Saturday, May 12, 2012

Behavior and Law: Mike Nova: BREIVIC SYNDROME

Behavior and Law: Mike Nova: BREIVIC SYNDROME

Mike Nova: BREIVIC SYNDROME 


Last Update: 5:51 PM 5/3/2012

Mike Nova:

Breivik Syndrome is the Grandiose - Persecutory type of Delusional Disorder with resulting mass murder in a messianic quest to promote militant far right ideology which serves as a defensive reaction formation and overcompensation in intense, elaborate, psychotic and delusional, antifeministic and "anti immigrant" castration phobia.

This psychopathology is both individual and social.

How many are afflicted with it, lurking there in the dark, behind their flags and "manifestos"?




Addiction Diagnoses May Rise Under Guideline Changes - New York Times - General Psychiatry News

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New York Times

Addiction Diagnoses May Rise Under Guideline Changes
New York Times
WASHINGTON — In what could prove to be one of their most far-reaching decisions, psychiatrists and other specialists who are rewriting the manual that serves as the nation's arbiter of mental illness have agreed to revise the definition of addiction, ...
Rewrite means millions more likely to be called addictsMinneapolis Star Tribune
Guideline revisions may increase addiction diagnosesBend Bulletin
You could be addicted but not know itOmaha World-Herald

all 10 news articles »
 

"For three decades psychiatrists have turned to Lishman's "Organic Psychiatry" as the standard neuropsychiatry reference. It stood as the last great single author reference text in medicine..." - General Psychiatry News

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via psychiatry - Google Blog Search by admin on 5/11/12
'For three decades psychiatrists have turned to Lishman's 'Organic Psychiatry' as the standard neuropsychiatry reference. It stood as the last great single...
 

Lishman's Organic Psychiatry: A Textbook of Neuropsychiatry

Lishman's Organic Psychiatry: A Textbook of NeuropsychiatryRating:
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"For three decades psychiatrists have turned to Lishman's "Organic Psychiatry" as the standard neuropsychiatry reference. It stood as the last great single author reference text in medicine, a combination of meticulous, exhaustive research conveyed in a beautifully clear style. Now the mantle has been passed to a group of five distinguished authors and it is to their considerable credit that the attributes which made Organic Psychiatry such a distinctive voice remain. The fourth Edition of Lishman's Organic Psychiatry is a rich blend of detailed clinical inquiry and up to date neuroscience. It should be on every psychiatrist;s book shelf."--Anthony Feinstein, MPhil, PhD., FRCP, Professor, Department of Psychiatry, University of Toronto, CanadaOver the past 30 years, thousands of physicians have depended on Lishman's "Organic Psychiatry." Its authoritative and reliable clinical guidance was - and still is - beyond compare.The new edition of this classic textbook has now been extensively revised by a team of five authors, yet it follows the tradition of the original single-authored book. It continues to provide a comprehensive review of the cognitive, emotional and behavioural consequences of cerebral disorders and their manifestations in clinical practice. Enabling clinicians to formulate incisive diagnoses and appropriate treatment strategies, "Lishman's Organic Psychiatry" is an invaluable source of information for practising psychiatrists, neurologists and trainees.This new edition: covers recent theoretical and clinical developments, with expanded sections on neuropsychology and neuroimagingincludes a new chapter on sleep disorders whilst the chapters on Alzheimer's disease and related dementias, Epilepsy, Movement disorders and Traumatic brain injury have been extensively revised reflecting the greatly improved understanding of their underlying pathophysiologiesshowcases the huge advances in brain imaging and important discoveries in the fields of molecular biology and molecular geneticshas been enhanced with the inclusion of more tables and illustrations to aid clinical assessmentincorporates important diagnostic tools such as magnetic resonance brain images.

Widespread alterations in white matter integrity are evident in major depressive disorder. These abnormalities are heightened with increasing severity of depressive symptoms. - General Psychiatry News

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via Medicine JournalFeeds » Psychiatry by admin on 5/12/12
White matter abnormalities and illness severity in major depressive disorder.
Br J Psychiatry. 2012 May 10;
Authors: Cole J, Chaddock CA, Farmer AE, Aitchison KJ, Simmons A, McGuffin P, Fu CH
Abstract

BACKGROUND: White matter abnormalities have been implicated in the aetiology of major depressive disorder; however, the relationship between the severity of symptoms and white matter integrity is currently unclear. AIMS: To investigate white matter integrity in people with major depression and healthy controls, and to assess its relationship with depressive symptom severity. METHOD: Diffusion tensor imaging data were acquired from 66 patients with recurrent major depression and a control group of 66 healthy individuals matched for age, gender and IQ score, and analysed with tract-based spatial statistics. The relationship between white matter integrity and severity of depression as measured by the Beck Depression Inventory was examined. RESULTS: Depressive illness was associated with widespread regions of decreased white matter integrity, including regions in the corpus callosum, superior longitudinal fasciculus and anterior corona radiata, compared with the control group. Increasing symptom severity was negatively correlated with white matter integrity, predominantly in the corpus callosum. CONCLUSIONS: Widespread alterations in white matter integrity are evident in major depressive disorder. These abnormalities are heightened with increasing severity of depressive symptoms.
PMID: 22576724 [PubMed - as supplied by publisher]

Friday, May 11, 2012

And the rest is history – a three year long debate ensued, often contentious, about the whole process - 1 Boring Old Man » quite a week…

1 Boring Old Man » quite a week…

1 Boring Old Man
quite a week…

Posted on Thursday 10 May 2012

    He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all…
    Sir William Osler
In March, I looked into the story of how the authors of the DSM-III, DSM-IIIR, and DSM-IV [Robert Spitzer and Allen Frances] came to be at odds with the current DSM-5 Directors [David Kupfer and Darrel Regier][see dangerous men…]. It started in April 2007 when Dr. Spitzer asked to look at the minutes of the DSM-5 Task, and after a nine month delay was turned down, citing reasons of confidentiality. Finally, in June 2008, after an article in which the outgoing APA president praised the openness of the DSM-5 group, Spitzer unloaded in an article in the Psychiatric Times. In a subsequent series of articles, Spitzer continued to attack the secrecy of the DSM-5 Task Force. He asked Allen Frances to join him but Frances declined, though he agreed with the complaint. But then in May, 2009, after hearing about the Psychosis Risk Syndrome at a party at the APA meeting in San Francisco, Allen Frances weighed in with an article of his own in the Psychiatric Times which contained these prophetic paragraphs:
A Warning Sign on the Road to DSM-V:
Beware of Its Unintended Consequences 
Psychiatric Times

By Allen Frances
June 26, 2009

The DSM-V goal to effect a “paradigm shift” in psychiatric diagnosis is absurdly premature. Simply stated, descriptive psychiatric diagnosis does not now need and cannot support a paradigm shift. There can be no dramatic improvements in psychiatric diagnosis until we make a fundamental leap in our understanding of what causes mental disorders.


The incredible recent advances in neuroscience, molecular biology, and brain imaging that have taught us so much about normal brain functioning are still not relevant to the clinical practicalities of everyday psychiatric diagnosis. The clearest evidence supporting this disappointing fact is that not even 1 biological test is ready for inclusion in the criteria sets for DSM-V. Fortunately, the NIMH is now embarked on a fascinating effort to effect the real paradigm shift of basing diagnosis on biological findings. Unfortunately, this is years [if not decades] from fruition… So long as psychiatric diagnosis is stuck at its current descriptive level, there is little to be gained and much to be lost in frequently and arbitrarily changing the system. Descriptive diagnosis should remain fairly stable until, disorder by disorder, we gradually attain a more fundamental and explanatory understanding of causality…
Indeed, there has been only 1 paradigm shift in psychiatric diagnosis in the past 100 years—the DSM-III introduction in 1980 of operational criteria sets and the multiaxial system. With these methodological advances, DSM-III rescued psychiatric diagnosis from unreliability and the oblivion of irrelevancy. In the subsequent evolution of descriptive diagnosis, DSM-III-R and DSM-IV were really no more than footnotes to DSM-III and, at best, DSM-V could only hope to join them in making a modest contribution. Descriptive diagnosis is simply not equipped to carry us much further than it already has. The real paradigm shift will require an increase in our knowledge—not just a “rearrangement of the furniture” of the various descriptive possibilities…
I think of the APA response to Dr. Frances’ article as a nasty-gram written by Dr. Alan Schatzberg, then President of the APA [under investigation at the time by the U.S. Senate for financial impropriety]. It did say that the DSM-III and DSM-IV were outdated and hadn’t kept up with current thinking and the advances of science, but then they accused Drs. Spitzer and Frances of having financial motives behind their complaints:
Setting the Record Straight:
A Response to Frances Commentary on DSM-V
Psychiatric Times
By Alan F. Schatzberg, MD, James H. Scully Jr, MD, David J. Kupfer, MD, Darrel A. Regier, MD, MPH
July 1, 2009

The DSM-III categorical diagnoses with operational criteria were a major advance for our field, but they are now holding us back because the system has not kept up with current thinking. Clinicians complain that the current DSM-IV system poorly reflects the clinical realities of their patients. Researchers are skeptical that the existing DSM categories represent a valid basis for scientific investigations, and accumulating evidence supports this skepticism. Science has advanced, treatments have advanced, and clinical practice has advanced since Dr. Frances’ work on DSM-IV. The DSM will become irrelevant if it does not change to reflect these advances…
Dr. Spitzer responded, continuing his theme of the dangers of the DSM-5 Task Force’s policy of secrecy:
APA and DSM-V:
Empty Promises
Psychiatric Times
By Robert L. Spitzer, MD
July 2, 2009

The debate over DSM-V has unfortunately taken an ugly turn with the APA leadership suggesting that Dr. Frances’s and my motivation for critiquing DSM-V is financial. People familiar with this controversy might recall that it all began when I asked Darrel Regier if I could look at the minutes of DSM-V Task Force meetings so that I could keep up with the ongoing process. He explained that he could not do this because of confidentiality agreements that all DSM-V participants have been required to sign. Because of my strong belief that DSM has been and should always be a completely open process, I started my effort to get APA to change its ways. Read Dr Frances’ commentary on DSM-V and the APA’s response For brevity’s sake, I will limit my comments regarding APA’s response to Dr Frances’ commentary to the core issue of transparency. APA continues to maintain the empty rhetoric that the DSM-V process is the “most open and inclusive ever”…
And the rest is history – a three year long debate ensued, often contentious, about the whole process. Those three articles were all published in one week in the month following the APA Annual Meeting in San Francisco. That was quite a week! Here are a few good references about the ongoing story


[A Moment of Crisis in the History of American Psychiatry, Inside the Battle to Define Mental Illness, DSM-V: Getting Closer to Pathologizing Everyone?].


In the three years since that week in 2009, a lot has happened. It’s no longer a rhetorical conflict that involves a handful of psychiatrists – it involves the entire specialty of psychiatry, the other mental health professions, the psychopharmaceutical industry, the clinical research industries, the medical reimbursement industry, and help seeking patients far and wide. Of course, Drs. Spitzer, Frances, and Kupfer didn’t cause the conflict any more than the Archduke Francis Ferdinand and his Assassin caused World War I. Their differences were just a focal point for something much bigger than all of them. But as is the case in such situations, the something-much-bigger tends to get submerged in the bluster that follows.
Dr. Spitzer got mad first, and the thing that made him mad was the secrecy [and the process] of the DSM-5 Task Force. Dr. Frances agreed with him about the secrecy, and didn’t care much for the process either, but he stayed out of the fray until he heard the kind of thing the DSM-5 Task Force was thinking about adding eg the Psychosis Risk Syndrome. That played into his own concerns about medicating kids. Then he got mad too and spoke out. Why was that the last straw for him? Speaking of last straws, why did I get so noisy around that same time myself? I wasn’t in these guys league, having been an early casualty in this same DSM-III Revolution – not really on the other side but close enough for government work. I was five or six years retired, thinking little about psychiatry. But in the summer of 2009, two things happened. I started seeing patients as a volunteer and did a review of psychopharmacology as part of that. And I continued to read about Senator Grassley’s investigation into psychiatrists in high places who were crooks – one of whom was the Chairman of a Department I’m still a part of. I’d lived with the dramatic changes in psychiatry after leaving academia and adapted. I’d had a fine career, though it felt a bit like being in exile.
I know what made me so angry. I found out what Dr. Frances and Spitzer couldn’t possibly not have also known – that all was not as it appeared. Corruption was prevalent in our ranks, our literature, and our treatment recommendations to patients. I’m guessing that’s a part of why the secrecy bothered Dr. Spitzer and the Psychosis Risk Syndrome bothered Dr. Frances, among the other things they knew about because they’d been DSMers. They knew that the current directions in psychiatry had opened to door for rampant corruption and they were both aware of a coming crisis [the one we're in right now]. Did Drs. Kupfer and Regier know too? Were they part of the problem? They would’ve had to put cotton in their ears and wear dark glasses not to know.


For one thing, corruption and secrecy are virtually synonyms.





At last, I reach the point of this post. Dr. Frances says above in his opening salvo, "descriptive psychiatric diagnosis does not now need and cannot support a paradigm shift." That’s in the center of this in my mind. While the DSM-III Revolution was, on the surface, a move to make psychiatric diagnosis more scientific and more reliable, it was also driven to exorcise unproven ideology from the diagnostic system and psychiatry at large – at that time specifically psychoanalysis. And that’s what happened. And then…
Psychiatry Should Stay Comfortable In Its Own Skin
No Good Comes From Overselling Our Science Base
DSM-5 in Distress : Psychology Today
by Allen J. Frances, M.D.
June 2, 2011

But there is one source of great and continuing frustration in our field. We are in the midst of a neuroscience revolution that has provided a miraculous and tantalizing window into normal brain functioning. But the vast accumulation of basic science knowledge revealing the mechanisms of normal brain functioning has shed relatively little light on the far greater complexity of what causes psychopathology. As a result, the neuroscience revolution has so far had almost no impact on how we diagnose and treat our patients. The inherent difficulty in translating from basic to clinical science guarantees that we will make only slow progress in unraveling the multitudinous heterogeneity of brain malfunctions that cause mental illness.

DSM 5 initially got into trouble because it was ambitious to jump-start a "paradigm shift" in psychiatry – well before there was sufficient scientific knowledge to make this possible.


We would not have been burdened by all the dangerous DSM 5 suggestions for unproven diagnoses if its workgroups had not been given the green light to be recklessly creative in promoting their pet innovations… Psychiatry does itself no good when we oversell ourselves…
Psychiatry should live comfortably within its own skin, not make excessive claims. We are largely successful at doing what we do best in our current clinical work. We are eager to advance and incorporate the ever advancing scientific understanding of mental disorders and how best to treat them. But [except for Alzheimer's], psychiatry is likely decades away from anything resembling a paradigm shift. It’s always best to modestly under-promise and then strive to over deliver. The sad tale of DSM 5 is a succession of overblown promises and then disappointing and potentially dangerous under performance. Psychiatry should work hard at what we do well – without reaching beyond our current grasp or raising expectations we can’t possibly fulfill
It’s unquestioned that down some road at some future time, biological causes or factors are going to be part of the mental illness nosology. It’s equally unquestioned that one identical twin can be the picture of mental health and the be other be as sick as a goat – that some mental illnesses of significance can comes from biography. The conundrum is that neither of those things should matter in the diagnostic system of psychiatry as it was conceived by Dr. Spitzer et al in 1980. In his system, causes or mechanisms only counted if they were known ["except for Alzheimer's"]. After sixteen years of Neurosis, Freud’s mental mechanisms had to go the way of Reich’s Orgone Box [a disillusionment from Spitzer's youth]. The DSM-5 Task Force had missed a very large point, as had many others. They mistook a failing of Robert Spitzer’s DSM-III Revolution for its essence – a failing so common in revolutions that it ought to be part of the definition. What was good about Spitzer’s direction was to aim for descriptive categories that were reliably grounded in observable phenomena – kappa was king. What was unfortunate was that, like most revolutions, there was another agenda. The old ways had to be ferreted out and exiled – expectable, but it lead to trouble.
The soft spot of the DSM-III was nowhere more evident than in the creation of the category of Major Depressive Disorder. It was in the area of depression that both the psychologically minded and the biologically oriented had made the most progress. In certain depressions, there was a statistically valid marker [not digital as everyone wished - but evidence nonetheless] and somewhat robust treatments [also not digital as everyone wished]. In the biopsychosocial realm, the relationship of some depressions was well understood in relationship to attachment and loss, and the mental mechanisms of some depressions as well as pathological grief had achieved a level of fairly clear clinical usefulness. All of those things hinged on the careful clinical discrimination of the depressions – aka diagnosis. In his zeal to make sure that his DSM-III was free of the problems of the past, Spitzer’s Major Depressive Disorder blunted the very real possibilities of the kind of advances psychiatry actually longs for. The Czar had to be killed and the Red Guard had to re-educate the "Roaders." Any fractionation of depressive diagnosis might have opened the door to Neurosis. So the successes of the past, at the time in their infancy, went the way of the bath water – Depressive Neuroses and Melancholia alike – both descriptively definable. If he didn’t like the names, he could’ve changed them. And not-psychological became biological in the minds of many, who then flourished. That should have been expected and happened relatively quickly.
The stated goal of this DSM-5 Task Force was to insert yet another unproven ideology into the diagnostic system, and thereby reframe psychiatry [A Research Agenda for DSM-V]. I call that ideology clinical neuroscience, borrowing the term from Dr. Tom Insel, Chief of the NIMH, but you could call it neurobiology, or biological psychiatry, or brain science. Whatever you call it, it’s the belief that problems mental are brain/biology problems and that proof is just around the corner. In their prequel, the DSM-5 leaders predicted that the DSM-5 itself would be solidly grounded in biology by the time it was released, though they had to back off from that prediction recently [Neuroscience, Clinical Evidence, and the Future of Psychiatric Classification in DSM-5].

 

Like the psychoanalysts in the 1950′s and 1960′s, the neuroscientists of the DSM-5 Task Force were so sure that they saw the future clearly that they lost sight of their Task [and relied on Force instead].


Their job was to carefully improve the terrain map of the desert, correcting the errors of earlier cartographers, adding new features only where justified and well documented. Instead, they gave in to their dreams. They failed to notice along the way that their critics weren’t their old enemies, but were rather the people that put them on the map in the first place. And when the second of the former Task Force chiefs, Allen Frances, joined the first, Robert Spitzer, in trying to point out their folly, they instead allied themselves with an APA President, Alan Schatzberg, who was himself a big part of the problem.

They failed to see that some of the criticism was directed at his kind of thinking which had opened the door to run-away corruption, that instead of closing old loopholes, they were opening new ones. They ignored the advice about process, transparency, and detail, and ended up with a set of Field Trial outcomes that have us obsessing about their flawed methodology rather than gaining any clarification at all from their work product. Main line diagnoses like Schizophrenia, Major Depressive Disorder, and Generalized Anxiety Disorder with reliability well less than half the way between chance and full agreement among clinicians? Groan…

They were so busy dreaming together of their paradigm shift in cloistered workgroups, they failed to attend to the organizational necessities of such a project; they failed to listen to the wisdom of their elders; and they allied themselves with the wrongest of crowds – obvious to anyone who read the newspaper of the time. In a single week three years ago, they declined two life-lines and decided to go down with the ship.They may keep spinning their story and publish their book. Some people might even use it. But instead of their grand plan of making it more scientific, they fueled the opposite impression – and they should’ve known.

 

If there’s any lessons at all for the future, one is that nosology should ride on the trailing edge of innovation and hypothesis, looking for things that are in need of clarification and correcting previous errors rather than involving itself with the whimsey and passion of the leading edge. The other lesson is that matters diagnostic are for clinicians, not dreamers and researchers…


    but he who studies medicine without patients does not go to sea at all…

3 Comments for 'quite a week…'

  1. May 10, 2012 | 7:01 pm
    Bravo! Excellent post, Dr. Mickey.
  2. Stan
    May 11, 2012 | 10:25 am
    Found this photo rap up from APA Philly 2012…not sure if David Kupfer and Darrel Regier are being depicted here: https://twitter.com/#!/WriteWithStan/status/199565919385694209/photo/1
  3. Stan
    May 11, 2012 | 10:28 am
    don’t believe the link worked; Try #2 – https://twitter.com/#!/WriteWithStan/status/199565919385694209

Leave a comment

3:27 PM 5/11/2012 - Mike Nova's starred items: Can You Call a 9-Year-Old a Psychopath? - NYTimes

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3:27 PM 5/11/2012 - Mike Nova's starred items

via NYT > Health by By JENNIFER KAHN on 5/11/12
Psychologists now believe fledgling psychopaths can be identified as early as kindergarten. The hope is to teach these children empathy before it’s too late.



Scientific American


Guideline Revisions May Sharply Increase Addiction Diagnoses
New York Times
“The chances of getting a diagnosis are going to be much greater, and this will artificially inflate the statistics considerably,” said Thomas F. Babor, a psychiatric epidemiologist at the University of Connecticut who is an editor of the international ...
DSM-5 Field Trials Generate Mixed ResultsMedscape
The Gloom-and-Doom Disease: Should Woody Allens Have a Home in the Manual of ...Scientific American (blog)

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via psychiatry - Google News on 5/11/12


Changes to autism manual
Gainesville Sun
It will be the fifth edition of what's called the Diagnostic and Statistical Manual for Mental Disorders, or DSM, a guide book in psychiatry. The new manual will include changes to the way autism is diagnosed and will help improve treatment for those ...

and more »

via Psychiatric Times on 5/11/12
Amid all the Super Bowl-esque hoopla of this year’s annual meeting of the American Psychiatric Association was the final round of a national competition among residency programs to demonstrate superior psychiatric knowledge. The several month competition, MindGames, pitted program against program on timed multiple choice exams on a diverse range of psychiatric topics, including theory, psychopharmacology, psychotherapy, geriatrics, addictions, and forensics.

via international psychiatry - Google Blog Search by averderame on 5/11/12
It is an honor to be in Philadelphia, the city of “brotherly love”, as one voice among many in this Occupation of the American Psychiatric Association, brilliantly organized by MindFreedom International. It is an honor to be a part ...

Reports here provided what may be the last public update on DSM-5, the next edition of American psychiatry's diagnostic guide, before it is formally released in May 2013. Many changes have been made since the first draft of ...

The DSM-V goal to effect a “paradigm shift” in psychiatric diagnosis is absurdly premature. Simply stated, descriptive psychiatric diagnosis does not now need and cannot support a paradigm shift. There can be no dramatic ...

via NYT > Health by By KEVIN SACK on 5/11/12
A shift by the federal government in how it pays for drugs for dialysis patients may have had an unintended and potentially dire consequence, researchers say.


via NYT > Health by By ANDREW POLLACK on 5/11/12
Government advisers recommended that the F.D.A. approve the weight-loss drug lorcaserin.



Mike Nova's starred items


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Army to study use of 'off label' drugs to treat PTSD
Stars and Stripes
Gary Wynn, a research psychiatrist from the Center for Military Psychiatry and Neuroscience at the Walter Reed Army Institute of Research, said in the release. “Much of the current pharmacologic treatment of combat-related PTSD is off-label and, ...
Tetris: A 'vaccine' for PTSD?HLNtv.com
Army launches study of PTSD medsAirForceTimes.com
PTSD: Weakness or Wound?TIME (blog)
US Navy SEALs Blog & Information (blog)
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Psychiatrists say diagnosis manual needs overhaul
Chicago Tribune
LONDON (Reuters) - Many psychiatrists believe a new edition of a manual designed to help diagnose mental illness should be shelved for at least a year for further revisions, despite some modifications which eliminated two controversial diagnoses.
Why Are There No Biological Tests in Psychiatry?Scientific American (blog)
Panel suggests DSM-5 psychiatry manual drops two disorders, keeps new autism ...CBS News
Psychiatry Manual Drafters Back Down on DiagnosesNew York Times
Fox News
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via Behavior and Law by Mike Nova on 5/11/12
Psychiatrists say diagnosis manual needs overhaul - chicagotribune.com

Psychiatrists say diagnosis manual needs overhaul

A patient looks through a window inside the Larco Herrera psychiatric hospital in Lima
A patient looks through a window inside the Larco Herrera psychiatric hospital in Lima (ENRIQUE CASTRO-MENDIVIL, REUTERS / May 10, 2012)




Kate Kelland Reuters
1:24 p.m. CDT, May 10, 2012


LONDON (Reuters) - Many psychiatrists believe a new edition of a manual designed to help diagnose mental illness should be shelved for at least a year for further revisions, despite some modifications which eliminated two controversial diagnoses.

The new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5), a draft of which is open for public consultation this month, will be the first full revision since 1994 of the renowned handbook, which determines how to interpret symptoms in order to diagnose mental illnesses.

But more than 13,000 health professionals from around the world have already signed an open letter petition (at http://dsm5-reform.com) calling for DSM 5 to be halted and re-thought.

"Fundamentally, it remains a bad system," said Peter Kinderman, a professor of clinical psychology at Britain's Liverpool University.

"The very minor revisions...do not constitute the wholesale revision that is called for," he said in an emailed comment.

The American Psychiatric Association (APA), which produces the manual and plans to publish DSM 5 next May, said on Wednesday it had decided to drop two proposed diagnoses, for "attenuated psychosis syndrome" and "mixed anxiety depressive disorder".

The former, intended to help identify people at risk of full-blown psychosis, and the latter, which suggested a blend of anxiety and depression, had been criticized as too ill-defined.

With these and other new diagnoses such as "oppositional defiant disorder" and "apathy syndrome", experts said the draft DSM 5 could define as mentally ill millions of healthy people - ranging from shy or defiant children to grieving relatives, to people with harmless fetishes.

"SIMPLY NOT USABLE"

Robin Murray, a professor of psychiatric research at the Institute of Psychiatry at Kings College London, said it was a great relief to see the changes in the draft, particularly to the attenuated psychosis diagnosis.

"It would have done a lot of harm by diverting doctors into thinking about imagined risk of psychosis (and) it would have led to unnecessary fears among patients that they were about to go mad," he said in a statement.

But Allen Frances, emeritus professor at Duke University in the United States, said it was "only a first small step toward desperately needed DSM 5 reform".

"Numerous dangerous suggestions remain, Frances, who chaired a committee overseeing the DSM 4, said, adding that DSM 5 "is simply not usable" and should be delayed for an extra year "to allow for independent review, to clean up its obscure writing, and for retesting".

Diagnosis is always controversial in psychiatry, since it defines how patients will be treated based on a cluster of symptoms, many of which occur in several different types of mental illness.

Peter Jones, a professor of psychiatry at Cambridge University, said DSM 5 should be "underpinned by science" built on an understanding of the biology and functions of the brain and mind - something he said neuroscience was not yet able to do comprehensively enough.


"On this basis DSM 5 is, at best, premature and a waste of time," he said.

Some argue that the whole approach needs to be changed to pay more attention to individual circumstances rather than slotting them into predefined categories.

Lucy Johnstone, a consultant clinical psychologist for the Cwm Taf Health Board in Wales agreed: "(The DSM)is wrong in principle, based as it is on redefining a whole range of understandable reactions to life circumstances as 'illnesses', which then become a target for toxic medications heavily promoted by the pharmaceutical industry," she said.

"The DSM project cannot be justified, in principle or in practice. It must be abandoned so that we can find more humane and effective ways of responding to mental distress."

One of the proposed changes that has survived in the draft DSM 5 - despite fierce public outcry - is in autism. The new edition eliminates the milder diagnosis of Asperger syndrome in favor of the umbrella diagnosis of autism spectrum disorder.

(Editing by Myra MacDonald)
Copyright © 2012, Reuters
sns-rt-us-psychiatry-dsmbre8490wq-20120510
____________________________________________________________________

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Psychiatrists say diagnosis manual needs overhaul

Ottawa Citizen - ‎13 seconds ago‎
By Kate Kelland, Reuters May 11, 2012 9:13 AM Experts say the draft DSM 5 could define as mentally ill millions of healthy people - ranging from shy or defiant children to grieving relatives, to people with harmless fetishes.

Reuters Health News Summary

Chicago Tribune - ‎1 hour ago‎
Following is a summary of current health news briefs. Psychiatrists say diagnosis manual needs overhaul LONDON (Reuters) - Many psychiatrists believe a new edition of a manual designed to help diagnose mental illness should be shelved for at least a ...

Battle looms in psychiatry world over controversial manual update

Montreal Gazette - ‎4 hours ago‎
'Numerous dangerous suggestions remain'despite revisions LONDON – Many psychiatrists believe a new edition of a manual designed to help diagnose mental illness should be shelved for at least a year for further revisions, despite some modifications ...

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    Psychiatrists say diagnosis manual needs overhaul
    Montreal Gazette
    Many psychiatrists believe a new edition of a manual designed to help diagnose mental illness should be shelved for at least a year for further revisions, despite some modifications which eliminated two controversial diagnoses.
    Why Are There No Biological Tests in Psychiatry?Scientific American (blog)
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    Alzheimer's research fraud case set for trial
    Chicago Tribune
    The lawsuit accuses Marilyn Albert, a former professor of psychiatry at Harvard Medical School, and Massachusetts General Hospital (MGH), where she was conducting research, of submitting a grant application based on manipulated data.

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    Alzheimer's research fraud case set for trial
    Chicago Tribune
    The lawsuit accuses Marilyn Albert, a former professor of psychiatry at Harvard Medical School, and Massachusetts General Hospital (MGH), where she was conducting research, of submitting a grant application based on manipulated data.

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    Alzheimer's research fraud case set for trial - chicagotribune.com

    www.chicagotribune.com/news/sns-rt-us-science-fraudbre8491n5-20120510,0,2693773.story

    chicagotribune.com

    Alzheimer's research fraud case set for trial


    Toni Clarke

    Reuters

    6:34 PM CDT, May 10, 2012


    BOSTON (Reuters) - Two Harvard teaching hospitals and a prominent Alzheimer's disease researcher accused of using falsified data to obtain a government research grant are set to stand trial after a federal appeals court said this week that a lower court erred when it dismissed the case.

    The lawsuit accuses Marilyn Albert, a former professor of psychiatry at Harvard Medical School, and Massachusetts General Hospital (MGH), where she was conducting research, of submitting a grant application based on manipulated data.


    The data showed results from a trial were scientifically significant when in fact they were not, according to the lawsuit.

    Brigham and Women's Hospital, which collaborated on the research, is also a defendant in the case. The lawsuit was brought in 2006 under the False Claims Act, a 150-year-old federal law designed to recover government funds appropriated through fraud.

    This is the first time a lawsuit dealing with alleged scientific fraud has been allowed to progress to trial under the False Claims Act, according to Michael Kohn, a lawyer with Kohn, Kohn & Colapinto in Washington, D.C.

    Kohn represents the whistle-blower in the case, Kenneth Jones, a former statistician at Massachusetts General Hospital, who filed suit in 2006 claiming the defendants violated the act by including false statements in a $15 million grant application to the National Institutes of Health (NIH).

    The case was dismissed in the lower court three days before it was due to go to trial. Barring settlement, a new trial could begin later this year in U.S. District Court in Boston, Kohn said.

    If the defendants are found guilty, they could pay as much as $45 million to the U.S. government. By law, whistle-blowers in such cases receive 15 percent to 30 percent of funds recovered.

    Albert, who is now director of the Division of Cognitive Neuroscience at Johns Hopkins University School of Medicine, declined to comment except to say in an email: "I am confident that there was no misconduct involved."

    Both hospitals said they are confident the researchers acted appropriately and according to the highest standards of scientific integrity.

    "While it is disappointing that additional time and resources will have to be devoted to defending the institution and its investigators, the MGH remains confident that the resolution of the case will show that the allegations are without merit," Massachusetts General said in a statement.

    Brigham and Women's responded with an identical statement.

    INFLUENTIAL RESEARCH

    Albert's research was part of an ongoing investigation into the structure of the brain as it progresses toward Alzheimer's disease. She specifically hoped to show that it might be possible to predict, years in advance, who might be destined to develop the disease, based on measurements taken over time of certain regions of the brain.

    The results of the trial were published in the scientific journal Annals of Neurology in April 2000 and, according to Jones, proved extremely influential.


    "The data appeared to confirm what had been suspected by some very prominent scientists, which is that Alzheimer's disease is associated with decreased blood flow to the brain," Jones said in an interview on Thursday. "The MRIs showed the volume of certain parts of the brain was decreasing in the people who were sick."

    There are multiple theories about the cause of Alzheimer's disease.

    In March 2001, Jones discovered what he believed to be anomalies in the research, specifically in data produced by one of the researchers, Ronald Killiany. The lawsuit alleges that Killiany revised his initial MRI measurements to prove the hypothesis of the trial.


    Killiany, now an associate professor at Boston University School of Medicine, did not return a phone call or email seeking comment. Kohn said he was not named as a defendant. In retrospect, Kohn said, "He probably should have been."


    Jones took his concerns to Albert, who authorized an investigation into the matter by Killiany's boss, Mark Moss. She declined to appoint an independent investigator, as requested by Jones, according to the lawsuit.


    Moss concluded that Killiany's second set of measurements was more accurate than the initial set. Albert accepted Moss's conclusion and proceeded to apply for an NIH grant in November 2001, according to the lawsuit.


    The defense argued before the appeals court that it would not have been unusual or inappropriate for Killiany to re-measure patient brain scans as long as he remained blind to the clinical status of the participants, and that this was a matter for scientific debate.


    This argument was accepted when the case was initially heard by the lower court in the United States District Court for the District of Massachusetts. On that basis, it dismissed the case in October 2010. Kohn said

    the court ruled that scientific fraud could not be brought under the False Claims Act, since the case related to a scientific dispute, not fraud.


    The appeals court, however, rejected the argument, saying, "We disagree that the creation of the data in question was necessarily a matter of scientific judgment."



    The court noted that the lower court's determination "misses the point that the various results produced in this case were obtained by one scientist purportedly using the same protocol."


    The government's Office of Research Integrity declined to say whether it is investigating the case.

    Jones said he hopes the trial will shed light on the issue of scientific misconduct.

    "My interest is in correcting the science and bringing this academic cheating to light," he said, "and maybe sending a message saying, 'You're being watched, and you shouldn't do it.'"

    The case is: U.S. ex rel. Jones v. Brigham and Women's Hospital, et al, 1st U.S. Circuit Court of Appeals, No: 10-2301.

    (Editing by Michele Gershberg and Douglas Royalty)
    Copyright © 2012, Reuters

    Public Disturbance at Mass Killer Trial in Norway - YouTube

    Public Disturbance at Mass Killer Trial in Norway - YouTube


    Published on May 11, 2012 by
    The trial of Norwegian mass killer Anders Breivik was stopped today. After a man identified as the older brother of one of the victims, threw a shoe at him, during his trial on Friday.

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    Norway's mass killer Anders Breivik speaks at start of trial - YouTube

    Norway's mass killer Anders Breivik speaks at start of trial - YouTube


    Published on Apr 16, 2012 by
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