Tuesday, May 1, 2012

“Actions Involuntary, Instinctive, Irresistible”: The Disordered Will of the 19th Century - Psychiatric Times

Psychiatric Times.

HISTORY OF PSYCHIATRY

“Actions Involuntary, Instinctive, Irresistible”: The Disordered Will of the 19th Century

By Greg Eghigian, PhD |April 19, 2012

In his 1996 book, The History of Mental Symptoms,¹ German Berrios, Professor of Psychiatry at Cambridge University, observed, “The ‘will’ no longer plays a role in psychiatry and psychology. A hundred years ago, however, it was an important descriptive and explanatory concept, naming the human ‘power, potency or faculty’ to initiate action.”^1(p351) Berrios is quite right. Outside of discussions about the achievements of athletes today, we seem to have lost our affinity for the notion of human will—so much so that it has now become fashionable to question the very existence of free will itself.²
Our 19th and early 20th century ancestors would likely find this neglect to be a very curious state of affairs. As Berrios noted, psychology and psychiatry at the turn of the last century considered the will an indispensable category. Along with perception, intellect, and emotion, it was widely understood to be one of the core dimensions and faculties of human beings. As Berrios goes on to explain:
Human beings were believed to be endowed with a discrete power or faculty of willing which embodied their essence as persons: ‘it seemed to many in the nineteenth century that the human mind harboured deep and natural desire-like forces . . . comparable to the forces that were being tamed in the environment “without.”’^1(p354)
Influenced by popular concepts within the physical sciences, 19th century psychology and psychiatry turned to thermodynamics for inspiration, understanding both the will and emotions in terms of forces and energies. One therefore spoke of having a strong or a weak will, of the need to resist, channel, or redirect “drives” and “impulses.” The term “willpower” effectively captured the sense observers at the time had that volition involved impetus and work.
As Paul Ricoeur³ has pointed out, Freud’s psychodynamic approach to neuroses was deeply indebted to this kind of energetic thinking, even as he undermined any simple notion of human intentionality. In seeing volition as subject to its own abnormalities, however, Freud was hardly alone. The Swiss André Matthey (1778-1842), the Frenchman Théodule Ribot (1839-1916) and the Germans Johann Christian August Heinroth (1773-1843) and Wilhelm Griesinger (1817-1868) all wrote on pathological disorders of the will.
One of the most compelling innovations of the 19th century specialists in disturbances of the will proved to be Jean Etien Esquirol’s (1772-1840) concept of monomania. Up until the early part of the century, madness had been widely seen as a state of unreason corrupting a person’s entire personality. Esquirol, on the other hand, posited the existence of a class of disorders that impaired an individual’s emotions or willpower, yet left their other faculties untouched. As he described it, “The patient is drawn away from his accustomed course, to the commission of acts, to which neither reason nor sentiment determine, which conscience rebukes, and which the will has no longer the power to restrain. The actions are involuntary, instinctive, irresistible.”⁴
Esquirol’s diagnostic category quickly gained acceptance throughout Europe, often referred to more commonly as “moral insanity.” By the last decade of the 19th century, though, German psychiatrist Julius Ludwig August Koch (1841-1908) redubbed the disorder “psychopathic inferiority,” describing its sufferers this way: “moral principles for them are poorer, limited, less vital and durable, and immoral urges are more difficult for them to resist.”⁵ Koch’s concept has served as the basis for the 20th century idea of psychopathy.
What then brought about the demise of psychiatry’s interest in and discussion about disorders of the will? Berrios points to the rise of experimentalism, psychoanalysis, and behaviorism as the chief reasons: all 3 had little use for the idea of a discrete and unitary volitional faculty. In its place have come notions such as “instinct,” “motivation,” and “decision-making,” he argues.¹ Still, there remain traces within the field of mental health of our earlier preoccupation with human will. Twelve-step programs and the positive-thinking movement seem to have retained the ideal of self-mastery implicit in the notion of willpower. Neuroscientists, it would seem, may be more comfortable dispensing with free will than the public at large.

References
1. Berrios GE. The History of Mental Symptoms: Descriptive Psychopathology Since the Nineteenth Century. Cambridge and New York: Cambridge University Press, 1996), 351.
2. [See, for instance] The Chronicle of Higher Education’s special series of articles, “Is Free Will an Illusion?” http://chronicle.com/article/Is-Free-Will-an-Illusion-/131159. Accessed April 19, 2012.
3. Ricoeur P. Freud and Philosophy: An Essay on Interpretation. New Haven and London: Yale University Press; 1970.
4. Esquirol E. Mental Maladies: A Treatise on Insanity. Philadelphia: Lea and Blanchard; 1845: 320.
5. Koch JLA. Die Psychopathischen Minderwertigkeiten, Vol. 1. Ravensburg: Otto Maier; 1891:116.

More Evidence Bilingualism Aids Thinking Skills - Health News - Health.com

More Evidence Bilingualism Aids Thinking Skills

April 30, 2012

MONDAY, April 30 (HealthDay News) — People who speak two languages have enhanced hearing processing, which improves their attention and memory skills, a new, small study says.
Northwestern University researchers recorded the brainstem responses in 23 English- and-Spanish speaking teens and 25 English-only speaking teens as they heard speech sounds in two conditions.

Under quiet conditions, both groups had similar results. But when there was background noise, the bilingual teens’ brains did better at detecting speech sounds.
The findings show that being bilingual changes how the nervous system responds to sound, according to the researchers.
“People do crossword puzzles and other activities to keep their minds sharp,” study co-author Viorica Marian, a bilingualism expert and associate professor of communication sciences, said in a university news release.
“But the advantages we’ve discovered in dual language speakers come automatically simply from knowing and using two languages. It seems that the benefits of bilingualism are particularly powerful and broad, and include attention, inhibition and encoding of sound,” she explained.
The study appears April 30 in the Proceedings of the National Academy of Sciences.
“Bilinguals are natural jugglers,” Marian said. “The bilingual juggles linguistic input and, it appears, automatically pays greater attention to relevant versus irrelevant sounds. Rather than promoting linguistic confusion, bilingualism promotes improved ‘inhibitory control,’ or the ability to pick out relevant speech sounds and ignore others.”
More information
The American Speech-Language-Hearing Association has more about the benefits of being bilingual.

– Robert Preidt

SOURCE: Northwestern University, news release, April 30, 2012
Last Updated: April 30, 2012
Copyright © 2012 HealthDay. All rights reserved.
*

Being Bilingual Brings Mental Health Benefits

American Psychology–Law Society - Wikipedia, the free encyclopedia

American Psychology–Law Society - Wikipedia, the free encyclopedia

American Psychology–Law Society

From Wikipedia, the free encyclopedia

Jump to: navigation, search

The American Psychology-Law Society (AP-LS) is an academic society for legal and forensic psychologists, as well as general psychologists who are interested in the application of psychology to the law. AP-LS serves as Division 41 of the American Psychological Association and publishes the academic journal Law and Human Behavior.

[edit] External links

Law and Human Behavior - Wikipedia, the free encyclopedia

Law and Human Behavior - Wikipedia, the free encyclopedia

Law and Human Behavior

From Wikipedia, the free encyclopedia

Jump to: navigation, search

Law and Human Behavior

Discipline	Legal psychology, forensic psychology
Language	English
Edited by	Margaret Bull Kovera
Publication details
Publisher	American Psychological Association
Publication history	1977-present
Frequency	Bimonthly
Impact factor (2010)	2.268
Indexing
ISSN	0147-7307 (print) 1573-661X (web)
LCCN	77641812
CODEN	LHBEDM
OCLC number	03173559
Links
Journal homepage Online access

Law and Human Behavior is a bimonthly academic journal published by the American Psychology–Law Society. It publishes original empirical papers, reviews, and meta-analyses on how the law, legal system, and legal process relate to human behavior, particularly legal psychology and forensic psychology.^[1] The current editor-in-chief is Margaret Bull Kovera (John Jay College of Criminal Justice). Past editors have been Brian Cutler (University of Ontario Institute of Technology), Richard Weiner (University of Nebraska), Ronald Roesch (Simon Fraser University), Michael J. Saks (Arizona State University), and Bruce Sales (University of Arizona).

[edit] Abstracting and indexing

The journal is abstracted and indexed by MEDLINE/PubMed and the Social Science Citation Index. According to the Journal Citation Reports, the journal has a 2010 impact factor of 2.268, ranking it 7th out of 58 journals in the category "Psychology, Social"^[2] and 13th out of 133 journals in the category "Law".^[3]

[edit] References

^ "Law and Human Behavior". American Psychological Association. January 3 2012. http://www.apa.org/pubs/journals/lhb/index.aspx. Retrieved 2012-01-03.
^ "Journals Ranked by Impact: Psychology, Social". 2010 Journal Citation Reports. Web of Science (Social Sciences ed.). Thomson Reuters. 2012.
^ "Journals Ranked by Impact: Law". 2010 Journal Citation Reports. Web of Science (Social Sciences ed.). Thomson Reuters. 2012.

[edit] External links

Official website

Am I a Dangerous Man?

Published on Psychology Today (http://www.psychologytoday.com)

Am I a Dangerous Man?

By Allen J. Frances, M.D.

Created Mar 16 2012 - 12:14am

According to this week's Time magazine, the American Psychiatric Association has just recruited a new public relations spokesman who previously worked at the Department of Defense. This is an appropriate choice for an association that substitutes a fortress mentality and warrior bluster for substantive discussion. The article quotes him as saying: "Frances is a 'dangerous' man trying to undermine an earnest academic endeavor." Fresh from DOD, it may be difficult for the new spokesman to leave behind combat cliches and perhaps he is not the best judge of academic endeavors. He enthusiastically extends the APA policy of shooting the messenger because it can't argue the message. Who knows—I may have become a picture card in his deck of high value targets.
In fact, my criticisms of DSM 5 arise precisely from its obvious failure to be an impartial, meticulous, and consensus academic endeavor. DSM 5 has suffered from a fatal combination of excessive ambition, sloppy method, and closed process. It fully deserves the concerted opposition it has generated from forty-seven professional organizations, the world press, the Society of Biological Psychiatry, the Lancet, and the general public. It has pretty much come down to DSM 5 against the world—not just me.
The piece in Time magazine manages to raise again the silly APA suggestion that my objections to DSM 5 are motivated by a feared loss of royalties. Let's set the record straight—hopefully for the last time. The royalties on my DSM IV handbook are about $10,000 a year—not at all commensurate with all the time I have spent trying to protect DSM 5 from making all its repeated mistakes.
My motivation for taking on this unpleasant task is simple—to prevent DSM 5 from promoting a general diagnostic inflation that will result in the mislabeling of millions of people as mentally disordered. Tagging someone with an inaccurate mental disorder diagnosis often results in unnecessary treatment with medications that can have very harmful side effects. I entered the DSM 5 controversy only because I had learned painful lessons working on the previous three DSM's, seeing how they can be misused with serious unintended consequences. It felt irresponsible to stay on the sidelines and not point out the obvious and substantial risks posed by the DSM 5 proposals.
I don't consider myself a dangerous man except insofar as I am raising questions that seem dangerous to DSM 5 because there are no convincing answers. My often repeated challenge to APA—provide us with some straightforward answers to these twelve simple questions:
1) Why insist on allowing the diagnosis of Major Depressive Disorder after only two weeks of symptoms that are completely compatible with normal grief?
2) Why open the floodgates to even more over-diagnosis and over-medication of Attention Deficit Disorder when its rates have already tripled in just fifteen years?
3) Why include a psychosis risk diagnosis which has been rejected as premature by most leading researchers in the field because it risks exacerbating what is already the shameful off-label overuse of antipsychotic drugs in children?
4) Why introduce Disruptive Mood Dysregulation Disorder when it has been studied by only one research team for only six years and risks encouraging the inappropriate antipsychotic drug prescription for kids with temper tantrums?
5) Why sneak in Hebephilia under the banner of Pedophilia when this will create a nightmare in forensic psychiatry?
6) Why lower the threshold for Generalized Anxiety Disorder and introduce Mixed Anxiety Depression when both of these changes will confound mental disorder with the anxieties and sadnesses of everyday life?
7) Why have a diagnosis for Minor Neurocognitive Disorder that will unnecessarily frighten many people who have no more than the memory problems of old age?
8) Why label as a mental disorder the experience of indulging in one binge eating episode a week for three months?
9) Why introduce a system of personality diagnosis so complicated it will never be used and will give dimensional diagnosis an undeserved bad name?
10) Why not delay publication of DSM 5 to allow enough time to complete the previously planned and crucial second stage of field testing that was abruptly cancelled because of the constant administrative delays in completing the first stage?
11) Why should we accept ambiguously worded DSM 5 diagnoses whose reliability barely exceeds chance?
12) And most fundamental. Why not allow for an independent scientific review of all the controversial DSM 5 changes identified above—proposed by forty-seven mental health organizations as the only way to guarantee a credible DSM 5? What is there to hide and what harm is done by additional careful review?
If I am a dangerous man, it is because I am exposing DSM 5's carelessness and thus putting at risk APA's substantial publishing profits. During the past three years, I have made numerous attempts, private and public, to warn the APA leadership of the troubles that lay ahead and to implore them to regain control of what was clearly a runaway DSM 5 process. This has had no real effect other than delaying publication of DSM 5 for a year and the appointment of an oversight committee that turned out to be toothless. I am reduced now to just one means of protecting patients, families, and the larger society from the recklessness of the DSM 5 proposals—repeatedly pointing out their risks in as many forums as possible.
Previous APA responses to criticism provide the bland and unsatisfying reassurance that we should trust DSM 5 on faith because it has been prepared by experts who have toiled long and hard. This simply won't wash—this emperor really has no clothes. It is long past time for DSM 5 to abandon phoney attempts at public relations and instead allow itself to be subjected to a rigorous independent scientific review. We need a safe and scientifically sound DSM 5—not a third rate product that is universally opposed and lacks all credibility.

Source URL: http://www.psychologytoday.com/node/90521

Links:
[1] http://www.psychologytoday.com/experts/allen-j-frances-md
[2] http://www.psychologytoday.com/blog/dsm5-in-distress
[3] http://www.psychologytoday.com/taxonomy/term/1051
[4] http://www.psychologytoday.com/taxonomy/term/3
[5] http://www.psychologytoday.com/taxonomy/term/1094
[6] http://www.psychologytoday.com/taxonomy/term/1064
[7] http://www.psychologytoday.com/tags/academic-endeavor
[8] http://www.psychologytoday.com/tags/academic-endeavors
[9] http://www.psychologytoday.com/tags/american-psychiatric-association
[10] http://www.psychologytoday.com/tags/apa-policy
[11] http://www.psychologytoday.com/tags/attention-deficit-disorder
[12] http://www.psychologytoday.com/tags/bluster-2
[13] http://www.psychologytoday.com/tags/cognitive-disorder-1
[14] http://www.psychologytoday.com/tags/dangerous-man-1
[15] http://www.psychologytoday.com/tags/depression
[16] http://www.psychologytoday.com/tags/disorder-diagnosis
[17] http://www.psychologytoday.com/tags/dsm-5-0
[18] http://www.psychologytoday.com/tags/dsm-iv
[19] http://www.psychologytoday.com/tags/eating-disorder-0
[20] http://www.psychologytoday.com/tags/fatal-combination
[21] http://www.psychologytoday.com/tags/fortress-mentality
[22] http://www.psychologytoday.com/tags/grief
[23] http://www.psychologytoday.com/tags/lancet
[24] http://www.psychologytoday.com/tags/mental-disorder
[25] http://www.psychologytoday.com/tags/picture-card
[26] http://www.psychologytoday.com/tags/professional-organizations
[27] http://www.psychologytoday.com/tags/royalties
[28] http://www.psychologytoday.com/tags/society-biological-psychiatry-0
[29] http://www.psychologytoday.com/tags/time-magazine
[30] http://www.psychologytoday.com/tags/unnecessary-treatment-1
[31] http://www.psychologytoday.com/tags/value-targets

Definitive Study Rejects the Diagnosis of “Psychosis Risk” and Finds No Treatment Benefit - Psychiatric Times

Psychiatric Times.

Definitive Study Rejects the Diagnosis of “Psychosis Risk” and Finds No Treatment Benefit

By Allen Frances, MD |April 16, 2012

The sad truth is that most clinical research has absolutely no effect on clinical practice—rarely does a study impact how we diagnose and treat patients. A paper by Morrison and colleagues¹ in the British Medical Journal is that rare exception. For the pleasure of reading it, see http://www.bmj.com/content/344/bmj.e2233.
In this one beautiful study, the authors have succeeded in definitively answering two of the most timely and consequential questions facing psychiatry today: (1) Is it a good idea to include a “psychosis risk syndrome” in DSM 5? (2) Can early treatment programs prevent psychosis? The answers to both questions are conclusively and emphatically—No.
First off, the study proves that we don't yet have the basic diagnostic tools needed to build a preventive psychiatry. Fundamental to any meaningful prevention program is the accurate identification of those who are really at risk. This study clearly demonstrates the impossibility of predicting who is (and who is not) likely to become psychotic. It is striking that only 8% of so called “ultra high risk” patients actually go on to have a psychotic episode? The unacceptably high false-positive rate means that more than 9 of 10 people entered into a psychosis prevention program will be misidentified and told they are at risk (or even worse “ultra high risk”) for eventually becoming psychotic—when quite clearly they are not. There can be no justification for burdening young people with such unnecessary stigma and worries, reduced ambitions, and the risk of receiving potentially dangerous antipsychotic drugs. If they have problems that need addressing, these should be addressed, but not under the misleading and pejorative auspice of being at “ultra high risk.”
The authors follow their findings to the by now obvious conclusion that “psychosis risk syndrome” is still in its early research phase of development and makes no sense as an official category for DSM-5. Their powerful data support the almost unanimous opposition of the leading researchers on psychosis risk—including most notably the pioneers in the field, Patrick McGorry and Alison Yung. It is puzzling that DSM-5 persists in offering a suggestion so far out of touch with current clinical reality.
The treatment results are even more important and should discourage all unrealistic expectations that early and intense intervention can prevent psychosis. Those who received the preventive intervention were just as likely to become psychotic as those who did not. The conclusion is inescapable—prevention of psychosis is a wonderful but elusive goal, one that we cannot now achieve. We are still in the early stages of prevention research and the findings so far are not encouraging. With such low rates of conversion to psychosis, it seems unlikely that a treatment effect will ever be demonstrated.
This one excellent study has killed two birds with one stone. It is a clear caution against the DSM-5 proposal for a psychosis risk syndrome and it should temper enthusiasm for rushing ahead with “ultra high risk” prevention programs. It does the wonderful cause of prevention no good to prematurely set impossible tasks that it cannot yet accomplish. The research foundation must be much more developed before psychosis prevention will be ready for the real world.
Reference
1. Morrison AP, French P, Stewart SL, et al. Early detection and intervention evaluation for people at risk of psychosis: multisite randomised controlled trial. BMJ. 2012;344:e2233. doi: 10.1136/bmj.e2233.

Mike Nova: The Health Of Nations

The idea of social justice is as old as are the ubiquitous and blatant practices of social injustice, first of all enslavement in its various forms and exploitation, on which "The Wealth Of Nations" was built. The 20th century Marxism seems to have combined both seamlessly.
Today we see more and more that "wealth of nations" depends to a large degree on "health of nations", namely, not only the conditions of their respective health services but their just (and therefore economically efficient) social and political order. The broad and universal concept of health with its notions of normal and abnormal social functioning can and should be applied to large social groups and systems, extending from the traditional notions of individual and small groups (family, industrial groups) to social health or socio-political pathology of countries and cultures (e.g. "failed states").

References and Links

Social class in the United States - From Wikipedia, the free encyclopedia:

Social class in the United States is a controversial issue, having many competing definitions, models, and even disagreements over its very existence.^[1] Many Americans believe in a simple three-class model that includes the "rich", the "middle class", and the "poor". More complex models that have been proposed describe as many as a dozen class levels;^[2]^[3] while still others deny the very existence, in the European sense, of "social class" in American society.^[4] Most definitions of class structure group people according to wealth, income, education, type of occupation, and membership in a specific subculture or social network.
Sociologists Dennis Gilbert, William Thompson, Joseph Hickey, and James Henslin have proposed class systems with six distinct social classes. These class models feature an upper or capitalist class consisting of the rich and powerful, an upper middle class consisting of highly educated and affluent professionals, a middle class consisting of college-educated individuals employed in white-collar industries, a lower middle class, a working class constituted by clerical and blue collar workers whose work is highly routinized, and a lower class divided between the working poor and the unemployed underclass.^[2]^[5]^[6]

^{A monument to the working and supporting classes
along}^{Market
Street}^{in the heart of}^{San
Francisco's Financial District}

Mike Nova: Individual, group and social psychopathology can be viewed and conceptualised on the same biopsychosocial continuum. "Erich Fromm proposed that, not just individuals, but entire societies "may be lacking in sanity" - Sanity - Wikipedia, the free encyclopedia

Mike Nova: Individual, group and social psychopathology (and "normality") can be viewed and conceptualised on the same biopsychosocial continuum.

References and links:

biopsychosocial continuum - Google Search

Biopsychosocial model - From Wikipedia, the free encyclopedia

Sanity - Wikipedia, the free encyclopedia

In The Sane Society, published in 1955, psychologist Erich Fromm proposed that, not just individuals, but entire societies "may be lacking in sanity". Fromm argued that one of the most deceptive features of social life involves "consensual validation."^[3]:

“

It is naively assumed that the fact that the majority of people share certain ideas or feelings proves the validity of these ideas and feelings. Nothing is further from the truth... Just as there is a folie à deux there is a folie à millions. The fact that millions of people share the same vices does not make these vices virtues, the fact that they share so many errors does not make the errors to be truths, and the fact that millions of people share the same form of mental pathology does not make these people sane.^[4]

Fromm, Erich. The Sane Society, Routledge, 1955, pp.14–15.

The subject of Industry Ties of DSM Workers - PsychiatryOnline | Psychiatric News | News Article

The subject of Industry Ties of DSM Workers

PsychiatryOnline | Psychiatric News | News Article

Psychiatric News | April 20, 2012

Volume 47 Number 8 page 1a-14

American Psychiatric Association

Professional News

Print
E-mail

Copyright © in the material you requested is held by The American Psychiatric Association (unless otherwise noted). This email ability is provided as a courtesy, and by using it you agree that you are requesting the material solely for personal, non-commercial use, and that it is subject to The American Psychiatric Association's Terms of Use. The information provided in order to email this topic will not be used to send unsolicited email, nor will it be furnished to third parties. Please refer to The American Psychiatric Association's Privacy Policy for further information.
Copyright © American Psychiatric Association. All rights reserved.
Share
Reprints

Article Misrepresents Industry Ties of DSM Workers

Mark Moran

View Disclosures and Other Information

Article

Citing Articles

More than 70 percent of DSM-5 Task Force and work group members now have no ties to industry.

An article in the online journal Public Library of Science (PLoS) has misrepresented facts about conflicts of interest among members of the DSM-5 Task Force and work groups, according to APA.

And it ignored the extent to which industry influence has been eliminated or greatly reduced because of strict financial disclosure requirements mandated by APA.

In a statement, APA President John Oldham, M.D., said the article, written by Lisa Cosgrove, Ph.D., and Sheldon Krimsky, Ph.D., “does not take into account the level to which DSM-5 Task Force and work group members have minimized or divested themselves from relationships with the pharmaceutical industry.”

Cosgrove is a research lab fellow at the Edmond J. Safra Center for Ethics at Harvard University. Krimsky is an adjunct professor in the Department of Public Health and Family Medicine at the Tufts School of Medicine

The article, “A Comparison of DSM-IV and DSM-5 Panel Members’ Financial Associations With Industry: A Pernicious Problem Persists,” states that APA’s financial disclosure policy for DSM-5 has not resulted in a reduction of conflicts of interest and concludes that “transparency alone cannot mitigate the potential for bias and is an insufficient solution for protecting the integrity of the revision process.”

The article appeared online March 13.

But Oldham said the authors of the article drew comparisons to DSM-IV—for which there were not the stringent requirements for financial disclosure that exist for DSM-5 contributors—to suggest erroneously that there has been an increase in conflicts of interest.

“[S]ince there were no disclosure requirements for journals, symposia, or the DSM-IV Task Force at the time of the 1994 release of DSM-IV, Cosgrove and Krimsky’s comparison of DSM-IV and DSM-5 Task Force and work group members is not valid,” Oldham said. “In assembling DSM-5 ’s Task Force and work groups, APA’s Board of Trustees developed an extensive process of written disclosure of potential conflicts of interest. These disclosures are required of all professionals who participate in the development of DSM-5. An independent APA committee reviews these disclosure documents, which are updated annually or whenever a member’s financial interests change.”

Oldham’s response noted that currently, 72 percent of the 153 members reported no relationships with the pharmaceutical industry during the previous year. Moreover, the scope of the relationships reported by the remaining 29 percent varies:

12 percent reported grant support only, including funding or receipt of medications for clinical trial research.
10 percent reported paid consultations including advice on the development of new compounds to improve treatments.
7 percent reported receiving honoraria.

These figures contradicted those cited by Cosgrove and Krimsky, who wrote, “Currently, 69 percent of the DSM-5 task force members report having ties to the pharmaceutical industry.”

They went on to add, “This represents a relative increase of 21 percent over the proportion of DSM-IV Task Force members with such ties (57 percent of DSM-IV task force members had ties).”

When queried for a response to APA’s challenge to the PLoS article, Cosgrove said their data for DSM-IV were “based on objective information we obtained from published sources since DSM did not disclose at that time the financial interests of panel members.”

She added, “We used the same methodology in the current study although the sources of information were different because DSM-5 did a lot of work for us by disclosing the financial ties.”

With regard to the apparent discrepancy in reported industry ties, Cosgrove said in her response that the figures she derived for the DSM-5 group include the full three-year period prior to each person’s nomination to the task force or work group, as was required for participation in DSM-5.

She added, “It is important in reporting financial interests that one chooses a time period prior to the publication of the document. Thus, in order to compare the commercial ties of the DSM-IV and DSM-5 groups, we relied on the best available data for each group: published disclosures (for example, in peer-reviewed medical journals) of financial ties for DSM-IV and the disclosure forms for the DSM-5 groups.”

But Darrel Regier, M.D., M.P.H, APA’s director of research, said that using the entire three-year reporting data and presenting the data as current ignores the degree to which DSM-5 reporting requirements have resulted in minimization or divestment of industry ties over time.

“As documented in their previous publications, these authors take the position that if there was ever any kind of relationship with the pharmaceutical industry, the clinician should be excluded from DSM-5 participation—an extreme position with which we disagree,” Regier told Psychiatric News. “As a result, they counted all disclosures for all years that were posted for DSM-IV Task Force members after 1994 publication of DSM-IV and contrasted that with DSM-5 Task Force member disclosures for three years prior to their appointment—without recognizing the substantial decrease in member affiliations as the DSM process progressed over five years.”

Regier added, “It is clear that there has been a sea change in how academic investigators related to industry over the past seven years since 2005—three years before the work group members were reviewed for their 2008 appointments to the DSM-5 Task Force. A good number of investigators were providing lectures at industry-sponsored symposia at the APA [annual meeting] and other meetings from 2005 to 2007, when those who were invited to participate in DSM-5 agreed to limit and often end such relationships.

“The use of the words ‘a pernicious problem persists’ in the headline is unfortunate and highly inaccurate,” Regier said. “The implication is that the relationships continue to exist as previously, when in fact there has been a marked drop in industry relationships—which the authors fail to recognize or acknowledge.”

“A Comparison of DSM-IV and DSM-5 Panel Members’ Financial Associations With Industry: A Pernicious Problem Persists” is posted at www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001190.

Being Bilingual Brings Mental Health Benefits

Psychiatric News Alert: Being Bilingual Brings Mental Health Benefits

Monday, April 30, 2012

Being Bilingual Brings Mental Health Benefits

Individuals who are bilingual appear to have superior sound-processing skills, Northwestern University researchers reported today in the Proceedings of the National Academy of Sciences. This finding suggests that bilingual individuals might possess an enhanced ability to pay attention, the researchers believe.

Being able to speak two languages likewise seems to reduce, in children, negative internalizing states such as anxiety, loneliness, and poor self-esteem, and negative externalizing behaviors such as arguing, fighting, or acting impulsively, other researchers have found. The reason, they hypothesized, may be because bilingual youngsters understand two cultures, and this understanding in turn helps them appreciate diversity and get along with their peers and teachers.

More information about this study of bilingual children can be found in Psychiatric News.

More Evidence Bilingualism Aids Thinking Skills - ...

*

The British Journal of Psychiatry current issue Review

Google Reader - Mike Nova's starred items

The British Journal of Psychiatry current issue Review

The Moon and Madness [Book reviews]

via The British Journal of Psychiatry current issue by Oyebode, F. on 5/1/12

Sleep in schizophrenia: time for closer attention [EDITORIALS]

via The British Journal of Psychiatry current issue by Wilson, S., Argyropoulos, S. on 4/2/12

Recent sleep research has highlighted two specific anomalies in schizophrenia that have a proven impact on cognition. One is an abnormality of circadian rhythm, reported in this journal in two separate studies over the past year, and the other is the finding in electroencephalograms of reduced sleep spindles.

Third-generation neuroimaging in early schizophrenia: translating research evidence into clinical utility [EDITORIALS]

via The British Journal of Psychiatry current issue by Borgwardt, S., Fusar-Poli, P. on 4/2/12

Psychiatric imaging needs to move away from simple investigations of the neurobiology underlying the early phases of schizophrenia to translate imaging findings in the clinical field, targeting clinical outcomes including transition, remission and response to preventive interventions.

Internal Racism: A Psychoanalytic Approach to Race and Difference [Book reviews]

via The British Journal of Psychiatry current issue by Fernando, S. on 5/1/12

Qualitative Research Methods in Mental Health and Psychotherapy: A Guide for Students and Practitioners [Book reviews]

via The British Journal of Psychiatry current issue by Oyebode, J. on 5/1/12

International Perspectives on Mental Health [Book reviews]

via The British Journal of Psychiatry current issue by Stein, D. J. on 5/1/12

Extrapyramidal motor side-effects of first- and second-generation antipsychotic drugs [PAPERS]

via The British Journal of Psychiatry current issue by Peluso, M. J., Lewis, S. W., Barnes, T. R. E., Jones, P. B. on 5/1/12

Background
Second-generation antipsychotics have been thought to cause fewer extrapyramidal side-effects (EPS) than first-generation antipsychotics, but recent pragmatic trials have indicated equivalence.
Aims
To determine whether second-generation antipsychotics had better outcomes in terms of EPS than first-generation drugs.
Method
We conducted an intention-to-treat, secondary analysis of data from an earlier randomised controlled trial (n = 227). A clinically significant difference was defined as double or half the symptoms in groups prescribed first- v. second-generation antipsychotics, represented by odds ratios greater than 2.0 (indicating advantage for first-generation drugs) or less than 0.5 (indicating advantage for the newer drugs). We also examined EPS in terms of symptoms emergent at 12 weeks and 52 weeks, and symptoms that had resolved at these time points.
Results
At baseline those randomised to the first-generation antipsychotic group (n = 118) had similar EPS to the second-generation group (n = 109). Indications of resolved Parkinsonism (OR = 0.5) and akathisia (OR = 0.4) and increased tardive dyskinesia (OR = 2.2) in the second-generation drug group at 12 weeks were not statistically significant and the effects were not present by 52 weeks. Patients in the second-generation group were dramatically (30-fold) less likely to be prescribed adjunctive anticholinergic medication, despite equivalence in terms of EPS.
Conclusions
The expected improvement in EPS profiles for participants randomised to second-generation drugs was not found; the prognosis over 1 year of those in the first-generation arm was no worse in these terms. The place of careful prescription of first-generation drugs in contemporary practice remains to be defined, potentially improving clinical effectiveness and avoiding life-shortening metabolic disturbances in some patients currently treated with the narrow range of second-generation antipsychotics used in routine practice. This has educational implications because a generation of psychiatrists now has little or no experience with first-generation antipsychotic prescription.

Prevalence of anti-basal ganglia antibodies in adult obsessive-compulsive disorder: cross-sectional study [PAPERS]

via The British Journal of Psychiatry current issue by Nicholson, T. R. J., Ferdinando, S., Krishnaiah, R. B., Anhoury, S., Lennox, B. R., Mataix-Cols, D., Cleare, A., Veale, D. M., Drummond, L. M., Fineberg, N. A., Church, A. J., Giovannoni, G., Heyman, I. on 5/1/12

Background
Symptoms of obsessive–compulsive disorder (OCD) have been described in neuropsychiatric syndromes associated with streptococcal infections. It is proposed that antibodies raised against streptococcal proteins cross-react with neuronal proteins (antigens) in the brain, particularly in the basal ganglia, which is a brain region implicated in OCD pathogenesis.
Aims
To test the hypothesis that post-streptococcal autoimmunity, directed against neuronal antigens, may contribute to the pathogenesis of OCD in adults.
Method
Ninety-six participants with OCD were tested for the presence of anti-streptolysin-O titres (ASOT) and the presence of anti-basal ganglia antibodies (ABGA) in a cross-sectional study. The ABGA were tested for with western blots using three recombinant antigens; aldolase C, enolase and pyruvate kinase. The findings were compared with those in a control group of individuals with depression (n = 33) and schizophrenia (n = 17).
Results
Positivity for ABGA was observed in 19/96 (19.8%) participants with OCD compared with 2/50 (4%) of controls (Fisher’s exact test P = 0.012). The majority of positive OCD sera (13/19) had antibodies against the enolase antigen. No clinical variables were associated with ABGA positivity. Positivity for ASOT was not associated with ABGA positivity nor found at an increased incidence in participants with OCD compared with controls.
Conclusions
These findings support the hypothesis that central nervous system autoimmunity may have an aetiological role in some adults with OCD. Further study is required to examine whether the antibodies concerned are pathogenic and whether exposure to streptococcal infection in vulnerable individuals is a risk factor for the development of OCD.

Prevalence of autoimmune diseases in in-patients with schizophrenia: nationwide population-based study [PAPERS]

via The British Journal of Psychiatry current issue by Chen, S.-J., Chao, Y.-L., Chen, C.-Y., Chang, C.-M., Wu, E. C.-H., Wu, C.-S., Yeh, H.-H., Chen, C.-H., Tsai, H.-J. on 5/1/12

Background
The association between autoimmune diseases and schizophrenia has rarely been systematically investigated.
Aims
To investigate the association between schizophrenia and a variety of autoimmune diseases and to explore possible gender variation in any such association.
Method
Taiwan’s National Health Insurance Research Database was used to identify 10 811 hospital in-patients with schizophrenia and 108 110 age-matched controls. Univariate and multiple logistic regression analyses were performed, separately, to evaluate the association between autoimmune diseases and schizophrenia. We applied the false discovery rate to correct for multiple testing.
Results
When compared with the control group, the in-patients with schizophrenia had an increased risk of Graves’ disease (odds ratio (OR) = 1.32, 95% CI 1.04–1.67), psoriasis (OR = 1.48, 95% CI 1.07–2.04), pernicious anaemia (OR = 1.71, 95% CI 1.04–2.80), celiac disease (OR = 2.43, 95% CI 1.12–5.27) and hypersensitivity vasculitis (OR = 5.00, 95% CI 1.64–15.26), whereas a reverse association with rheumatoid arthritis (OR = 0.52, 95% CI 0.35–0.76) was also observed. Gender-specific variation was found for Sjögren syndrome, hereditary haemolytic anaemia, myasthenia gravis, polymyalgia rheumatica and dermatomyositis.
Conclusions
Schizophrenia was associated with a greater variety of autoimmune diseases than was anticipated. Further investigation is needed to gain a better understanding of the aetiology of schizophrenia and autoimmune diseases.

See more of Mike Nova's starred items ...

Mike Nova's starred items

Severe mental illness in 33 588 prisoners worldwide: systematic review and meta-regression analysis [REVIEW ARTICLES]

via The British Journal of Psychiatry current issue by Fazel, S., Seewald, K. on 5/1/12

Background
High levels of psychiatric morbidity in prisoners have been documented in many countries, but it is not known whether rates of mental illness have been increasing over time or whether the prevalence differs between low–middle-income countries compared with high-income ones.
Aims
To systematically review prevalence studies for psychotic illness and major depression in prisoners, provide summary estimates and investigate sources of heterogeneity between studies using meta-regression.
Method
Studies from 1966 to 2010 were identified using ten bibliographic indexes and reference lists. Inclusion criteria were unselected prison samples and that clinical examination or semi-structured instruments were used to make DSM or ICD diagnoses of the relevant disorders.
Results
We identified 109 samples including 33 588 prisoners in 24 countries. Data were meta-analysed using random-effects models, and we found a pooled prevalence of psychosis of 3.6% (95% CI 3.1–4.2) in male prisoners and 3.9% (95% CI 2.7–5.0) in female prisoners. There were high levels of heterogeneity, some of which was explained by studies in low–middle-income countries reporting higher prevalences of psychosis (5.5%, 95% CI 4.2–6.8; P = 0.035 on meta-regression). The pooled prevalence of major depression was 10.2% (95% CI 8.8–11.7) in male prisoners and 14.1% (95% CI 10.2–18.1) in female prisoners. The prevalence of these disorders did not appear to be increasing over time, apart from depression in the USA (P = 0.008).
Conclusions
High levels of psychiatric morbidity are consistently reported in prisoners from many countries over four decades. Further research is needed to confirm whether higher rates of mental illness are found in low- and middle-income nations, and examine trends over time within nations with large prison populations.

Autoimmunity in psychiatry [EDITORIALS]

via The British Journal of Psychiatry current issue by Davison, K. on 5/1/12

Current knowledge of the role of autoimmunity in the pathogenesis of the main psychiatric disorders is briefly outlined. The significance of immunological effects on synaptic transmission and associated neuropsychiatric syndromes is emphasised. Clinical psychiatrists are encouraged to keep abreast of developments in this increasingly important area.

Behavior and Law - Blog by Michael Novakhov, M.D.

Tuesday, May 1, 2012