Saturday, February 26, 2011

Couch Potatoes Unleashed

There seems to be an epidemic of what I refer to as "parent-noia" going around the US today.  Parents everywhere seem to live in absolute terror that they might not be doing right by their kids.  The minute kids start having even the most inconsequential emotional problem or start acting out, the parents immediately ask themselves, "What did I do wrong?"

In yesterday's newspaper, parenting columnist John Rosemond described what he called, "America's Hidden Domestic Abuse Problem."  He spoke of an "epidemic of children of all ages who assault or threaten to assault their parents when they don't get their way.  Unheard of 50-plus years ago, this sort of outrage is not at all uncommon today."

Parents who have this happen to them, as Rosemond points out, are often heard to desperately inquire, "What am I doing to make him so angry with me?"  The correct answer to this question?  You are letting your children get away with this free of any serious consequences.  That's what.

Often the parental self-flagellation is short lived and followed quickly by a search for something or someone else to blame.  This makes such parents particularly vulnerable to unscrupulous doctors and drug companies who will provide them with such a scapegoat.  "The child has a diseased brain," the doctors insist.  "Childhood bipolar disorder.  ADHD.  Maybe both.  We'll help you solve the problem by drugging your child with both an upper and a downer."

Other parents who do not like this medicalized answer look for something else to blame.  For quite a long time in the eighties, juvenille delinquents or suicide-attempting youths were hospitalized in for-profit psychiatric hospitals for months until their insurance ran out.  The problematic behavior was often blamed by the psychiatrists at these facilities on popular culture, particularly heavy metal music.

This nonsense came to a head in July of 1990 when the group Judas Priest went on trial, accused by two sets of parents of having driven their kids to suicide through subliminal messages in their music.  Thankfully, they were acquitted on all charges.

Let's see.  I just listened to the album St. Anger by Metallica.  I have an irresistable urge to go out and murder someone.  But wait.  I also just listened to the song, I Think I'm Going to Kill Myself by Elton John.  I now have an irresistable urge to kill myself instead.  Which should I do??  Such a horrible dilemma!  (I do hope that no readers think I'm being serious).

The latest scapegoats are violent video games.  Studies were done that showed that youths exposed to these games experienced an increase in aggressive thoughts immediately after playing said games.  Proof positive, it was said, that the games were contributing to youth violence.  Of course, the increase in aggressive thoughts was extremely temporary and not accompanied by any specific acts, but those salient facts were always left out of public discussions.

My theory is that kids who spend hours playing video games do not have a whole lot of hours left in their day to be out raising mayhem or consorting with gang members.  In fact, they seem to be couch potatoes to me.

We finally have a new study whose results show that violent video games do not predict serious acts of aggression in youths, at least among a sample that was mostly Hispanic.  (Ferguson CJ. Video Games and Youth Violence: A Prospective Analysis in Adolescents. J Youth Adolesc. 2010 Dec 14).  In fact, nor did exposure to television violence. 

What was correlated with acts of aggression in this study?  Current levels of depressive symptoms were strong predictors of serious aggression and violence across most outcome measures.

Draw your own conclusions and share them with me with your comments.

Monday, February 21, 2011

Guest Post: What Parents Can Do If They Do Not Like Their Child's Romantic Partner

The first guest post on my blog is contributed by Kitty Holman, a freelance writer, pursuing her online Journalism course. She loves to write on health, parenting, environment, and education-related topics. She regularly writes on the topics of nursing colleges. She welcomes your comments at:  In this post she discusses how parents can respect their adult children's autonomy in a difficult situation.

What Parents Can Do If They Do Not Like Their Child's Romantic Partner

Sooner or later, parents have to face the prospect of their son or daughter's eventually entering a romantic relationship. Of course, each set of parents will have their own way of handling this process: at what point their children can start dating, whom they can date, what curfews they'll face, and so on. However, there will come a day when your child is on his or her own, dating and seeing other people, and there just might be that one romantic partner whom you absolutely cannot stand.

How will you handle it? What do you take into consideration when deciding how to act regarding this new development? After all, you are the parent, and your parental instincts might tell you that this relationship is bad for your child, but you also have to respect your child's wishes, especially since he or she is a grown adult now, for if you overstep your bounds, you risk not only damaging your child's relationship with a potential partner, but also your relationship with your child.


Your first step, the first action you can take in this situation, is one of non-action. Simply observe. Do your best to observe your child in this new relationship. Watch how he or she interacts with the partner. Listen to how they speak to one another. Listen also to how your child speaks about this new partner. You want to gather as much information as possible before making any judgments.


Next, if you get a bad feeling about your child's partner, one thing you can do is invite everyone to hang out together. This way you can also interact with the partner on your own. Get a feel for how your child's partner treats you and your family. How they initially treat you will give you some insight into how they will treat you and your family later on, as well as how they treat your son or daughter. If this phase confirms your suspicions, then you'll want to take some action.


This is perhaps the trickiest part of the process, as how you approach your child about his or her partner will determine the tone of the rest of the discussion and perhaps the rest of the time your child is dating that person. Try to find a time to talk to your child about the relationship. Preface your remarks by saying that you only wish to offer your opinion and a little advice, and that you respect your child's decisions. If you can approach the situation gently, then you can save you and your child a lot of heartache later on. You have to trust your child at this point to understand your concern, but you have to also realize that your child is an adult who can make his or her own decisions. Think of yourself as an advisor at this point.


However, should you find that your child is in danger, either mentally or physically, then you just might have to take steps to intervene on his or her behalf. This should be an action of last resort, as the consequences of your intervention can be drastic if you misjudge the situation. But, you are the parent, and ultimately, your experience in the world gives you the tools to be the most helpful, caring parent possible for your child. That's something that no professional can really lay claim too.

The question, then, is how exactly do you intervene? The simplest, perhaps less confrontational method would be to ask to speak with both your child and his or her romantic partner. This method requires that you take an extra step in your discussion. Simply giving advice is not an option. You might request that your child and partner go to family or relationship counseling; you could offer to help pay for it as encouragement. You could offer to even join them. However, if this intervention does not work, then you may need to seek help from the justice system. Unfortunately, you cannot take out a restraining order on a third party, so you will need to talk to your child about this option. Ultimately, if your child resists, your best bet is to encourage him or her to be careful in the relationship. Be as supportive as possible, but understand that your child is an adult who can act on his or her own.

Wednesday, February 16, 2011

Antipsychotics Are For Psychosis, Not Insomnia

For quite some time, psychiatrists have known that in many cases of severe chronic schizophrenia, over the long term there was dramatic evidence of marked shrinking of brain tissue and enlarged cerebral ventricles (fluid-filled hollow parts at the center of the brain) - cerebral atrophy.  I had been taught that this phenomenon was first discovered in patients who had never been treated with antipsychotic medication. 

When I mentioned that in an argument on an anti-psychiatry blog, however, I was immediately challenged on whether the subjects studied had really not been treated. 

When I did a literature search, I was surprised to find out that what I had been taught was wrong, and that the other folks were right.  As far as I could find on the search, the subjects whose brains were scanned had almost all taken antipsychotic medication at some point during their lives.   (Hey guys, I can admit when I was wrong!  Can you?)

The black areas on the scan are empty of brain cells

Of course, that still begs the question, what caused the atrophy?  Was it the disease, the drugs used to treat it, or a combination of both?  Of course, even if it was entirely due to the drugs, one would still have to weigh the risks of cerebral atrophy versus the risk of being chronically tortured by accusatory hallucinations and living out on the street, as was well-portrayed in the movie The Soloist. 

Go check out Skid Row in L.A. in person if you don't believe it.  That part of town is actually marked with a sign that says, "Skid Row."  See the folks on street corners loudly preaching incoherent gibberish about the Gospels for hours to an audience one at all.

Unfortunately, due to pharmaceutical marketing techniques and to psychiatrists who cannot tell sedation from other therapeutic effects, atypical antipsychotics are being used for a lot of other things besides psychosis.  Seroquel is being used commonly as a sleeping medication!  Because of TV commercials, most people think Abilify is an antidepressant. 

Now, we've known for decades that in some patients with real and severe melancholic clinical depression antipsychotics can indeed augment an antidepressant in treatment-resistant cases.  But so does lithium, which is both way more effective and a hell of a lot safer than antipsychotics. 

Now, in this month's Archives of General Psychiatry comes a study that adds more information to address the initial question about cerebral atrophy ("Long-term Antipsychotic Treatment and Brain Volumes: A Longitudinal Study of First-Episode Schizophrenia," Beng-Choon Ho, MRCPsych; Nancy C. Andreasen, MD, PhD; Steven Ziebell, BS; Ronald Pierson, MS; Vincent Magnotta, PhD, Arch Gen Psychiatry 2011;68(2):a128-137). The authors followed first-break patients with schizophrenia for many years who were all treated with antipsychotics and took serial MRI tests to continuously measure brain volume. 

On average, each patient had 3 scans (≥2 and as many as 5) over 7.2 years (up to 14 years). Unfortunately, there was no control group of patients with schizophrenia who were not treated with antipsychotics, because it is considered unethical to withhold treatment.

They instead controlled mathematically for severity of the underlying disorder under the theory that more severe cases were likely to have been given more antipsychotic medication, thereby clouding the picture of whether it was the disease or the treatment causing the atrophy.

The results: more antipsychotic treatment was associated with smaller gray matter (one type of brain tissue) volumes when disease severity was adjusted for.  Progressive decrement in white matter (the othert type of brain tissue) volume was also most evident among patients who received more antipsychotic treatment. Illness severity had relatively modest correlations with tissue volume reduction, and alcohol/illicit drug misuse had no significant associations when effects of the other variables were adjusted.

The conclusion: it appears that both the disease itself and the medication appeared to both contribute to cerebral atrophy.  Of course, without the control group, this can not be a definitive conclusion.  Also, we do not know if the drugs would do anything like this on patients who do not have schizophrenia but some other psychiatric disorder, or no disorder at all.

Nonetheless, these results should certainly give pause to any doctor treating a non-psychotic patient with anti-psychotic medication - especially since much safer alternative drugs are available.  This potential risk is on top of the serious risks that these medications may cause diabetes, high cholesterol, and a chronic untreatable neurological condition called tardive dyskinesia.  As all these risks are cumulative, long term treatment of non-psychotic individuals with anti-psychotics before all other measures are tried is particularly reprehensible.

Friday, February 11, 2011

Dysfunctional Family Roles Part II: The Best of the Rest

As promised in my last post, here is a rundown of dysfunctional family systems roles other than the previously described spoiler.

1. The savior: In this scenario, a parent has suppressed his or her ambition to excel at some endeavor in order to satisfy cultural mandates, leading the child to act out the parent's forbidden ambition. The savior role often leads to chronic depression in the patient playing the role. For example, a woman from a traditional culture who has been exposed to female professionals in the United States might secretly wish to become a doctor. She can admit such a wish to neither herself nor anyone else, for fear of being disowned by her traditional relatives who expect her to be nothing more than a wife and mother.

Because parents often live vicariously through identification with their children, the woman might push her son or possibly even a daughter to become a doctor. This child becomes the parent’s savior. Whether the mother’s “stage mother” behavior initially produces a conflict in the child depends on whether or not that child had a natural inclination to become a doctor. However, even if the child were so inclined, a conflict will develop as the child gets closer to the goal. If the son or daughter succeeds in getting through medical school, the mother may, for example, become depressed.

The reason that the mother becomes depressed is that the child’s success reminds her that she herself was not able to do what she had really wanted to do all along. When she reacts negatively to the child, she is in reality covertly thinking about her own disappointment. From the perspective of the child, however, it can easily look as if the mother never really wanted him or her to become a doctor in the first place. The child becomes depressed because success becomes equated with a sense of helplessness and futility over keeping the parent stable.

2. The avenger: The avenger acts out a parent’s forbidden anger and hostility. This often leads the avenger to develop antisocial traits. For example, a father who is angry at his own employer but who was expected by his own Depression-era parents to keep his nose to the grindstone may react with not-so-hidden glee when his son creates havoc for the son's boss at the son’s place of employment. If the son keeps it up, however, father then feels obligated to be critical, for two reasons. First, he was taught that such flagrant self-expression is wrong in employment contexts. Second, he really does not want to see his son lose his job.

3. The defective: This role often leads to somatization or chronic psychological impairment. It is often seen in families with traditional gender role conflicts. The parents may or may not be conflicted over the role of parent per se, but feel useless when they are no longer needed in their capacity as traditional family caretakers. Children of course grow up, and the empty nest approaches. During this period, the parents may have fantasies about being free from family obligations and indulging in their more individualistic tendencies. Unfortunately, they feel useless and vaguely guilty if they do indulge them.

The child of such parents fears becoming independent for fear the parents might develop a pathological empty nest syndrome. He or she responds by failing to become self-sufficient. So that the parents do not blame themselves for the child’s lack of independence, or feel as though they had been inadequate parents, the child blames this inability to take care of himself or herself on some physical or psychological disorder.

The actual disorder may or may not be present, and if present, may or may not be exaggerated. Often it is unclear whether or not the child is purposely exaggerating his or her apparent disability. This way, depending on whether the parent is feeling guilty or angry at a given time, the child can assuage one polarity and feed into the other. He or she attempts to regulate exactly how much of each their parents’ are experiencing, in order to provide maximum stability.

Diseases that were traditionally thought to be "psychosomatic" are usually the ones used by a defective in need of a physical impairment.  That is because they can be easily faked.  One can wheeze even when one is not having an asthma attack, or have a pseudo-seizure when not having a real seizure.

4. The go-between: In this situation, the child is triangulated into a conflictual parental marriage. One or both parents may use the child as a confidant to complain about the other parent. Sometimes the parent may even subconsicously induce the child to act as a sort of surrogate spouse - providing to that parent what the real spouse is not providing.  In the latter scenario, if the parent-child relationship has any sexual overtones, the child may exhibit histrionic traits. Sometimes, adult go-betweens are “on call” to settle marital disputes. Mother might come over and say to a grown daughter, “Go tell your father to do such and such; he won’t do it if I ask him but he will for you.” If the daughter complies, the mother may become jealous of her child’s relationship with the father.

5. Little man: This scenario is a variant of the savior role that leads to narcissistic issues. It is usually seen in males but may occur in a slightly different form with females. Gender role conflicts once again are the main culprit. In this situation, a woman who may have been taught as a child to be dependent on men and defer to men for most major decisions marries a man who is inadequate in some way. She may describe him as “never there for me.” He may be a poor provider due to a general unwillingness to work hard or may even desert the family altogether.

The woman then turns to her son to take care of her in all the ways his father did not. However, the son fails in this role for two reasons. One, he may be too young and simply lack the capabilities to look after her; he probably needs his mother to take care of him. Second, the mother resents his attempts at looking after her and subverts them. The reason for this is that she really is not - nor does she really want to be - as dependent as she may appear to be. The more the son tries to meet her needs, the more the mother emasculates him.

A male with narcissistic personality disorder may marry a female with BPD. Such a union is a common couple type seen in marital therapy and is an excellent example of a marital quid pro quo.  The female with BPD is almost a prototype of a woman who seems to be in dire need of someone who will take care of her, but who spoils any attempt by anyone to do so. The relationship of the narcissistic male with his mother is thusly re-created in an even more extreme form within the marital relationship.

6. Monster. These people become seemingly horrific people within the family through such reprehensible behavior as severe child abuse. Everyone loves to hate these people. They may even brag about their misdeeds so that other people are fooled into thinking they are actually proud of them and therefore hate them all the more. This role can serve various purposes, such as to take the heat off parents who were themselves playing the monster role.

The monster is in effect saying, “It was OK that you abused me because look how awful I am. I clearly deserved whatever it was you dished out. In fact, I even do the exact same things you did.” Such people rarely come to therapy, so I have mostly learned about this role indirectly when my patients have to deal with parents who played the role. I believe it is central in cases in which abused children become abusive parents themselves.

These are the major role types, but there are also supporting roles such as the circuit breaker, who distracts two warring family members just when their arguments are about to escalate into violence. There is also the switchboard, who relays messages between other family members who are playing the major roles and their parents when the two parties are not speaking directly to one another.

Sunday, February 6, 2011

Dysfunctional Family Roles, Part I: The Spoiler

In two previous posts, I discussed how children act out certain roles in their family of origin in order to try to emotionally stabilize parents who are emotional unstable. Doing so also has the effect of maintaining dysfunctional relationship patterns so that the family operates in predictable ways (family homeostasis). In my July 15 post, It’s the Relationship, Stupid, I mentioned the family systems role of avenger. In my post of September 11, If at First You’ve Never Even Tried, Fail Fail Again, I mentioned the savior role.

The concept of children acting out specific roles to stabilize family homeostasis was first described by psychoanalyst Sam Slipp in his 1984 book, Object Relations: A Dynamic Bridge Between Individual and Family Treatment. I subsequently enlarged his little catalog of roles to include, among others, the role of spoiler. This role is the basis for the problematic behavior of individuals with borderline personality disorder (BPD).

The basic problem in the "borderline" family - to make a complicated and highly variable story tremendously oversimplified - is that the parents in such families see the role of being parents as the end all and be all of human existence, but deep down they hate being parents or see their roles as parents as an impediment to their future personal fulfillment.

This leads to a pattern in which the parents go back and forth between hostile overinvolvement  or abuse, and hostile underinvolvement or neglect.  The double message inherent in this pattern in turn leads the children to perceive a message from their parents that roughly translates into, “I need you, but I hate you.”  The overinvolvement or underinvolvement polarity may predominate in a particular family, but if you wait long enough, the other extreme rears its ugly head.

How can the child remain central in the parents’ life - even if contact seems very limited – and still provide them with an easy justification for taking their anger out on the child so they do not have to feel guilty about it? Spoiling behavior is the perfect solution, and it is ingenious.

Spoiling behavior was first described by psychoanalyst Melanie Klein, who though it had something to do with primitive envy of the mother’s breast. I personally think Melanie Klein's explanation verges on psychotic, but she was describing a very real pattern of adult behavior.

Not the kind of spoiler I'm talking about

The spoiler child refuses to grow up, remains dependent in some way on the parent or a parent surrogate, and ruins everything the parents try to give. A child might start to lose or mistreat valuable designer clothes, and then demand both replacement of the expensive gifts and more of her mother’s time. Nothing the parent does or says is ever good enough. The “child” – and this continues well into adulthood - will figuratively piss all over everything the parent does for them. The parents’ motives are consistently misinterpreted and they are constantly accused of being selfish, overly-demanding, stupid, or downright evil. They are treated with utter contempt.

This treatment of the parents is a form of invalidation. The child is, in effect, doing to the parents exactly what the parents have been doing to the child. Spoilers never become independent of their parents because they never really function as competent adults.  At the same time, their outrageous and scandalous behavior gives the parents a much needed excuse to vent their often unacknowledged hostility at their offspring.

The spoiler role is difficult to maintain, and the child needs to continually practice it with lovers, spouses, and of course therapists.

In an upcoming post I will discuss some of the other major family systems roles, including a review of the two I already mentioned in the previous posts: savior, avenger, defective, go-between, little man and monster.

Tuesday, February 1, 2011

A Stupid Study and an Even Stupider Headline

A news article posted at the above website, MedwireNews, had the headline, "Hypomania common in young adults."  It reported on a study about to be published in the Journal of Affective Disorders by Serge Brand and others (currently available on line) and states rather unequivocally, "Hypomania affects around one-fifth of young adults..." 

Hypomania is supposedly a mood episode characteristic of a disorder called bipolar II in which a person has an elevated mood, but does not have the severe, often psychotic form found in a full-blown manic epsiode.

Wait a minute. Twenty per cent of all young adults may have bipolar II?  I mean, unipolar hypomania (recurring hypomanic episodes without any history of episodes of clinical depression, otherwise known officially as Major Depressive Episodes), is nowhere to be found in any version of the diagnostic book in psychiatry, the DSM, past, present, or future. 

If these research subjects - and actually they were all college students in Switzerland - really were having hypomanic episodes, then they should all have "Bipolar II" disorder.  That would be a preposterously high proportion of this population.

Furthermore, the journal article described in the news story also distinguished two subtypes of hypomania, the "bright side" and the "dark side" types.  This is the way that the news article summarized this finding from the Brand article: "Participants with dark-side hypomania had significantly higher levels of depressive symptoms, sleep disturbances, stress, negative coping strategies, and lower self-efficacy."  Dark side hypomania?  Sorta an oxymoron.  Gee, it sounds more like symptoms of an agitated depression than hypomania to me.

Of course, in my opinion - after having been in practice in two states with a wide variety of clinical populations (private practice, private hospitals, medical school outpatient department including screening potential patients for studies, state hospitals, county hospitals, and a veterans' hospital) since finshing my training in 1977 - the whole diagnosis of bipolar II is a figment of Hagop Akiskal's imagination. 

Hagop Akiskal is an academic psychiatrist I used to know. He did some of his early work where I am now on the faculty, at the University of Tennessee (UT) Department of Psychiatry.  Not coincidentally, he is also one of two editors-in-chief of the Journal of Affective Disorders, along with a Dr. C. Katona - the journal that is publishing the study in question.

I had tentatively formed a rather skeptical opinion of Dr. Akiskal's diagnostic procedures and acumen in mood disorders from listening to a few stray remarks from a couple of people who worked with him when he worked at UT, but I never had a chance to directly observe him in action with patients or research subjects.  However, I did hear him speak at a "Grand Rounds" (academic speak for an invited lecture) not too many years ago.  He made a couple of what to me were amazing proclamations.

First, he said that if a depressed patient was given an anti-depressant like Prozac and had became more agitated as a result, he just knew that the patient was bipolar. So I guess benzodiazepines like Xanax or Klonopin must be a cure for bipolar disorder, because they make the side effect of agitation go away immediately.

Second, he said that if he was referred a depressed patient who immediately displayed an angry, nasty attitude when they first met (I can't recall his exact words, but that was clearly the gist of what he was saying), then he just knew the patient was bipolar. Of course, patients who have borderline personality traits, as well as other personality problems, act like that all the time, so it sounded to me like he might be either unable or unwilling to tell the difference.

He had also told me in private on an earlier occasion that he knew that a lot of his "bipolar" patients had been abused as children - another characteristic of patients who have personality problems but something not exceptionally common in patients with true bipolar disorder. I have never personally heard of him saying anything about this in public.

In any event, I became concerned that he might be making rather hasty diagnoses before he had even done a complete psychiatric evaluation, and was seeing bipolar disorder where there was no bipolar disorder at all.

Hagop Akiskal

But even if bipolar II exists, a fifth of all young adults?  Please.  Interesting, the MedwireNews article neglected to mention any of the limitations of the study that were in fact mentioned in the actual journal article.  One of these limitations: "The pattern of results [of this study] may be due to other characteristics such as psychiatric disorders (e.g., eating disorders, personality disorders, and addictions) or motivation, which were not assessed in the present study." 

The study was entirely based on a self report instrument, the HCL-32,  that clearly should be limited for use only in screening subjects for an actual diagnostic interview.   All such screening instruments, as I have mentioned in previous posts, are designed to have a lot of false positives, meaning that many of the people who seem to be positive for a disorder based on the test do not have it.  They are meant to cast a wide net so that the experimenters do not miss subjects who falsely appear to be negative for the disorder. 

In the article that "validated" this self-report instrument by Angst et. al. (Isn't that a great name for a psychiatrist?), also conveniently published in the Journal of Affective Disorders (88 [2005] 217-233),  it states:  "Despite the use of broader and slightly differing criteria for BP-II, the HCL-32 still showed good discrimination between the unipolar and bipolar samples. The cut-off of 14 offered the best trade off between sensitivity (true bipolars) and specificity (true non-bipolars) with the total scale showing a sensitivity of 80% and a specificity of 51% for both BP. 

In other words, the instrument totally mis-diagnosed at least half of the population it was validated against as bipolar when they did not have the disorder.  This is typical of a screening measure, as I mentioned above. 

Unlike some of the other phony instruments used for diagnosing mania, the HCL-32 at least tries to address the duration criteria for a hypomanic episode mentioned in the DSM.  In order to distinguish reactive mood changes due solely to environmental events from true bipolar disorder,  a manic or hypomanic episode has to go on non-stop for at least a few days, last all day every day, and be completely atypical of a patient's usual functioning. 

The HCL-32 asks the subjects about the "Length of your “highs” as a rule (on the average)."  However, it does not address any environmental events the subjects might have been experiencing at the time; nor does it even mention anything about how the "high" feeling they were asking about should essentially never abate throughout the entire episode.

Many of the symptoms listed on the HCL-32 may be characteristic of people who are highly engaged in what they are doing, such as going to college classes, when they are in fact actively engaged, but which may later go away when things slow down.  What follows are some of the symptoms as they are described in the test. Answers are either "yes" or "no" with no opportunity for subjects to qualify or describe any complexity in their answer:

Please try to remember a period when you were in a “high” state.  How did you feel then? Please answer all these statements independently of your present condition. In such a state:

2. I feel more energetic and more active
3. I am more self-confident
4. I enjoy my work more
8. I spend more money/too much money
10. I am physically more active (sport etc.)
20. I make more jokes or puns when I am talking
21. I am more easily distracted
22. I engage in lots of new things
29. I drink more coffee

Do you know any active people who do not have periods like this?  I don't think I do.

The instrument also asks subjects to answer only for those periods when they were not high on drugs.  I do not know about Swiss college students, but a lot of American students use stimulants like Ritalin and Adderall as "academic steroids."  I wonder how many of the Swiss students might have thought that using these meds, since they are prescription drugs, did not qualify as times during which they were high on drugs? 

We will never know, because they were never asked.  Sleep deprivation can also lead to some of these symptoms.  They were not asked about that either.  Know any students who party a lot and don't sleep as much as they should?

The MedwireNews article makes it sounds like the Brand study is conclusive.  I talk in more detail about the process involved in the journey of facts that have not been at all established as they become accepted by doctors and the public alike as if they were established facts in my book, How Dysfunctional Families Spur Mental Disorders. 

In my opinion, the bastardization of news may have become another one of big PhARMA's strategies to expand psychiatric diagnoses so they can sell more drugs.