Wednesday, May 9, 2012

Noam Chomsky on Cannabis « Talesfromthelou's Blog

Noam Chomsky on Cannabis « Talesfromthelou's Blog

According to the Arts and Humanities Citation Index in 1992, Chomsky was cited as a source more often than any other living scholar during the 1980–92 period, and was the eighth most-cited source.[13][14][15]
He has opposed the U.S. global “war on drugs” numerous times. For example:
The War on Drugs is a controversial prohibition campaign undertaken by the United States government with the assistance of participating countries, intended to reduce the illegal drug trade, to curb supply and diminish demand for specific psychoactive substances deemed immoral, harmful, dangerous, or undesirable….
“, claiming its language to be misleading, and referring to it as “the war on certain drugs.” He favors education and prevention rather than military or police action as a means of reducing drug use. In an interview in 1999, Chomsky argued that, whereas crops such as tobacco receive no mention in governmental exposition, other non-profitable crops, such as marijuana, are specifically targeted due to the effect achieved by persecuting the poor
“US domestic drug policy does not carry out its stated goals, and policymakers are well aware of that. If it isn’t about reducing substance abuse, what is it about? It is reasonably clear, both from current actions and the historical record, that substances tend to be criminalized when they are associated with the so-called dangerous classes, that the criminalization of certain substances is a technique of social control.

Myanmar's grim, unfinished reform: Hundreds of political inmates languish in ... - Washington Post - Prison Psychiatry News

Google Reader - Prison Psychiatry News

via prisons - Google News on 5/9/12
Myanmar's grim, unfinished reform: Hundreds of political inmates languish in ...
Washington Post
YANGON, Myanmar — In a remote prison in northwest Myanmar, Aye Aung wakes up each day as he has for nearly 14 years — alone in a dark cell on a wooden plank, a prisoner of conscience all but forgotten by the world. For hours, the former student ...

and more »

Pubmed: forensic psychiatry: The Antisocial Brain: Psychopathy Matters: A Structural MRI Investigation of Antisocial Male Violent Offenders: Offenders with ASPD+P displayed significantly reduced GM volumes bilaterally... within areas implicated in empathic processing, moral reasoning, and processing of prosocial emotions such as guilt and embarrassment... psychopathy represents a distinct phenotype. | Juvenile and Adult Offenders Arrested for Sexual Homicide: An Analysis of Victim-Offender Relationship and Weapon Used by Race* - Behavior and Law

Behavior and Law

Pubmed: forensic psychiatry

Arch Gen Psychiatry. 2012 May 7. [Epub ahead of print]

The Antisocial Brain: Psychopathy Matters: A Structural MRI Investigation of Antisocial Male Violent Offenders.


Hodgins, and Blackwood), Clinical Neuroscience (Dr ffytche), Neuroimaging (Drs Simmons and Howard), and Psychology (Dr Kumari), Institute of Psychiatry, King's College London, and The North London Forensic Service (Dr Blackwood), London, England; and Département de Psychiatrie, Université de Montréal, Montréal, Canada (Dr Hodgins).



The population of men who display persistent antisocial and violent behavior is heterogeneous. Callous-unemotional traits in childhood and psychopathic traits in adulthood characterize a distinct subgroup.


To identify structural gray matter (GM) differences between persistent violent offenders who meet criteria for antisocial personality disorder and the syndrome of psychopathy (ASPD+P) and those meeting criteria only for ASPD (ASPD-P).


Cross-sectional case-control structural magnetic resonance imaging study.


Inner-city probation services and neuroimaging research unit in London, England.


Sixty-six men, including 17 violent offenders with ASPD+P, 27 violent offenders with ASPD-P, and 22 healthy nonoffenders participated in the study. Forensic clinicians assessed participants using the Structured Clinical Interview for DSM-IV and the Psychopathy Checklist-Revised.


Gray matter volumes as assessed by structural magnetic resonance imaging and volumetric voxel-based morphometry analyses.


Offenders with ASPD+P displayed significantly reduced GM volumes bilaterally in the anterior rostral prefrontal cortex (Brodmann area 10) and temporal poles (Brodmann area 20/38) relative to offenders with ASPD-P and nonoffenders. These reductions were not attributable to substance use disorders. Offenders with ASPD-P exhibited GM volumes similar to the nonoffenders.


Reduced GM volume within areas implicated in empathic processing, moral reasoning, and processing of prosocial emotions such as guilt and embarrassment may contribute to the profound abnormalities of social behavior observed in psychopathy. Evidence of robust structural brain differences between persistently violent men with and without psychopathy adds to the evidence that psychopathy represents a distinct phenotype. This knowledge may facilitate research into the etiology of persistent violent behavior.
[PubMed - as supplied by publisher]


J Forensic Sci. 2012 May 4. doi: 10.1111/j.1556-4029.2012.02188.x. [Epub ahead of print]

Juvenile and Adult Offenders Arrested for Sexual Homicide: An Analysis of Victim-Offender Relationship and Weapon Used by Race*


Department of Criminology, University of South Florida, 4202 East Fowler Avenue SOC 107, Tampa, FL. Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam Road, Hong Kong, SAR. Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI. Forensic Psychiatry Program, Rhode Island Hospital, Coro Center West, Suite 2.030, One Hoppin Street, Providence, RI.


Limited information is available on racial offending patterns of sexual homicide offenders (SHOs). This study used a 30-year U.S. Supplementary Homicide Reports sample of SHOs arrested in single-victim situations (N = 3745). The analysis strength was used to determine whether the findings yielded meaningful patterns for offender profiling. Several important findings emerged for the juvenile offenders. Juvenile White SHOs were likely to target victims with whom they shared a mutual relationship. In contrast, Black juveniles were equally likely to murder strangers and those with whom they had prior and familial relationships. Notably, no juvenile Black SHOs were arrested for murdering intimate partners. Juvenile White SHOs were twice as likely to use edged weapons as their Black counterparts. Black juveniles, conversely, were more likely than White juveniles to use personal weapons. Beyond these findings, known victim-offender relationships and weapon used may not have significant utility for investigators in identifying the SHO race, even after controlling for offender age. Limitations and future directions are discussed.
© 2012 American Academy of Forensic Sciences.
[PubMed - as supplied by publisher]

Related citations in PubMed

  • [Behav Sci Law. 2012]

Behav Sci Law. 2012 Mar;30(2):90-102. doi: 10.1002/bsl.2000. Epub 2012 Mar 23.

Juvenile homosexual homicide.


Department of Criminology, University of South Florida, Tampa, FL, USA.


Limited information exists on juvenile homosexual homicide (JHH), that is, youths who perpetrate sexual homicides against same-sex victims. Only a handful of cases from the United States and internationally have been described in the literature. This study, the first of its kind, examines the epidemiology, victimology, victim-offender relationship, and weapon-use patterns in JHH offenders using a large U.S. database on homicide spanning three decades. The data for this study were derived from the Federal Bureau of Investigation's Supplementary Homicide Reports (SHRs) for the years 1976 through 2005. A total of 93 cases of JHH were identified. On average, three of these crimes occurred annually in the U.S., and there was a marked decline in its incidence over the study period. Ninety-five percent were male offender-male victim cases and 5% were female offender-female victim cases. JHH offenders were over-represented amongst all juvenile sexual murderers, similar to their adult counterparts. The majority of these boys were aged 16 or 17 and killed adult victims. They were significantly more likely to kill adult victims than other age groups, to be friends or acquaintances of the victims, and to use contact/edged weapons or firearms. Most offenders killed same-race victims, although Black offenders were significantly more likely than White offenders to kill interracially. A case report is provided to illustrate JHH. Further research is needed to promote our understanding of the pathogenesis, etiology, and associated risk factors for this aberrant form of murder by children. Copyright © 2012 John Wiley & Sons, Ltd.
Copyright © 2012 John Wiley & Sons, Ltd.
[PubMed - in process]
See reviews...See all...

[School shooting in statu nascendi].

via pubmed: forensic psychiatry by Knecht T on 5/9/12
[School shooting in statu nascendi].
Arch Kriminol. 2012 Jan-Feb;229(1-2):1-10
Authors: Knecht T
In the last few years, amok-like killings and especially so-called "school shootings" have received a great deal of public attention both in the Old and the New world. Meanwhile, criminal psychological research has gained a thorough insight into this dangerous development in young people. Thus, the possibility to assess the concrete threat of such a multiple killing before it is carried out has been considerably improved, as many prognostic criteria have been worked out in the meantime. The case report presented shows that it is possible to exercise a favourable influence on this critical negative trend.
PMID: 22448465 [PubMed - indexed for MEDLINE]

Female perpetrators of sexual abuse of minors: What are the consequences for the victims? - Contemporary studies offer limited information about this issue and the consequences it has on the victims. The majority of such cases are not reported. Sometimes sexual abuse by female perpetrators is considered more acceptable than sexual abuse by males. - International Journal of Law and Psychiatry - International Journal of Law and Psychiatry - Female perpetrators of sexual abuse of minors: What are the consequences for the victims?

Female perpetrators of sexual abuse of minors: What are the consequences for the victims?

  • Christos Tsopelasa,
  • Spyridoula Tsetsoua,
  • Petros Ntounasa,
  • Athanassios Douzenisb, Corresponding author contact information, E-mail the corresponding author
  • a Psychiatric Hospital of Attica, Athens, Greece
  • b 2nd Psychiatric Dept. University of Athens, Attikon Hospital, Athens, Greece
View full text



The definition of sexual abuse changes according to the moral values and culture of each era. In the past the perpetrators of sexual abuse were perceived to be exclusively male. However, contemporary literature is placing increasing emphasis on the role of female sexual abusers. The aim of the current literature review is to focus on the consequences of sexual abuse in minors when the perpetrator is female.


A literature search of the main databases for studies was conducted. Restriction was placed on European and North American literature due to perceived culture differences.


Victims of sexual abuse by female perpetrators are usually friends or relatives of the abuser and find themselves sometimes under persuasion and psychological coercion to participate in sexual acts. The percentage of male victims is growing. There are severe and longstanding psychological consequences for the victims which are further analyzed.


Contemporary studies offer limited information about this issue and the consequences it has on the victims. The majority of such cases are not reported. Sometimes sexual abuse by female perpetrators is considered more acceptable than sexual abuse by males. Psychological interventions could be a powerful tool in reduction of female sexual abuse and its consequences on the victims.

  • Sexual offenders;
  • Female sexual offenders;
  • Victims;
  • Consequences

Psychiatric News Alert: More News From APA's 2012 Annual Meeting

Psychiatric News Alert: More News From APA's 2012 Annual Meeting

Monday, May 7, 2012

More News From APA's 2012 Annual Meeting

APA's 2012 annual meeting continues in Philadelphia. Here is more news from that meeting.

Schizophrenia Expert Proposes New Model for Understanding Psychosis - Psychiatric News Alert

Psychiatric News Alert

Schizophrenia Expert Proposes New Model for Understanding Psychosis
Psychosis may be essentially a disorder of learning and memory mediated by impaired glutamate signaling in the hippocampus, causing disruptions in synaptic encoding of memories, according to schizophrenia expert Carol Tamminga, M.D. Read more here.

APA President Calls on APA Members to ‘Protect the Heartbeat of Our Field’
APA President John Oldham, M.D., presented a stirring address to a standing-room only audience at the Opening Session of APA's annual meeting. Read more about his remarks here.

Ingredients of Successful Aging Exist Now, Says APA President-Elect
"Positive psychiatry"—a psychiatry that aims not just to reduce psychiatric symptoms but to help patients grow and flourish-is the future, said APA President-elect Dilip Jeste, M.D., at the Opening Session of APA’s annual meeting. Read more about his remarks here.

Antidepressants Do Not Increase Risk of Suicide, Says Expert
Antidepressants do "really work" and do not "cause suicide," said Anthony Rothschild, M.D., at APA's annual meeting in Philadelphia. Read more about his remarks here.

Author Discusses Treatment for Personality Disorders
In this video, Eve Caligor, M.D., discusses psychotherapy for patients for higher level personality disorders and how her work and that of her colleagues, Otto Kernberg, M.D., and John Clarkin, Ph.D., led to the writing of Handbook of Dynamic Psychotherapy for Higher Level Personality Pathology. The book can be purchased here.

Patient empowerment—who empowers whom? : The Lancet

Patient empowerment—who empowers whom? : The Lancet

Virtually all people are patients at some point in their lives. Improving a person's ability to understand and manage his or her own health and disease, negotiate with different cadres of health professionals, and navigate the complexities of health systems is crucial to achieving better health outcomes. ENOPE 2012, and the political commitment it fostered, is most welcome. However, empowerment is a process for the individual and all those who might advocate for it. Of all the challenges ahead, starting a dialogue directly with medical professionals on patient empowerment seems the critical next step.

Mentally ill female prisoners treated cruelly, inhumanly, report finds - Toronto Star - General Psychiatry News

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Toronto Star

Mentally ill female prisoners treated cruelly, inhumanly, report finds
Toronto Star
“It is shocking to see the extent of human rights abuses against women at home,” said Renu Mandhane, director of the International Human Rights Program at University of Toronto, which published the report. “I think, with the Ashley Smith story and the ...

Mentally ill female prisoners treated cruelly, inhumanly, report finds

Published On Wed May 9 2012

Ashley Smith died at the age of 19 at the Grand Valley Institution for Women in Kitchener, Ont. Correctional Investigator Howard Sapers says a host of "serious failures" at the institution set the stage for the troubled teen's death.
Ashley Smith died at the age of 19 at the Grand Valley Institution for Women in Kitchener, Ont. Correctional Investigator Howard Sapers says a host of "serious failures" at the institution set the stage for the troubled teen's death.
Handout photo
Diana ZlomislicStaff Reporter
Canada’s treatment of mentally ill female prisoners amounts to “cruel and inhuman” punishment, a new report finds.
“It is shocking to see the extent of human rights abuses against women at home,” said Renu Mandhane, director of the International Human Rights Program at University of Toronto, which published the report.
“I think, with the Ashley Smith story and the ongoing inquest, everyone assumed that no one is currently in that situation,” said Mandhane, who co-chairs the Advocacy Committee of Human Rights Watch Canada.
“The fact is there are still women imprisoned who are subject to long periods of segregation and uses of force despite their mental health status. That is quite disturbing.”

More: Read the report
Smith died at Grand Valley Institution in Kitchener in 2007 after tying a ligature around her neck — a habitual behaviour that was considered a dangerous coping mechanism to deal with prolonged periods of isolation. She was 19 and had served nearly a year in federal custody. A report by the Office of the Correctional Investigator found her mental health issues, which went unaddressed in the system, were exacerbated by 17 institutional transfers and continual segregation.

More: Ottawa endorses overhaul of mental-health services but funding still a question
Smith entered the youth justice system as a teen after throwing crabapples at a postal worker in her hometown of Moncton, N.B. Her time in custody grew with the number of institutional charges laid against her for bad behaviour.
Nearly five years after Smith’s death, Canadian prisons are still relying on segregation, force and chemical restraints to manage mentally ill inmates.

“This report confirms that what happened to (Smith) could and will happen again,” said Bonnie Brayton, national executive director of DisAbled Women’s Network Canada.
At least one in three federally sentenced women suffers from a mental health issue and nearly half have tried to harm themselves, the report states.
The Correctional Service of Canada in a brief statement Tuesday night said that “addressing the mental health needs of offenders, including women offenders, is a priority for the Correctional Service of Canada.”
In her research, Mandhane visited the Kitchener prison where Smith died to gauge how inmates there are coping today.
On the maximum security unit, she met a mentally ill, 35-year-old Aboriginal woman described as “K.J.” in the report who had been subject to extensive segregation and institutional transfers.
Accompanied by University of Toronto law students Elizabeth Bingham and Rebecca Sutton, the report’s authors, Mandhane sat down with K.J, who has spent the last 14 years in prison on what was originally a six-year sentence.
It’s not uncommon for the sentences of mentally ill inmates to balloon in custody because of additional institutional charges often brought on by disruptive behaviour.
K.J. came prepared for the interview with a list of diagnoses she has received and the medications she has been given to treat her mental illnesses.
“The list was more than a page and a half long,” Mandhane said.
K.J. said she sees a psychologist twice a week for about 10 minutes per session. The inmate said the therapist uses the time to ask questions about other women on the unit, which K.J. sees as an attempt to gather information that will be passed on to correctional staff.
“There’s no real provision for treatment,” Mandhane said.
“There’s a reliance on medication rather than therapy or treatment and when women are given access to psychologists or psychiatrists, it’s really about an assessment of risk or time in segregation, not engaging their needs.”
Kim Pate, a longtime prisoner rights advocate, said she is not surprised by the report’s findings.
Pate is executive director of the Canadian Association of Elizabeth Fry Societies, an umbrella group that supports women and girls in the justice system. Pate worked with Smith while she was incarcerated at the Grand Valley Institution for Women.
Canada, she says, needs more mental health units in hospitals rather than prisons attempting to provide mental health services, “which, I think, everybody is acknowledging now cannot be done.”
A hospital in Brockville has opened a unit for mentally ill female inmates.
Just before Christmas in 2010, the unit accepted its first and only federally sentenced woman.
Prior to her transfer, the inmate was injuring herself almost daily in segregation at the Regional Psychiatric Centre in Saskatoon, which is designated as a psychiatric hospital and prison.
“She was in confinement most of the time,” Pate said. “She was often being strapped down in the same way Ashley had been.”
Pate said staff refused to follow the psychiatry chief’s advice that the woman be released from segregation and offered support and treatment.
When the inmate was finally transferred to the Ontario hospital, her self-harming behaviour decreased dramatically.
“I think she had one incident of self-injury in about four or five months, which was unheard of,” Pate said.
She wants to see more shared service agreements between the federal prison service and provincial and territorial ministries of health.
Pate hopes prison officials and politicians will learn from this success story.
Until then, Canada’s blatant and continued violation of the rights of federally sentenced women with mental health issues has sweeping implications for civil and political rights around the world, Mandhane said.
“Canada is seen as a global leader in corrections and disability rights,” she said. “When Canada fails to show leadership, we set the bar far too low.”

Also on The Star:

Star challenges secrecy around teen’s death in jail

Psychiatry Manual Drafters Back Down on Diagnoses - New York Times - General Psychiatry News

Google Reader - General Psychiatry News

Psychiatry Manual Drafters Back Down on Diagnoses

In a rare step, doctors on a panel revising psychiatry’s influential diagnostic manual have backed away from two controversial proposals that would have expanded the number of people identified as having psychotic or depressive disorders.
Sam Hodgson for The New York Times
The current edition of the Diagnostic and Statistical Manual of Mental Disorders. The manual affects treatment, research and insurance.
The doctors dropped two diagnoses that they ultimately concluded were not supported by the evidence: “attenuated psychosis syndrome,” proposed to identify people at risk of developing psychosis, and “mixed anxiety depressive disorder,” a hybrid of the two mood problems.
They also tweaked their proposed definition of depression to allay fears that the normal sadness people experience after the loss of a loved one, a job or a marriage would not be mistaken for a mental disorder.
But the panel, appointed by the American Psychiatric Association to complete the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders, or D.S.M., did not retreat from another widely criticized proposal, to streamline the definition of autism. Predictions by some experts that the new definition will sharply reduce the number of people given a diagnosis are off base, panel members said, citing evidence from a newly completed study.
Both the study and the newly announced reversals are being debated this week at the psychiatric association’s annual meeting in Philadelphia, where dozens of sessions were devoted to the D.S.M., the standard reference for mental disorders, which drives research, treatment and insurance decisions.
Dr. David J. Kupfer, a professor of psychiatry at the University of Pittsburgh and the chairman of the task force making revisions, said the changes came in response to field trials — real-world studies testing whether newly proposed diagnoses are reliable from one psychiatrist to the next — and public commentary. The psychiatric association has posted its proposals online, inviting public reaction. More than 10,500 comments have come through the site, many of them critical.
“At long last, DSM 5 is correcting itself and has rejected its worst proposals,” said Dr. Allen Frances, a former task force chairman and professor emeritus at Duke University who has been one of the most prominent critics. “But a great deal more certainly needs to be accomplished. Most important are the elimination of other dangerous new diagnoses and the rewriting of all the many unreliable criteria sets.”
The criticism of “mixed anxiety depressive disorder” was that it would unnecessarily tag millions of moderately neurotic people with a psychiatric label. Mixed states of depression and anxiety can be severe, but the proposed hybrid had looser criteria than either depression or anxiety on its own — lowering the bar significantly for a diagnosis.
The primary concern with “attenuated psychosis syndrome” was that it would lead to unwarranted drug treatment of youngsters. The diagnosis was meant to identify people, usually young, who exhibit psychosis-like symptoms and treat them early. But 70 percent to 80 percent of people who report having weird thoughts and odd hallucinations do not ever qualify for a full-blown diagnosis — and might be treated for something they did not have.
On the manual’s site, in blogs and other public forums, advocates, therapists, scientists and people receiving services sounded off on the proposed changes. The psychiatric association made an effort to listen, Dr. Kupfer said. The site “is not just a P.R. effort,” he said. “We’re getting feedback, and it all goes to the working groups.”
The proposed definition of autism, which would eliminate related labels like Asperger’s syndrome and “pervasive developmental disorder,” came under fire in January, when researchers at Yale University presented evidence that about half of the people who currently have a diagnosis on the high end of the “autism spectrum” would no long qualify under the new definition.
At this week’s annual meeting, researchers presented data from an unpublished study of some 300 children, finding that the proposed definition would exclude very few who currently have a diagnosis of autism or a related disorder.
But meeting attendees got mixed messages on autism. In a talk on Tuesday, Dr. Susan E. Swedo, head of the panel proposing the new definition, said that many people who identify themselves as “aspes,” for Asperger’s syndrome, “don’t actually have Asperger’s disorder, much less an autism spectrum disorder.” Dr. Swedo is a researcher at the National Institute of Mental Health.
The issue is hardly settled. Findings from published studies are conflicting, but three recent analyses provide support for the Yale estimate, and more papers in the pipeline are also documenting a significant reduction in numbers of those who would qualify under the new criteria. Getting such a diagnosis is critical to obtain state-financed services for children with special needs.
“I certainly hope the D.S.M. task force is right, that the numbers won’t change much,” said Dr. Fred R. Volkmar, director of the Child Study Center at the Yale School of Medicine and senior author of the study presented in January. But if the new definition does not change who gets a diagnosis, he asked, “Why mess with it at all?”The D.S.M. panel also made an attempt to clarify the difference between normal sadness and depression, by spelling it out in a footnote added to the proposed depression definition.
The note reads, in part, “The normal and expected response to an event involving significant loss, including feelings of intense sadness, rumination about the loss, insomnia, poor appetite and weight loss, may resemble a depressive episode” but is not necessarily one.
Judging from the past year, the normal and expected response to most of these revisions will be more contentious disagreement that will most likely intensify over the coming weeks.
The psychiatric association send out reminders this week that the current — and final — period for public comment ends on June 15. The final draft of the manual is due at the printer at the end of the year and is scheduled for release in May 2013.


Psychiatry Manual Drafters Back Down on Diagnoses - New York Times

Scientific American (blog)

Psychiatry Manual Drafters Back Down on Diagnoses
New York Times
... are being debated this week at the psychiatric association's annual meeting in Philadelphia, where dozens of sessions were devoted to the DSM, the standard reference for mental disorders, which drives research, treatment and insurance decisions.
Newsflash from APA Meeting: DSM-5 Has Flunked Its Reliability TestsHuffington Post (blog)
Science Remains a Stranger to Psychiatry's New BibleScientific American (blog)
Most DSM-5 Revisions Pass Field TrialsMedPage Today
Washington Post -Gawker
all 20 news articles »


Science Remains a Stranger to Psychiatry's New BibleScientific American (blog)

The scoop on how we think, feel and act
Streams of Consciousness HomeAboutContact

Science Remains a Stranger to Psychiatry’s New Bible

By Ferris Jabr*
Part 2 of a series
In the offices of psychiatrists and psychologists across the country you can find a rather hefty tome called the Diagnostic and Statistical Manual for Mental Disorders (DSM).
The current edition of the DSM, the DSM-IV, is something like a field guide to mental disorders: the book pairs each illness with a checklist of symptoms, just as a naturalist’s guide describes the distinctive physical features of different birds. These lists of symptoms, known as diagnostic criteria, help psychiatrists choose a disorder that most closely matches what they observe in their patients. Every few decades, the American Psychiatric Association (APA) revises the diagnostic criteria and publishes a brand new version of the DSM. The idea is to make the criteria more accurate, drawing on what psychologists and psychiatrists have learned about mental illness since the manual’s last update.


The fat volume on top is still skinny on the science. Courtesy of Ferris Jabr.
In May 2013, the APA plans to publish the fifth and newest edition of the DSM, which it has been preparing for more than 11 years. On its DSM-5 Development website, the APA states that the motivation for the ongoing revisions was an agreement to “expand the scientific basis for psychiatric diagnosis and classification.” The website further states that “over the past two decades, there has been a wealth of new information in neurology, genetics and the behavioral sciences that dramatically expands our understanding of mental illness.”
In other words, the APA intended to make the DSM-5 the most scientific edition of its reference guide yet, which would be a real boon for a book that has been routinely lambasted as fiction borne out of convenience, rather than a solid clinical text grounded in research. Now, only one year away from the planned publication of the DSM-5, most psychiatrists have accepted that the APA’s initial optimism about informing revisions with cutting edge science is well intentioned, but premature. Most of the proposed revisions to current DSM criteria—many of which are genuine improvements—are based not on insights from genetics and neuroscience, but rather on clinical experience, prevalence studies and plain old common sense. Indeed, many of these changes could have been made years ago. (For more on these changes, see “Psychiatry’s ‘Bible’ Gets an Overhaul,” by Ferris Jabr, Scientific American Mind, May/June 2012.)
Cutting and Collapsing Categories
Consider, for example, that the DSM-IV organizes schizophrenia into six types, all of which the APA proposes eliminating from the DSM-5. Why? Because these archaic subcategories were never grounded in empirical research in the first place; they were just what sounded good to the DSM authors of yore. In truth, these ostensible types of schizophrenia probably do not exist. Similarly, the APA is nixing three of the 10 current personality disorders, essentially acknowledging that these were never legitimate illnesses in the first place. So many people fit the criteria for more than one personality disorder simultaneously that 10 varieties become superfluous.
Likewise, the DSM-5 collapses four of the five current pervasive developmental disorders—including autistic disorder and Asperger’s—into a single category called autism spectrum disorders, because there is so much overlap in their respective criteria. None of these revisions are founded on recent revelations from genetics and neuroimaging research. Study after study has failed to discover a set of genes or unusual brain structures that reliably identifies major mental disorders. Rather, these are changes that many psychiatrists have been advocating for the past two decades based on their everyday clinical experience, studies of illness prevalence and the sense that some of the current criteria do not make sense. Despite awareness of these flaws, the APA did not get around to updating the DSM until now, the first substantial revision in 30 years.
One exception to the APA’s disappointed ambitions to base the ongoing revisions on neuroscience are the proposed changes to addictions. Scientists understand quite a bit about how the addicted brain differs from a typical brain. The APA has proposed adding gambling disorder to the DSM-5, in part because reward circuits in the brains of gambling addicts light up in the same way as those in alcoholics and drug addicts. Still, some researchers worry that the DSM will end up sanctioning addictions to everything—gambling, sex, the Internet—shifting focus to what people are addicted to from why addictions form in the first place.
Flaws in the Process
cube decorated with words of despair plus pills
Easing the pain of mental illness requires labeling it. Courtesy of breahn via Flickr.
All the proposed revisions to the DSM-5 emerge from the task force: 27 scientists affiliated with the APA who sort through all the relevant research literature. In the past, many psychiatrists have criticized the APA for not creating an independent review committee to examine this literature—a group of scientists who are not obligated to appease the APA.
In January of this year, David Elkins, president of the Society for Humanistic Psychology, authored an open letter to the APA calling for such independent review: “As you know, it is common practice for scientists and scholars to submit their work to others for independent review…Will you submit the controversial proposals in DSM-5 to an independent group of scientists and scholars with no ties to the DSM-5 Task Force or the American Psychiatric Association for an independent, external review?” [Emphasis theirs]
In a letter of its own, the APA responded: “There is, in fact, no outside organization that has the capacity to replicate the range of expertise that DSM-5 has assembled over the past decade to review diagnostic criteria.”
Recently, the APA has mentioned here and there that it has in fact created such a “scientific review committee,” separate from the task force, but you will not find any satisfactory description of it or its responsibilities on the DSM-5 Development website. Darrel Regier, vice-chair of the Task Force, explained that the committee includes about six scientists selected by the board of trustees, because “there is no way you can have truly independent review,” and declined to say more. Allen Frances, chair of the DSM-IV Task Force and the most outspoken critic of the DSM-5, says that the APA only created this group at the last minute in response to criticisms. “The scientific review committee is not even transparent,” Frances says. “They report confidentially to APA.”
Frances and other critics have pointed to a related flaw in the ongoing revisions. Every time the APA revises the DSM, it conducts “field trials” of new diagnostic criteria. These are dry runs of the proposed revisions in clinical settings that test their reliability—that is, whether two different psychiatrists using the new criteria reach the same conclusion about a given patient.
Since 2010, the APA has been conducting field trials for the proposed DSM-5 diagnostic criteria. (For more on the results of the field trials, click here.) Critics contend—and Regier confirms—that the trials fail to explicitly compare the criteria suggested for the DSM-5 to that in the DSM-IV, except in the case of post-traumatic stress disorder. That is like a taste test in which the judges decide that a new diet soda is better than its non-diet predecessor because everyone approved of the flavor, even though the judges never bothered to directly compare the diet and regular versions. Although in past revisions the APA has done such a comparison, Regier says that this time doing so would double the size of the survey, making it too costly and time-consuming to conduct. “You just don’t do science that way,” Frances says.
*Ferris Jabr is an Associate Editor at Scientific American
Tomorrow: Edward Shorter, a historian of psychiatry at the University of Toronto, argues that the principal diagnoses of the DSM—depression, schizophrenia and bipolar disorder—are artifacts and should essentially be discarded.
Ingrid Wickelgren 
About the Author: Ingrid Wickelgren is an editor at Scientific American Mind, but this is her personal blog at which, at random intervals, she shares the latest reports, hearsay and speculation on the mind, brain and behavior. Follow on Twitter @iwickelgren.
The views expressed are those of the author and are not necessarily those of Scientific American.

Senate Panel to Examine Painkiller Makers’ Financial Ties - via NYT > Health | American Pain Foundation Shuts Down As Senators Launch Investigation Of Prescription Narcotics · OPB News

via NYT > Health

by By BARRY MEIER on 5/8/12

The inquiry is studying financial ties between producers of prescription painkillers and pain experts, patient advocacy groups and organizations that set guidelines on use.


American Pain Foundation Shuts Down As Senators Launch Investigation Of ...
OPB News
In recent weeks, two articles in medical journals have documented different aspects of abuse. According to a paper published online this week by the Archives of Pediatrics & Adolescent Medicine, one in eight high school seniors surveyed said they had ...

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American Pain Foundation Shuts Down As Senators Launch Investigation Of Prescription Narcotics · OPB News

American Pain Foundation Shuts Down As Senators Launch Investigation Of Prescription Narcotics

As the U.S. Senate Finance Committee launched an investigation Tuesday into makers of narcotic painkillers and groups that champion them, a leading pain advocacy organization said it was dissolving "due to irreparable economic circumstances."
The American Pain Foundation, which described itself as the nation’s largest organization for pain patients, was the focus of a December investigation by ProPublica in the Washington Post that detailed its close ties to drugmakers.
The group received 90 percent of its $5 million in funding in 2010 from the drug and medical-device industry, ProPublica found, and its guides for patients, journalists and policymakers had played down the risks associated with opioid painkillers while exaggerating the benefits from the drugs.
It is unclear whether the group's announcement Tuesday evening -- that it would "cease to exist, effective immediately" -- was related to letters sent earlier in the day from Sens. Max Baucus, D-Mont., the finance panel chairman, and Charles Grassley, R-Iowa, to the foundation, drug companies and others.
In the letters, the senators cited an "an epidemic of accidental deaths and addiction resulting from the increased sale and use of powerful narcotic painkillers," including popular brand names like Oxycontin, Vicodin and Opana.
Growing evidence, they wrote, suggests that drug companies "may be responsible, at least in part, for this epidemic by promoting misleading information about the drugs' safety and effectiveness."
The American Pain Foundation's website carried a statement Tuesday night saying its board had voted May 3 to dissolve the organization because it couldn't stay "operational." The foundation did not respond to requests for comment Tuesday.
The senators are targeting a who's who of the pain industry, seeking extensive records and correspondence documenting the links, financial and otherwise, between them and the makers of the top-prescribed narcotic painkillers.
Letters went to three pharmaceutical companies, Purdue Pharma, Endo Pharmaceuticals and Johnson & Johnson, as well as five groups that support pain patients, physicians or research: the American Pain Foundation, American Academy of Pain Medicine, American Pain Society, Wisconsin Pain & Policy Studies Group, and the Center for Practical Bioethics.
The Federation of State Medical Boards, the trade group for agencies that license doctors, received a letter, as did The Joint Commission, an independent nonprofit that accredits hospitals nationwide and made pain management a national priority in 2001.
A report by the U.S. Government Accountability Office in 2003 noted that the commission partnered with Purdue Pharma, the maker of Oxycontin, to distribute pain educational materials nationwide. The committee's letter to Purdue noted that the company pleaded guilty in 2007 to federal criminal charges that it misled regulators, physicians and consumers about Oxycontin's risk of addiction.
The senators requested payment information since 1997 to 10 groups and eight people, including two doctors featured in ProPublica's December report. They asked about any influence the companies had on a 2004 pain guide for physicians that was distributed by the Federation of State Medical Boards; on the American Pain Society's guidelines; and on the American Pain Foundation's Military/Veterans Pain Initiative.
In addition, to citing ProPublica's work, the letters also mention the reporting of the Milwaukee Journal Sentinel/MedPage Today.
Patients in serious pain need access to opioids, the senators wrote, but drugmakers and health-care groups "must distribute accurate information about these drugs in order to prevent improper use and diversion to drug abusers."
"The problem of opioid abuse is bad and getting worse," Sen. Grassley said in a statement. "Something has to change."
"When it comes to these highly addictive painkillers, improper relationships between pharmaceutical companies and the organizations that promote their drugs can put lives at risk," Baucus said in a prepared statement.
Dr. Andrew Kolodny, chairman of psychiatry at Maimonides Medical Center in Brooklyn, N.Y., and president of Physicians for Responsible Opioid Prescribing, applauded the investigation.
"These groups, these pain organizations … helped usher in an epidemic that's killed 100,000 people by promoting aggressive use of opioids," Kolodny said. "What makes this especially disturbing is that despite overwhelming evidence that their effort created a public health crisis, they're continuing to minimize the risk of addiction."
Concerns about the overuse and abuse of painkillers have intensified in recent years. As sales of the powerful drugs have boomed — rising 300 percent since 1999 — so, too, have overdose deaths. Opioids were involved in 14,800 overdose deaths in 2008, more than cocaine and heroin combined, according to the U.S. Centers for Disease Control and Prevention.
In 2009, the use and misuse of the drugs were cited in more than 475,000 emergency department visits, nearly doubling the 2004 number, the CDC said.
Pain doctors and patient groups say that while drug overdoses are a legitimate concern, only a small percentage of deaths involves patients who receive them from their doctors. Most deaths involve illicitly obtained drugs, statistics show.
The groups also say that patients' risk is low if they do not have addictive personalities, and that any restrictions should not punish patients who suffer from serious pain.
In recent weeks, two articles in medical journals have documented different aspects of abuse.
According to a paper published online this week by the Archives of Pediatrics & Adolescent Medicine, one in eight high school seniors surveyed said they had used prescription opioids for nonmedical reasons.
A paper released last month by the Journal of the American Medical Association found that the rate of newborns diagnosed with drug withdrawal jumped threefold from 2000 to 2009. And the rate of mothers using opioids at the time of delivery was five times higher in 2009. (Not all babies born to mothers using the drugs exhibit signs of withdrawal.)
Janssen Pharmaceuticals, a Johnson & Johnson subsidiary that makes the painkiller Nucynta, said in a statement that it "is committed to the responsible prescribing and appropriate use of opioid pain medications" and has supported educational websites about safe use.
The company is reviewing the senators' letter and "will work with them to fulfill their request for information," spokesman Mark Wolfe said via e-mail.
Purdue Pharma acknowledged in a statement that it had received the letter, was reviewing it, and looked forward to "cooperating with the committee on this matter."
Endo did not return a request for comment. A spokeswoman for The Joint Commission said the group had just received the senators' letter and had no comment yet. The Federation of State Medical Boards responded but did not offer immediate comment.