Wednesday, May 9, 2012

Welcome To AAPP: The Association for the Advancement of Philosophy and Psychiatry

Welcome To AAPP





Association for the Advancement
of Philosophy & Psychiatry




The Association for the Advancement of Philosophy and Psychiatry (AAPP) was establlished in 1989 to promote cross-disciplinary research, educational initiatives, and graduate training programs in philosophy and psychiatry. Philosophical methods bring to psychiatry a kind of analysis and critique that are invaluable in their clarity of thought, meaning, and application to practice. But over the years, we also have found that, in addition to having its own philosophical problems, psychiatry also informs philosophical theorizing itself, and that the field of "philosophy and psychiatry" is developing into its own interdisciplinary field.

AAPP is dedicated to philosophical inquiry in psychiatric theory and practice. AAPP aims to enhance the effectiveness of the psychiatrist as teacher, researcher, and practitioner by illuminating the philosophical issues embedded in these activities. AAPP also aims to consider the ways in which psychiatric knowledge, theories, and practices can enrich and challenge basic philosophical assumptions about mind, knowledge, and subjectivity, for instance. Topics of interest include the identification, understanding, and explication of abnormal experience and behavior; the problem of psychiatric classification; the relationship between neuroscience and cllinical practice; the evaluation of clinical methods; and moral and ethical issues raised by psychiatric categories and practice.

The goals of AAPP are realized through:

  • Fostering research in the philosophical aspects of psychiatric theory and practice.
  • Identifying and supporting collaborative cross-disciplinary research teams in philosophy, psychiatry, and psychology and related fields.
  • Sponsoring educational courses, an annual meeting, international meetings, regional meetings with local chapters and symposia with other societies.
  • Sharing syllabi on courses relevant to philosophy and psychiatry.
  • Reaching a greater public audience and popularizing the interdisciplinary field through the use of new technologies.
  • Publishing in the area of philosophy and psychiatry.
  • Mentoring those who are new to the interdisciplinary field.
  • Providing consultation to graduate training programs.

Philosophy, Psychiatry, & Psychology (PPP) is the official journal of the organization, published in conjunction with the Royal College of Psychiatrists Philosophy Group by The Johns Hopkins University Press.

AAPP is an energetic association, and we can promise you genuine collegiality, an opportunity to contribute and to learn, lively topics for consideration, and instructive and enjoyable meetings.


Officers & Executive Council Members


Affiliated, Local, and Special Interest Groups


Meetings & Conferences
Annual Meeting May 5 & 6, 2012


Members Only


The Journal - Philosophy, Psychiatry, & Psychology


Join AAPP Now

News Review - Mike Nova's starred items - 1:09 PM 5/9/2012

Google Reader - Mike Nova's starred items

via pubmed: "behav sci law"[jour... by Zagar RJ, Busch KG, Felthous AR on 5/9/12
Introduction to this Issue: International Perspectives on Juvenile Crime.
Behav Sci Law. 2012 Mar;30(2):87-9
Authors: Zagar RJ, Busch KG, Felthous AR
PMID: 22496045 [PubMed - in process]

via pubmed: "behav sci law"[jour... by Myers WC, Chan HC on 5/9/12
Juvenile homosexual homicide.
Behav Sci Law. 2012 Mar;30(2):90-102
Authors: Myers WC, Chan HC
Abstract
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.
PMID: 22447462 [PubMed - in process]

via pubmed: "behav sci law"[jour... by Grande TL, Hallman J, Rutledge B, Caldwell K, Upton B, Underwood LA, Warren KM, Rehfuss M on 5/9/12
Examining mental health symptoms in male and female incarcerated juveniles.
Behav Sci Law. 2012 May;30(3):365-9
Authors: Grande TL, Hallman J, Rutledge B, Caldwell K, Upton B, Underwood LA, Warren KM, Rehfuss M
Abstract
Varying risk factors for both incarceration and mental health diagnoses have been identified for female juveniles, highlighting the need for gender-specific assessments and treatment protocols. The purpose of this study is to determine how the prevalence rates of mental health symptoms differ in male and female juvenile offenders. It was hypothesized that the prevalence rates would be greater for females than males. This study found significant differences between males and females on several clinical scales. These findings are consistent with past studies that have identified differences in mental health symptoms between genders. Copyright © 2012 John Wiley & Sons, Ltd.
PMID: 22411502 [PubMed - in process]

via pubmed: "behav sci law"[jour... by Edens JF, Cox J on 5/9/12
Examining the prevalence, role and impact of evidence regarding antisocial personality, sociopathy and psychopathy in capital cases: a survey of defense team members.
Behav Sci Law. 2012 May;30(3):239-55
Authors: Edens JF, Cox J
Abstract
Although anecdotal case accounts suggest that evidence concerning Antisocial Personality Disorder (APD), sociopathy and psychopathy is frequently introduced by the prosecution in capital murder trials, to date there has been no systematic research to determine the actual prevalence, role, or perceived impact of such evidence in these cases. Survey data collected from attendees at a national capital mitigation conference (n = 41) indicated that prosecution evidence concerning APD was quite prevalent, with "sociopath" and "psychopath" labels being introduced less frequently. Evidence concerning these disorders, which were assessed primarily via DSM criteria and self-report personality inventories, was most often introduced by the prosecution in the sentencing phase to address a defendant's ostensible risk of future dangerousness and/or to rebut mitigating evidence-although it was also introduced frequently in the guilt/innocence phase of these trials to rebut mental health evidence offered by the defense. Survey respondents believed that evidence concerning APD, sociopathy, and psychopathy had a considerable impact on trial outcomes. Also, although defense objections were common, such evidence was rarely ruled to be inadmissible in these cases. Copyright © 2012 John Wiley & Sons, Ltd.
PMID: 22374708 [PubMed - in process]

Publication year: 2012
Source:International Journal of Law and Psychiatry
Jochem Willemsen, Paul Verhaeghe
There is general consensus in clinical and research literature that the core feature of psychopathy consists of an affective deficit. However, previous studies tend to find weak and inconsistent associations between psychopathy and measures of internalizing psychopathology. In this study we test whether the predominant practice of using questionnaires to assess internalizing psychopathology has influenced the results of previous research. We argue that questionnaires measure general distress rather than specific symptoms of internalizing psychopathology, and that the validity of questionnaires might be impaired by psychopathic traits, such as impression management and lack of affective experience. Combining a questionnaire (Depression Anxiety Stress Scales-21; DASS-21) and a semi-structured interview (Structured Clinical Interview for DSM-IV-R Axis 1 Disorders; SCID-I) for internalizing psychopathology, we test the differential association of both measures with the Psychopathy Checklist—Revised (PCL-R) in a sample of 89 male detainees. In accordance with our prediction, we found moderate negative associations between the Interpersonal and Affective facets of the PCL-R and SCID-I, but no significant associations with the DASS-21. We found no evidence that psychopathic traits decrease the validity of the responses on a questionnaire. We conclude that the interpersonal and affective features of psychopathy are negatively related to specific symptoms of internalizing psychopathology, but not with general distress.

Publication year: 2012
Source:International Journal of Law and Psychiatry
Christos Tsopelas, Spyridoula Tsetsou, Petros Ntounas, Athanassios Douzenis
Introduction 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. Methods 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. Results 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. Conclusion 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.

via candidaabrahamson by rfinkel on 5/9/12
I’ve now received upmteen notices, through various family, friends, and psychiatric publications, that the DSM 5 has made an about-face. It’s not the first, by a long shot. Remember the narcissists? Out one day–back in the next? That was a good switcher-oo. And now, it seems, the Committee has dropped two diagnoses considered somewhat controversial. One [...]

via Observations by Ferris Jabr on 5/6/12
DSM(Credit: Ferris Jabr)
PHILADELPHIA—In the summer of 2011 I began working on a feature article about a book that most people have never heard of—the Diagnostic and Statistical Manual of Mental Disorders (DSM), a reference guide for psychiatrists and clinicians. Most of the DSM‘s pages contain lists of symptoms that characterize different mental disorders (e.g. schizophrenia: delusions, hallucinations, disorganized speech and so on). The DSM not only defines mental illness, it often determines whether patients receive treatment—in many cases, insurance companies require an official DSM diagnosis before they subsidize medication or other therapies.
For the first time in 30 years the American Psychiatric Association (APA) is substantially revising the DSM to make diagnoses more accurate and make the book more user-friendly (1994′s DSM-IV did not differ dramatically from 1980′s DSM-III). The association plans to publish a brand new edition of the manual, the DSM-5, in May 2013.
When I was reporting my feature article, published in the May/June issue of Scientific American MIND, I spent a lot of time on the phone with members of the APA Task Force—the group of psychiatrists and researchers who oversee the revisions to the DSM. This weekend I attended the APA’s annual meeting here in Philadelphia to hear some of these researchers speak in person and to learn more about the DSM-5. I was particularly excited about results from the “field trials”—dry runs of the new DSM-5 diagnoses at universities and clinics around the country. The field trials are primarily concerned with one question: do different psychiatrists using the revised DSM-5 diagnoses reach the same conclusion about the same patient? If they do, the updated lists of symptoms have high “reliability”—a good thing in medicine. If not, the new diagnoses are unreliable and the revisions are a failure.
The APA has not yet published the results of the field trials, but at the annual meeting in Philly the association gave a preview of the findings during a Saturday symposium. It was a first glimpse at extremely important data that many people have been waiting a long time to see.
Some of the results—and the way in which the speakers presented them—frustrated and concerned me.
To understand why, it’s helpful to first discuss some statistics. I’ll keep it simple. The APA uses a statistic called kappa to measure the reliability of different diagnoses. The higher the value of kappa, the more reliable the diagnosis, with 1.0 representing perfect reliability. The APA considers a diagnosis with a kappa of 0.8 or higher miraculously reliable; 0.6 to 0.8 is excellent; 0.4 to 0.6 is good; 0.2 to 0.4 “could be accepted” and anything below 0.2 is unacceptably unreliable. Low reliability is a big problem for clinicians, patients and researchers alike: it means that only a minority of clinicians agree when diagnosing a disorder and that researchers who want to study a particular disorder will have a very hard time identifying participants who truly have the disorder in question. If no one agrees, it is hard to make progress of any kind.
Darrel Regier, vice chair of the APA’s DSM-5 Task Force, presented kappas for various DSM-5 diagnoses—the first publicly released results from the field trials. Fortunately, the kappas for many of the DSM-5 diagnoses look strong. Field trials of the new autism spectrum disorder (ASD), for example—which collapses DSM-IV diagnoses for autistic disorder, Asperger’s and other developmental conditions into one category—yielded a kappa of 0.69. However, two pitiful kappas shocked me. The kappa for generalized anxiety disorder was about 0.2 and the kappa for major depressive disorder was about 0.3.
These numbers are way too low according to the APA’s own scales—and they are much lower than kappas for the disorders in previous versions of the DSM. Regier and other members of the APA emphasized that field trial methodology for the latest edition is far more rigorous than in the past and that kappas for many diagnoses in earlier editions of the DSM were likely inflated. But that doesn’t change the fact that the APA has a problem on its hands: its own data suggests that some of the updated definitions are so flawed that only a minority of psychiatrists reach the same conclusions when using them on the same patient. And the APA has limited time to do something about it.
Although the APA has been working on the DSM-5 for more than 11 years now, field trials only started within the last year. While reporting my feature, I asked members of the APA why they waited so long to conduct the field trials. After all, only one year remains until scheduled publication of the DSM-5 and we still do not know whether the revised diagnoses are reliable and whether they are a genuine improvement over their predecessors. I never received a satisfactory answer
To make an analogy, consider a baker who spends months developing a recipe for the ultimate chocolate cake in his head and—a day before he has to deliver the cake—finally tries out the recipe only to discover that the cake tastes awful. He has one day to come up with something else. The APA has placed itself in a similarly desperate position. The final drafts of the new manual are due December of this year, which means the APA has less than 8 months to implement what it has learned from the field trials if it wants to publish on schedule. New field trials would take years to arrange and at least one additional year to conduct. Either the association delays publication of the DSM-5 for several more years, revises the diagnoses yet again and conducts new field trials—or it goes forward with the current schedule and publishes a significantly flawed DSM-5.
If the APA has a plan of action—beyond vague statements like “continuing to analyze our data”—the association did not make it clear at the symposium. The presenters hardly seemed troubled by the alarming results. Even worse, they sometimes came off as oblivious.
Eve Moscicki of the American Psychiatric Institute for Research and Education gave the final presentation in the symposium. Moscicki helped coordinate the field trials in clinics. For some reason, Moscicki decided to spend more than half her allotted time on irrelevant details—such as the benefits of a good technical support team—before getting to the actual field trial results. Finally she pulled up some colorful bar graphs showing what clinicians and patients thought about the new DSM-5 diagnoses. The bars showed what percentage of respondents thought that the new definitions were Extremely Useful, Very Useful, Moderately Useful, Slightly Useful or Not at All Useful. Infographic enthusiasts know that bar graphs are a weak way to present data like this—it’s difficult to make visual comparisons across so many categories at the same time. A pie chart would have been much clearer. **(See Edited to Add below for corrections and clarification).**
“Well, yes, it looks to me like the majority thought it was very or extremely useful,” Moscicki said of the one revised diagnoses.
“That’s incorrect,” I said, standing up. “37 percent plus 7 percent does not equal more than 50 percent.” In fact, the majority of respondents thought that the new criteria were somewhere between moderately to not at all useful. “You can’t present this data as a bar graph. It’s deceptive,” I added. It was the third time that Moscicki had made such a mistake, overestimating the percentage of positive responses and glossing over the DSM-5‘s shortcomings apparent in the results.
“Well, umm, just remember this is a first look…”
“Totally deceptive,” I said. I swung my backpack over one shoulder and walked out of the room.
In retrospect, I should not have called the graph deceptive, although I do still think that the data was poorly presented. I wish I had stuck around for the final minutes of the presentation, but I was too upset to remain in the room any longer. Perhaps I overreacted. After reflecting on the experience, however, I remain genuinely concerned about the future of the DSM.
Moscicki is right about one thing: this is just a first look. Until the APA officially publishes the results of the field trials, nobody outside the association can complete a proper analysis. What I have seen so far has convinced me that the association should anticipate even stronger criticism than it has already weathered. In fairness, the APA has made changes to the drafts of the DSM-5 based on earlier critiques. But the drafts are only open to comment for another six weeks. And so far no one outside the APA has had access to the field trial data, which I have no doubt many researchers will seize and scour. I only hope that the flaws they uncover will make the APA look again—and look closer.
**Edited to Add**
A few people have pointed out that a pie chart is not necessarily clearer than a bar graph when it comes to presenting the data I discussed. That’s true. I realize now I did not explain my meaning correctly. What bothered me is that Moscicki was guesstimating. She was eyeballing the percentages represented by different bars and adding them together in her head to see if, combined, the Very and Extremely useful percentages were greater than the rest of the categories. Instead, she should have graphically combined the data into two categories for clear comparison—whether as two wedges in a pie chart or as two bars—before her presentation. The solution that popped into my mind at the time was a pie chart in which the wedge representing the combined Very and Extremely useful percentages was clearly less than half of the pie and the wedge representing the combined Moderately, Slightly and Not at All useful categories was clearly more than half. In the grand scheme of things, this particular point is a quibble—but it was the straw that broke the camel’s back. My frustration had been building throughout the symposium and I could not stand for what I perceived as glib treatment of crucial data.


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via Death Penalty Information Center by edeleon on 5/7/12
A new study conducted by researchers at Duke University found that the racial composition of jury pools has a profound effect on the probability of a black defendant being convicted. According to the study led by Professor Patrick Bayer of Duke, juries formed from all-white jury pools in Florida convicted black defendants 16 percent more often than white defendants. In cases with no black potential jurors in the jury pool, black defendants were convicted 81 percent of the time, while white defendants were convicted 66 percent of the time. When at least one member of the jury pool was black, the conviction rates for white (73%) and black (71%) defendants were nearly identical. Professor Bayer commented, “I think this is the first strong and convincing evidence that the racial composition of the jury pool actually has a major effect on trial outcomes… Simply put, the luck of the draw on the racial composition of the jury pool has a lot to do with whether someone is convicted and that raises obvious concerns about the fairness of our criminal justice system.” The study examined over 700 non-capital felony cases in Sarasota and Lake counties in Florida and was published in the Quarterly Journal of Economics. Watch a video interview with Professor Bayer.
(S. Hartsoe, "Study: All-White Jury Pools Convict Black Defendants 16 Percent More Often Than Whites," Duke Today, April 17, 2012; posted May 7, 2012; "The Impact of Jury Race in Criminal Trials," senior author Patrick Bayer, Duke University; Shamena Anwar, Carnegie Mellon University; Randi Hjalmarsson, Queen Mary, University of London. Quarterly Journal of Economics, online April 17, 2012, print in May 2012; DOI number 0.1093/QJE/QJS014).
In April in North Carolina, a Superior Court judge issued a ruling in the first case under the state's Racial Justice Act, finding evidence of intentional bias by the state in selecting juries for death penalty cases. The court held that “race was a materially, practically and statistically significant factor in the decision to exercise peremptory challenges during jury selection by prosecutors” at the time of the defendant's trial. Lawyers had presented findings from a study conducted at Michigan State University that concluded that qualified black jurors in North Carolina were struck from juries at more than twice the rate of qualified white jurors in the state’s 173 capital cases between 1990-2010. The judge said that the disparity was strong enough “to support an inference of intentional discrimination.” The defendant ’s death sentence was reduced to life without parole. See Race. Read more studies on the death penalty. Listen to DPIC's podcast on Race.

Mike Nova's starred items


Telegraph.co.uk

Breivik trial turns more confrontational as Utøya witnesses begin testimony
Christian Science Monitor
The Labor Party youth camp attendees who were on Utøya island when Anders Behring Breivik went on a shooting rampage, killing 69, began their testimony today. By Valeria Criscione, Correspondent / May 9, 2012 The self-confessed killer behind Norway's ...
Anders Behring Breivik 'cried with joy' as he carried out Utoya massacreTelegraph.co.uk
Anders Behring Breivik shouted with joy during Utoeya massacre, survivor saysCalgary Herald
Anders Breivik showed 'joy' at Norway massacre sceneBBC News
Washington Post -Herald Sun
all 74 news articles »


The Foreigner

New witnesses for Breivik's trial
The Foreigner
New witnesses for Breivik's trial. Anders Behring Breivik's defence counsel Geir Lippestad has presented an updated list of witnesses to Oslo District Court. The list includes sociologist Johan Galtung, who alleged there was a possible connection ...

and more »

via anders behring breivik - Google Blog Search by TheYoungTurks on 4/23/12
Via The Huffington Post: "Anders Behring Breivik, the Norwegian man who confessed to killing 77 people last July, punctuated another day in court on Monday b...


BBC News

Anders Breivik trial: Norway survivors detail Utoeya massacre
BBC News
The trial of Anders Behring Breivik has begun hearing the first testimony from survivors of the massacre he carried out on the Norwegian island of Utoeya, in which 69 people died last July. The trial will also continue to hear evidence about coroners' ...
Oslo shooting: survivors to testifyIndependent Online
Anders Breivik TrialIBTimes.co.uk
Can a Heinous Murderer Be Considered Sane?Discovery News
The Foreigner -CBC.ca -The Copenhagen Post
all 34 news articles »

Publication year: 2012
Source:Journal of Criminal Justice
Matt DeLisi


via PsycCRITIQUES Blog by Danny Wedding, PhD on 6/10/09
APAIn his review of The Dark Side: The Inside Story of How the War on Terror Turned Into a War on American Ideals, Edward J. Tejirian writes,
[A secret] memo provided the rationalization for a whole range of abusive "techniques" that were put into practice at Guantanamo, Abu Ghraib, Afghanistan, and in the CIA's secret prisons. It also enabled the president to flatly declare, "We don't torture," and, in his own mind, to believe that he was telling the truth. Yet, in practice—and this is what makes The Dark Side: The Inside Story of How the War on Terror Turned Into a War on American Ideals so critically relevant to psychologists and to psychology—almost all the torture inflicted on those detained was psychological in means and intent. It is true that physical abuse that adversely affected the health and safety of detainees was also used—the occasional beating, exposure to extremes of heat and cold, and, of course, water boarding. But it was the "dark side" of psychological theory that provided the rationale for the suffering that was inflicted on those detained in the "war on terror."
Psychologists interested in these issues are encouraged to read Tejirian's review of The Dark Side, along with the companion review by Steven Behnke, and Charles Figley's review of The Trauma of Psychological Torture in the same release.


Read the Review
ReviewAlternate Realities
By Edward J. Tejirian
PsycCRITIQUES, 2009 Vol 54(22)


Army wants to monitor soldiers' computer activity
Clarksville Leaf Chronicle
“We don't want to be forensics experts. We want to catch it at the perimeter,” Smith said. “We want to catch this before it has a chance to be exploited.” The Army's efforts dovetail with a broader federal government initiative.

and more »

via pubmed: "behav sci law"[jour... by Reid Meloy J, Hoffmann J, Guldimann A, James D on 5/9/12
The role of warning behaviors in threat assessment: an exploration and suggested typology.
Behav Sci Law. 2012 May;30(3):256-79
Authors: Reid Meloy J, Hoffmann J, Guldimann A, James D
Abstract
The concept of warning behaviors offers an additional perspective in threat assessment. Warning behaviors are acts which constitute evidence of increasing or accelerating risk. They are acute, dynamic, and particularly toxic changes in patterns of behavior which may aid in structuring a professional's judgment that an individual of concern now poses a threat - whether the actual target has been identified or not. They require an operational response. A typology of eight warning behaviors for assessing the threat of intended violence is proposed: pathway, fixation, identification, novel aggression, energy burst, leakage, directly communicated threat, and last resort warning behaviors. Previous research on risk factors associated with such warning behaviors is reviewed, and examples of each warning behavior from various intended violence cases are presented, including public figure assassination, adolescent and adult mass murder, corporate celebrity stalking, and both domestic and foreign acts of terrorism. Practical applications and future research into warning behaviors are suggested. Copyright © 2011 John Wiley & Sons, Ltd.
PMID: 22556034 [PubMed - in process]

Lenin’s Death Remains a Mystery for Doctors - NYTimes.com


Lenin’s Stroke: Doctor Has a Theory (and a Suspect)
Lenin’s Death Remains a Mystery for Doctors - NYTimes.com

BALTIMORE — The patient founded a totalitarian state known for its “merciless terror,” Dr. Victoria Giffi told a rapt audience of doctors and medical students on Friday afternoon. He died suddenly at 6:50 p.m. on Jan. 21, 1924, a few months before his 54th birthday. The cause of death: a massive stroke.
Associated Press
The Soviet leader Vladimir Ilyich Lenin on his death bed, in an undated photo.
Science Times Podcast
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This week: An H.I.V. success story; a Soviet medical mystery; and a hard look at the U.S. health care system.

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Experts differ on the likely causes of the stroke that killed Lenin at 53.
The man’s cerebral arteries, Dr. Giffi added, were “so calcified that when tapped with tweezers they sounded like stone.”
The occasion was a so-called clinicopathological conference, a mainstay of medical schools in which a mysterious medical case is presented to an audience of doctors and medical students. In the end, a pathologist solves the mystery with a diagnosis.
But this was a conference with a twist. The patient was long dead — he was, in fact, Vladimir Ilyich Lenin. The questions posed to the conference speakers: Why did he have a fatal stroke at such a young age? Was there something more to his death than history has acknowledged?
At the University of Maryland, a clinicopathological conference focused on historical figures has been an annual event for the past 19 years; attending doctors have reviewed the case records of Florence Nightingale, Alexander the Great, Mozart, Beethoven and Edgar Allan Poe. The pathologists’ conclusion that Poe died of rabies even became a final question on the “Jeopardy!” game show.
Dr. Philip A. Mackowiak, vice chairman of the university’s school of medicine and organizer of these conferences, said he later did a much more comprehensive review of Poe’s medical records and concluded that Poe’s doctor had embellished Poe’s medical history.
“Poe was a hopeless alcoholic,” Dr. Mackowiak said in a telephone interview. “He almost certainly died of delirium tremens.”
On Friday, two experts were called upon to solve the mystery of Lenin’s death: Dr. Harry Vinters, professor of neurology and neuropathology at the University of California, Los Angeles, and Lev Lurie, a Russian historian in St. Petersburg.
Dr. Vinters began by telling the audience some details of Lenin’s medical and family history.
As a baby, Lenin had a head so large that he often fell over. He used to bang his head on the floor, making his mother worry that he might be mentally disabled.
As an adult, Lenin suffered diseases that were common at the time: typhoid, toothaches, influenza and a painful skin infection called erysipelas. He was under intense stress, of course, which led to insomnia, migraines and abdominal pain.
At 48, he was shot twice in an assassination attempt. One bullet lodged in his collarbone after puncturing his lung. Another got caught in the base of his neck. Both bullets remained in place for the rest of his life.
Lenin’s father died early, too, at 54. The cause of death was said to be cerebral hemorrhage, but Lenin’s father had an illness at the time of his death that may have been typhoid fever.
Most of Lenin’s seven brothers and sisters died young, two in infancy. A brother was executed at age 21 for plotting to assassinate Emperor Alexander III, and another brother died of typhoid at 19. Of the three who survived past young adulthood, a sister died of a stroke at age 71, another sister died of a heart attack at 59, and a brother died at age 69 of “stenocardia,” an archaic medical term whose meaning is no longer clear.
In the two years before he died, Lenin had three debilitating strokes. Prominent European doctors were consulted and proposed a variety of diagnoses: nervous exhaustion, chronic lead intoxication from the two bullets lodged in his body, cerebral arteriosclerosis and “endarteritis luetica.”
Dr. Vinters speculates that the last term referred to meningovascular syphilis, inflammation of the walls of blood vessels mainly around the brain, resulting in a thickening of the interior of the vessel. But there was no evidence of this on autopsy, and Lenin’s syphilis test was said to have been negative. He had been treated anyway with injections of a solution containing arsenic, the prevailing syphilis remedy.
Then, in his last hours and days of his life, Lenin experienced severe seizures.
An autopsy revealed a near total obstruction of the arteries leading to the brain, some of which were narrowed to tiny slits. But Lenin did not have some of the traditional risk factors for strokes.
He did not have untreated high blood pressure — had that been his problem, the left side of his heart would have been enlarged. He did not smoke and would not tolerate smoking in his presence. He drank only occasionally and exercised regularly. He did not have symptoms of a brain infection, nor did he have a brain tumor.
So what brought on the stroke that killed Lenin?
The clues lie in Lenin’s family history, Dr. Vinters said. The three siblings who survived beyond their 20s had evidence of cardiovascular disease, and Lenin’s father died of a disease that was described as being very much like Lenin’s. Dr. Vinters said Lenin might have inherited a tendency to develop extremely high cholesterol, causing the severe blockage of his blood vessels that led to his stroke.
Compounding that was the stress Lenin experienced, which can precipitate a stroke in someone whose blood vessels are already blocked.
But Lenin’s seizures in the hours and days before he died are a puzzle and perhaps historically significant. Severe seizures, Dr. Vinters said in an interview before the conference, are “quite unusual in a stroke patient.”
But, he added, “almost any poison can cause seizures.”
Dr. Lurie concurred on Friday, telling the conference that poison was in his opinion the most likely immediate cause of Lenin’s death. The most likely perpetrator? Stalin, who saw Lenin as his main obstacle to taking over the Soviet Union and wanted to get rid of him.
Communist Russia in the early 1920s, Dr. Lurie told the conference, was a place of “Mafia-like intrigue.”
In 1921 Lenin started complaining that he was ill. From then until his death in 1924, Lenin “began to feel worse and worse,” Dr. Lurie said.
“He complained that he couldn’t sleep and that he had terrible headaches. He could not write, he did not want to work,” Dr. Lurie said. He wrote to Alexei Maximovich Gorky, “I am so tired, I do not want to do anything at all.”
But he nonetheless was planning a political attack on Stalin, Dr. Lurie said. And Stalin, well aware of Lenin’s intentions, sent a top-secret note to the Politburo in 1923 claiming that Lenin himself asked to be put out of his misery.
The note said: “On Saturday, March 17th in the strictest secrecy Comrade Krupskaya told me of ‘Vladimir Ilyich’s request to Stalin,’ namely that I, Stalin, should take the responsibility for finding and administering to Lenin a dose of potassium cyanide. I felt it impossible to refuse him, and declared: ‘I would like Vladimir Ilyich to be reassured and to believe that when it is necessary I will fulfill his demand without hesitation.’”
Stalin added that he just could not do it: “I do not have the strength to carry out Ilyich’s request and I have to decline this mission, however humane and necessary it might be, and I therefore report this to the members of the Politburo.”
Dr. Lurie said Stalin might have poisoned Lenin despite this assurance, as Stalin was “absolutely ruthless.”
Dr. Vinters believes that sky-high cholesterol leading to a stroke was the main cause of Lenin’s death. But he said there is one other puzzling aspect of the story. Although toxicology studies were done on others in Russia, there was an order that no toxicology be done on Lenin’s tissues.
So the mystery remains.
But if Lenin had lived today, or if today’s cholesterol-lowering drugs had been available 100 years ago, might he have been spared those strokes?
“Yes,” Dr. Vinters said. “Lenin could have gone on for another 20 or 25 years, assuming he wasn’t assassinated. History would have been totally different.”

This article has been revised to reflect the following correction:
Correction: May 8, 2012

An earlier version of this article misstated, using information provided by the University of Maryland, Vladimir Lenin’s age when he was shot twice in an assassination attempt. He was 48, not 38.

Sue Bailey - The President's Blog: Since Saturday, I’ve been at the American Psychiatric Association’s annual meeting in Philadelphia.

The President's Blog

The President's Blog

About this blog

RCPsych President, Professor Sue Bailey

Professor Sue Bailey started her term of office as President in June 2011. She is a consultant child and adolescent forensic psychiatrist in Greater Manchester.

In this blog, Sue will update members on how she is representing psychiatry, both nationally and internationally.

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5/8/2012 4:59:23 PM

At the APA

Tuesday, 8 May

Since Saturday, I’ve been at the American Psychiatric Association’s annual meeting in Philadelphia. The first symposium I was involved in was about cross-cultural issues in the use of psychotropic medications in children. There was a great deal of discussion, and colleagues from the US, Canada and New Zealand gave their perspectives on the cultural and policy influences on prescribing.
Next, I was guest at the Assembly of the APA where business is conducted. Of particular interest was a presentation from Paul Summergrad MD on the role of psychiatry in health reform, integrated care and how psychiatrists can work with primary care colleagues. It is interesting how we share many of the same issues with the US – the need to protect funding for the most vulnerable populations, and not allowing monies for our patients to be swept off into other fields of medicine.
John Oldham MD, outgoing President of the APA, gave a very touching talk about the work he had done over the last 12 months to ensure psychiatry is part of the "house of medicine”. He talked about the patient’s right to quality treatment, the importance of integrated care, and how we have to maintain a high quality of education and research.
The new APA President is Dilip Jeste, a psychogeriatrician. His theme for his presidency will be pursuing well-being across the lifespan. Both Dilip and John stressed the importance of the Mental Health Parity Act which was passed in 2008 in the USA, and how subsequently they have been able to use this as a powerful lever to halt policy or practice that would have a negative impact on mental health users and carers, and to deliver better services. It’s encouraging to hear that, given what has been achieved over here with parity of esteem through the Health and Social Care Act, and I hope that this will ensure we achieve the best for our patients –whatever the challenges and challenges in health care commissioning.
I also attended a really positive meeting of European leaders and APA leaders. The emphasis was on integrating better with primary care and public health, and brain migration across the world.
In between lectures and meetings, I’ve had the opportunity to observe Philadelphia society. It is a city full of history (see my photo of Benjamin Franklin!) but like every city it has its problems –

Benjamin Franklin - APA meeting 2012

including homelessness. The hotel I am staying in is next to the equivalent of one of our magistrates’courts so, as a forensic psychiatrist, I feel quite at home! Through the window I’ve been watching life outside the court unfold– people hovering outside and waiting, some entering and not returning, and relatives pacing up and down outside.
I’ve also had time to watch a bit of television. At least half of the adverts seem to be about prescription medication, inviting you to go to your doctor and ask for a named drug, and all accompanied by a roll call of a long list of side effects. It’s interesting to watch, as I suspect few of us read all of the small print on leaflets accompanying medication in the UK. Then the rest of the adverts seem to be from lawyers, telling you how to sue the doctors that have prescribed the medication that’s given you one of these side effects!
It’s interesting how much the APA Congress has changed over the years. In times past, the exhibition hall resembled the set of a 1930s film extravaganza – lights, curtains and glamour to advertise pharmaceutical companies and medications. Now it is a more subdued affair, with many of the stands occupied by competing health providers eager to show why working for them would be better than working for their neighbour. There are also some amazing NGO stands, which aren’t very flashy but show how they are providing life-changing support for those with serious mental illness and acquired brain damage.
Sue
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Treating Sleep Disorder Improves Psychiatric Outcomes - Medscape - General Psychiatry News

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Treating Sleep Disorder Improves Psychiatric Outcomes
Medscape
The most common sleep disorder diagnosis was sleep apnea, Dr. Vyas said. Comorbid psychiatric disorders were present in 54 patients (46.2%). Between baseline and 24 months, Dr. Vyas found that psychiatric status significantly improved compared with ...



Treating Sleep Disorder Improves Psychiatric Outcomes
Medscape
May 9, 2012 (Philadelphia, Pennsylvania) — A new study suggests that treating sleep disorders, and sleep apnea in particular, is associated with improvement over baseline in symptoms of comorbid psychiatric disorders. "There is a strong need for ...

Man found competent to stand trial in death at state mental hospital - baltimoresun.com

Man found competent to stand trial in death at state mental hospital - baltimoresun.com

www.baltimoresun.com/explore/howard/news/crime/ph-ho-cf-davydov-hearing-0216-20120209,0,2360163.story

baltimoresun.com


Man found competent to stand trial in death at state mental hospital


By David Greisman, dgreisman@tribune.com

2:43 PM EST, February 9, 2012

A man accused of killing one of his roommates last year at the Clifton T. Perkins state psychiatric hospital in Jessup is competent to go to trial.
Vitali Davydov, 24, is facing one count of first-degree murder. He is accused in the fatal beating of David Rico-Noyola, 22, in the hospital's maximum-security wing on Oct. 21.
A psychiatrist who spoke to Davydov found him to be competent, said Howard County Deputy State's Attorney Mary V. Murphy at a hearing Thursday morning in the county Circuit Court. One of Davydov's attorneys, Rockville-based Barry H. Helfand, did not object to that finding, which means Davydov understands what is going on and is able to participate in his own defense.
"He's competent today. But is he competent tomorrow?" Helfand said after the hearing. Davydov is on several medications and at times hears voices and has delusions, Helfand said. "As we get closer to trial, we might want to have another examination."
The psychiatrist met with Davydov for 70 minutes on Jan. 23 and another 45 minutes on Jan. 30 before issuing her report on Feb. 6..
Davydov pleaded guilty in 2007 to killing a Montgomery County psychologist in 2006, but was found to be not criminally responsible, according to The Washington Post. Rico-Noyola was in the hospital awaiting a November 2011 competency hearing to see if he could go to trial on charges that he killed his mother three years earlier in Anne Arundel County.
Davydov, Rico-Noyola and another man shared a room at the hospital. At about 2:24 p.m. on Oct. 21, Davydov walked out of the room and told a nurse, "My roommate tried to rape me, and I beat him up," according to charging documents. The nurse noticed that Davydov's neck was scratched and there was blood on his hands.
The nurse went to the room and saw Rico-Noyola face down on the floor in a pool of blood. He was taken to Howard County General Hospital and pronounced dead about half an hour later, according to charging documents. The third roommate was not in the room at the time.
Davydov's trial has been scheduled for July 16, with a motions hearing set for April 30.
After the competency hearing, Helfand said he was interested in seeing records for Rico-Noyola — and also wants to look into getting his body exhumed and tested to help determine if a sexual assault took place.
"I'm trying to get to the root of what caused this incident," he said.
Helfand said he believes Davydov will be found not criminally responsible, a determination that would be made after his client is found guilty or not guilty.
Rico-Noyola's death was one of three at the facility in 13 months, and one of two within the span of a week.
El Soundani Elwahhabi, 51, is awaiting trial on a charge of first-degree murder, accused of killing 45-year-old Susan Sachs in September 2010. Andre Mayo, 46, has been accused of killing Rogelion Mondragon, 40, on Oct. 27.
Mayo has a competency hearing scheduled for Feb. 14. Elwahhabi, who was found competent, has his trial set to begin on Feb. 27.
Prosecutors in Elwahhabi's case have moved successfully to keep him from using a defense that he was not criminally responsible.

Screening Women for Domestic Violence Could Help Prevent Abuse - Selected Blogs

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Screening Women for Domestic Violence Could Help Prevent Abuse

via Health News by Health Editor on 5/8/12
By Carina StorrsHealthDay Reporter TUESDAY, May 8 (HealthDay News) — Routine screening of women for domestic violence could reduce cases of abuse and injuries, a new analysis indicates. The review of recent studies, which was commissioned by the U.S. Preventive Services Task Force (USPSTF), also found that general screening for domestic violence did not appear to [...]

Study finds psychopaths have distinct brain structure - baltimoresun.com

via Faktensucher by curi56 on 5/8/12

__________________________________________________________________________

Study finds psychopaths have distinct brain structure - baltimoresun.com

Study finds psychopaths have distinct brain structure

Psychopath brains

A brain scan shows areas of reduced gray matter volume in the temporal pole of the brain of the psychopathic group of antisocial men compared to the non-psychopathic group of antisocial men. (Institute of Psychiatry King's College London/Reuters/Handout / May 7, 2012)


LONDON (Reuters) - Scientists who scanned the brains of men convicted of murder, rape and violent assaults have found the strongest evidence yet that psychopaths have structural abnormalities in their brains.

The researchers, based at King's College London's Institute of Psychiatry, said the differences in psychopaths' brains mark them out even from other violent criminals with anti-social personality disorders (ASPD), and from healthy non-offenders.

Nigel Blackwood, who led the study, said the ability to use brain scans to identify and diagnose this sub-group of violent criminals has important implications for treatment.

The study showed that psychopaths, who are characterized by a lack of empathy, had less grey matter in the areas of the brain important for understanding other peoples' emotions.

While cognitive and behavioral treatments may benefit people with anti-social personality disorders, the same approach may not work for psychopaths with brain damage, Blackwood said.

"To get a clear idea of which treatments are working, you've got to clearly define what people are like going into the treatment programs," he said in a telephone interview.

Essi Viding a professor in the psychology and language sciences department of University College London, who was not involved in Blackwood's study, said it provided "weighty new evidence" about the importance of distinguishing psychopathic from non-psychopathic people rather than grouping them together.

The findings also have implications for the justice system, because linking psychopathy to brain function raises the prospect of arguing a defense of insanity.

Interest in what goes on inside the heads of violent criminals has been sharpened by the trial of Anders Behring Breivik, the Norwegian who massacred 77 people last July.

Two court-appointed psychiatric teams who examined Breivik came to opposite conclusions about his mental health. The killer himself has railed being called insane.

LESS GREY MATTER IN BRAIN'S "SOCIAL" AREAS

Blackwood's team used magnetic resonance imaging (MRI) to scan the brains of 44 violent adult male offenders in Britain who had already been diagnosed with anti-social personality disorders.

The crimes they had committed included murder, rape, attempted murder and grievous bodily harm.

Of the 44 men scanned, 17 met the diagnosis for ASPD plus psychopathy and 27 did not. The researchers also scanned the brains of 22 healthy non-offenders.

The results showed that the psychopaths' brains had significantly less grey matter in the anterior rostral prefrontal cortex and temporal poles than the brains of the non-psychopathic offenders and non-offenders.

These areas of the brain are important for understanding other people's emotions and intentions, and are activated when people think about moral behavior, the researchers said.

Damage to these areas is linked with a lack of empathy, a poor response to fear and distress and a lack of self-conscious emotions such as guilt or embarrassment.

Lindsay Thomson, a professor of forensic psychiatry at the University of Edinburgh who was not involved in this study, said Blackwood's findings add to evidence that psychopathy is a distinct neurodevelopmental brain disorder.

Research shows that most violent crimes are committed by a small group of persistent male offenders with ASPD.

In England and Wales, for example, around half of male prisoners meet diagnostic criteria for ASPD. A major review of studies covering 23,000 prisoners from 62 countries conducted in 2002 found that 47 percent had anti-social personality disorder.

Such people typically react in an aggressive way to frustration or perceived threats, but most are not psychopaths, the researchers wrote in a summary of their study, which was published in the Archives of General Psychiatry journal.

There are clear behavior differences among people with ASPD depending on whether they also have psychopathy. Their patterns of offending are different, suggesting the need for a separate approach to treatment.

"We describe those without psychopathy as 'hot-headed' and those with psychopathy as 'cold-hearted'," Blackwood explained.

"The 'cold-hearted' psychopathic group begin offending earlier, engage in a broader range and greater density of offending behaviors, and respond less well to treatment programs in adulthood compared to the 'hot-headed' group."

(Reporting by Kate Kelland; Editing by Rosalind Russell)

Man Wrongly Convicted in SF-Murder Questions Police Lineups - Selected Blogs

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via Faktensucher by curi56 on 5/8/12