Elyn Saks
Politico - The Agenda
Originally published August 9, 2017
Patient consent is an important principle in medicine, but when it comes to mental illness, things get complicated. Other diseases don’t affect a patient’s cognition the way a mental illness can. When the organ with the disease is a patient’s brain, how can it be trusted to make decisions?
That’s one reason that, historically, psychiatric patients were given very little authority to make decisions about their own care. Mental illness and incompetence were considered the same thing. People could be hospitalized and treated against their will if they were considered mentally ill and “in need of treatment.” The presumption was that people with mental illness—essentially by definition—lacked the ability to appreciate their own need for treatment.
In the 1970s, the situation began to change. First, the U.S. Supreme Court ruled that a patient could be hospitalized against his will only if he were dangerous to himself or others, or “gravely disabled,” a decision that led to the de-institutionalization of most mental health care. Second, anti-psychotic medications came into wide use, effectively handing patients the power—on a daily basis—to decide whether to consent to treatment or not, simply by deciding whether or not to take their pills.
The article is here.
Tuesday, September 12, 2017
Personal values in human life
Lilach Sagiv, Sonia Roccas, Jan Cieciuch & Shalom H. Schwartz
Nature Human Behaviour (2017)
doi:10.1038/s41562-017-0185-3
Abstract
The construct of values is central to many fields in the social sciences and humanities. The last two decades have seen a growing body of psychological research that investigates the content, structure and consequences of personal values in many cultures. Taking a cross-cultural perspective we review, organize and integrate research on personal values, and point to some of the main findings that this research has yielded. Personal values are subjective in nature, and reflect what people think and state about themselves. Consequently, both researchers and laymen sometimes question the usefulness of personal values in influencing action. Yet, self-reported values predict a large variety of attitudes, preferences and overt behaviours. Individuals act in ways that allow them to express their important values and attain the goals underlying them. Thus, understanding personal values means understanding human behaviour.
Monday, September 11, 2017
Do’s and Don’ts for Media Reporting on Suicide
David Susman
The Mental Health and Wellness Blog
Originally published June 15, 2017
Here is an excerpt:
I was reminded recently of the excellent resources which provide guidelines for the responsible reporting and discussion of suicide in the media. In the guideline document, “Recommendations for Reporting on Suicide,” several useful and concrete guidelines are offered for how to talk about suicide in the media. Most of the material in this article comes from this source. Let’s first review and summarize the list of do’s and don’ts.
1) Don’t use big or sensationalistic headlines with specific details about the method of suicide. Do inform without sensationalizing the suicide and without providing details in the headline.
2) Don’t include photos or videos of the location or method of death, grieving family or friends, funerals. Do use a school or work photo; include suicide hotline numbers or local crisis contacts.
3) Don’t describe suicide as “an epidemic,” “skyrocketing,” or other exaggerated terms. Do use accurate words such as “higher rates” or “rising.”
4) Don’t describe a suicide as “without warning” or “inexplicable.” Do convey that people exhibit warning signs of suicide and include a list of common warning signs and ways to intervene when someone is suicidal (see section below).
5) Don’t say “she left a suicide note saying…” Do say “a note from the deceased was found.”
6) Don’t investigate and report on suicide as though it is a crime. Do report on suicide as a public health issue.
7) Don’t quote police or first responders about the causes of suicide. Do seek advice and information from suicide prevention experts.
8) Don’t refer to suicide as “successful,” “unsuccessful,” or a “failed attempt.” Avoid the use of “committed suicide,” which is an antiquated reference to when suicidal acts or attempts were punished as crimes. Do say “died by suicide,” “completed” or “killed him/herself.”
The article is here.
The Mental Health and Wellness Blog
Originally published June 15, 2017
Here is an excerpt:
I was reminded recently of the excellent resources which provide guidelines for the responsible reporting and discussion of suicide in the media. In the guideline document, “Recommendations for Reporting on Suicide,” several useful and concrete guidelines are offered for how to talk about suicide in the media. Most of the material in this article comes from this source. Let’s first review and summarize the list of do’s and don’ts.
1) Don’t use big or sensationalistic headlines with specific details about the method of suicide. Do inform without sensationalizing the suicide and without providing details in the headline.
2) Don’t include photos or videos of the location or method of death, grieving family or friends, funerals. Do use a school or work photo; include suicide hotline numbers or local crisis contacts.
3) Don’t describe suicide as “an epidemic,” “skyrocketing,” or other exaggerated terms. Do use accurate words such as “higher rates” or “rising.”
4) Don’t describe a suicide as “without warning” or “inexplicable.” Do convey that people exhibit warning signs of suicide and include a list of common warning signs and ways to intervene when someone is suicidal (see section below).
5) Don’t say “she left a suicide note saying…” Do say “a note from the deceased was found.”
6) Don’t investigate and report on suicide as though it is a crime. Do report on suicide as a public health issue.
7) Don’t quote police or first responders about the causes of suicide. Do seek advice and information from suicide prevention experts.
8) Don’t refer to suicide as “successful,” “unsuccessful,” or a “failed attempt.” Avoid the use of “committed suicide,” which is an antiquated reference to when suicidal acts or attempts were punished as crimes. Do say “died by suicide,” “completed” or “killed him/herself.”
The article is here.
Nonvoluntary Psychiatric Treatment Is Distinct From Involuntary Psychiatric Treatment
Dominic A. Sisti
JAMA. Published online August 24, 2017
Some of the most ethically challenging cases in mental health care involve providing treatment to individuals who refuse that treatment. Sometimes when persons with mental illness become unsafe to themselves or others, they must be taken, despite their outward and often vigorous refusal, to an emergency department or psychiatric hospital to receive treatment, such as stabilizing psychotropic medication. On occasion, to provide medical care over objection, a patient must be physically restrained.
The modifier “involuntary” is generally used to describe these cases. For example, it is said that a patient has been involuntarily hospitalized or is receiving involuntary medication ostensibly because the patient did not consent and was forced or strongly coerced into treatment. Importantly, a person may be involuntarily hospitalized but retain the right to refuse treatment. “Involuntary” is also used to describe instances when an individual is committed to outpatient treatment by a court. The fact that a person is being treated involuntarily raises numerous challenges; it raises concerns about protecting individual liberty, respect for patient autonomy, and the specter of past abuses of patients in psychiatric institutions.
Although it has become both a clinical colloquialism and legal touchstone, the concept of involuntary treatment is used imprecisely to describe all instances in which a patient has refused the treatment he or she subsequently receives. In some cases, a patient outwardly refuses treatment but may have previously expressed a desire to be treated in crisis or, according to a reasonable evaluator, he or she would have agreed to accept stabilizing treatment, such as antipsychotic medication. A similar scenario occurs in the treatment of individuals who experience a first episode of psychosis and who outwardly refuse treatment. With no prior experience of what it is like to have psychosis, these patients are unable to develop informed preferences about treatment in advance of their first crisis. In these cases, some believe it is reasonable to provide treatment despite the opposition of the patient, although this could be debated.
The article is here.
JAMA. Published online August 24, 2017
Some of the most ethically challenging cases in mental health care involve providing treatment to individuals who refuse that treatment. Sometimes when persons with mental illness become unsafe to themselves or others, they must be taken, despite their outward and often vigorous refusal, to an emergency department or psychiatric hospital to receive treatment, such as stabilizing psychotropic medication. On occasion, to provide medical care over objection, a patient must be physically restrained.
The modifier “involuntary” is generally used to describe these cases. For example, it is said that a patient has been involuntarily hospitalized or is receiving involuntary medication ostensibly because the patient did not consent and was forced or strongly coerced into treatment. Importantly, a person may be involuntarily hospitalized but retain the right to refuse treatment. “Involuntary” is also used to describe instances when an individual is committed to outpatient treatment by a court. The fact that a person is being treated involuntarily raises numerous challenges; it raises concerns about protecting individual liberty, respect for patient autonomy, and the specter of past abuses of patients in psychiatric institutions.
Although it has become both a clinical colloquialism and legal touchstone, the concept of involuntary treatment is used imprecisely to describe all instances in which a patient has refused the treatment he or she subsequently receives. In some cases, a patient outwardly refuses treatment but may have previously expressed a desire to be treated in crisis or, according to a reasonable evaluator, he or she would have agreed to accept stabilizing treatment, such as antipsychotic medication. A similar scenario occurs in the treatment of individuals who experience a first episode of psychosis and who outwardly refuse treatment. With no prior experience of what it is like to have psychosis, these patients are unable to develop informed preferences about treatment in advance of their first crisis. In these cases, some believe it is reasonable to provide treatment despite the opposition of the patient, although this could be debated.
The article is here.
Sunday, September 10, 2017
Google has created a tool that tests for clinical depression
Katherine Ellen Foley
Quartz
Originally posted August 24, 2017
People often delay seeking treatment for mental health conditions like depression. The longer they wait to see their doctors, the worse the condition becomes, making it harder to treat in the future.
In an effort to encourage more patients to seek treatment sooner, Google announced Aug. 23 that it has teamed up with National Alliance on Mental Illness (NAMI), an advocacy group, to create a simple tool for users to assess if they may be depressed. Now, when people in the US search for “clinical depression” on their phones, the typical “knowledge panel”—a container that displays company-vetted information on Google’s search results page—will come with an option to take a quiz that can assess the severity of symptoms. (Google says the quiz results will not be seen by anyone but the quiz-taker.)
Google’s quiz isn’t new. It’s a reskinned version of the 18-year-old PQH-9 (pdf), used by physicians to help diagnose patients with mental illnesses like depression and anxiety. It asks about general interest in activities, eating and sleeping habits, and overall mood. Alone, the PQH-9 won’t give a definitive diagnosis. Doctors use it in conjunction with physical exams to rule out other causes for patients’ symptoms, like a thyroid problem. Google says its incorporation of the PQH-9 test in its search results is not meant as a final diagnosis, but as a tool to inspire people to have conversations with their healthcare providers if they were hesitant before.
The article is here.
Quartz
Originally posted August 24, 2017
People often delay seeking treatment for mental health conditions like depression. The longer they wait to see their doctors, the worse the condition becomes, making it harder to treat in the future.
In an effort to encourage more patients to seek treatment sooner, Google announced Aug. 23 that it has teamed up with National Alliance on Mental Illness (NAMI), an advocacy group, to create a simple tool for users to assess if they may be depressed. Now, when people in the US search for “clinical depression” on their phones, the typical “knowledge panel”—a container that displays company-vetted information on Google’s search results page—will come with an option to take a quiz that can assess the severity of symptoms. (Google says the quiz results will not be seen by anyone but the quiz-taker.)
Google’s quiz isn’t new. It’s a reskinned version of the 18-year-old PQH-9 (pdf), used by physicians to help diagnose patients with mental illnesses like depression and anxiety. It asks about general interest in activities, eating and sleeping habits, and overall mood. Alone, the PQH-9 won’t give a definitive diagnosis. Doctors use it in conjunction with physical exams to rule out other causes for patients’ symptoms, like a thyroid problem. Google says its incorporation of the PQH-9 test in its search results is not meant as a final diagnosis, but as a tool to inspire people to have conversations with their healthcare providers if they were hesitant before.
The article is here.
Saturday, September 9, 2017
Will Technology Help Us Transcend the Human Condition?
Michael Hauskeller & Kyle McNease
Transcendence used to be the end of a spiritual quest and endeavour. Not anymore. Today we are more likely to believe that if anything can help us transcend the human condition it is not God or some kind of religious communion, but science and technology. Confidence is high that, if we do things right, and boldly and without fear embrace the new opportunities that technological progress grants us, we will soon be able to accomplish things that no human has ever done, or even imagined doing, before. With luck, we will be unimaginably smart and powerful, and virtually immortal, all thanks to a development that seems unstoppable and that has already surpassed all reasonable expectations.
Once upon a time, not so long ago, we used maps and atlases to find our way around. Occasionally we even had to stop and ask someone not named Siri or Cortana if we were indeed on the correct route. Today, our cars are navigated by satellites that triangulate our location in real time while circling the earth at thousands of miles per hour, and self-driving cars for everyone are just around the corner. Soon we may not even need cars anymore. Why go somewhere if technology can bring the world to us? Already we are in a position to do most of what we have to or want to do from home: get an education, work, do our shopping, our banking, our communication, all thanks to the internet, which 30 years ago did not exist and is now, to many of us, indispensable. Those who are coming of age today find it difficult to imagine a world without it. Currently, there are over 3.2 billion people connected to the World Wide Web, 2 billion of which live in developing countries. Most of them connect to the Web via increasingly versatile and powerful mobile devices few people would have thought possible a couple of generations ago. Soon we may be able to dispense even with mobile devices and do all of it in our bio-upgraded heads. In terms of the technology we are using every day without a second thought, the world has changed dramatically, and it continues to do so. Computation is now nearly ubiquitous, people seem constantly attached to their cellular phones, iPads, and laptops, enthusiastically endorsing their own progressive cyborgization. And connectivity does not stop at the level of human beings: even our household objects and devices are connected to the internet and communicate with each other, using their own secret language and taking care of things largely without the need for human intervention and control. The world we have built for ourselves thrives on a steady diet of zeroes and ones that have now become our co-creators, continuing the world-building in often unexpected ways.
The paper is here.
Transcendence used to be the end of a spiritual quest and endeavour. Not anymore. Today we are more likely to believe that if anything can help us transcend the human condition it is not God or some kind of religious communion, but science and technology. Confidence is high that, if we do things right, and boldly and without fear embrace the new opportunities that technological progress grants us, we will soon be able to accomplish things that no human has ever done, or even imagined doing, before. With luck, we will be unimaginably smart and powerful, and virtually immortal, all thanks to a development that seems unstoppable and that has already surpassed all reasonable expectations.
Once upon a time, not so long ago, we used maps and atlases to find our way around. Occasionally we even had to stop and ask someone not named Siri or Cortana if we were indeed on the correct route. Today, our cars are navigated by satellites that triangulate our location in real time while circling the earth at thousands of miles per hour, and self-driving cars for everyone are just around the corner. Soon we may not even need cars anymore. Why go somewhere if technology can bring the world to us? Already we are in a position to do most of what we have to or want to do from home: get an education, work, do our shopping, our banking, our communication, all thanks to the internet, which 30 years ago did not exist and is now, to many of us, indispensable. Those who are coming of age today find it difficult to imagine a world without it. Currently, there are over 3.2 billion people connected to the World Wide Web, 2 billion of which live in developing countries. Most of them connect to the Web via increasingly versatile and powerful mobile devices few people would have thought possible a couple of generations ago. Soon we may be able to dispense even with mobile devices and do all of it in our bio-upgraded heads. In terms of the technology we are using every day without a second thought, the world has changed dramatically, and it continues to do so. Computation is now nearly ubiquitous, people seem constantly attached to their cellular phones, iPads, and laptops, enthusiastically endorsing their own progressive cyborgization. And connectivity does not stop at the level of human beings: even our household objects and devices are connected to the internet and communicate with each other, using their own secret language and taking care of things largely without the need for human intervention and control. The world we have built for ourselves thrives on a steady diet of zeroes and ones that have now become our co-creators, continuing the world-building in often unexpected ways.
The paper is here.
Friday, September 8, 2017
Study questions why thousands with developmental disabilities are prescribed antipsychotics
Peter Goffin
The Toronto Star
Originally published August 23, 2017
Researchers with the Centre for Addiction and Mental Health and the Institute for Clinical Evaluative Sciences have called for “guidelines and training around antipsychotic prescribing and monitoring” for doctors, pharmacists and care home staff after finding that nearly 40 per cent of people with developmental disabilities were prescribed antipsychotic drugs at some point over a six-year period.
One-third of the patients prescribed antipsychotics had no documented diagnosis of mental illness, according to the study, which tracked more than 51,000 people with developmental disabilities who are eligible for provincial drug benefits.
“We don’t know, with the data, why this one person was prescribed or this (other) person was prescribed so we’re trying to almost guess at why,” said psychologist Yona Lunsky, lead author of the study.
“It could be behaviour, aggression, self-injury, agitation.”
For people with developmental disabilities who live in group homes, the rate of antipsychotic prescriptions was even higher.
About 56 percent of developmentally disabled group home residents were prescribed antipsychotics. Of those, around 43 percent had no documented mental health issues.
The article is here.
The Toronto Star
Originally published August 23, 2017
Researchers with the Centre for Addiction and Mental Health and the Institute for Clinical Evaluative Sciences have called for “guidelines and training around antipsychotic prescribing and monitoring” for doctors, pharmacists and care home staff after finding that nearly 40 per cent of people with developmental disabilities were prescribed antipsychotic drugs at some point over a six-year period.
One-third of the patients prescribed antipsychotics had no documented diagnosis of mental illness, according to the study, which tracked more than 51,000 people with developmental disabilities who are eligible for provincial drug benefits.
“We don’t know, with the data, why this one person was prescribed or this (other) person was prescribed so we’re trying to almost guess at why,” said psychologist Yona Lunsky, lead author of the study.
“It could be behaviour, aggression, self-injury, agitation.”
For people with developmental disabilities who live in group homes, the rate of antipsychotic prescriptions was even higher.
About 56 percent of developmentally disabled group home residents were prescribed antipsychotics. Of those, around 43 percent had no documented mental health issues.
The article is here.
Errors in the 2017 APA Clinical Practice Guideline for the Treatment of PTSD: What the Data Actually Says
Dominguez, S. and Lee, C.
Front. Psychol., 22 August 2017
Abstract
The American Psychological Association (APA) Practice Guidelines for the Treatment of Posttraumatic Stress Disorder (PTSD) concluded that there was strong evidence for cognitive behavioral therapy (CBT), cognitive processing therapy (CPT), cognitive therapy (CT), and exposure therapy yet weak evidence for eye movement desensitization and reprocessing (EMDR). This is despite the findings from an associated systematic review which concluded that EMDR leads to loss of PTSD diagnosis and symptom reduction. Depression symptoms were also found to improve more with EMDR than control conditions. In that review, EMDR was marked down on strength of evidence (SOE) for symptom reduction for PTSD. However, there were several problems with the conclusions of that review. Firstly, in assessing the evidence in one of the studies, the reviewers chose an incorrect measure that skewed the data. We recalculated a meta-analysis with a more appropriate measure and found the SOE improved. The resulting effect size for EMDR on PTSD symptom reduction compared to a control condition was large for studies that meet the APA inclusion criteria (SMD = 1.28) and the heterogeneity was low (I2 = 43%). Secondly, even if the original measure was chosen, we highlight inconsistencies with the way SOE was assessed for EMDR, CT, and CPT. Thirdly, we highlight two papers that were omitted from the analysis. One of these was omitted without any apparent reason. It found EMDR superior to a placebo control. The other study was published in 2015 and should have been part of APA guidelines since they were published in 2017. The inclusion of either study would have resulted in an improvement in SOE. Including both studies results in standard mean difference and confidence intervals that were better for EMDR than for CPT or CT. Therefore, the SOE should have been rated as moderate and EMDR assessed as at least equivalent to these CBT approaches in the APA guidelines. This would bring the APA guidelines in line with other recent practice guidelines from other countries. Less critical but also important, were several inaccuracies in assessing the risk of bias and the failure to consider studies supporting strong gains of EMDR at follow-up.
The article is here.
Front. Psychol., 22 August 2017
Abstract
The American Psychological Association (APA) Practice Guidelines for the Treatment of Posttraumatic Stress Disorder (PTSD) concluded that there was strong evidence for cognitive behavioral therapy (CBT), cognitive processing therapy (CPT), cognitive therapy (CT), and exposure therapy yet weak evidence for eye movement desensitization and reprocessing (EMDR). This is despite the findings from an associated systematic review which concluded that EMDR leads to loss of PTSD diagnosis and symptom reduction. Depression symptoms were also found to improve more with EMDR than control conditions. In that review, EMDR was marked down on strength of evidence (SOE) for symptom reduction for PTSD. However, there were several problems with the conclusions of that review. Firstly, in assessing the evidence in one of the studies, the reviewers chose an incorrect measure that skewed the data. We recalculated a meta-analysis with a more appropriate measure and found the SOE improved. The resulting effect size for EMDR on PTSD symptom reduction compared to a control condition was large for studies that meet the APA inclusion criteria (SMD = 1.28) and the heterogeneity was low (I2 = 43%). Secondly, even if the original measure was chosen, we highlight inconsistencies with the way SOE was assessed for EMDR, CT, and CPT. Thirdly, we highlight two papers that were omitted from the analysis. One of these was omitted without any apparent reason. It found EMDR superior to a placebo control. The other study was published in 2015 and should have been part of APA guidelines since they were published in 2017. The inclusion of either study would have resulted in an improvement in SOE. Including both studies results in standard mean difference and confidence intervals that were better for EMDR than for CPT or CT. Therefore, the SOE should have been rated as moderate and EMDR assessed as at least equivalent to these CBT approaches in the APA guidelines. This would bring the APA guidelines in line with other recent practice guidelines from other countries. Less critical but also important, were several inaccuracies in assessing the risk of bias and the failure to consider studies supporting strong gains of EMDR at follow-up.
The article is here.
Thursday, September 7, 2017
Harm to self outweighs benefit to others in moral decision making
Lukas J. Volz, B. Locke Welborn, Matthias S. Gobel, Michael S. Gazzaniga, and Scott T. Grafton
PNAS 2017 ; published ahead of print July 10, 2017
Abstract
How we make decisions that have direct consequences for ourselves and others forms the moral foundation of our society. Whereas economic theory contends that humans aim at maximizing their own gains, recent seminal psychological work suggests that our behavior is instead hyperaltruistic: We are more willing to sacrifice gains to spare others from harm than to spare ourselves from harm. To investigate how such egoistic and hyperaltruistic tendencies influence moral decision making, we investigated trade-off decisions combining monetary rewards and painful electric shocks, administered to the participants themselves or an anonymous other. Whereas we replicated the notion of hyperaltruism (i.e., the willingness to forego reward to spare others from harm), we observed strongly egoistic tendencies in participants’ unwillingness to harm themselves for others’ benefit. The moral principle guiding intersubject trade-off decision making observed in our study is best described as egoistically biased altruism, with important implications for our understanding of economic and social interactions in our society.
Significance
Principles guiding decisions that affect both ourselves and others are of prominent importance for human societies. Previous accounts in economics and psychological science have often described decision making as either categorically egoistic or altruistic. Instead, the present work shows that genuine altruism is embedded in context-specific egoistic bias. Participants were willing to both forgo monetary reward to spare the other from painful electric shocks and also to suffer painful electric shocks to secure monetary reward for the other. However, across all trials and conditions, participants accrued more reward and less harm for the self than for the other person. These results characterize human decision makers as egoistically biased altruists, with important implications for psychology, economics, and public policy.
The article is here.
PNAS 2017 ; published ahead of print July 10, 2017
Abstract
How we make decisions that have direct consequences for ourselves and others forms the moral foundation of our society. Whereas economic theory contends that humans aim at maximizing their own gains, recent seminal psychological work suggests that our behavior is instead hyperaltruistic: We are more willing to sacrifice gains to spare others from harm than to spare ourselves from harm. To investigate how such egoistic and hyperaltruistic tendencies influence moral decision making, we investigated trade-off decisions combining monetary rewards and painful electric shocks, administered to the participants themselves or an anonymous other. Whereas we replicated the notion of hyperaltruism (i.e., the willingness to forego reward to spare others from harm), we observed strongly egoistic tendencies in participants’ unwillingness to harm themselves for others’ benefit. The moral principle guiding intersubject trade-off decision making observed in our study is best described as egoistically biased altruism, with important implications for our understanding of economic and social interactions in our society.
Significance
Principles guiding decisions that affect both ourselves and others are of prominent importance for human societies. Previous accounts in economics and psychological science have often described decision making as either categorically egoistic or altruistic. Instead, the present work shows that genuine altruism is embedded in context-specific egoistic bias. Participants were willing to both forgo monetary reward to spare the other from painful electric shocks and also to suffer painful electric shocks to secure monetary reward for the other. However, across all trials and conditions, participants accrued more reward and less harm for the self than for the other person. These results characterize human decision makers as egoistically biased altruists, with important implications for psychology, economics, and public policy.
The article is here.
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