Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label Psychopharmacology. Show all posts
Showing posts with label Psychopharmacology. Show all posts

Friday, July 31, 2020

Antipsychotics for Children With ADHD Should Be a Last Resort

Jeannette Y. Wick
pharmacytimes.com
Originally published 20 Feb 20

Here is an excerpt:

ANTIPSYCHOTICS: NOT FIRST LINE

A freestanding diagnosis of ADHD is not an indication for antipsychotic medications. Although no studies have determined which children who get an ADHD diagnosis are most likely to receive antipsychotic medications, mental health comorbidity is a possible factor.

ADHD often occurs in conjunction with other mental health conditions. Common comorbidities include conduct disorder (depression, or oppositional defiant disorder), and prescribers may use antipsychotic drugs to augment other approaches. The evidence does not support using antipsychotic medication for depression in youths, but some data support a risperidone trial for conduct disorder or oppositional defiant disorder in stimulant-resistant youths with ADHD.

A second concern is aggression. Aggression that stems from poor impulse control is common in youths who have ADHD, and it frequently occurs in children who have comorbidities. This behavior is often associated with a need for assessment, hospitalization, or urgent care and requires careful follow-up and cautious risk assessment. ADHD may not respond to stimulant medications, so prescribers may use antipsychotic drugs off-label in an effort to reduce aggressive outbursts. Research shows that antipsychotic-treated youths with ADHD often have clinical characteristics associated with aggression. However, few youths with ADHD who were treated with antipsychotics received the evidence-indicated trial doses of 2 stimulants before an antipsychotic.

The info is here.

Sunday, November 19, 2017

Rigorous Study Finds Antidepressants Worsen Long-Term Outcomes

Peter Simons
madinamerica.com
Originally posted

Here is an excerpt:

These results add to a body of research that indicates that antidepressants worsen long-term outcomes. In an article published in 1994, the psychiatrist Giovanni Fava wrote that “Psychotropic drugs actually worsen, at least in some cases, the progression of the illness which they are supposed to treat.” In a 2003 article, he wrote: “A statistical trend suggested that the longer the drug treatment, the higher the likelihood of relapse.”

Previous research has also found that antidepressants are no more effective than placebo for mild-to-moderate depression, and other studies have questioned whether such medications are effective even for severe depression. Concerns have also been raised about the health risks of taking antidepressants—such as a recent study which found that taking antidepressants increases one’s risk of death by 33% (see MIA report).

In fact, studies have demonstrated that as many as 85% of people recover spontaneously from depression. In a recent example, researchers found that only 35% of people who experienced depression had a second episode within 15 years. That means that 65% of people who have a bout of depression are likely never to experience it again.

Critics of previous findings have argued that it is not fair to compare those receiving antidepressants with those who do not. They argue that initial depression severity confounds the results—those with more severe symptoms may be more likely to be treated with antidepressants. Thus, according to some researchers, even if antidepressants worked as well as psychotherapy or receiving no treatment, those treated with antidepressants would still show worse outcomes—because they had more severe symptoms in the first place.

The article is here.

The target article is here.

Monday, July 3, 2017

How Scientists are Working to Create Cyborg Humans with Super Intelligence

Hannah Osborne
Newsweek
Originally posted on June 14, 2017

Here is an excerpt:

There are three main approaches to doing this. The first involves recording information from the brain, decoding it via a computer or machine interface, and then utilizing the information for a purpose.

The second is to influence the brain by stimulating it pharmacologically or electrically: “So you can stimulate the brain to produce artificial sensations, like the sensation of touch, or vision for the blind,” he says. “Or you could stimulate certain areas to improve their functions—like improved memory, attention. You can even connect two brains together—one brain will stimulate the other—like where scientists transferred memories of one rat to another.”

The final approach is defined as “futuristic.” This would include humans becoming cyborgs, for example, and would raise the ethical and philosophical questions that will need to be addressed before scientists merge man and machine.

Lebedev said these ethical concerns could become real in the next 10 years, but the current technology poses no serious threat.

The article is here.

Thursday, April 13, 2017

Identity change and informed consent

Karsten Witt
Journal of Medical Ethics
Published Online First: 20 March 2017.
doi: 10.1136/medethics-2016-103684

Abstract

In this paper, I focus on a kind of medical intervention that is at the same time fascinating and disturbing: identity-changing interventions. My guiding question is how such interventions can be ethically justified within the bounds of contemporary bioethical mainstream that places great weight on the patient's informed consent. The answer that is standardly given today is that patients should be informed about the identity effects, thus suggesting that changes in identity can be treated like ‘normal’ side effects. In the paper, I argue that this approach is seriously lacking because it misses important complexities going along with decisions involving identity changes and consequently runs into mistakes. As a remedy I propose a new approach, the ‘perspective-sensitive account’, which avoids these mistakes and thus provides the conceptual resources to systematically reflect on and give a valid consent to identity-changing interventions.

The article is here.

Editor's note: While this article deals with medical interventions, such as Deep Brain Stimulation, the similar concerns might be generalized to psychotherapy and/or psychopharmacology.

Friday, November 25, 2016

A New Spin on the Quantum Brain

By Jennifer Ouellette
Quanta Magazine
November 2, 2016

The mere mention of “quantum consciousness” makes most physicists cringe, as the phrase seems to evoke the vague, insipid musings of a New Age guru. But if a new hypothesis proves to be correct, quantum effects might indeed play some role in human cognition. Matthew Fisher, a physicist at the University of California, Santa Barbara, raised eyebrows late last year when he published a paper in Annals of Physics proposing that the nuclear spins of phosphorus atoms could serve as rudimentary “qubits” in the brain — which would essentially enable the brain to function like a quantum computer.

As recently as 10 years ago, Fisher’s hypothesis would have been dismissed by many as nonsense. Physicists have been burned by this sort of thing before, most notably in 1989, when Roger Penrose proposed that mysterious protein structures called “microtubules” played a role in human consciousness by exploiting quantum effects. Few researchers believe such a hypothesis plausible. Patricia Churchland, a neurophilosopher at the University of California, San Diego, memorably opined that one might as well invoke “pixie dust in the synapses” to explain human cognition.

The article is here.

Thursday, July 23, 2015

Common medications sway moral judgment

By Kelly Servick
Science Magazine
Originally published July 2, 2015

Here is an excerpt:

The researchers could then calculate the “exchange rate between money and pain”—how much extra cash a person must be paid to accept one additional shock. In previous research, Crockett’s team learned that the exchange rate varies depending on who gets hurt. On average, people are more reluctant to profit from someone else’s pain than their own—a phenomenon the researchers call “hyperaltruism.”

In the new study, the scientists tested whether drugs can shift that pain-to-money exchange rate. A few hours before the test, they gave the subjects either a placebo pill or one of two drugs: the serotonin-enhancing antidepressant drug citalopram or the Parkinson’s treatment levodopa, which increases dopamine levels.

On average, people receiving the placebo were willing to forfeit about 55 cents per shock to avoid harming themselves, and 69 cents to avoid harming others. Those amounts nearly doubled in people who took citalopram: They were generally more averse to causing harm, but still preferred profiting from their own pain over another’s, Crockett’s team reports online today in Current Biology. Levodopa had a different effect: It seemed to make people just as willing to shock others as themselves for profit.

The entire article is here.

Saturday, July 18, 2015

Are You Morally Modified?: The Moral Effects of Widely Used Pharmaceuticals.

Levy N, Douglas T, Kahane G, Terbeck S, Cowen PJ, Hewstone M, Savulescu J.
Philos Psychiatr Psychol. 2014 Jun 1;21(2):111-125.

Abstract

A number of concerns have been raised about the possible future use of pharmaceuticals designed to enhance cognitive, affective, and motivational processes, particularly where the aim is to produce morally better decisions or behavior. In this article, we draw attention to what is arguably a more worrying possibility: that pharmaceuticals currently in widespread therapeutic use are already having unintended effects on these processes, and thus on moral decision making and morally significant behavior. We review current evidence on the moral effects of three widely used drugs or drug types: (i) propranolol, (ii) selective serotonin reuptake inhibitors, and (iii) drugs that effect oxytocin physiology. This evidence suggests that the alterations to moral decision making and behavior caused by these agents may have important and difficult-to-evaluate consequences, at least at the population level. We argue that the moral effects of these and other widely used pharmaceuticals warrant further empirical research and ethical analysis.

The entire article is here.

Monday, April 20, 2015

Moral bioenhancement: a neuroscientific perspective

By Molly Crockett
J Med Ethics 2014;40:370-371
doi:10.1136/medethics-2012-101096

Here is an excerpt:

The science of moral bioenhancement is in its infancy. Laboratory studies of human morality usually employ highly simplified models aimed at measuring just one facet of a cognitive process that is relevant for morality. These studies have certainly deepened our understanding of the nature of moral behaviour, but it is important to avoid overstating the conclusions of any single study. De Grazia cites several purported examples of ‘non-traditional means of moral enhancement’, including one of my own studies. According to De Grazia, we showed that ‘selective serotonin reuptake inhibitors (can be used) as a means to being less inclined to assault people’. In fact, our findings are a bit more subtle and nuanced than implied in the target article, as is often the case in neuroscientific studies of complex human behaviour.

The entire article is here.

Tuesday, October 14, 2014

Is It Possible to Create an Anti-Love Drug?

By Maia Szalavitz
New York Magazine - Science of Us
Originally posted May 19, 2014

Here is an excerpt:

A drug that precisely targets only one specific relationship for destruction may be decades away, but drugs that interfere with specific aspects of love like sexual desire are already here. And as scientists begin to tease out the chemical chronology and specific brain systems involved in love, they are already investigating how existing medications taken in carefully timed ways could, for example, prevent the "bonding hormone" oxytocin from initiating or sustaining a relationship.

This could forever change what it means to sever romantic ties. And the ramifications go beyond “Please let me forget”–type situations à la Eternal Sunshine. Anti-love drugs could also provide an intriguing new “treatment” for those trapped in abusive relationships.

The entire article is here.

Saturday, June 21, 2014

Morality pills: reality or science fiction?

The complexities of ethics and the brain make it difficult for scientists to develop a pill to enhance human morals

By Molly Crockett
The Guardian
Originally published June 3, 2014

Could we create a "morality pill"? Once the stuff of science fiction, recent studies in neuroscience have shown that brain chemicals can subtly influence some aspects of moral judgments and decisions. However, science is very far from creating pills that can turn sinners into saints, as I have argued many times before. So imagine my surprise when I came across the headline, “‘Morality Pills’ Close to Reality, Claims Scientist”– referring to a lecture I gave recently in London. (I asked the newspaper where the reporter got his misinformation, but received no response to my query.)

The entire story is here.

Monday, February 17, 2014

Episode 2: Prescriptive Authority for Psychologists - Where are we now?

Bob McGrath
In this episode, John speaks with Robert McGrath, Ph.D.  Bob is a psychologist and Director of the Masters in Science Program in Clinical Psychopharmacology at Fairleigh Dickinson in New Jersey.  He is a tireless advocate of RxP for psychologists.  John and Bob discuss the prescriptive authority movement as well as the benefits of a prescribing psychologists. Training issues, legislative advocacy, and the two states that granted psychologists prescriptive authority will be addressed.

At the end of the podcast, the listener will be able to:


1. Describe two reasons why psychologists are seeking prescriptive authority;

2. Explain two benefits for patients who work with a prescribing psychologist; and,
3. Name two states that permit appropriately trained psychologists to prescribe  
      medication.

Click here to purchase 1 APA-approved Continuing Education credit

Find this podcast in iTunes


Or listen directly on this page


 


Resources


Fairleigh Dickinson Masters Degree in Psychopharmacology


Contact Bob McGrath via email

Prescriptive Authority for Psychologists: Issues and Considerations
Lynn Merrick, Legislative Reference Bureau, State Capitol, Honolulu, Hawaii 96813

Prescriptive Authority for Psychologists
Bob McGrath

APA Resources


Designation Criteria for Education and Training Programs in Preparation for Prescriptive 

Authority (2009)

Division 55 Home Page - American Society for the Advancement of Pharmacotherapy


Model Legislation


Prescriptive Authority Page


Saturday, October 12, 2013

How serotonin shapes moral judgment and behavior

By Jenifer Z. Siegel and Molly J. Crockett
Annals of the New York Academy of Sciences
Originally published September 24, 2013

DOI: 10.1111/nyas.12229

Abstract

Neuroscientists are now discovering how hormones and brain chemicals shape social behavior, opening potential avenues for pharmacological manipulation of ethical values. Here, we review recent studies showing how altering brain chemistry can alter moral judgment and behavior, focusing in particular on the neuromodulator serotonin and its role in shaping values related to harm and fairness. We synthesize previous findings and consider the potential mechanisms through which serotonin could increase the aversion to harming others. We present a process model whereby serotonin influences social behavior by shifting social preferences in the positive direction, enhancing the value people place on others’ outcomes. This model may explain previous findings relating serotonin function to prosocial behavior, and makes new predictions regarding how serotonin may influence the neural computation of value in social contexts.

The entire paper is here.

Wednesday, August 15, 2012

Psychiatry’s Legitimacy Crisis

All We Have to Fear: Psychiatry's Transformation of Natural Anxieties into Mental Disorders
by Allan V. Horwitz and Jerome C. Wakefield

Book Review by Andrew Scull
The Los Angeles Book Review
Originally published on August 8, 2012

ABOUT 40 YEARS AGO, American psychiatry faced an escalating crisis of legitimacy. All sorts of evidence suggested that, when confronted with a particular patient, psychiatrists could not reliably agree as to what, if anything, was wrong. To be sure, the diagnostic process in all areas of medicine is far more murky and prone to error than we like to think, but in psychiatry the situation was — and indeed still is — a great deal more fraught, and the murkiness more visible. It didn’t help that psychiatry’s most prominent members purported to treat illness with talk therapy and stressed the central importance of early childhood sexuality for adult psychopathology. In this already less-than-tidy context, the basic uncertainty regarding how to diagnose what was wrong with a patient was potentially explosively destabilizing.

The modern psychopharmacological revolution began in 1954 with the introduction of Thorazine, hailed as the first “anti-psychotic.” It was followed in short order by so-called “minor tranquilizers:” Miltown, and then drugs like Valium and Librium. The Rolling Stones famously sang of “mother’s little helper,” which enabled the bored housewife to get through to her “busy dying day.” Mother’s helper had a huge potential market. Drug companies, however, were faced with a problem. As each company sought its own magic potion, it encountered a roadblock of sorts: its psychiatric consultants were unable to deliver homogeneous populations of test subjects suffering from the same diagnosed illness in the same way. Without breaking the amorphous catchall of “mental disturbance” into defensible sub-sets, the drug companies could not develop the data they needed to acquire licenses to market the new drugs.

The entire story is here.

Saturday, July 7, 2012

Psychiatry's identity crisis - A Response

The Lancet, Volume 379, Issue 9835, Page 2428, 30 June 2012
By Andres Barkil-Oteo

Psychiatry has attempted to cope with its identity problem (April 7, p 1274) mainly by assuming an evidence-based approach, favoured throughout medicine. Evidence-based, however, became largely synonymous with psychopharmacological approaches, with relative disregard for other evidence-based modalities.

This situation has created a dilemma since the evidence for many common medication-prescribing practices is being challenged, whereas many of the psychological approaches have very solid evidence but are underused (eg, family psychoeducation). A good example is the extensive use of second-generation antipsychotic drugs, despite evidence of their lack of superiority over first-generation medication, as well as additional economic cost and the added burden of medical complications.

The entire response is here.

Psychiatry's identity crisis - Original letter

The Lancet, Volume 379, Issue 9823, Page 1274, 7 April 2012

Last week, the American Psychiatric Association issued a press release highlighting an ongoing decline in the recruitment of medical students into the specialty—at a time when the numbers of practising psychiatric professionals in the USA is falling. Various reasons are proposed, including the short-term nature of placements (usually just 4 weeks); the sheer breadth of an evolving specialty, which is drawing students towards newer areas such as clinical neuroscience; and concerns that psychiatry is not as lucrative as other specialties.

(cut)

Psychiatrists, first and foremost, are clinicians. Evidence-based approaches should be at the core of the psychiatrist and non-clinical members of any mental health team.

The entire piece is here.

Sunday, June 3, 2012

Bias found in mental health drug research presented at major psychiatric meeting


When thousands of psychiatrists attend their field's largest annual meeting each year, the presentations they hear about research into drug treatments report overwhelmingly on positive results.

That's the finding of a new study published in the Journal of Clinical Psychopharmacology by two young psychiatrists from the University of Michigan and Yale University, who analyzed the presentations given at two recent meetings of the American Psychiatric Association.

Of 278 studies presented at the 2009 and 2010 APA meetings that compared at least two medicines against each other for any psychiatric illness, they found that 195 had been supported by industry, and 83 funded by other means. The authors then evaluated the studies without knowing which kind of support each one had.

Of the industry-supported studies, 97.4 percent reported results that were positive toward the medicine that the study was designed to test, and 2.6 percent reported mixed results. No industry-sponsored studies with negative results were found.

The entire article is here.

The journal article can be purchased here.

Saturday, December 10, 2011

Practice Guidelines Regarding Psychologists' Involvement in Pharmacological Issues

A psychologist can download this document for future reference.

There is a link to this document under "Relevant Links".

APA Pharmacological