Schizophrenia Bulletin publishes a review of published articles that finds the use of schizophrenia subtypes (Catatonic, Disorganized, Paranoid, Residual & Undifferentiated), “while widely used in the past,” has declined over the last 20 years to the point that they should be eliminated from research and “evolving knowledge” on the topic.
What makes the DSM so pernicious is that it is a cultural document whose influence transcends not only psychiatric practice but also the Western civilization from which it originates. Each revision of the DSM rescripts and reimagines how we make sense of our experiences, reinterprets what thoughts, feelings and behaviors are socially sanctioned, and ultimately what it means to be human. Full Article →
At the University of Minnesota, the answer is apparently $1,446. If harmless clerical errors were to blame for oddities like this, that fact should be easy to clarify simply by looking at the relevant documents. But if there are systematic issues with the administration of clinical trials that makes it possible to bill for a visit with a dead subject, those issues would be important for other universities and private trial sites as well. Full Article →
While some people find their lives ruined by belief in imagined conspiracies that affect them personally – they may isolate from, or even attack, friends and family, and get diagnosed with psychosis – many other people believe in conspiracies on the basis of little evidence, yet have prominent places in society or even bodies like the US Senate. Yet it seems clear to me that the same dynamics are often involved in both. Full Article →
Researchers in Germany, China and Australia teamed up to find, through a meta-analysis of research pertaining to 1045 patients receiving antipsychotics, that augmentation with benzodiazepines did not improve outcomes. The authors recommend that benzodiazepines should be considered only for “ultra short-term sedation of acutely agitated patients but not for augmentation of antipsychotics in the medium- and long-term pharmacotherapy of schizophrenia and related disorders.”
French researchers looked at the outcomes of 467 “antipsychotic drug-naive” patients six months after a first psychotic episode (and treatment with medication), finding that the outcomes were heterogenous. A lower initial level of functioning and negative symptoms were the best predictors of worse outcomes. The sole predictor of rapid improvement, however, was employment. Results appear in Acta Psychiatrica Scandinavica. Abstract →Discuss →
Chinese researchers find, in a literature review for the International Journal of Endocrinology find an increased rate of osteoporosis among people with a schizophrenia diagnosis, and conclude that that increased risk is secondary to hyperprolactinemia caused by antipsychotics.
Earth Day 2013 is a good time to reflect on how problems in our mental health system reflect deep flaws in “normal” conceptions of what it means to be a human being. These flawed conceptions then contribute in a critical way to the climate crisis that threatens us all. Full Article →
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? Full Article →
British researchers find that a 10% increase in pain medication resulted in a dramatic reduction in the use of antipsychotic and other medications. “When people with dementia are showing distress reactions this may be due to them experiencing pain or discomfort, yet too often rather than trying to identify and relieve this symptom they are needlessly given anti-psychotic drugs to calm them and keep them quiet,” said the head of quality and dementia care for Four Seasons Health Care, which conducted the (non-peer reviewed) study.
A paper in Health reviews how one recovery-based approach, the Whole Life Manual, is applied in clinical practice, finding that “Our findings support the data in studies that show that increasing confidence, hope and optimism are key features of the process and outcomes of recovery based approaches, and in particular in the Whole Life Programme. Respectful and flexible approaches within the relationship with the therapist; an increase in knowledge about other resources and how to use them themselves, and improved relationships and having greater control over their lives were also important.”
The Annual Review of Clinical Psychology presents a review by Boston University’s Center for Psychiatric Rehabilitation (and others) of “Psychosocial Treatments for Schizophrenia,” encompassing the recovery model of mental health and a range of evidence-based practices including “promising” practices such as cognitive adaptive therapy, CBT for post-traumatic stress disorder, first-episode psychosis intervention, healthy lifestyles interventions, peer support services, supported education and supported housing.
The Cochrane Library reports that “many older people with Alzheimer’s dementia and NPS (neuropsychiatric symptoms) can be withdrawn from chronic antipsychotic medication without detrimental effects on their behavior… the results of this review suggest that discontinuation programmes could be incorporated into routine practice. However, two studies of people whose agitation or psychosis had previously responded well to antipsychotic treatment found an increased risk of relapse or shorter time to relapse after discontinuation.”
What is “healthy” spirituality and what supports it? Is it our human right to question our spiritual orientations, to experience transcendence and dark nights of the soul? Is it not normal to go through strange and transforming processes in our becoming who we are? Is it not our right to have significant questions about God or to get bold ideas and big feelings about the world and our place in it? Full Article →
The label of schizophrenia has a chilling ring. It carries with it the suggestion of a wrecked and wretched life. It is also a diagnosis that is notoriously difficult to shed. For this reason, the diagnosis of schizophrenia should not be applied lightly and not without a thorough understanding of the patient’s family and wider circumstances. Full Article →
Despite the integral importance of blinding and blinding assessment to randomized controlled trials (RCTs), they are rarely reported on or documented in trial reports according to this study published yesterday in Psychotherapy and Psychosomatics. The study of schizophrenia and affective disorder medication research in 2,467 publications from 2000 to 2010 found that an absence of blinding and blinding assessment was associated with an increased rate of positive findings of treatment success, industrial sponsorship, and diagnosis of schizophrenia.
Martin Harrow and Thomas Jobe have a new article coming out in Schizophrenia Bulletin that I wish would be read by everyone in our society with an interest in “mental health.” Harrow and Jobe, who conducted the best study of long-term schizophrenia outcomes that has ever been done, do not present new data in this article, but rather discuss the central question raised by their research: Does long-term treatment of schizophrenia with antipsychotic medications facilitate recovery? Or does it hinder it? Full Article →
Robin Murray, Scottish psychiatrist and professor of Psychiatric Research at the Institute of Psychiatry, Kings College in London, presents his keynote at the 2012 Hearing Voices World Congress in Cardiff, Wales. Full Article →
Researchers from England, in a study of 458 first episodes of psychosis, find that delusional beliefs coupled with elation, fear, anxiety are not associated with violence. Delusional beliefs in the context of depression are associated with less violence. “Anger due to delusions appeared to constitute the main drive to serious violence,” said the authors of the study, published in JAMA Psychiatry.
Psychiatrists at the University of Minnesota forced a young man into a profitable study of antipsychotic drugs over the objections of his mother, who desperately warned that his condition was deteriorating and that he was in danger of killing himself. On May 8, 2004, Mary Weiss’ only son, Dan Markingson, committed suicide. A petition to the governor of Minnesota now asks for an investigation. Full Article →
Researchers in London and Spain, in a prospective, randomized, study of long-term (3 year) effects of first- and second-generation antipsychotics on neurocognition in 79 patients following a “first episode of schizophrenia spectrum disorders”, find that “haloperidol, olanzapine, and risperidone have not demonstrated substantial neurocognitive effectiveness.” Results appeared online in Psychopharmacology on March 2, 2013.
When we begin to question, we discover that (1) scientifically flawed research has been used to promote ideas around mental illness and its heritability, and (2) instead of focusing on nature vs. nurture causes of mental illness, it’s time to consider whether certain phenomena are really symptoms of pathology or instead are inextricable aspects of our humanity.
In the business of clinical trials, the most valuable commodities are the research subjects. Filling clinical trials is hard, and filling them quickly is even harder. That’s why in 2000 a clinical investigator told the HHS Office of the Inspector General that research sponsors were looking for three things from research sites: “No. 1—rapid enrollment. No. 2 — rapid enrollment. No. 3 — rapid enrollment.” Full Article →