May 19, 2013

For me there are at least four separate questions to be addressed. The first is whether neuroscience is capable of understanding human emotion and higher level cognitive experiences. The second is the extent to which that understanding – even if it is achievable – is critical to our being able to help people in distress. The third is whether is it is correct to assume, as many people seem to do, that if we come to some basic understanding of brain function as it pertains to core human emotion and suffering that this will automatically translate into treatments that are commonly thought of as “biological,” such as drug treatment. The fourth relates to the limitations and relevance of studying the brain in isolation when we are constantly in interaction with our environment.
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Categorized in: Blogs, Featured Blogs, Neuroscience, Uncategorized

May 13, 2013

As the medical director of a community mental health center, my colleagues look to me for guidance on how to approach the new edition of the DSM. How many should we buy? How much time should be devoted to staff training? This is my answer.
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Categorized in: Blogs, DSM, Featured Blogs

April 22, 2013

In previous posts in this series, I noted that the standard treatment of conditions labeled as schizophrenia (and related disorders) is to start neuroleptics early and to continue them indefinitely. This is based on the belief that untreated psychosis is bad for the brain and that relapse is much higher when the drugs are stopped than when they are continued. The rationale for this approach, and my discussion of the limitations of these assertions, were the topics of previous blogs in this series. In this final post I want to discuss how realistic this paradigm of care is.
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Categorized in: Antipsychotics, Blogs, Featured Blogs, Psychiatric Drugs

April 14, 2013

For the past 20 years, there has been a prevailing concern in psychiatry that psychosis is bad for the brain. When I read Anatomy of an Epidemic, this was one of my most pressing concerns; if I suggested to my patients that they pursue other treatments before starting drug treatment, was I helping or harming them?
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Categorized in: Adult, Antipsychotics, Blogs, Disorders, Featured Blogs, Psychiatric Drugs, Research, Schizophrenia/Psychotic Disorders

March 30, 2013

A major research group mentions in a paper published in an academically rigorous psychiatric journal (and I get it that some readers consider that an oxymoron) the possible influence of super-sensitivity on increasing the risk of relapse when neuroleptic drugs are stopped. Yet those of us who raise this as a reason to moderate our use of these drugs are considered biased or scientifically naive.

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Categorized in: Antipsychotics, Blogs, Featured Blogs, Psychiatric Drugs

March 23, 2013

This post and the ones to follow will summarize my current thinking on the optimal use of neuroleptic drugs.
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January 1, 2013

It has been a year this since the Mad In America website launched and I posted my first blog. You have been a smart and well informed audience. I know that many of you are eager to change the mental health system; for what it is worth, you have changed one doctor.
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Categorized in: Blogs

December 3, 2012

This week, MIA highlighted a recently published study of the four most commonly prescribed neurolpetics. As noted in the post, the major outcome was that these drugs were not found to be effective or safe. This important study, co-authored by Dilip Jeste the current president of the American Psychiatric Association, is worth reviewing in greater detail.
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Categorized in: Antipsychotics, Blogs, Featured Blogs, Psychiatric Drugs, Uncategorized

November 12, 2012

(August, 1985) My first academic article, entitled, “Dissociation and Psychotic Symptoms” is published in The American Journal of Psychiatry. It was a case report of a young girl who experienced visions and voices. We thought that she had dissociative symptoms and we had taught her how to control these experiences through self hypnosis. In the same month, an article was published in another academic journal. This was entitled, “Treatment of Bulimia and Rapid-Cycling Bipolar Disorder with Sodium Valproate: A case Report .” We were describing the same young girl. Our treatments were concurrent. How could this be?
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October 26, 2012

Dr. Torrey accuses me of being ignorant and perhaps in this regard he is correct. Where he sees such clarity, I see profoundly difficult questions.

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Categorized in: Blogs, Featured Blogs

October 7, 2012

Although I have always been conservative in my use of these drugs, I now include in my discussion with patients my concerns about brain atrophy and long term outcome. This is added to an ongoing conversation I have had regarding the risks of tardive dyskinesia and metabolic effects of these medications. In my opinion, informed consent is a process, so these are conversations that I have been having repeatedly with my patients.
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Categorized in: Blogs, Featured Blogs

September 27, 2012

A recent Medscape article by a prominent US psychiatrist sheds light on why there is inadequate attention to non-pharmacological treatments of mental distress.
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September 23, 2012

The 17th International Conference on the Treatment of Psychosis included nurses, psychologists, psychiatrists, and other clinicians as well as several persons with lived experience and at least one philosopher, anthropologist, family member, and chaplain. I will try to summarize what I learned and experienced.
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Categorized in: Blogs, Featured Blogs

September 15, 2012

What follows is my attempt to report on the Pre-Seminar program from the 17th International Conference on the Treatment of Psychosis.
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September 2, 2012

I have just attended the 17th International Conference on the Treatment of Psychosis in Tornio, Finland. I am full of thoughts and I keep trying to figure out how I will explain this meeting to others.
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August 21, 2012

Readers on this site have wondered how the notion of a “chemical imbalance” could have been accepted by so many when the research did not actually support the concept. A recent paper from the Treatment Advocacy Center that summarizes studies of anosognosia in psychosis gives some clue as to how this type of thinking becomes entrenched and accepted.
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July 7, 2012

Robert Whitaker has raised questions about the problems with long term exposure to antipsychotic drugs but recent research raises questions about their efficacy in the short run.
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June 9, 2012

I was invited to present a work shop with Dan Fisher, MD PhD at the 2012 NAMI-VT annual meeting. These are my comments. They reflect my long term beliefs integrated with my reappraisal of practice in the past year.
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Categorized in: Blogs, Uncategorized

May 17, 2012

I am a psychiatrist who believes that involuntary treatment is rarely effective in the long run but I am also a psychiatrist who sometimes forces people into hospitals against their will.
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Categorized in: Blogs, Coercion

April 25, 2012

I don’t do “med checks”. What do I do?
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Categorized in: Blogs, Uncategorized