Stigmatized Schizophrenia Gets a Rebrand

By Elizabeth Picciuto
The Daily Beast
Originally published March 26, 2015

Here are two excerpts:

The word “schizophrenia” was coined in the early 20th century, deriving from the Greek word for “split mind.” The term conveyed the idea that people with schizophrenia experienced a splitting of their personality—that they no longer had unified identities.

Considering all the words for mental illness, both those used by medical doctors and those that are cruel slurs used by the general public, it is striking how many of them have connotations of being broken or disorganized: deranged, crazy (which means cracked— itself a derogatory term), unglued, having a screw loose, unhinged, off the wall.

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“The first lesson from the Japanese experience is that a change is possible and that the change may be beneficial for mental health users and their careers, for professionals and researchers alike,” said Lasalvia. “An early effect of renaming schizophrenia, as proven by the Japanese findings, would increase the percentage of patients informed about their diagnosis, prognosis, and available interventions. A name change would facilitate help seeking and service uptake by patients, and would be most beneficial for the provision of psychosocial interventions, since better informed patients generally display a more positive attitude towards care and a more active involvement in their own care programs.”

The entire article is here.

Can You Call a 9-Year-Old a Psychopath?

By Jennifer Kahn
The New York Times
Originally published May 11, 2012

Here is an excerpt:

For the past 10 years, Waschbusch has been studying “callous-unemotional” children — those who exhibit a distinctive lack of affect, remorse or empathy — and who are considered at risk of becoming psychopaths as adults. To evaluate Michael, Waschbusch used a combination of psychological exams and teacher- and family-rating scales, including the Inventory of Callous-Unemotional Traits, the Child Psychopathy Scale and a modified version of the Antisocial Process Screening Device — all tools designed to measure the cold, predatory conduct most closely associated with adult psychopathy. (The terms “sociopath” and “psychopath” are essentially identical.) A research assistant interviewed Michael’s parents and teachers about his behavior at home and in school. When all the exams and reports were tabulated, Michael was almost two standard deviations outside the normal range for callous-unemotional behavior, which placed him on the severe end of the spectrum.

Currently, there is no standard test for psychopathy in children, but a growing number of psychologists believe that psychopathy, like autism, is a distinct neurological condition — one that can be identified in children as young as 5. Crucial to this diagnosis are callous-unemotional traits, which most researchers now believe distinguish “fledgling psychopaths” from children with ordinary conduct disorder, who are also impulsive and hard to control and exhibit hostile or violent behavior.

The entire article is here.

Mental Suffering and the DSM-5

By Stijn Vanheule
DxSummit.org
Originally published June 3, 2014

In his writings on the topic of diagnosis, the French philosopher and physician Georges Canguilhem makes a crucial distinction between pathology and abnormality, thus paving the way for the studies of his student Michel Foucault on the topics of psychiatric power and biopolitics. In Canguilhem’s view, decision making about normality and abnormality is generally based on two factors. One starts from the observation that there is variability in the ways human beings function: individuals present with a variety of behaviours just as their mental life is characterized by a variety of beliefs and experiences, of which some are more prevalent than others. Then, a judgment is made about (ab-)normality; this tends to be based on a norm or standard against which all behaviours are evaluated and considered as deviant or not.

At this level, two possibilities open: a judgement is made based on either psychosocial criteria or statistical norms.

The entire article is here.

Trial of alleged Fort Hood shooter renews call for restraint

By Art Caplan
Clinical Psychiatry News
Originally posted August 2, 2013

One year ago this month, after the theater shooting in Aurora, Colo., I wrote a column for this newspaper headlined, “The Aurora Shootings: Why the Mental Health Community Must Show Restraint.” In this column, I talked about the risks inherent in offering public comments about a defendant’s mental state and about Section 7.3 of the American Psychiatric Association’s Principles of Medical Ethics, which state:

On occasion psychiatrists are asked for an opinion about an individual who is in the light of public attention or who has disclosed information about himself or herself through public media. In such circumstances, a psychiatrist may share with the public his or her expertise about psychiatric issues in general.

However, it is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement.”

The entire article is here.

The DSM-5: A Vehicle For High-Profit Patent Extensions?

Gregg Fields & Lisa Cosgrove | Labcast
Harvard University SoundCloud Podcast

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders affects drugs with sales in the billions of dollars. In research supported by the Edmond J. Safra Center for Ethics, Lisa Cosgrove of UMass-Boston investigated financial ties between DSM panel members and the pharmaceutical companies that have a vested interest in finding new indications for their blockbuster drugs. In this podcast, she tells journalist Gregg Fields what she found, what it means—and why we all should care.

"Tripartite Conflicts of Interest and High Stakes Patent Extensions in the DSM-5," Psychotherapy and Psychosomatics.

ICD-10 and DSM-5: The Reality

Are You Ready For Two Code Sets on October 1?

By Lisette Wright
Behavioral HealthCare
Originally published January 29, 2014

The ICD-10 transition is proving to be a formidable challenge in the healthcare industry for everyone involved. Provider organizations need to train their clinical staff, worry about revenue cycle disruption,  and conduct internal and external testing with all parties. Third-party vendors such as Electronic Health Record companies are also struggling to keep up, with Meaningful Use Stage 2, 2014 Certification, and the ICD-10 transition. Fortunately, there are many trainings available to help you understand the what the ICD-10 transition involves. Unfortunately, most of these trainings are medically-focused, not given by those in the mental health or substance use industry, and they do not really explain how the DSM-5 fits into this transition.

The entire article is here.

Debating DSM-5: diagnosis and the sociology of critique

By Martyn Pickersgill
Journal of Medical Ethics
J Med Ethics doi:10.1136/medethics-2013-101762

Abstract

The development of the fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders—the DSM-5—has reenergised and driven further forward critical discourse about the place and role of diagnosis in mental health. The DSM-5 has attracted considerable criticism, not least about its role in processes of medicalisation. This paper suggests the need for a sociology of psychiatric critique. Sociological analysis can help map fields of contention, and cast fresh light on the assumptions and nuances of debate around the DSM-5; it underscores the importance of diagnosis to the governance of social and clinical life, as well as the wider discourses critical commentaries connect with and are activated by. More normatively, a sociology of critique can indicate which interests and values are structuring the dialogues being articulated, and just how diverse clinical opinion regarding the DSM can actually be. This has implications for the considerations of health services and policy decision-makers who might look to such debates for guidance.

The entire article is here.

Judge gives probation to teen who killed four in DWI crash citing 'affluenza'

By Jim Douglas
KHOU - Houston Texas
Originally posted December 10, 2013

Here is two excerpts:

Prior to sentencing, a psychologist called by the defense, Dr. G. Dick Miller,  testified that Couch's life could be salvaged with one to two years' treatment and no contact with his parents.

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Miller said Couch's parents gave him "freedoms no young person should have." He called Couch a product of "affluenza," where his family felt that wealth bought privilege and there was no rational link between behavior and consequences.

He said Couch got whatever he wanted. As an example,  Miller said Couch's parents gave no punishment after police ticketed the then-15-year-old when he was found in a parked pickup with a passed out, undressed 14-year-old girl.

The entire story is here.

Ethical Considerations in the Development and Application of Mental and Behavioral Nosologies: Lessons from DSM-5

By Robert M. Gordon and Lisa Cosgrove
Psychological Injury and Law
10.1007/s12207-013-9172-9
December 13, 2013

Abstract

We are not likely to find a diagnostic system as “unethical,” per se, but rather find that it creates ethical concerns in its formulation and application. There is an increased risk of misuse and misunderstanding of the DSM-5 particularly when applied to forensic assessment because of documented problems with reliability and validity. For example, when field tested, the American Psychiatric Association reported diagnostic category kappa levels as acceptable that were far below the standard level of acceptability. The DSM-5 does not offer sensitivity and specificity levels and thus psychologists must keep this in mind when using or teaching this manual. Also, especially in light of concerns about diagnostic inflation, we recommend that psychologists exercise caution when using the DSM-5 in forensic assessments, including civil and criminal cases. Alternatives to the DSM-5, such as the International Classification of Diseases and the Psychodynamic Diagnostic Manual are reviewed.

Here is an excerpt:

It should be emphasized that ethical concerns about DSM-5 panel members having commercial ties is not meant in any way to imply that any task force or work group member intentionally made pro- industry decisions. Decades of research have demonstrated that cognitive biases are commonplace and very difficult to eradicate, and more recent studies suggest that disclosure of financial conflicts of interest may actually worsen bias (Dana & Lowenstein, 2003). This is because bias is most often manifested in subtle ways unbeknownst to the researcher or clinician, and thus is usually implicit and unintentional. Physicians—like everyone else—have ethical blind spots. Social scientists have documented the fact that physicians often fail to recognize their vulnerability to commercial interests because they mistakenly believe that they are immune to marketing and industry influence (Sah & Faugh-Burman, 2013).

The entire article is here.

The Not-So-Hidden Cause Behind the A.D.H.D. Epidemic

By MAGGIE KOERTH-BAKER
The New York Times
Published: October 15, 2013

Here are two excerpts:

Of the 6.4 million kids who have been given diagnoses of A.D.H.D., a large percentage are unlikely to have any kind of physiological difference that would make them more distractible than the average non-A.D.H.D. kid. It’s also doubtful that biological or environmental changes are making physiological differences more prevalent. Instead, the rapid increase in people with A.D.H.D. probably has more to do with sociological factors — changes in the way we school our children, in the way we interact with doctors and in what we expect from our kids.

Which is not to say that A.D.H.D. is a made-up disorder.

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This lack of rigor leaves room for plenty of diagnoses that are based on something other than biology. Case in point: The beginning of A.D.H.D. as an “epidemic” corresponds with a couple of important policy changes that incentivized diagnosis. The incorporation of A.D.H.D. under the Individuals With Disabilities Education Act in 1991 — and a subsequent overhaul of the Food and Drug Administration in 1997 that allowed drug companies to more easily market directly to the public — were hugely influential, according to Adam Rafalovich, a sociologist at Pacific University in Oregon.

The entire article is here.

Under-Treatment, Treated.

By Iain Brassington
BMJ Group Blogs
Originally published August 29, 2013

Right: file this paper from the JAMA under “Properly Odd”: it’s a proposal that nonadherence to a treatment regime be classed as a treatable medical condition in its own right.

No, really.  Look at the title: “Medication Nonadherence: A Diagnosable and Treatable Medical Condition”.

Starting from the fairly straightforward premise that non-adherence to treatment regimes is “a common and costly problem”, Marcum et al move at the end of their opening paragraph to have medication nonadherence recognised “as a diagnosable and treatable medical condition”.

The entire blog post is here.

A proposal to classify happiness as a psychiatric disorder

By Richard P Bentall
Journal of medical ethics, 1992, 18, 94-98

Abstract

It is proposed that happiness be classified as a psychiatric disorder and be included in future editions of the major diagnostic manuals under the new name: major affective disorder, pleasant type. In a review of the relevant literature it is shown that happiness is statistically abnormal, consists of a discrete cluster of symptoms, is associated with a range of cognitive abnormalities, and probably reflects the abnormal functioning of the central nervous system. One possible objection to this proposal remains - that happiness is not negatively valued.  However, this objection is dismissed as scientifically irrelevant.

The entire article is here.

More U.S. Children Being Diagnosed With Youthful Tendency Disorder

The Onion
(In light of all the issues related to diagnoses, this is psychology humor)

Nicholas and Beverly Serna's daughter Caitlin was only four years old, but they already knew there was a problem.

Day after day, upon arriving home from preschool, Caitlin would retreat into a bizarre fantasy world. Sometimes, she would pretend to be people and things she was not. Other times, without warning, she would burst into nonsensical song. Some days she would run directionless through the backyard of the Sernas' comfortable Redlands home, laughing and shrieking as she chased imaginary objects.

When months of sessions with a local psychologist failed to yield an answer, Nicholas and Beverly took Caitlin to a prominent Los Angeles pediatric neurologist for more exhaustive testing. Finally, on Sept. 11, the Sernas received the heartbreaking news: Caitlin was among a growing legion of U.S. children suffering from Youthful Tendency Disorder.

"As horrible as the diagnosis was, it was a relief to finally know," said Beverly. "At least we knew we weren't bad parents. We simply had a child who was born with a medical disorder."

Youthful Tendency Disorder (YTD), a poorly understood neurological condition that afflicts an estimated 20 million U.S. children, is characterized by a variety of senseless, unproductive physical and mental exercises, often lasting hours at a time. In the thrall of YTD, sufferers run, jump, climb, twirl, shout, dance, do cartwheels, and enter unreal, unexplainable states of "make-believe."

The rest of the article is here.

A Glut of Antidepressants

By RONI CARYN RABIN
The New York Times
Originally published August 12, 2013

Over the past two decades, the use of antidepressants has skyrocketed. One in 10 Americans now takes an antidepressant medication; among women in their 40s and 50s, the figure is one in four.

Experts have offered numerous reasons. Depression is common, and economic struggles have added to our stress and anxiety. Television ads promote antidepressants, and insurance plans usually cover them, even while limiting talk therapy. But a recent study suggests another explanation: that the condition is being overdiagnosed on a remarkable scale.

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Elderly patients were most likely to be misdiagnosed, the latest study found. Six out of seven patients age 65 and older who had been given a diagnosis of depression did not fit the criteria. More educated patients and those in poor health were less likely to receive an inaccurate diagnosis.

The entire article is here.

Lost in the Forest -DSM-V Book Review

By Ian Hacking
London Review of Books
Vol. 35 No. 15 · 8 August 2013
pages 7-8 | 3428 words

The new edition of the DSM replaces DSM-IV, which appeared in 1994. The DSM is the standard – and standardising – work of reference issued by the American Psychiatric Association, but its influence reaches into every nook and cranny of psychiatry, everywhere. Hence its publication has been greeted by a flurry of discussion, hype and hostility across all media, both traditional and social. Most of it has concerned individual diagnoses and the ways they have changed, or haven’t. To invoke the cliché for the first time in my life, most critics attended to the trees (the kinds of disorder recognised in the manual), but few thought about the wood. I want to talk about the object as a whole – about the wood – and will seldom mention particular diagnoses, except when I need an example.

Many worries have already been aired. In mid-May an onslaught was delivered by the Division of Clinical Psychology of the British Psychology Society, which is sceptical about the very project of standardised diagnosis, especially of schizophrenia and bipolar disorders. More generally, it opposes the biomedical model of mental illness, to the exclusion of social conditions and life-course events.

The entire book review is here.

Thanks to Tom Fink for this review.

Mental Illness: It's Not in Your Genes

by KAS THOMAS
BigThink Blog
Originally posted JULY 21, 2013

Even before the Human Genome Project wrapped up in April 2003, scientists have worked overtime to find the gene or genes responsible for autism, schizophrenia, Alzheimer's, ADHD, alcoholism, depression, and other ailments "known" to have major genetic components.

The problem is, many neuropsychiatric ailments that are assumed to have a major genetic component don't seem to have one.

More than a decade after the sequencing of the human genome, there is still no reliable genetic test for autism, Alzheimer's, schizophrenia, or any other major neuropsychiatric disorder (except for Huntington's disease, for which there was already a test, prior to the Human Genome Project).

The entire story is here.

Thanks to Lamar Freed for this information.

Doctors Protest Psychiatric Manual Revision in Global Petition

By Natasha Khan
Bloomberg News
May 15, 2013

Doctors are protesting new guidance for the diagnosis of some mental disorders, including autism, contained in the revised edition of a professional manual to be released in coming days.

The so-called “psychiatric bible,” whose first update in 19 years will be released at a medical meeting that opens in San Francisco on May 18, also influences the way patients are treated and reimbursed for mental disorders. A petition that raised concerns about the manual’s diagnostic categories and patient safety received more than 3,000 signatures from Paris to Montreal in recent months.

The Diagnostic and Statistical Manual of Mental Disorders is the standard used by mental-health professionals for diagnosing illness and for research. The newest edition is meant to incorporate the latest research findings and has collapsed several conditions, including Asperger’s syndrome and child disintegrative disorder, into a single autism diagnosis.

The entire article is here.

Medicine's big new battleground: does mental illness really exist?

The latest edition of DSM, the influential American dictionary of psychiatry, says that shyness in children, depression after bereavement, even internet addiction can be classified as mental disorders. It has provoked a professional backlash, with some questioning the alleged role of vested interests in diagnosis

By Jaime Doward
The Observer
Originally published May 11, 2013

It has the distinctly uncatchy, abbreviated title DSM-5, and is known to no one outside the world of mental health.

But, even before its publication a week on Wednesday, the fifth edition of the Diagnostic and Statistical Manual, psychiatry's dictionary of disorders, has triggered a bitter row that stretches across the Atlantic and has fuelled a profound debate about how modern society should treat mental disturbance.

Critics claim that the American Psychiatric Association's increasingly voluminous manual will see millions of people unnecessarily categorised as having psychiatric disorders. For example, shyness in children, temper tantrums and depression following the death of a loved one could become medical problems, treatable with drugs. So could internet addiction.

Inevitably such claims have given ammunition to psychiatry's critics, who believe that many of the conditions are simply inventions dreamed up for the benefit of pharmaceutical giants.

A disturbing picture emerges of mutual vested interests, of a psychiatric industry in cahoots with big pharma. As the writer, Jon Ronson, only half-joked in a recent TED talk: "Is it possible that the psychiatric profession has a strong desire to label things that are essential human behaviour as a disorder?"

Psychiatry's supporters retort that such suggestions are clumsy, misguided and unhelpful, and complain that the much-hyped publication of the manual has become an excuse to reheat tired arguments to attack their profession.

The entire article is here.

New Efforts to Overhaul Psychiatric Diagnoses Spurred by DSM Turmoil

By Greg Miller
Wired Science
Originally posted May 17, 2013

Thousands of psychiatrists will descend on San Francisco this weekend for a meeting that will mark the release of the latest edition of the profession’s diagnostic guide, the Diagnostic and Statistical Manual of Mental Disorders, or DSM for short. This hugely influential book has been 14 years in the making, and it’s been dogged by controversies every step of the way.

To name just a few, there have been allegations of financial conflicts of interest, debates over whether internet addiction is really a thing (it is not, but “disordered gambling” is), arguments that the new diagnostic criteria will medicalize normal grief and temper tantrums, and lead to millions of people being falsely diagnosed with mental disorders.

With the new manual on the eve of its official debut, many experts are already looking beyond it. Some envision a future in which psychiatric diagnoses are based on the underlying biological causes instead of a description of a patient’s symptoms. Others caution that such a single-minded focus on biology ignores important social factors that contribute to mental illness. If there’s any area of agreement it’s this: There has to be a better way.


The DSM is used by doctors to diagnose patients, by insurance companies to decide what treatments to pay for, and by pharmaceutical companies and government funding agencies to set research priorities. The new edition, DSM-5, defines hundreds of mental disorders.

The fundamental problem, according to many of DSM’s critics, is that these definitions don’t carve nature at its joints.

“An obvious, easy example is schizophrenia,” said Peter Kinderman, a clinical psychologist at the University of Liverpool. “If you’re a 52-year-old man who hears voices, you’ll receive a diagnosis of schizophrenia. If you’re a 27-year-old woman with delusional beliefs, you’ll also receive a diagnosis of schizophrenia,” Kinderman said. “Two people can receive the same diagnosis and not have a single thing in common. That’s ludicrous scientifically.”

In most areas of medicine, diagnoses are based on the cause of illness. Heartburn and heart attacks both cause chest pain, but they’re different diagnoses because they have different underlying causes.

The entire story is here.

A.D.H.D. Seen in 11% of U.S. Children as Diagnoses Rise

By ALAN SCHWARZ and SARAH COHEN
The New York Times
Published: March 31, 2013

Nearly one in five high school age boys in the United States and 11 percent of school-age children over all have received a medical diagnosis of attention deficit hyperactivity disorder, according to new data from the federal Centers for Disease Control and Prevention.

These rates reflect a marked rise over the last decade and could fuel growing concern among many doctors that the A.D.H.D. diagnosis and its medication are overused in American children.

The figures showed that an estimated 6.4 million children ages 4 through 17 had received an A.D.H.D. diagnosis at some point in their lives, a 16 percent increase since 2007 and a 41 percent rise in the past decade. About two-thirds of those with a current diagnosis receive prescriptions for stimulants like Ritalin or Adderall, which can drastically improve the lives of those with A.D.H.D. but can also lead to addiction, anxiety and occasionally psychosis.

“Those are astronomical numbers. I’m floored,” said Dr. William Graf, a pediatric neurologist in New Haven and a professor at the Yale School of Medicine. He added, “Mild symptoms are being diagnosed so readily, which goes well beyond the disorder and beyond the zone of ambiguity to pure enhancement of children who are otherwise healthy.”

The entire story is here.