Tuesday, May 21, 2013

More Recent Psychiatry News Headlines of Relevance to This Blog

When psychiatry news breaks, I fix it

Maybe it's because they aren't residual symptoms 

4/5/13.  Small Study: CBT May Improve Dysfunctional Attitudes In Euthymic Patients With BD.

Medwire (4/5, Cowen) reports, "Cognitive behavioral therapy (CBT) improves dysfunctional attitudes and is associated with a reduction in residual symptoms in euthymic patients with bipolar disorder [BD]," according to a study to be published in the September issue of the Journal of Behavior Therapy and Experimental Psychiatry. "The findings come from a study of 57 patients with remitted bipolar disorder.

It is amazing how many psychiatrists assume that when a patient with true manic-depressive illness is not in either the bipolar depressed or manic state, any emotional problems they may exhibit must be due to the underlying disorder. In fact, when patients with bipolar are euthymic (in the normal state), they can have any mood or any behavioral problem that anyone without bipolar disorder can have. 

They can be unhappy, have interpersonal problems, or have personality issues that have absolutely nothing to do with bipolar disorder. So of course psychotherapy can help then. On the other hand, try doing psychotherapy with someone in a full blown manic state, or in a severe depression with marked mental slowing (psychomotor retardation). I dare you.


It’s About Time, Department. 

5/1/13.  Colleges Tightening Rules On AD/HD Diagnoses, Prescriptions.
The New York Times (5/1, A10, Schwarz, Subscription Publication) reports that "dozens of colleges [are] tightening the rules on the diagnosis of" attention-deficit/hyperactivity disorder (AD/HD) "and the subsequent prescription of amphetamine-based medications" to treat it. "Some schools are reconsidering how their student health offices handle AD/HD, and even if they should at all. Various studies have estimated that as many as 35 percent of college students illicitly take these stimulants to provide jolts of focus and drive during finals and other periods of heavy stress."
Lawsuit Filed Against Harvard Spotlights Issues Involving AD/HD Diagnosis. In a related story, the New York Times (5/1, A12, Schwarz, Subscription Publication) reports that a lawsuit filed against Harvard University "provides rare detail on the issues involving a diagnosis of attention-deficit/hyperactivity disorder [AD/HD] from a student-health department." The case centers around a rising sophomore who had been prescribed a medication for AD/HD "after a single examination at Harvard University Health Services." The young man went on to commit suicide about half a year later after he received a prescription for antidepressants. The father of the victim "contends, among other accusations, that his son had never had AD/HD and that Harvard's original diagnostic procedure, and subsequent prescriptions for Adderall [amphetamine mixed salts], did not meet medical standards."


What hath Whitaker wrought? 

5/1/13. Concerns Mount Over Anti-Psychotic Drug Spending In California Prisons.


The AP (5/1) reports, "Under federal court oversight, California's prison mental health system has been spending far more on anti-psychotic drugs than other states with large prison systems, raising questions about whether patients are receiving proper treatment." According to the AP, anti-psychotics "account for nearly $1 of every $5 spent on pharmaceuticals purchased for the state prison system." Sharon Aungst, formerly the chief deputy secretary for the Division of Health Care Services, "said there was a tendency for prison health care workers to practice 'defensive medicine' for fear of triggering a lawsuit or violating federal court orders."

The anti-psychiatry crowd wants people with chronic and persistent psychotic disorders to stay off medication, and to stay out of psychiatric hospitals unless they want to be there. So instead, these patients end up in jail, where they get the medication anyway! I guess that means they are better off.

At least the private prison industry is happy. They have a lot more inmates than they would if these folks were in hospitals, so they can make a lot more money. Using your tax dollars to do it!  (Hospital care is actually a lot cheaper than prisons).

Assessing violence potential?  How about just asking the patient?

5/7/13.  According to a new article in Psychiatric Services, clinicians are often called upon to assess patients’ violence risk, and many researchers are focused on developing accurate tools for this purpose. Why not ask the patients themselves? The lead article describes a study in which clinicians did just that. They interviewed inpatients who were considered to pose a high risk of violence, using two well-regarded tools to rate the patients’ violence potential. They also asked the patients to rate their own risk. Patients’ ratings were fairly accurate in predicting violent behavior two months after hospital discharge—more accurate than predictions based on the two clinical tools.

Gee.  Finding out about patients by just talking to them gives doctors more accurate info than having them fill out an "empirical" checklist?? Who'd'a thunk?  I wonder when psychiatrists who are so enamored by “objective tools” will realize that they give far less information than an intense clinical interview. This is particularly true when the doctor can spot inconsistencies and plot holes in patient’s stories about themselves, and ask incisive follow up questions.  

Computers are terrible about doing that. And the superiority of clinical interviewing goes double for so called “empirical” research studies, so the holy grail of “randomized controlled studies” ain’t so holy for psychiatric patients, who are a hell of a lot more complex and multi-determined than any other possible object of scientific study. Most of these studies rely on "tools," (and are often performed by them). 

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