day. That was enough for him. So he's always been aware of his illness. Anosognosia 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 Anosognosia because when you're talking about Anosognosia, it's actually also refers to your ability to self-assess

and people with psychosis are notoriously bad at self-assessment. Do you underestimate some of the things he can do? And grossly, overest in it's 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. 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 viewed that and how they interact that way?”

They will, if they're very psychotic at the time and their self-esteem is more, you know, they're going to look at someone and they're going to interpret, you know, they're interaction in a very negative fashion. Ideas of reference, they're going to hear something and that's walking by and the other person may have been in the conversation completely unattached and not even aware of the patient, but basically that person just said, "I'm fat and I'm terrible."

It's a real cognitive problem, you know, anesthynesia. It's interesting. It does get better over time. So, Claude's opinion, the one nice thing about it is it changes the trajectory of the illness. And a lot of kids who have had really terrible anesthynesia where they've absolutely no concept that they're sick and think everything is hunky-dory and why would I ever take any medicine? Half over the years gone to accept Claude's opinion. So, the beauty of Claude's opinion

is it quiets your mind as opposed to detaining it. And if you're follow kids that have been on Claude's opinion and you've got them on established houses, the acceptance rate with Claude's opinion is in the high 80s. Now, if you look at our data, we have at one year and we now over two other patients, Claude's opinion or acceptance rate is in 94%. Yeah, no, so 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 getting past anesthynesia. Not where I start. I usually start with,

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 a rinse on, because she said she doesn't need it anymore. There would 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 10 years to get their life completely figured out. Yeah, that's what I'm”

trying to stop. So we have been approached, you know, called ease. I wrote a paper with a guy by the imagery, Keshevon, who loves acronyms. E is early because all these illnesses at all these psychotic illnesses are to, certain extent, genetically based neurodevelopmental and would not appropriately treated neuroditiative. We know that untreated psychosis or warly treated psychosis

leads to loss of brain, peprenas or lows, never, what you may call a chair, I guess, chair,

president, probably president of the APA always likes to say that psychosis is like a slow-moving stroke. And you'll lose about 1% 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 with this be controversial. And the only drug that has the FDA indication for resistant schizophrenia and loosely defined as,

“you know, people that have failed to other anti-psychotics 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 5% will be successful being another drug.

Whereas with class of being just by class being alone, that group will get 50 to 70 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 that if you get started on another anti-psychotic, that's not as difficult to manage because class being is a lot of war. You do have to manage the side effects. Some of the anti-psychotics really don't have appreciable side effects. And if they return to the former status, they go back and they 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 because usually that same group will respond to very low doses of class being, which then will have less side effects. And we know class of being 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 wouldn't use class of being the night half, he's class being right at the inception of illness. If I could Daniel, it turned out it was a year and a half before he started class of being. 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 the illness a few months ago. And he's on a tiny dose of class of being 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 Dr. McCabe in the 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. You're point about the 10 years.

The most successful first episode psychosis programs are the programs that quickly go on to class speed. 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.”

10 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. Why? I shouldn't say never. But it's

almost never. It has complete because there's never and ever as I keep finding out. 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 bigger challenges you've had to face? Then you've kind of finally figured it out and moved forward. You know, I haven't figured it out yet because probably the

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 mean, I made a very good livelihood when I was in a phrologist. And, you know, I'm working just as hard doing, you know, take care of psychotic individuals as an internist. But I'm actually making about a third of the amount that I was making back then. And most of it is not insurance based insurance will not pay for that. So at this point, yeah, I think our biggest obstacle is the

inability of the insurances 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, right on the border with Connecticut in the Westchester County, right next to Fairfield in Greenwich, Connecticut. You know, I'm 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 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 problem around access to our treatment plans. And how can I get access and a reasonable cost? Well, we decided we would use nurse practitioners because they're a little more economical that physicians, you know, the rates are lower and they're 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 psychiatrist or wanting to be paid. No, absolutely. They've 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. We are employed right now. I supervise them regularly. I've got the two original founders who had work for a firefly and Athena Health in

“roles of I think chief technical officers in the chief operating officers in those roles,”

but they had loved ones with serious mental illness. So this is more 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. In fact, we're still on the bleeding money side, but we're starting to see or a 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 clasping 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. It's a tremendous cost savings because instead of the revolving door of hospitalizations, it costs more to use clasping, 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 of the year before 94% of our individuals, 94.93 actually, sorry, I don't want to 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 15% go back in the hospital and that extends from one year to as long as 15 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 pride. Dick is bumping 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 NPCs. I supervise them. They do a great job. My wife and I are over 200 patients were personally and I always like to put this on a podcast. Not taking any

“new patients because I'm 68 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 worked. Oh, let me finish my approach. He's so early use of clasping. A is a assertive management and a wrap around service. Not only giving medicine, but we talked about before. DIA exercise, cognitive behavioral therapy, socialization. And these kids come to my house, normalizing relationship, taking it out of the medical environment.

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, takes 10 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 care of serious mental illness. And that's just a sin where as I like to say, sorry about my Judaism as Shanda, Shanda, which is even a bigger shame. And you know, you got engaged, you got to 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 the Anna-Secnesia, I've had kids tell me, don't talk to my parents. You know, I'm not permitting it. HIPAA actually gives the doctor a permission to use his best judgment when the patient is, as we would say, not of their right mind. So if 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 trying 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 and what they need to know? So as I said, the nihilism in psychiatry, the belief that, you know, your kid's life is overwhelmed. My son is, you know, a stand-up comic, which, of course, most people with schizophrenia are, you know,

that's a decent career in New York City. And as finally engaged, the serious mental illness

came in, they because they need to see. So we were just at an event in the layout in California, like South of San Francisco, and Daniel would get up and did a 20-minute set of stand-up comedy. Then we showed our movie, which is into the light meeting for recovery, a little plug for that, and then I do my usual talk. And the sponsor 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.

Hospital reduces up by 90 percent or 80 to 90 percent or so. I don't want to exaggerate again.

You know, long-term survival, the fined money study, the entire finished population, where they, they have actually a national health care system, and a national database. So they have less than six million people. They have 62,500 people with psychosis, and they followed them for 20 years. People not on anti-psychotics and psychosis, 46 percent had passed away, almost 50 percent mortality. People on a non-closipping based anti-psychotic,

almost 16 percent or no, not 16 percent. 25.8 percent died. And then with

“"closipping" it was 15.8 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. The man, if your kid is great on whatever anti-psychotic they're on, fine, but keep it open mind. As I said, these illnesses tend to progress. Demand the best treatment, that's all on the escape. And that is a "closipping 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. At first, I just wrote it for the general public, each addition. 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 100 pages. Now it's about 500 pages, probably too long. So it's meaningful recovery from schizophrenia and serious mental illness with "closipping". It'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 it. 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.

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