A Recent Study of Atypical Neuroleptics: “The Results of our Study are Sobering”

Sandra Steingard, M.D.
Mad In America
Originally published December 3, 2012


This week, MIA highlighted a recently published study of the four most commonly prescribed neuroleptics.  As noted in the post, the major outcome was that these drugs were not found to be effective or safe.

This important study, co-authored by Dilip Jeste the current president of the American Psychiatric Association, is worth reviewing in greater detail.

The study was modeled to capture clinical practice.  Entry to the study was broad and not limited to a specific diagnostic category.  It is characterized as a study of “older adults” and I admit to some chagrin that this meant anyone over 40.  Diagnoses included schizophrenia, schizoaffective disorder,  and psychosis associated with mood disorder, PTSD or dementia.  It was open to individuals who were either already taking an atypical neuroleptic or had a psychiatrist who was recommending this.

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What was most striking to me is this line from the study: there was

“no significant change in psychopathology with any of the study atypical antipsychotics“

They did not even report the numbers in their report.

The entire information is here.

Thanks to Tom Fink for this information.

Mislabeling Medical Illness

By ALLEN FRANCES, MD
The Health Care Blog
Originally published on February 12, 2013


Many readers of my previous blog listing the 10 worst suggestions in DSM 5 were shocked that I failed to mention an 11th dangerous mistake — that DSM-5 will harm people who are medically ill by mislabeling their medical problems as mental disorder. They are absolutely right. I apologize for my previous failure to attend to this danger and hope it is not now too late to influence the process.

Adding to the woes of the medically ill could be one of the biggest problems caused by DSM-5. It will do this in two ways: 1) by encouraging a quick jump to the erroneous conclusion that someone’s physical symptoms are ‘all in the head’; and 2) by mislabeling as mental disorders what are really just the normal emotional reactions that people understandably have in response to a medical illness.

UK health advocate, Suzy Chapman, has closely monitored every step in the development of DSM-5. Her website is the best available resource for finding just about everything you need to know about DSM-5 and ICD-11. Ms Chapman sent me a troubling email that summarizes where DSM-5 has gone wrong and the many harmful consequences that will follow. More details are available at: ‘Somatic Symptom Disorder could capture millions more under mental health diagnosis’ (http://wp.me/pKrrB-29B )

Ms Chapman writes:

…The DSM-5 Somatic Symptom Disorders Work Group is planning to eliminate several little used DSM-IV Somatoform Disorders and replace them instead with an extremely broad new category that is likely to be wildly overused (‘Somatic Symptom Disorder’ — SSD).

A person will meet the criteria for SSD by reporting just one bodily symptom that is distressing and/or disruptive to daily life and having just one of the following three reactions to it that persist for at least six months: 1) ‘disproportionate’ thoughts about the seriousness of their symptom(s); or 2) a high level of anxiety about their health; or, 3) devoting excessive time and energy to symptoms or health concerns.

The entire blog post is here.

Focus on Mental Health Laws to Curb Violence Is Unfair, Some Say

By ERICA GOODE and JACK HEALY
The New York Times
Published: January 31, 2013

In their fervor to take action against gun violence after the shooting in Newtown, Conn., a growing number of state and national politicians are promoting a focus on mental illness as a way to help prevent further killings.

Legislation to revise existing mental health laws is under consideration in at least a half-dozen states, including Colorado, Oregon and Ohio. A New York bill requiring mental health practitioners to warn the authorities about potentially dangerous patients was signed into law on Jan. 15. In Washington, President Obama has ordered “a national dialogue” on mental health, and a variety of bills addressing mental health issues are percolating on Capitol Hill.

But critics say that this focus unfairly singles out people with serious mental illness, who studies indicate are involved in only about 4 percent of violent crimes and are 11 or more times as likely than the general population to be the victims of violent crime.

And many proposals — they include strengthening mental health services, lowering the threshold for involuntary commitment and increasing requirements for reporting worrisome patients to the authorities — are rushed in execution and unlikely to repair a broken mental health system, some experts say.

“Good intentions without thought make for bad laws, and I think we have a risk of that,” said J. Reid Meloy, a forensic psychologist and clinical professor at the University of California, San Diego, who has studied rampage killers.

The entire story is here.

CMS Issues Sunshine Rule

By Joyce Frieden, News Editor, MedPage Today
Published: February 01, 2013


The Centers for Medicare and Medicaid Services issued a long-awaited rule Friday finalizing the details for a database that will list payments made to physicians by pharmaceutical and device manufacturers.

"You should know when your doctor has a financial relationship with the companies that manufacture or supply the medicines or medical devices you may need," Peter Budetti, MD, the agency's deputy administrator for program integrity, said in a statement. "Disclosure of these relationships allows patients to have more informed discussions with their doctors."

The rule, a provision of the Affordable Care Act known as the Physician Payments Sunshine Act, "finalizes the provisions that require manufacturers of drugs, devices, biologicals, and medical supplies covered by Medicare, Medicaid, or the Children's Health Insurance Program to report payments or other transfers of value they make to physicians and teaching hospitals to CMS," the statement explained. "CMS will post that data to a public website. The final rule also requires manufacturers and group purchasing organizations (GPOs) to disclose to CMS physician ownership or investment interests."

Data collection will start on Aug. 1, CMS said, noting that "Applicable manufacturers and applicable GPOs will report the data for August through December of 2013 to CMS by March 31, 2014 and CMS will release the data on a public website by Sept. 30, 2014. CMS is developing an electronic system to facilitate the reporting process."

The rule "is intended to help reduce the potential for conflicts of interest that physicians or teaching hospitals could face as a result of their relationships with manufacturers," the statement continued.

The American Medical Association responded cautiously to the release of the final rule. "The AMA will carefully review the new Physician Payment Sunshine Act rule," AMA President Jeremy Lazarus, MD, said in a statement. "Physicians' relationships with the pharmaceutical industry should be transparent and focused on benefits to patients ... As the rule is implemented, we will work to make sure physicians have up-to-date information about the new reporting process."

The entire story is here.

Path ordered to pay $800,000 to settle FTC privacy charges

By Shawn Knight
Techspot
Originally published February 1, 2013

Social networking startup Path has been ordered to pay an $800,000 fine to the Federal Trade Commission in addition to other measures to settle a controversial privacy issue. The service was accused of using deceitful tactics to collect personal information from members’ mobile device address books and storing it locally on their servers – even from children.

The FTC levied the fine against Path for collecting personal information from children without parental consent. Path allegedly collected information from around 3,000 kids under the age of 13, a move that violated the Children’s Online Privacy Protection act.

The entire article is here.

Clergy are not doctors — and the U.S. has its own Savita Halappanavars

By Irin Carmon
Salon.com
Originally published February 7, 2013

The death of Savita Halappanavar — the woman who died of sepsis in Ireland after being denied her request for termination of a nonviable pregnancy — drew outrage and attention in the United States late last fall, but one crucial point was often missed. Even in America, where abortion is mostly legal, cases like Halappanavar’s are a known reality in Catholic hospitals.

Take one case detailed to medical sociologist Lori Freedman by the doctor involved. A woman 16 weeks pregnant with twins was diagnosed with a molar pregnancy, which can lead to cancer, and “didn’t want to carry the pregnancy further.” She went to the hospital with vaginal bleeding, but unluckily for her, it was a Catholic one. There, the ethics committee decided that a uterine evacuation was tantamount to abortion, because there was a slim chance one of the fetuses would survive.

According to another doctor who witnessed the situation, “The clergy who made the decision Googled molar pregnancy.”

The woman was transferred out, Freedman wrote in a recent study published in the American Journal of Bioethics Primary Research, “despite the fact that terminating a bleeding molar pregnancy is safer in the hospital setting due to a high risk of hemorrhage.” What Freedman learned tracked closely with her previous studies focused on doctors’ concerns about miscarriage care in Catholic hospitals in situations very much like Halappanavar’s. Many doctors told her they preferred to send patients elsewhere rather than navigate the ethics committee.

The tension between religious beliefs and denial of medical care is currently playing out in the courtroom battles over the contraceptive coverage requirements under Obamacare, and for years, in legislative battles over “conscience clauses” that allow medical providers to opt out of some procedures. But some doctors’ consciences are being violated in the opposite fashion: Their recommendations for what is best for the women’s health and life, and often the wishes of the women themselves, are being circumvented by ethics committees at ever-expanding Catholic hospitals.

The entire story is here.

Thanks to Gary Schoener for this article.

New Report Suggests 'Moral Realism' May Lead To Better Moral Behavior

Medical News Today
Originally published February 1, 2013

Getting people to think about morality as a matter of objective facts rather than subjective preferences may lead to improved moral behavior, Boston College researchers report in the Journal of Experimental Social Psychology.

In two experiments, one conducted in-person and the other online, participants were primed to consider a belief in either moral realism (the notion that morals are like facts) or moral antirealism (the belief that morals reflect people's preferences) during a solicitation for a charitable donation. In both experiments, those primed with moral realism pledged to give more money to the charity than those primed with antirealism or those not primed at all.

"There is significant debate about whether morals are processed more like objective facts, like mathematical truths, or more like subjective preferences similar to whether vanilla or chocolate tastes better," said lead researcher Liane Young, assistant professor of psychology at Boston College. "We wanted to explore the impact of these different meta-ethical views on actual behavior."

The entire story is here.

Moral realism as moral motivation: The impact of meta-ethics on everyday decision-making can be found here.

As Suicides Rise in U.S., Veterans Are Less of Total

By JAMES DAO
The New York Times
Published: February 1, 2013

Suicides among military veterans, though up slightly in recent years, account for a shrinking percentage of the nation’s total number of suicides — a result of steadily rising numbers of suicides in the general population, according to a report released on Friday by the Department of Veterans Affairs.

The report, based on the most extensive data the department has ever collected on suicide, found that the number of suicides among veterans reached 22 a day in 2010, the most recent year available.

That was up by 22 percent from 2007, when the daily number was 18. But it is only 10 percent higher than in 1999, according to the report. Department officials described the numbers as “relatively stable” over the decade.

In the same 12-year period, the total number of suicides in the country rose steadily to an estimated 105 a day in 2010, up from 80 in 1999, a 31 percent increase.

As a result, the percentage of the nation’s daily suicides committed by veterans declined to 21 percent in 2010, from 25 percent in 1999.

The entire story is here.

VA report: 22 veterans commit suicide each day

The number of veterans who commit suicide each day is more than 20 percent higher than previously estimated
 

By Kevin Freking

Salon.com
Originally published February 1, 2013

The number of veterans who commit suicide each day is more than 20 percent higher than the Department of Veterans Affairs has previously estimated, but the problem doesn’t appear to be getting worse for veterans compared to the rest of the country, according to a VA study released Friday.

Indeed, the overall percentage of suicides by veterans has declined in recent years. VA researchers say the trend suggests that efforts to reduce suicide among veterans may be having an effect.

About 22 veterans committed suicide each day in 2010. Previous estimates from the VA put the number at 18.

While much attention has been paid to suicides by veterans of Iraq and Afghanistan, the report indicates the problem is worse among older veterans. About 70 percent of veterans who commit suicide are over age 50.

The latest projections from the VA incorporate data from about two dozen states that recorded the cause of death on death certificates. Previous estimates focused only on those getting care from the VA’s hospitals and clinics. The department described the study as the most comprehensive it has ever taken on the issue. 

“We have more work to do, and we will use this data to continue to strengthen our suicide prevention efforts and ensure all veterans receive the care they have earned and deserve,” said VA Secretary Eric K. Shinseki.