Is Addiction a Brain Disease?

Kent C. Berridge
Neuroethics (2016). pp 1-5.
doi:10.1007/s12152-016-9286-3

Abstract

Where does normal brain or psychological function end, and pathology begin? The line can be hard to discern, making disease sometimes a tricky word. In addiction, normal ‘wanting’ processes become distorted and excessive, according to the incentive-sensitization theory. Excessive ‘wanting’ results from drug-induced neural sensitization changes in underlying brain mesolimbic systems of incentive. ‘Brain disease’ was never used by the theory, but neural sensitization changes are arguably extreme enough and problematic enough to be called pathological. This implies that ‘brain disease’ can be a legitimate description of addiction, though caveats are needed to acknowledge roles for choice and active agency by the addict. Finally, arguments over ‘brain disease’ should be put behind us. Our real challenge is to understand addiction and devise better ways to help. Arguments over descriptive words only distract from that challenge.

The article is here.

Brief depression questionnaires could lead to unnecessary antidepressant prescriptions

University of California School of Medicine - Davis
Press Release
Originally released September 2, 3014

Short questionnaires used to identify patients at risk for depression are linked with antidepressant medications being prescribed when they may not be needed, according to new research from UC Davis Health System published in the September-October issue of the Journal of the American Board of Family Medicine.

Known as “brief depression symptom measures,” the self-administered questionnaires are used in primary care settings to determine the frequency and severity of depression symptoms among patients. Several questionnaires have been developed to help reduce untreated depression, a serious mental illness that can jeopardize relationships, employment and quality of life and increase the risks of heart disease, drug abuse and suicide.

The UC Davis team was concerned that the questionnaires might lead to prescriptions for antidepressant medication being given to those who aren’t depressed. Antidepressants are effective in treating moderate-to-severe depression but can have significant side effects, including sexual dysfunction, sedation and anxiety. They also have to be taken over several months to be effective.


“It is important to treat depression, but equally important to make sure those who get treatment actually need it,” said Anthony Jerant, professor of family and community medicine at UC Davis and lead author of the study.

The entire pressor is here.

The link to the study is in a blue hyperlink above.  The conclusion of the research is as follows:

Conclusions: These exploratory findings suggest administration of brief depression symptom measures, particularly the PHQ-9, may be associated with depression diagnosis and antidepressant recommendation and prescription among patients unlikely to have major depression. If these findings are confirmed, researchers should investigate the balance of benefits and risks (eg, overdiagnosis of depression and overtreatment with antidepressants) associated with use of a brief symptom measure.

Why We Need to Abandon the Disease-Model of Mental Health Care

By Peter Kinderman
Scientific American Blog
Originally published on November 17, 2014

Here is an excerpt:

Some neuroscientists have asserted that all emotional distress can ultimately be explained in terms of the functioning of our neural synapses and their neurotransmitter signalers. But this logic applies to all human behavior and every human emotion and it doesn’t differentiate between distress — explained as a product of chemical “imbalances” — and “normal” emotions. Moreover, while it is clear that medication (like many other substances, including drugs and alcohol) has an effect on our neurotransmitters, and therefore on our emotions and behavior, this is a long way from supporting the idea that distressing experiences are caused by imbalances in those neurotransmitters.

Many people continue to assume that serious problems such as hallucinations and delusional beliefs are quintessentially biological in origin, but we now have considerable evidence that traumatic childhood experiences (poverty, abuse, etc.) are associated with later psychotic experiences. There is an almost knee-jerk assumption that suicide, for instance, is a consequence of an underlying illness, explicable only in biological terms.

The entire blog post is here.

Effects of biological explanations for mental disorders on clinicians’ empathy

By Matthew S. Lebowitz and Woo-kyoung Ahn
Effects of biological explanations for mental disorders on clinicians’ empathy
PNAS 2014 : 1414058111v1-201414058

Abstract

Mental disorders are increasingly understood in terms of biological mechanisms. We examined how such biological explanations of patients’ symptoms would affect mental health clinicians’ empathy—a crucial component of the relationship between treatment-providers and patients—as well as their clinical judgments and recommendations. In a series of studies, US clinicians read descriptions of potential patients whose symptoms were explained using either biological or psychosocial information. Biological explanations have been thought to make patients appear less accountable for their disorders, which could increase clinicians’ empathy. To the contrary, biological explanations evoked significantly less empathy. These results are consistent with other research and theory that has suggested that biological accounts of psychopathology can exacerbate perceptions of patients as abnormal, distinct from the rest of the population, meriting social exclusion, and even less than fully human. Although the ongoing shift toward biomedical conceptualizations has many benefits, our results reveal unintended negative consequences.

Significance

Mental disorders are increasingly understood biologically. We tested the effects of biological explanations among mental health clinicians, specifically examining their empathy toward patients. Conventional wisdom suggests that biological explanations reduce perceived blameworthiness against those with mental disorders, which could increase empathy. Yet, conceptualizing mental disorders biologically can cast patients as physiologically different from “normal” people and as governed by genetic or neurochemical abnormalities instead of their own human agency, which can engender negative social attitudes and dehumanization. This suggests that biological explanations might actually decrease empathy. Indeed, we find that biological explanations significantly reduce clinicians’ empathy. This is alarming because clinicians’ empathy is important for the therapeutic alliance between mental health providers and patients and significantly predicts positive clinical outcomes.

The entire article is here.

The Selling of ADHD

By Alan Schwarz
The New York Times
Originally posted December 14, 2013


Here is an excerpt:

“The numbers make it look like an epidemic. Well, it’s not. It’s preposterous,” Dr. Conners, a psychologist and professor emeritus at Duke University, said in a subsequent interview. “This is a concoction to justify the giving out of medication at unprecedented and unjustifiable levels.”

The rise of A.D.H.D. diagnoses and prescriptions for stimulants over the years coincided with a remarkably successful two-decade campaign by pharmaceutical companies to publicize the syndrome and promote the pills to doctors, educators and parents. With the children’s market booming, the industry is now employing similar marketing techniques as it focuses on adult A.D.H.D., which could become even more profitable.

Few dispute that classic A.D.H.D., historically estimated to affect 5 percent of children, is a legitimate disability that impedes success at school, work and personal life. Medication often assuages the severe impulsiveness and inability to concentrate, allowing a person’s underlying drive and intelligence to emerge.

The entire story is here.

Perception of Addiction and Its Effects on One's Moral Responsibility

By Justin Caouette
AJOB Neuroscience
Volume 4, Issue 3, 2013

Addressing concerns about framing addiction as disease, authors (Hammer et. al 2013) argue that we should refrain from doing so as such a categorization may unfairly stigmatize the addict.  They suggest that an analysis of disease metaphors bolsters their view, and the utility that could be had by labeling addiction as disease is outweighed by the potential disutility in doing so. Tolend support to their view they appeal to intuitions about the common folk‟s analysis of diseased individuals. Their claim is that a common understanding of disease unfairly depicts addicts as “wretches” or “sinners”.   They use this as evidence in favor of rejecting the addiction -as-disease model. We argue that the author‟s metaphoric framing of how common folks often view diseased individuals is misguided for a number of reasons. We focus on three points of contention.

The entire piece is here.

Antipsychotics: Taking the Long View

By Thomas Insel
NIMH Director's Blog
Originally published on August 28, 2013

Here is an excerpt:

An article recently posted online in JAMA-Psychiatry tells an interesting story about medications and recovery.1 Wunderink and colleagues from the Netherlands report on a seven-year follow-up of 103 people with schizophrenia and related disorders who had experienced a first episode of psychosis between 2001 and 2002. After six months of symptomatic remission following antipsychotic treatment, patients were randomly assigned to either maintenance antipsychotic treatment or a tapering-off and discontinuation of the drug. As expected, the group that stopped taking their medications experienced twice the relapse rates in the early phase of the follow-up. But these rates evened out after a few years, as some patients in the maintenance group also stopped taking their medication. Most important, by seven years, the discontinuation group had achieved twice the functional recovery rate: 40.4 percent vs. only 17.6 percent among the medication maintenance group. To be clear, this study started with patients in remission and only 17 of the 103 patients—21 percent of the discontinuation group and 11 percent of the maintenance group—were off medication entirely during the last two years of follow-up. An equal number were taking very low doses of medication—meaning that roughly one-third of all study patients were eventually taking little or no medication.

Emphasis added.

The entire blog post is here.

Thanks to Tom Fink for this story.

The New Science of Mind

By ERIC R. KANDEL
The New York Times
Published: September 6, 2013

Here is an excerpt:

These results show us four very important things about the biology of mental disorders. First, the neural circuits disturbed by psychiatric disorders are likely to be very complex.

Second, we can identify specific, measurable markers of a mental disorder, and those biomarkers can predict the outcome of two different treatments: psychotherapy and medication.

Third, psychotherapy is a biological treatment, a brain therapy. It produces lasting, detectable physical changes in our brain, much as learning does.

And fourth, the effects of psychotherapy can be studied empirically. Aaron Beck, who pioneered the use of cognitive behavioral therapy, long insisted that psychotherapy has an empirical basis, that it is a science. Other forms of psychotherapy have been slower to move in this direction, in part because a number of psychotherapists believed that human behavior is too difficult to study in scientific terms.

ANY discussion of the biological basis of psychiatric disorders must include genetics. And, indeed, we are beginning to fit new pieces into the puzzle of how genetic mutations influence brain development.

The entire story is here.

The Psychiatric Drug Crisis

BY GARY GREENBERG

The New Yorker

Originally posted on September 3, 2013

It’s been just over twenty-five years since Prozac came to market, and more than twenty per cent of Americans now regularly take mind-altering drugs prescribed by their doctors. Almost as familiar as brands like Zoloft and Lexapro is the worry about what it means that the daily routine in many households, for parents and children alike, includes a dose of medications that are poorly understood and whose long-term effects on the body are unknown. Despite our ambivalence, sales of psychiatric drugs amounted to more than seventy billion dollars in 2010. They have become yet another commodity that consumers have learned to live with or even enjoy, like S.U.V.s or Cheetos.

Yet the psychiatric-drug industry is in trouble. “We are facing a crisis,” the Cornell psychiatrist and New York Times contributor Richard Friedman warned last week. In the past few years, one pharmaceutical giant after another—GlaxoSmithKline, AstraZeneca, Novartis, Pfizer, Merck, Sanofi—has shrunk or shuttered its neuroscience research facilities. Clinical trials have been halted, lines of research abandoned, and the new drug pipeline has been allowed to run dry.

The entire story is here.

Thanks to Tom Fink for this story.

3 Ways To Save Psychotherapy

People have been turning away from psychotherapy in favor of medication for years, despite the evidence that therapy works. Here are a few tips for improving the industry's image.

By Shaunacy Ferro
www.popsi.com
Posted 08.21.2013

The subtle art of lying on a therapist's couch is in rapid decline. Psychotherapy, the traditional one-on-one weekly session with a therapist, has been on the downswing for years, as more and more psychiatrists and even primary care doctors prescribe psychotropic medications instead of therapy. As the graphic above illustrates, between 1998 and 2007, psychotherapy use for people being treated for mental health conditions in the U.S. decreased from almost 16 percent to 10.5 percent, and therapy use in conjunction with medication went from 40 percent to 32 percent. By contrast, usage rates of medication alone shot up from 41 percent to a little more than 57 percent.

The entire story is here.

A Dry Pipeline for Psychiatric Drugs

By RICHARD A. FRIEDMAN, M.D.
The New York Times
Published: August 19, 2013

Fully 1 in 5 Americans take at least one psychiatric medication. Yet when it comes to mental health, we are facing a crisis in drug innovation.

Sure, we have many antidepressants, antipsychotics, hypnotic medications and the like. But their popularity masks two serious problems.

First, each of these drug classes is filled with “me too” drugs, which are essentially just copies of one another; we have six S.S.R.I. antidepressants that essentially do the same thing, and likewise for the 10 new atypical antipsychotic drugs.

Second, the available drugs leave a lot to be desired: patients with illnesses like schizophrenia, major depression and bipolar disorder often fail to respond adequately to these medications or cannot tolerate their side effects.

The entire story 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.

(cut)

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.