Robert Whitaker notes on Al Jazeera’s “Inside Story” that a helpful diagnostic text must be both reliable and valid, and the DSM is neither – resulting in a harmful expansion of diagnosis and medication. Allen Frances says that experts “always expand, they never reduce” their authority over a domain. 5% of the population has a psychiatric disorder that can be diagnosed and effectively treated, Frances says, but the DSM is misused such that more than 25% of the population is so diagnosed and a “ridiculous” 20% of the population is taking medication. Discuss →
Jeffrey Lieberman, incoming president of the APA, responds to criticism of the DSM and psychiatry, saying “it’s important to understand the difference between thoughtful, legitimate debate, and the inevitable outcry from a small group of critics – made louder by social media and support from dubious sources — who have relentlessly sought to undermine the credibility of psychiatric medicine and question the validity of mental illness.” Discuss →
A 33-year controlled, prospective study conducted as a collaboration by researchers in New York, Mexico, and Verona, Italy found that men diagnosed with ADHD as children had significantly higher rates of obesity as adults. The causal link, however – whether a common neurobiological dysfunction underlies both ADHD and obesity, or a tendency toward impulsiveness, or an effect of ADHD medication – is unclear.
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.
As demonstrators outside the Moscone Center in San Francisco protested the invalidity of the just-released DSM-5, and the harm they assert has been done in its name, the APA’s incoming president proclaimed psychiatry’s imminent legitimacy as a medical specialty, saying (paraphrasing John F. Kennedy), “‘On this day let the word go forth from this time and place,’ to consumers to clinicians, to policymakers and providers, to advocates and stakeholders, and to all the members of the APA, that for the field of psychiatry and for the patients that we serve, ‘our time has come.’”
NPR’s Marketplace covers the DSM-5′s rollout, with Allen Frances noting that “financial pressures – like dwindling membership – are forcing the APA to treat the DSM like a cash cow, not a public trust”, and psychiatrist (and MIA blogger) Sandra Steingard commenting that she has advised her agency against buying it. Regardless, Marketplace notes, the APA already has more than $150 million in pre-orders.
The Canadian Task Force on Preventive Health Care has reversed its 2005 recommendations, finding methodological flaws, possible bias, and uncertain generalizability in a review of the literature. “In the absence of a demonstrated benefit of screening, and in consideration of the potential harms, we recommend not routinely screening for depression in primary care settings, either in adults at average risk or in those with characteristics that may increase their risk of depression,” the task force writes in a forthcoming edition of the Canadian Medical Association Journal.
MIA reader/commenter Brett Deacon’s article in the prominent Clinical Psychology Review says that despite “widespread faith in the potential of neuroscience”, the biomedical era has produced poor mental health outcomes. He calls for an open and critical dialogue of the model, asking whether it is ethical to propound the “chemical imbalance story” in order to increase the credibility of antidepressant medication, when there isn’t “even one instance in which neurobiology alone can explain a psychological experience,” and when the model has failed to produce two of its prime objectives; the reduction of stigma, and good long-term outcomes. He calls for critical examination of the biomedical model’s effects, and mentions the vigorous dialogue taking place on madinamerica.com, among other venues.
The Economist, in its upcoming edition, says of the DSM “No other major branch of medicine has such a single text, with so much power over people’s lives. And that is worrying. Because in no other branch of medicine is the scientific reality underpinning the pronouncements of doctors so uncertain… the current over-reliance on one point of view in this extremely uncertain science is healthy neither for psychiatry, nor for those it treats.”
The New York Times reports that the “baffling” rise in suicide rates in the U.S. military is not correlated to deployment, as is often assumed. “Perhaps the biggest challenge facing the Pentagon is simply getting suicidal service members into treatment,” the article states, adding that “despite campaigns to reduce stigma, many service members continue to believe that treatment will be ineffective or hurt their careers.” However, nearly every example given in the article mentions that the person was taking antidepressants – evidence that the person was “not in a good place.”
A meta-analysis of studies of mental health websites by John Read found that 42% are either drug company owned or receive funding from drug companies, and that sites funded by drug companies are significantly more biased toward biogenetic causes and medication than sites that are financially independent of the industry.
Johnson & Johnson is negotiating with federal authorities over language that might be used in dozens of civil lawsuits regarding abnormal breast development and milk production, sometimes in boys, resulting from its antipsychotic Risperdal. The Wall Street Journal says the feds want J&J to acknowledge it downplayed relevant data.
David Kupfer, Chair of the DSM-5 Task Force, while defending the DSM as a useful diagnostic tool in a press release, concedes that ”biological and genetic markers that provide precise diagnoses that can be delivered with complete reliability and validity” are still “disappointingly distant. We’ve been telling patients for several decades that we are waiting for biomarkers. We’re still waiting.”
Calling for a complete overhaul of research into psychiatric diagnosis, Director of the NIMH Thomas Insel writes that “Over the past 18 months, we have tried to define several major categories for a new nosology… It became immediately clear that we cannot design a system based on biomarkers or cognitive performance because we lack the data.” Insel cites the current paradigm’s “lack of validity”, saying that “symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment.”
A study of 530,000 patients who underwent surgery at 375 U.S. hospitals found a 10% increased risk of post-operative complications including bleeding, transfusion, hospital readmission and death. However, the authors note that patients on SSRIs are also more likely to have conditions that increase surgical risk such as obesity, chronic pulmonary disease and depression. Results appear in JAMA Internal Medicine.
The largest trial to look into Electroconvulsive Therapy (ECT in the UK in more than 30 years will look into how ketamine may reduce the unwanted side effects of ECT and speed its antidepressant effect. Though ketamine is not approved for use as an antidepressant, the University of Manchester study will look at the anesthetic’s ability to reduce the memory loss associated with ECT, and to reduce the number of ECT treatments needed.
More than 60% of a sample of 5,639 participants with clinician-identified depression (drawn from the 2009-10 US National Survey of Drug Use and Health) did not actually meet criteria for major depression, a study from the Bloomberg School of Public Health and Johns Hopkins University found.
Robert Whitaker, Irving Kirsch, Joanna Moncrieff, Pat Bracken, Giovanni Fava, Jaakko Seikkula and others are to participate in a June 14-15 conference, hosted by the Vatican, that will examine the evidence for (and against) the rise of psychiatric medication and fall of psychosocial treatment for children.
MIA blogger (and lawyer) Jim Gottstein presented a 20-minute Oral Argument in ex rel Watson v. King-Vassel in front of the US Court of Appeals for the Seventh Circuit in Chicago last Thursday. ”The technical issue on appeal is a lawyer nerd question about whether expert testimony is required,” said Gottstein, “but I like to think it contains a succinct and clear explanation of why even though a doctor can prescribe a drug for anything, if they prescribe one off-label to a child they are causing a False Claim (committing Medicaid Fraud) unless the use has support in at least one of the specified drug references called Compendia.”
Based on a psychiatrist’s recommendation that the effects of citalopram (Celexa) had contributed to a 61 year-old grandmother’s lethal bludgeoning of her friend of over 20 years as they had tea, the High Court in Edinburgh accepted a reduced plea of ‘culpable homicide.’ The psychiatrist indicated that she had been prescribed a dosage “far in excess of what she should have been prescribed.”
The U.K.’s Mail reports of an effect of SSRIs that, though rare, has shown up in significant numbers of people according to David Healy’s RxISK website; unusual aggressiveness and recklessness associated with relatively minor drinking. “Once I started drinking I found it hard to stop. I also found I was becoming confused after drinking alcohol… I got banned from restaurants and bars in my local town and became an embarrassment to my friends. Once I climbed onto my roof. I was not trying to kill myself. I felt as if I was in a dream.”
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.”