conflict of interest: Dr. Lieberman

New-Psychiatry

Anti-​Psychiatry Prej­u­dice? A response to Dr. Lieber­man
by Judy Stone at Sci­en­tific American

… the Direc­tor of the National Insti­tutes of Men­tal Health (NIMH), Dr. Thomas Insel, has rejected the DSM, stating:

The weak­ness is its lack of valid­ity. Unlike our def­i­n­i­tions of ischemic heart dis­ease, lym­phoma, or AIDS, the DSM diag­noses are based on a con­sen­sus about clus­ters of clin­i­cal symp­toms, not any objec­tive lab­o­ra­tory mea­sure. In the rest of med­i­cine, this would be equiv­a­lent to cre­at­ing diag­nos­tic sys­tems based on the nature of chest pain or the qual­ity of fever. Indeed, symptom-​based diag­no­sis, once com­mon in other areas of med­i­cine, has been largely replaced in the past half cen­tury as we have under-​stood that symp­toms alone rarely indi­cate the best choice of treat­ment. Patients with men­tal dis­or­ders deserve better…NIMH will be re-​orienting its research away from DSM categories.”…

… Dr. Frances chides, “I believe that the Amer­i­can Psy­chi­atric Asso­ci­a­tion (APA)’s finan­cial con­flict of inter­est, gen­er­ated by DSM pub­lish­ing prof­its needed to fill its bud­get deficit, led to pre­ma­ture pub­li­ca­tion of an incom­pletely tested and poorly edited prod­uct. The APA refused a peti­tion for an inde­pen­dent sci­en­tific review of the DSM-​5 that was endorsed by more than 50 men­tal health asso­ci­a­tions. Pub­lish­ing prof­its trumped pub­lic inter­est.

 New psy­chi­atric diag­noses are now poten­tially more dan­ger­ous than new psy­chi­atric drugs, because diagnos-​tic expan­sions may lead to drug com­pany pro-​motions that dra­mat­i­cally increase the use of unnec­es­sary med­ica­tions, with high cost and poten­tially harm­ful side effects.”

book: Sally Satel on the limits of brain imaging

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Brain­washed: The Seduc­tive Appeal of Mind­less Neu­ro­science by Sally Satel

excerpt from book:

Brain scan images are not what they seem…or at least not how the media often depict them. Nor are brain-​scan images what they seem. They are not pho­tographs of the brain in action in real time. Sci­en­tists can’t just look “in” the brain and see what it does. Those beau­ti­ful color-​dappled images are actu­ally rep­re­sen­ta­tions of par­tic­u­lar areas in the brain that are work­ing the hard­est— as mea­sured by increased oxy­gen con­sump­tion— when a sub­ject per­forms a task such as read­ing a pas­sage or react­ing to a stim­uli, such as pic­tures of faces. The pow­er­ful com­puter located within the scan­ning machine trans­forms changes in oxy­gen lev­els into the famil­iar candy-​colored splotches indi­cat­ing the brain regions that become espe­cially active dur­ing the subject’s per­for­mance. Despite well-​informed infer­ences, the great­est chal­lenge of imag­ing is that it is very dif­fi­cult for sci­en­tists to look at a fiery spot on a brain scan and con­clude with cer­tainty what is going on in the mind of a person.

SSRI induced mania and dopaminergic supersensitivity from antipsychotics

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abstract: Antidepressant-​associated mania and psy­chosis result­ing in psy­chi­atric admis­sions. at PubMed

Despite the pos­i­tive changes in the side effect pro­file of anti­de­pres­sant drugs, the rate of admis­sions due to antidepressant-​associated adverse behav­ioral effects remains significant.

free online arti­cle at The Jour­nal of Neu­ro­science “Break­through” dopamine super­sen­si­tiv­ity dur­ing ongo­ing antipsy­chotic treat­ment leads to treat­ment fail­ure over time.

Antipsy­chotics often lose effi­cacy in patients despite chronic con­tin­u­ous treat­ment. Why this occurs is not known. It is known, how­ever, that with­drawal from chronic antipsy­chotic treat­ment induces behav­ioral dopamin­er­gic super­sen­si­tiv­ity in ani­mals. How this emerg­ing super­sen­si­tiv­ity might inter­act with ongo­ing treat­ment has never been assessed. There­fore, we asked whether dopamine super­sen­si­tiv­ity could over­come the behav­ioral and neu­ro­chem­i­cal effects of antipsy­chotics while they are still in use. Using two mod­els of antipsychotic-​like effects in rats, we show that dur­ing ongo­ing treat­ment with clin­i­cally rel­e­vant doses, haloperi­dol and olan­za­p­ine pro­gres­sively lose their effi­cacy in sup­press­ing amphetamine-​induced loco­mo­tion and con­di­tioned avoid­ance responding.

study: over-​diagnosing depression and over prescribing

drugs and earth blue

A Glut of Anti­de­pres­sants by Roni Caryn Rabin

Over the past two decades, the use of anti­de­pres­sants has sky­rock­eted. One in 10 Amer­i­cans now takes an anti­de­pres­sant med­ica­tion; among women in their 40s and 50s, the fig­ure is one in four.

Experts have offered numer­ous rea­sons. Depres­sion is com­mon, and eco­nomic strug­gles have added to our stress and anx­i­ety. Tele­vi­sion ads pro­mote anti­de­pres­sants, and insur­ance plans usu­ally cover them, even while lim­it­ing talk ther­apy. But a recent study sug­gests another expla­na­tion: that the con­di­tion is being over­diag­nosed on a remark­able scale.

The study, pub­lished in April in the jour­nal Psy­chother­apy and Psy­cho­so­mat­ics, found that nearly two-​thirds of a sam­ple of more than 5,000 patients who had been given a diag­no­sis of depres­sion within the pre­vi­ous 12 months did not meet the cri­te­ria for major depres­sive episode as described by the psy­chi­a­trists’ bible, the Diag­nos­tic and Sta­tis­ti­cal Man­ual of Men­tal Dis­or­ders (or D.S.M.).

The study is not the first to find that patients fre­quently get “false pos­i­tive” diag­noses for depres­sion. Sev­eral ear­lier review stud­ies have reported that diag­nos­tic accu­racy is low in gen­eral prac­tice offices, in large part because seri­ous depres­sion is so rare in that setting…

…The new study drew 5,639 indi­vid­u­als who had been diag­nosed with depres­sion from among a nation­ally rep­re­sen­ta­tive sam­ple of over 75,000 adults who took part in the National Sur­vey of Drug Use and Health in 2009 and 2010. The sub­jects were then inter­viewed in per­son with ques­tions based on the D.S.M.-4 criteria.

epidemics” in childhood “mental disorders”

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viva com­plex­ity by Dr. Mickey Nardo at 1 bor­ing old man

Link­ing to an arti­cle (that is behind a pay wall), Dr. Nardo posts excerpts of it then writes about his expe­ri­ence as a psy­chi­a­trist and clin­i­cian work­ing with chil­dren in rural Appalachia.

the fol­low­ing are excerpts from Too many psy­chi­atric diag­noses for chil­dren: an epi­demic of labels: Child in Mind by Clau­dia Gold which is a response to Why So Many Epi­demics of Child­hood Men­tal Dis­or­ders? by Dr. Allen Francis

Since the pub­li­ca­tion of DSM-​IV in 1994, the rates of 3 men­tal dis­or­ders have sky­rock­eted: atten­tion deficit dis­or­der [ADD] tripled, autism increased by 20-​fold, and child­hood bipo­lar dis­or­der by 40-​fold. It is no acci­dent that diag­nos­tic infla­tion has focused on the men­tal dis­or­ders of chil­dren and teenagers. These are inher­ently dif­fi­cult to diag­nose accu­rately because young­sters have a short track record; are in devel­op­men­tal flux that makes pre­sen­ta­tions tran­sient and unsta­ble; are sen­si­tive to fam­ily, peer, and school stresses; and may be using drugs. If ever diag­no­sis should be con­ser­v­a­tive, it should be in kids. Instead, we have expe­ri­enced an unprece­dented diag­nos­tic exu­ber­ance encour­aged in part by DSM-​IV, but mostly stim­u­lated by the pow­er­ful exter­nal forces of drug com­pany mar­ket­ing and the close cou­pling of school ser­vices to a diag­no­sis of men­tal disorder.

Three years after DSM-​IV was pub­lished, drug com­pa­nies intro­duced new and expen­sive on-​patent drugs that pro­vided the incen­tive and resources for an aggres­sive mar­ket­ing cam­paign to psy­chi­a­trists, pedi­a­tri­cians, and fam­ily doc­tors. Simul­ta­ne­ously, suc­cess­ful drug com­pany lob­by­ing gave them unre­stricted free­dom to adver­tise directly to con­sumers. Par­ents and teach­ers were inun­dated with the mes­sage that ADD was ter­ri­bly under­diag­nosed and eas­ily treated with a pill. Sales of ADD drugs bal­looned to an astound­ing $7 billion.

Child­hood bipo­lar dis­or­der is an even more chill­ing case. DSM-​IV had wisely rejected a pro­posal that there be a sep­a­rate and much looser def­i­n­i­tion of bipo­lar dis­or­der in chil­dren. The argu­ment for inclu­sion rested on the unrepli­cated find­ings of just 1 [albeit very influ­en­tial] research group sug­gest­ing that kids present a devel­op­men­tally dif­fer­ent pro­dro­mal form of bipo­lar dis­or­der char­ac­ter­ized by ambi­ent irri­tabil­ity, impul­siv­ity, and tem­per out­bursts, rather than the typ­i­cal cycli­cal mood swings of adults. Rejec­tion by DSM-​IV did not stop charis­matic thought lead­ers [who were heav­ily financed by drug com­pa­nies] from spread­ing the gospel of child­hood bipo­lar dis­or­der. The 40-​fold increase in rates was accom­pa­nied by an increase in antipsy­chotic spend­ing up to $18.2 bil­lion in 2011. These drugs fre­quently cause mas­sive weight gain in chil­dren. The overuse of antipsy­chotics in kids was not deterred by the fact that child­hood obe­sity is an impor­tant risk fac­tor for dia­betes and heart dis­ease. Drug com­pa­nies have received bil­lion dol­lar fines for off-​label mar­ket­ing to kids, but these pale in com­par­i­son to the enor­mous rev­enues. Of note, the inap­pro­pri­ate use of antipsy­chotics is most pro­nounced among chil­dren who are eco­nom­i­cally disadvantaged.

The intro­duc­tion of Asperger’s by DSM-​IV was expected to result in a 3– to 4-​fold increase rates of autism. Severe clas­sic autism had an unmis­tak­able pre­sen­ta­tion with rates lower than 1 per 2000. Asperger’s blends imper­cep­ti­bly into nor­mal eccen­tric­ity, and the rates of autism are now reported at 1 per 88 in the United States and 1 in 38 in Korea. The­o­ries con­nect­ing the increase in preva­lence to vac­ci­na­tion have been dis­cred­ited. Instead, the rates have grown so rapidly because a diag­no­sis of autism is required to allow a child access to greatly enhanced school ser­vices. About half the young­sters who now receive the diag­no­sis do not really meet the DSM-​IV cri­te­ria when these are care­fully applied. And follow-​up stud­ies find­ing that half the kids no longer meet cri­te­ria also con­firm that diag­nos­tic infla­tion is ram­pant. Eli­gi­bil­ity for school ser­vices should be decou­pled from an unre­li­able clin­i­cal diag­no­sis and instead be based on edu­ca­tional need.

articles on psycho-​social aspects of mental illness and the DSM

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paint­ing by Wass­ily Kandinsky

Psy­chi­a­trists under fire in men­tal health bat­tle by Jamie Doward in the guardian

In a ground­break­ing move that has already prompted a fierce back­lash from psy­chi­a­trists, the British Psy­cho­log­i­cal Society’s divi­sion of clin­i­cal psy­chol­ogy (DCP) will on Mon­day issue a state­ment declar­ing that, given the lack of evi­dence, it is time for a “par­a­digm shift” in how the issues of men­tal health are under­stood. The state­ment effec­tively casts doubt on psychiatry’s pre­dom­i­nantly bio­med­ical model of men­tal dis­tress – the idea that peo­ple are suf­fer­ing from ill­nesses that are treat­able by doc­tors using drugs. The DCP said its deci­sion to speak out “reflects fun­da­men­tal con­cerns about the devel­op­ment, per­sonal impact and core assump­tions of the (diag­no­sis) sys­tems”, used by psychiatry.

Dr Lucy John­stone, a con­sul­tant clin­i­cal psy­chol­o­gist who helped draw up the DCP’s state­ment, said it was unhelp­ful to see men­tal health issues as ill­nesses with bio­log­i­cal causes.

On the con­trary, there is now over­whelm­ing evi­dence that peo­ple break down as a result of a com­plex mix of social and psy­cho­log­i­cal cir­cum­stances – bereave­ment and loss, poverty and dis­crim­i­na­tion, trauma and abuse,” John­stone said. The provoca­tive state­ment by the DCP has been timed to come out shortly before the release of DSM-​5, the fifth edi­tion of the Amer­i­can Psy­chi­a­try Association’s Diag­nos­tic and Sta­tis­ti­cal Man­ual of Men­tal Disorders.

The man­ual has been attacked for expand­ing the range of men­tal health issues that are clas­si­fied as dis­or­ders. For exam­ple, the fifth edi­tion of the book, the first for two decades, will clas­sify man­i­fes­ta­tions of grief, tem­per tantrums and wor­ry­ing about phys­i­cal ill-​health as the men­tal ill­nesses of major depres­sive dis­or­der, dis­rup­tive mood dys­reg­u­la­tion dis­or­der and somatic symp­tom dis­or­der, respectively.

Some of the manual’s omis­sions are just as con­tro­ver­sial as the manual’s inclu­sions. The term “Asperger’s dis­or­der” will not appear in the new man­ual, and instead its symp­toms will come under the newly added “autism spec­trum disorder”.

The DSM is used in a num­ber of coun­tries to vary­ing degrees. Britain uses an alter­na­tive man­ual, the Inter­na­tional Clas­si­fi­ca­tion of Dis­eases (ICD) pub­lished by the World Health Organ­i­sa­tion, but the DSM is still hugely influ­en­tial – and controversial.

The writer Oliver James, who trained as a clin­i­cal psy­chol­o­gist, wel­comed the DCP’s deci­sion to speak out against psy­chi­atric diag­no­sis and stressed the need to move away from a bio­med­ical model of men­tal dis­tress to one that exam­ined soci­etal and per­sonal factors.

Do we need to change the way we are think­ing about men­tal ill­ness? fol­low­ing quote by Oliver James in the Guardian

A stu­dent friend of mine once started claim­ing that she was being con­trolled by elec­tri­cal impulses beamed across the city by “author­i­tar­ian cap­i­tal­ists”. She spent hours in the bath, clean­ing herself.

Fol­low­ing her removal to an asy­lum, her par­ents arrived to col­lect her pos­ses­sions. Nearly all of her (mostly clean) clothes were deemed so “soiled” they would need to be burnt. The room was obses­sively cleaned. Her father was a health inspector.

Within the med­ical model of men­tal ill­ness, she had inher­ited genes pre­dis­pos­ing her to obses­sive rit­u­als and to psy­chosis. The model does not enter­tain the pos­si­bil­ity that the health inspector’s intru­sive­ness dis­tressed her or, as it turned out, that he had sex­u­ally abused her.

Yet 13 stud­ies find that more than half of schiz­o­phren­ics suf­fered child­hood abuse. Another review of 23 stud­ies shows that schiz­o­phren­ics are at least three times more likely to have been abused than non-​schizophrenics. It is becom­ing appar­ent that abuse is the major cause of psy­choses. It is also all too clear that the med­ical model is bust.

In the press release accom­pa­ny­ing pub­li­ca­tion of DSM-​5, David Kupfer, who over­saw its cre­ation, states: “We’ve been telling patients for sev­eral decades that we are wait­ing for bio­mark­ers. We’re still wait­ing.” This is an aston­ish­ing admis­sion that there are no reli­able genetic or neu­ro­log­i­cal mea­sure­ments that dis­tin­guish a per­son with men­tal illness.

While there is some evi­dence that the electro-​chemistry of dis­tressed peo­ple can be dif­fer­ent from the undis­tressed, the Human Genome Project seems to be prov­ing that genes play almost no part in caus­ing this. Eleven years of care­ful study of our DNA shows that dif­fer­ences in it do not explain men­tal ill­ness, hardly at all. If one sib­ling is anx­ious or depressed and another is not, at most, dif­fer­ences in DNA can only explain 1 – 5% of why it is one and not the other.

Of course, some researchers main­tain that, given more time (and money), they will still come up with sig­nif­i­cant results. But off the record, nearly all mol­e­c­u­lar geneti­cists admit that it now really does look as if dif­fer­ences in DNA will explain very little.

By con­trast, there is a huge body of evi­dence that our early child­hood expe­ri­ences com­bined with sub­se­quent expo­sure to adver­sity explain a very great deal. This is dose depen­dent: the more mal­treat­ment, the ear­lier you suf­fer it and the worse it is, the greater your risk of adult emo­tional dis­tress. These expe­ri­ences set our electro-​chemical thermostats.

So does sub­se­quent adult adver­sity. For instance, a per­son with six or more per­sonal debts is six times more likely to be men­tally ill than some­one with none, regard­less of their social class: the more debts, the greater the risk.

We need fun­da­men­tal changes in how our soci­ety is organ­ised to give par­ents the best chance of meet­ing the needs of chil­dren and to pre­vent the amount of adult adversity.

Britons and Amer­i­cans have exactly twice the amount of men­tal ill­ness of main­land west­ern Euro­peans (23% ver­sus 11.5%). Thirty years of Thatcher and “Blatcher” turned us into a nation of “affluenza”-stricken, shop-​till-​you-​drop, “it could be you”, credit-​fuelled con­sumer junkies. Per­sonal debt – a major stres­sor for adults – rose from £200bn in 1980 to £1,400bn in 2006. After 1979, the amount of men­tal ill­ness mushroomed.

For­get about genes. We would halve the amount of emo­tional dis­tress in this coun­try if we had the more equal, rel­a­tively cohe­sive, less debt-​ridden polit­i­cal eco­nom­ics of our Euro­pean neighbours.

challenges to the biological/​genetic explanations for schizophrenia

Via Invol­un­tary Transformations

Schiz­o­phre­nia and Genet­ics— does crit­i­cal thought stop here? by Mary Boyle at a con­fer­ence enti­tled “From Gal­ton to the Human Genome Project: A crit­i­cal appraisal of genetic the­o­ries in psy­chol­ogy and psy­chi­a­try”, 2004

Mary Boyle is Emer­i­tus Pro­fes­sor of Clin­i­cal Psy­chol­ogy, Uni­ver­sity of East Lon­don and the author of Schiz­o­phre­nia: A Sci­en­tific Delusion?

psychiatry: Stop-​DSM

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David Gothard

Stop-​DSM

HAVING IT OUT ONCE AND FOR ALL WITH THE DSM

MENTAL HEALTH SHOULD NO LONGER REFER TOSINGLE TEXTBOOK REQUIRED BY THE WHO.

The nomen­cla­ture of the DSM, on which WHO’s ICD-​10 has been mod­eled, has pro­gres­sively become the sin­gle and oblig­a­tory clas­si­fi­ca­tory ref­er­ence of “men­tal disorders”:

- in epidemiology;

- in the field of research and sci­en­tific publications;

- for social pro­tec­tion sys­tems and insurances;

- in order to col­lect sta­tis­ti­cal data for care pol­icy and financing;

- as an unique ref­er­ence man­ual in the teach­ing of psy­chi­a­try in med­ical and psy­chol­ogy schools, for the train­ing of pro­fes­sion­als and lec­tur­ers in health, social and spe­cial edu­ca­tion fields;

- finally, for physi­cians, who, hav­ing no other rel­e­vant train­ing, pre­scribe more and more psy­chotropic drugs, based on ques­tion­able diag­nos­tic criteria.

With the pur­pose of respond­ing to spe­cific and dis­tinct require­ments, the wide­spread use of this unique clas­si­fi­ca­tion becomes a con­fu­sion, inad­e­quacy and risks source. Espe­cially since the WHO is not empow­ered to take deci­sions on sci­en­tific research, but instead it should rec­om­mend inde­pen­dence, diver­sity and pro­mote the coex­is­tence of dif­fer­ent approaches.

More­over, far short of sci­en­tific rigor, the DSM is based on unam­bigu­ously par­tial con­cep­tions. It neglects the clin­i­cal data, mul­ti­plies the patho­log­i­cal cat­e­gories and low­ers the thresh­old of diag­nos­tic cri­te­ria for inclu­sion, which leads to false-​positives and pseudo-​outbreaks (as, for exam­ple, hyper­ac­tiv­ity, bipo­lar dis­or­der or autism). It is mis­used for pre­dic­tive pur­poses in chil­dren and ado­les­cents, tak­ing the risk of harm­ing their devel­op­ment and inte­gra­tion. It also pro­motes what has become, for a large part of the pop­u­la­tion, a real addic­tion to psy­chotropic drugs.

We are on the thresh­old of the DSM-V’s edi­tion, which will increase again the num­ber of cat­e­gories, already over­crowded, and extend the scope of pre­dic­tion. We can­not let it estab­lish such an ori­en­ta­tion, designed to increase arti­fi­cially the num­ber of pathologies.

medical illnesses misdiagnosed as mental illnesses.

inca panimage by inca pan

Con­fus­ing Med­ical Ail­ments with Men­tal Illness

An elderly woman’s sud­den depres­sion turns out to be a side effect of her high blood-​pressure medication.

A new mother’s exhaus­tion and dis­in­ter­est in her baby seem like post­par­tum depres­sion — but actu­ally sig­nal a post­par­tum thy­roid imbal­ance that med­ica­tion can correct.

A middle-​aged man­ager has angry out­bursts at work and fre­quently feels “ready to explode.” A brain scan reveals temporal-​lobe seizures, a type of epilepsy that can be treated with surgery or medication.

More than 100 med­ical dis­or­ders can mas­quer­ade as psy­cho­log­i­cal con­di­tions, accord­ing to Har­vard psy­chi­a­trist Bar­bara Schild­krout, who cited these exam­ples among oth­ers in “Unmask­ing Psy­cho­log­i­cal Symp­toms,” a book aimed at help­ing ther­a­pists broaden their diag­nos­tic skills.

More than 100 med­ical dis­or­ders can mas­quer­ade as psy­cho­log­i­cal con­di­tions or con­tribute to them, com­pli­cat­ing treat­ment decisions.

bio-​bio-​bio-​psychiatry. over-​prescribing. hubris.

fighting-stigma1
Psy­chi­a­try by Num­bers by melody at the Cargo Cult Con­trar­ian blog at the on-​line mag­a­zine the Sci­en­tific American

Two years ago, Camille went to her local health­care clinic com­plain­ing of gen­eral anx­i­ety and sleep prob­lems, hop­ing to be seen by a ther­a­pist. Instead, within a month, her psy­chi­a­trist had pre­scribed her five drugs to help reg­u­late her mood: Adder­all (a stim­u­lant), Ati­van (an anti-​anxiety med­ica­tion), Celexa (an anti-​depressant), Tra­zodone (a sleep aid and anti-​depressant), and Yazmin (hor­monal birth con­trol). Since she did not meet the cri­te­ria for a major psy­chi­atric dis­or­der, such as bipo­lar or schiz­o­phre­nia, she has never seen a ther­a­pist. Since that time, she has become addicted to Ati­van, and has suf­fered severe with­drawal the few times she has tried to go off it. Her weight has plum­meted. She has dif­fi­culty dis­tin­guish­ing wak­ing life from dreams. The prob­lems she hoped to resolve in ther­apy remain largely unresolved…

…What trou­bles us about these sto­ries is the way that the tan­gled skein of human lives are reduced down to symp­toms, while cause and con­text are for­got­ten or out­right ignored. To give a phys­i­cal anal­ogy: I might feel a sharp pain in my lower calf because I have ‘flesh-​eating’ necro­tiz­ing fasci­itis. Or it may be that I have badly strained a mus­cle after a par­tic­u­larly stren­u­ous work-​out. In one case, intra­venous antibi­otics and surgery are called for; in the other, an ibupro­fen and a mas­sage would do the trick just fine. Even a physi­cian fac­ing a moti­vated hypochon­driac could tell the dif­fer­ence. But lis­ten­ing to how psy­chotropic drugs are pre­scribed, one comes away with the uncom­fort­able feel­ing that when it comes to dis­or­ders of the mind, many doc­tors sim­ply can’t tell the dif­fer­ence. And they’re not being paid to.