Friday, May 4, 2012
Telepsychiatry, neuromodulation, the role of genetics, and updates for the upcoming Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) are just some of the hot items on the agenda of this year's APA ... - DSM-5 Field Trial Results a Hot Topic at APA 2012 Meeting - Medscape
https://news.google.com/news/more?ned=us&ncl=dmEtOzSxt0wEpaMRg4nr-wjn0oSSM
How do controversial revisions in psychiatry's guidebook make you feel?
Philadelphia Inquirer - 4 hours ago
By Stacey Burling When upward of 10000 members of the American Psychiatric Association meet here this weekend, they'll be met by protesters - there are always protesters - and tough questions about where their profession is headed and how it will ...
Coalition of Individuals with Psychiatric Labels Supports Protestors' Efforts ...
MarketWatch (press release) - 15 hours ago
WASHINGTON, May 3, 2012 /PRNewswire via COMTEX/ -- The National Coalition for Mental Health Recovery (NCMHR), a coalition comprising 32 statewide organizations of individuals in recovery from mental health conditions, supports an upcoming peaceful ...
DSM-5 Debate: Committee Backs Off Some Changes, Re-Opens Comments
TIME - 18 hours ago
By Maia Szalavitz | @maiasz | May 3, 2012 | + The committee responsible for revising the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders — psychiatry's diagnostic “bible” commonly referred to as the DSM — has dropped the ...
Occupy the American Psychiatric Association In A Darker Dark Age
Age of Autism - 2 hours ago
By Adriana Gamondes By Adriana Gamondes I'm writing this post for two reasons. First it's to announce an event which autism families might take an interest in—a chance to protest the proposed changes to the “bible of psychiatry,” the Diagnostic and ...
APA Announces New Changes to Drafts of the DSM-5, Psychiatry's New “Bible”
Scientific American (blog) - 14 hours ago
By Ferris Jabr | May 3, 2012 | I have this slim silver book on my desk called the “Quick Reference to the Diagnostic Criteria From DSM-IV-TR.” Page 153 reads: A. Characteristic symptoms: Two (or more) of the following, each present for a significant ...
DSM-5 Field Trial Results a Hot Topic at APA 2012 Meeting
Medscape - 15 hours ago
May 3, 2012 — Telepsychiatry, neuromodulation, the role of genetics, and updates for the upcoming Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) are just some of the hot items on the agenda of this year's American ...
'Integrated care' will be a hot topic in Philadelphia this weekend
Newsworks.org - 15 hours ago
By Maiken Scott Integrated Care, bringing together mental and physical health care, is the theme of this year's American Psychiatric Association conference, which begins in Philadelphia this weekend. What role will psychiatrists play if healthcare ...
A Major Transformation in Psychiatry?
Medscape - 19 hours ago
Hello, this is Dr. Jeffrey Lieberman of Columbia University, speaking to you today for Medscape. For some time now, I have said that the one thing that would have the biggest impact on changing the way the public looks at mental illness is the ...
Body composition in patients with schizophrenia: comparison with healthy controls
7thSpace Interactive (press release) - 19 hours ago
Recently, a relationship between obesity and schizophrenia has been reported. Although fat mass and fat-free mass have been shown to be more predictive of health risk than body mass index, there are limited findings about body composition among ...
CCHR STL Blog and News Archive
Citizens Commission on Human Rights of St. Louis - May 3, 2012
We wish we could give you all the true data about autism, but we don't know it all. Instead, we can give you many related facts and a few opinions; perhaps these can help you evaluate the subject. The reason we discuss it at all is because the ...
How do controversial revisions in psychiatry's guidebook make you feel?
How do controversial revisions in psychiatry's guidebook make you feel?
Read more: http://www.philly.com/philly/health/20120504_How_do_controversial_revisions_in_psychiatry_s_guidebook_make_you_feel_.html?viewAll=y#ixzz1tts42VMT
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How do controversial revisions in psychiatry's guidebook make you feel?
When upward of 10,000 members of the American Psychiatric Association meet here this weekend, they'll be met by protesters - there are always protesters - and tough questions about where their profession is headed and how it will define normalcy for the rest of us. The official theme of the annual meeting, which opens Saturday at the Pennsylvania Convention Center, is integrated care, a nod to the increasingly interdisciplinary nature of medicine in the health-reform era. But many sessions will also focus on the association's highly controversial overhaul of the Diagnostic and Statistical Manual of Mental Disorders, the dominant guidebook to mental maladies and a key factor in determining insurance payments.
The current tome, the DSM-IV, was published in 1994 and updated in 2000. The book now in the works, the DSM-5 (yes, they dropped the Roman numerals), is due out by next year's APA meeting.
Supporters say the revisions incorporate more current science into the highly influential book. It also strives for diagnoses that show how seriously ill patients are.
Critics say the changes jump ahead of the science and expand what is considered mental illness. While the association tries to detect illnesses earlier and possibly prevent their most tragic symptoms, it risks calling essentially normal people mentally ill, needlessly exposing thousands to stigma and strong medicines, and handing drugmakers a bonanza.
One hot-button proposal allows grieving people to be considered depressed after two weeks of symptoms. Another addresses children who were being labeled bipolar by creating a different diagnosis: disruptive mood dysregulation disorder. Some worry that diagnoses meant to identify thinking problems in the elderly will turn normal aging into a disorder.
The University of Pennsylvania was one of 11 academic medical centers that field-tested the book's new approach. It looked at five diagnoses, including three new ones: hoarding disorder, binge-eating disorder, and mixed depression and anxiety.
In what is surely biting criticism in the mental-health world, David N. Elkins, a psychology professor emeritus at Pepperdine University, said the APA "should listen. They don't listen very well. They need to listen to the outcry and take it seriously."
The APA must have listened a little. It announced this week that it had moved the new attenuated psychosis syndrome, which attempted to identify young people likely to develop psychosis, and mixed anxiety and depression to a book section for conditions that need more research. They also tried to better differentiate normal grief from depression.
Last fall, Elkins, president of the Society for Humanistic Psychology, helped draft an open letter critiquing proposed changes. It got 13,000 signatures online, he said.
His and other groups are so miffed that they plan to write their own book. "We are calling for a summit in New York City in the summer of 2013 of all the mental-health professions," Elkins said. "We need a manual that is produced in an egalitarian way."
One of the most vocal critics is psychiatrist Allen Frances, who edited the DSM-IV. He said that overdiagnosing and overprescribing of antipsychotic drugs, particularly in children and the elderly, were already big problems. Psychiatry, he said, should be asking, "How can we put a governor on this? What DSM-5 will do, instead, is open up the flood gates."
The new approach, he said, gives "drug companies a free pass to convince everyone in the world that they have one disorder or two or three."
There's also the matter of autism. Its proposed definition is more restrictive. That has caused an outcry from autism advocates, who fear children will lose school services.
Frances thinks his group has made the current definition too broad. If fewer children with mild symptoms are diagnosed, "that's a good thing."
He also thinks the APA has too much money at stake to be objective. He says it makes $5 million to $10 million a year on sales of the manual.
The APA says it has invested $25 million in developing the new DSM over the last 12 years. It deflected a question about how much income the book generates.
David Kupfer, a University of Pittsburgh psychiatrist who heads the DSM-5 task force, said nothing was set in stone. A third six-week comment period opened Wednesday. The APA already has received close to 10,800 comments.
"We do want more public commentary," Kupfer said. "We are carefully examining this with some of our review groups. We certainly do not want to make changes for the sake of making changes."
For the record, he said, the number of diagnoses is dropping from 280 to 220.
John Oldham, the psychiatric association's president, said one of the DSM's roles has been to provide definitions that lead to better research. Mental health and illness are on a continuum with no clear lines of demarcation, but scientists need to find the earliest signs of dysfunction. "It's important for us," he said, "to be trying to understand when the right time is to intervene."
Thomas R. Insel, a psychiatrist who directs the National Institute of Mental Health, sees psychiatry heading toward what he calls "clinical neuroscience." Psychiatrists should study the brain the way cardiologists study the heart, he said.
While people assume that thinking of mental illnesses as brain disorders will lead to more medication, Insel said his agency has funded research into cognitive training, therapy that uses the brain's ability to change. It also is studying diet and family support.
"There is no biochemical imbalance that we have ever been able to demonstrate," he said. "What we think about are changes in circuitry and how the brain is processing information."
It makes sense to him to try to identify at-risk youths before they develop symptoms that can devastate their ability to work or have fulfilling relationships. The most debilitating of the mental illnesses, schizophrenia and bipolar disorder, often are diagnosed in early adulthood, but researchers are studying signs that emerge years earlier.
Critics say that lots of teens have eccentric behaviors but won't become mentally ill. This is true, Insel said, but "science entirely supports" figuring out who's going to become psychotic and preventing it. "That doesn't mean medicate earlier," he said.
The institute has embarked on its own attempt to classify mental illnesses based on what's happening in the brain rather than on symptoms.
Asked whether the association should delay rewriting the DSM until the science advances, he said, "That's a fair question. I'm not going to answer it." Then he said, "I think the DSM-IV is extremely helpful."
Mahendra Bhati, a psychiatrist who headed the Penn field trial, is confident that the new disorders his clinic tested are genuine mental illnesses. They don't necessarily need drug treatment.
But he found the new approach to personality disorders "clinically impractical."
Overall, he said, "I honestly don't think it's going to make a huge difference in how I practice psychiatry." His prescriptions, he said, are based on symptoms, not diagnoses.
On Saturday, as psychiatrists inside the convention center discuss proposed DSM changes, protesters outside plan to "Occupy the American Psychiatric Association." They'll have a "label rip," where they tear up the very diagnosis names that the psychiatrists are intent on defining.
"We'd have to be Don Quixote to think we're going to stop it at this point," David Oaks said of the DSM-5. A veteran of many such protests, Oaks, a Harvard grad who has been called schizophrenic and bipolar, is executive director of MindFreedom International and one of the event organizers. He says psychiatrists have not listened enough to their "customers," who often find peer and social support more helpful than drugs.
The current tome, the DSM-IV, was published in 1994 and updated in 2000. The book now in the works, the DSM-5 (yes, they dropped the Roman numerals), is due out by next year's APA meeting.
Supporters say the revisions incorporate more current science into the highly influential book. It also strives for diagnoses that show how seriously ill patients are.
Critics say the changes jump ahead of the science and expand what is considered mental illness. While the association tries to detect illnesses earlier and possibly prevent their most tragic symptoms, it risks calling essentially normal people mentally ill, needlessly exposing thousands to stigma and strong medicines, and handing drugmakers a bonanza.
One hot-button proposal allows grieving people to be considered depressed after two weeks of symptoms. Another addresses children who were being labeled bipolar by creating a different diagnosis: disruptive mood dysregulation disorder. Some worry that diagnoses meant to identify thinking problems in the elderly will turn normal aging into a disorder.
The University of Pennsylvania was one of 11 academic medical centers that field-tested the book's new approach. It looked at five diagnoses, including three new ones: hoarding disorder, binge-eating disorder, and mixed depression and anxiety.
In what is surely biting criticism in the mental-health world, David N. Elkins, a psychology professor emeritus at Pepperdine University, said the APA "should listen. They don't listen very well. They need to listen to the outcry and take it seriously."
The APA must have listened a little. It announced this week that it had moved the new attenuated psychosis syndrome, which attempted to identify young people likely to develop psychosis, and mixed anxiety and depression to a book section for conditions that need more research. They also tried to better differentiate normal grief from depression.
Last fall, Elkins, president of the Society for Humanistic Psychology, helped draft an open letter critiquing proposed changes. It got 13,000 signatures online, he said.
His and other groups are so miffed that they plan to write their own book. "We are calling for a summit in New York City in the summer of 2013 of all the mental-health professions," Elkins said. "We need a manual that is produced in an egalitarian way."
One of the most vocal critics is psychiatrist Allen Frances, who edited the DSM-IV. He said that overdiagnosing and overprescribing of antipsychotic drugs, particularly in children and the elderly, were already big problems. Psychiatry, he said, should be asking, "How can we put a governor on this? What DSM-5 will do, instead, is open up the flood gates."
The new approach, he said, gives "drug companies a free pass to convince everyone in the world that they have one disorder or two or three."
There's also the matter of autism. Its proposed definition is more restrictive. That has caused an outcry from autism advocates, who fear children will lose school services.
Frances thinks his group has made the current definition too broad. If fewer children with mild symptoms are diagnosed, "that's a good thing."
He also thinks the APA has too much money at stake to be objective. He says it makes $5 million to $10 million a year on sales of the manual.
The APA says it has invested $25 million in developing the new DSM over the last 12 years. It deflected a question about how much income the book generates.
David Kupfer, a University of Pittsburgh psychiatrist who heads the DSM-5 task force, said nothing was set in stone. A third six-week comment period opened Wednesday. The APA already has received close to 10,800 comments.
"We do want more public commentary," Kupfer said. "We are carefully examining this with some of our review groups. We certainly do not want to make changes for the sake of making changes."
For the record, he said, the number of diagnoses is dropping from 280 to 220.
John Oldham, the psychiatric association's president, said one of the DSM's roles has been to provide definitions that lead to better research. Mental health and illness are on a continuum with no clear lines of demarcation, but scientists need to find the earliest signs of dysfunction. "It's important for us," he said, "to be trying to understand when the right time is to intervene."
Thomas R. Insel, a psychiatrist who directs the National Institute of Mental Health, sees psychiatry heading toward what he calls "clinical neuroscience." Psychiatrists should study the brain the way cardiologists study the heart, he said.
While people assume that thinking of mental illnesses as brain disorders will lead to more medication, Insel said his agency has funded research into cognitive training, therapy that uses the brain's ability to change. It also is studying diet and family support.
"There is no biochemical imbalance that we have ever been able to demonstrate," he said. "What we think about are changes in circuitry and how the brain is processing information."
It makes sense to him to try to identify at-risk youths before they develop symptoms that can devastate their ability to work or have fulfilling relationships. The most debilitating of the mental illnesses, schizophrenia and bipolar disorder, often are diagnosed in early adulthood, but researchers are studying signs that emerge years earlier.
Critics say that lots of teens have eccentric behaviors but won't become mentally ill. This is true, Insel said, but "science entirely supports" figuring out who's going to become psychotic and preventing it. "That doesn't mean medicate earlier," he said.
The institute has embarked on its own attempt to classify mental illnesses based on what's happening in the brain rather than on symptoms.
Asked whether the association should delay rewriting the DSM until the science advances, he said, "That's a fair question. I'm not going to answer it." Then he said, "I think the DSM-IV is extremely helpful."
Mahendra Bhati, a psychiatrist who headed the Penn field trial, is confident that the new disorders his clinic tested are genuine mental illnesses. They don't necessarily need drug treatment.
But he found the new approach to personality disorders "clinically impractical."
Overall, he said, "I honestly don't think it's going to make a huge difference in how I practice psychiatry." His prescriptions, he said, are based on symptoms, not diagnoses.
On Saturday, as psychiatrists inside the convention center discuss proposed DSM changes, protesters outside plan to "Occupy the American Psychiatric Association." They'll have a "label rip," where they tear up the very diagnosis names that the psychiatrists are intent on defining.
"We'd have to be Don Quixote to think we're going to stop it at this point," David Oaks said of the DSM-5. A veteran of many such protests, Oaks, a Harvard grad who has been called schizophrenic and bipolar, is executive director of MindFreedom International and one of the event organizers. He says psychiatrists have not listened enough to their "customers," who often find peer and social support more helpful than drugs.
Read more: http://www.philly.com/philly/health/20120504_How_do_controversial_revisions_in_psychiatry_s_guidebook_make_you_feel_.html?viewAll=y#ixzz1tts42VMT
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Speculation Arises about the Role of Concussions in Another NFL Player’s Suicide | Common Pesticide “Disturbs” the Brains of Children - Mike Nova's starred items
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Mike Nova's starred items
Credit: JJ Hall/Wikimedia CommonsNFL legend Junior Seau died today after reportedly shooting himself in the chest, according to various news reports.
What prompted the apparent suicide is still unknown. But Seau’s taking of his own life will inevitably raise questions about a possible role of chronic traumatic encephalopathy (CTE), a disorder that results from repeated concussions and that can produce dementia and other forms of cognitive dysfunction.
The NFL has had to contend with a growing incidence of this disorder. Dave Duerson, an NFL safety, committed suicide in 2011 by shooting himself in the chest and directed that his brain be used for research on CTE. Any player in the NFL, and in other contact sports like hockey, probably leaves a long career with some traces of brain injury. But tests will be needed to determine whether Seau merited a clinical diagnosis.
No reports have emerged so far that Seau suffered from dementia-like symptoms. An SUV that Seau was driving in 2010 near his home in Oceanside, Calif., went over a cliff that fronted on a beach, according to The Los Angeles Times. The incident occurred following his arrest that year related to suspicion of domestic violence.
Seau, a 12-time NFL Pro linebacker following a career as an All-American at University of Southern California, registered 13 seasons with the San Diego Chargers, three seasons with the Miami Dolphins and ended his career with the New England Patriots.
See Scientific American’s In-Depth Report—The Science of Concussion and Brain Injury—and the article “The Collision Syndrome” (pay wall) from the February 2012 Scientific American for more on CTE.
Banned for indoor use since 2001, the effects of the common insecticide known as chlorpyrifos can still be found in the brains of young children now approaching puberty. A new study used magnetic imaging to reveal that those children exposed to chlorpyrifos in the womb had persistent changes in their brains throughout childhood.
The brains of 20 children exposed to higher levels of chlorpyrifos in their mother’s blood (as measured by serum from the umbilical cord) “looked different” compared to those exposed to lower levels of the chemical, says epidemiologist Virginia Rauh of the Mailman School of Public Health at Columbia University, who led the research published online by Proceedings of the National Academy of Sciences on April 30. “During brain development some type of disturbance took place.”
The 6 young boys and 14 little girls, whose mothers were exposed to chlorpyrifos when it was commonly used indoors in bug sprays prior to the ban, ranged in age from seven to nearly 10. All came from Dominican or African American families in the New York City region. Compared to 20 children from the same kinds of New York families who had relatively low levels of chlorpyrifos in umbilical cord blood, the 20 higher dose kids had protuberances in some regions of the cerebral cortex and thinning in other regions. “There were measurable volumetric changes in the cerebral cortex,” Rauh notes.
Though the study did not map specific disorders associated with any of these brain changes, the regions affected are associated with functions like attention, decision-making, language, impulse control and working memory. The “structural anomalies in the brain could be a mechanism, or explain why we found cognitive deficits in children” in previous studies, Rauh notes.
The findings echo similar results with animal studies of the insecticide, which remains widely used in agriculture to kill crop-spoiling insects. Rats exposed to the chemical also experience changes to the brain as well as altered behavior—all at doses below those considered safe by current federal guidelines from the U.S. Environmental Protection Agency (EPA). The change, at least for rats, is irreversible.
Previous studies have linked chlorpyrifos in children to everything from low birth weight to attention problems in both urban and agricultural exposures. And a low, but measurable, dose reaches yet other populations via food—a study that fed children a diet of organic food showed drops in the levels of chlorpyrifos and other organophosphate pesticides that then rebounded when they returned to their regular diet. The insecticide is used on everything from peaches to cilantro. “It’s the fruits and vegetables,” that can carry chlorpyrifos, Rauh notes.
Of course, it remains unclear what, if any, danger such doses pose but it is now apparent that chlorpyrifos exposure in the womb has impacts on brain structure that persist through childhood, at least. And the children in this study were exposed to lower levels of chlorpyrifos than found in a random sampling from a Cincinnati blood bank (which showed levels twice as high as those in the affected children). It also remains unclear whether the brain changes—some of which skew masculine or feminine brain characteristics—will have an impact in puberty. “Whether or not there would be any measurable effects is not clear,” Rauh says. “Hopefully, going forward, we’ll be able to answer some of those questions and determine whether the process of puberty or other aspects of sexual differentiation could be assessed.”
The good news is that washing fruits and vegetables can rinse away lingering chlorpyrifos and, presumably, mitigate any risk. In addition, although chlorpyrifos can persist in indoor environments, it breaks down relatively quickly when exposed to sunlight and other natural elements. And the EPA is now following up its prior ban on indoor use by re-evaluating its policy more broadly. “We have a lot of risky chemicals in our environment,” Rauh says. “We need to determine if the risk persists, if it is reversible and look at the larger regulatory picture for chemicals.”
As of now, however, the use of chlorpyrifos remains widespread in conventional agriculture. “Eating organic is a great idea, however, it is very expensive and out of reach for many average families,” such as the ones in this study, Rauh notes. It’s a “better idea to wash your apples. That would eliminate a whole variety of problems.”
Image: © iStockphoto.com / Federico Rostagno
Image courtesy of iStockphoto/kali9It’s always nice to get the full recommended seven or nine hours of sleep every day. But life—and work—often gets in the way. And getting too little sleep can decrease attention and short-term memory and can also alter rational judgment—in addition to increasing the risk for some diseases and making it harder to lose weight.
Thus, for those who work in an industry where a simple error can lead to injury or death, missing out on sleep can be seriously dangerous. Moreover, according to a new survey, workers in industries with heavy equipment are among the least likely to be well rested.
A study of more than 15,000 employed U.S. adults shows that 30 percent of all workers reported getting fewer than six hours of sleep every day. That’s some 28.3 million workers who are operating (themselves and often machinery) with far less sleep than recommended. The findings were published online April 27 by the U.S. Centers for Disease Control and Prevention (CDC).
Night shift workers were, predictably, the most likely to be getting less z’s, with 44 percent—some 2.2 million people—getting fewer than six hours a day. (Trying to sleep during daylight hours can be a challenge because the body’s circadian rhythms are more likely to be sending stay-awake hormonal signals.)
Of people who work in transportation and warehousing on overnight shifts, almost 70 percent are getting fewer than six hours of sleep a day. This is of particular concern considering that at least one in five vehicle accidents is the result of a fatigued driver.
More than half (about 52 percent) of those working overnight in health care and other assistance industries reported fewer than six hours of sleep. Fatigue in the medical field has been shown to increase both errors and injuries. A 2007 study found that medical trainees who were sleep-deprived were three times as likely to accidentally stick themselves with a needle.
Other sectors that were likely to be getting little sleep (for any shift) were mining (at about 42 percent), utilities workers (at 38 percent) and manufacturing (about 34 percent).
“Short sleep duration is associated with various adverse health effects (e.g., cardiovascular disease or obesity), decreased workplace and public safety, and impaired job performance,” wrote the report authors, led by Sara Luckhaupt, of the CDC’s National Institute for Occupational Safety and Health.
Workplace safety might sound like the lame stuff of training videos and OSHA (Occupational Safety and Health Administration) posters. But in the U.S., thousands of workers still die from on-the-job injuries every year. And some 2.7 million workers had to go to the emergency room after sustaining an injury on the job in 2010 alone. Personal safety aside, these accidents are expensive. Fatal injuries on the job cost the U.S. some $6 billion annually, and nonfatal workplace injuries drain some $186 billion, according to the CDC. The agency points out that April 28 is the other Memorial Day: Workers Memorial Day, to recognize “those workers who have died or sustained work-related injuries or illnesses.” Presumably those insults are more substantial than the familiar paper cut.
Aside from individual attention to sleep habits and health, sleeping times can also be boosted by better policies. One way employers could help those with variable shifts, for example, is by “rotating workers forward from evening to night shifts rather than backward from night to evening shifts,” which “makes it easier for circadian rhythms to adjust so that workers can sleep during their rest times,” Luckhaupt noted.
And not everyone who is burning the midnight oil is missing out on sleep. Those who work nights in the “arts, entertainment and recreation” fields seem to be doing just fine sleeping in. Less than 10 percent of them reported getting fewer than six hours of sleep.
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via Observations by Gary Stix on 5/2/12
Credit: JJ Hall/Wikimedia CommonsWhat prompted the apparent suicide is still unknown. But Seau’s taking of his own life will inevitably raise questions about a possible role of chronic traumatic encephalopathy (CTE), a disorder that results from repeated concussions and that can produce dementia and other forms of cognitive dysfunction.
The NFL has had to contend with a growing incidence of this disorder. Dave Duerson, an NFL safety, committed suicide in 2011 by shooting himself in the chest and directed that his brain be used for research on CTE. Any player in the NFL, and in other contact sports like hockey, probably leaves a long career with some traces of brain injury. But tests will be needed to determine whether Seau merited a clinical diagnosis.
No reports have emerged so far that Seau suffered from dementia-like symptoms. An SUV that Seau was driving in 2010 near his home in Oceanside, Calif., went over a cliff that fronted on a beach, according to The Los Angeles Times. The incident occurred following his arrest that year related to suspicion of domestic violence.
Seau, a 12-time NFL Pro linebacker following a career as an All-American at University of Southern California, registered 13 seasons with the San Diego Chargers, three seasons with the Miami Dolphins and ended his career with the New England Patriots.
See Scientific American’s In-Depth Report—The Science of Concussion and Brain Injury—and the article “The Collision Syndrome” (pay wall) from the February 2012 Scientific American for more on CTE.
via Observations by David Biello on 5/1/12
Banned for indoor use since 2001, the effects of the common insecticide known as chlorpyrifos can still be found in the brains of young children now approaching puberty. A new study used magnetic imaging to reveal that those children exposed to chlorpyrifos in the womb had persistent changes in their brains throughout childhood.The brains of 20 children exposed to higher levels of chlorpyrifos in their mother’s blood (as measured by serum from the umbilical cord) “looked different” compared to those exposed to lower levels of the chemical, says epidemiologist Virginia Rauh of the Mailman School of Public Health at Columbia University, who led the research published online by Proceedings of the National Academy of Sciences on April 30. “During brain development some type of disturbance took place.”
The 6 young boys and 14 little girls, whose mothers were exposed to chlorpyrifos when it was commonly used indoors in bug sprays prior to the ban, ranged in age from seven to nearly 10. All came from Dominican or African American families in the New York City region. Compared to 20 children from the same kinds of New York families who had relatively low levels of chlorpyrifos in umbilical cord blood, the 20 higher dose kids had protuberances in some regions of the cerebral cortex and thinning in other regions. “There were measurable volumetric changes in the cerebral cortex,” Rauh notes.
Though the study did not map specific disorders associated with any of these brain changes, the regions affected are associated with functions like attention, decision-making, language, impulse control and working memory. The “structural anomalies in the brain could be a mechanism, or explain why we found cognitive deficits in children” in previous studies, Rauh notes.
The findings echo similar results with animal studies of the insecticide, which remains widely used in agriculture to kill crop-spoiling insects. Rats exposed to the chemical also experience changes to the brain as well as altered behavior—all at doses below those considered safe by current federal guidelines from the U.S. Environmental Protection Agency (EPA). The change, at least for rats, is irreversible.
Previous studies have linked chlorpyrifos in children to everything from low birth weight to attention problems in both urban and agricultural exposures. And a low, but measurable, dose reaches yet other populations via food—a study that fed children a diet of organic food showed drops in the levels of chlorpyrifos and other organophosphate pesticides that then rebounded when they returned to their regular diet. The insecticide is used on everything from peaches to cilantro. “It’s the fruits and vegetables,” that can carry chlorpyrifos, Rauh notes.
Of course, it remains unclear what, if any, danger such doses pose but it is now apparent that chlorpyrifos exposure in the womb has impacts on brain structure that persist through childhood, at least. And the children in this study were exposed to lower levels of chlorpyrifos than found in a random sampling from a Cincinnati blood bank (which showed levels twice as high as those in the affected children). It also remains unclear whether the brain changes—some of which skew masculine or feminine brain characteristics—will have an impact in puberty. “Whether or not there would be any measurable effects is not clear,” Rauh says. “Hopefully, going forward, we’ll be able to answer some of those questions and determine whether the process of puberty or other aspects of sexual differentiation could be assessed.”
The good news is that washing fruits and vegetables can rinse away lingering chlorpyrifos and, presumably, mitigate any risk. In addition, although chlorpyrifos can persist in indoor environments, it breaks down relatively quickly when exposed to sunlight and other natural elements. And the EPA is now following up its prior ban on indoor use by re-evaluating its policy more broadly. “We have a lot of risky chemicals in our environment,” Rauh says. “We need to determine if the risk persists, if it is reversible and look at the larger regulatory picture for chemicals.”
As of now, however, the use of chlorpyrifos remains widespread in conventional agriculture. “Eating organic is a great idea, however, it is very expensive and out of reach for many average families,” such as the ones in this study, Rauh notes. It’s a “better idea to wash your apples. That would eliminate a whole variety of problems.”
Image: © iStockphoto.com / Federico Rostagno
via Observations by Katherine Harmon on 4/27/12
Image courtesy of iStockphoto/kali9Thus, for those who work in an industry where a simple error can lead to injury or death, missing out on sleep can be seriously dangerous. Moreover, according to a new survey, workers in industries with heavy equipment are among the least likely to be well rested.
A study of more than 15,000 employed U.S. adults shows that 30 percent of all workers reported getting fewer than six hours of sleep every day. That’s some 28.3 million workers who are operating (themselves and often machinery) with far less sleep than recommended. The findings were published online April 27 by the U.S. Centers for Disease Control and Prevention (CDC).
Night shift workers were, predictably, the most likely to be getting less z’s, with 44 percent—some 2.2 million people—getting fewer than six hours a day. (Trying to sleep during daylight hours can be a challenge because the body’s circadian rhythms are more likely to be sending stay-awake hormonal signals.)
Of people who work in transportation and warehousing on overnight shifts, almost 70 percent are getting fewer than six hours of sleep a day. This is of particular concern considering that at least one in five vehicle accidents is the result of a fatigued driver.
More than half (about 52 percent) of those working overnight in health care and other assistance industries reported fewer than six hours of sleep. Fatigue in the medical field has been shown to increase both errors and injuries. A 2007 study found that medical trainees who were sleep-deprived were three times as likely to accidentally stick themselves with a needle.
Other sectors that were likely to be getting little sleep (for any shift) were mining (at about 42 percent), utilities workers (at 38 percent) and manufacturing (about 34 percent).
“Short sleep duration is associated with various adverse health effects (e.g., cardiovascular disease or obesity), decreased workplace and public safety, and impaired job performance,” wrote the report authors, led by Sara Luckhaupt, of the CDC’s National Institute for Occupational Safety and Health.
Workplace safety might sound like the lame stuff of training videos and OSHA (Occupational Safety and Health Administration) posters. But in the U.S., thousands of workers still die from on-the-job injuries every year. And some 2.7 million workers had to go to the emergency room after sustaining an injury on the job in 2010 alone. Personal safety aside, these accidents are expensive. Fatal injuries on the job cost the U.S. some $6 billion annually, and nonfatal workplace injuries drain some $186 billion, according to the CDC. The agency points out that April 28 is the other Memorial Day: Workers Memorial Day, to recognize “those workers who have died or sustained work-related injuries or illnesses.” Presumably those insults are more substantial than the familiar paper cut.
Aside from individual attention to sleep habits and health, sleeping times can also be boosted by better policies. One way employers could help those with variable shifts, for example, is by “rotating workers forward from evening to night shifts rather than backward from night to evening shifts,” which “makes it easier for circadian rhythms to adjust so that workers can sleep during their rest times,” Luckhaupt noted.
And not everyone who is burning the midnight oil is missing out on sleep. Those who work nights in the “arts, entertainment and recreation” fields seem to be doing just fine sleeping in. Less than 10 percent of them reported getting fewer than six hours of sleep.
via Observations by Ferris Jabr on 5/3/12
I have this slim silver book on my desk called the “Quick Reference to the Diagnostic Criteria From DSM-IV-TR.” Page 153 reads:
Schizophrenia
A. Characteristic symptoms: Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated):
(1) delusions
(2) hallucinations
(3) disorganized speech (e.g., frequent derailment or incoherence)
(4) grossly disorganized or catatonic behavior
(5) negative symptoms, i.e., affective flattening, alogia, or avolition
Throughout the book, similarly organized lists of symptoms follow the names of every officially recognized mental disorder—bipolar disorder, autistic disorder, generalized anxiety disorder and so on. My slim silver volume is an abridged version of the Diagnostic and Statistical Manual for Mental Disorders IV-TR (DSM-IV-TR), the most current edition of the standard reference guide for psychiatrists. It’s the book that many psychiatrists consult when deciding what ails their patients.
For the past 11 years, the American Psychiatric Association (APA), which publishes the DSM, has been working on a brand new version of the manual, the DSM-5 (no more Roman numerals, now that we have fully entered the age of digital publishing). Psychiatry’s new “bible” is slated for publication in May, 2013.
The APA has overhauled the DSM several times in the past—always a laborious and controversial process. This time, the association is doing things a little differently. Psychiatrists within and outside the APA have long criticized the revision process for its opacity. So the APA has made drafts of the new DSM-5 available on their website for public comment and has amended the drafts based on feedback from the psychiatrists, psychologists and the general public.
The latest drafts of the DSM-5 are now available online and open to comment for the next six weeks. Here are the most significant updates:
-The APA is no longer considering “Attenuated Psychosis Syndrome” as a new official disorder in the DSM-5. The proposed diagnosis was supposed to help identify children at risk for developing a psychotic disorder, but research has shown that 2/3 of children who qualify as “at risk” never progress to true psychosis.
-The APA is no longer considering “Mixed Anxiety Depressive Disorder” as a new official disorder in the DSM-5. Many psychiatrists worried that the new diagnosis was too vague and that too many people would qualify.
-The APA has added a footnote to the Major Depressive Disorder criteria “to clarify the difference between normal bereavement associated with a significant loss and a diagnosis of a mental disorder.” Previous changes to the depression criteria reframed grief that lasted longer than 2 months as a sign of depression, even if someone had recently lost a loved one—a mistake that drew intense criticism.
Over at Time magazine, Maia Szalavitz has a great discussion of the newest changes. She also points to Allen Frances’s critical analysis at Psychology Today.
This year, the APA is holding its annual meeting from May 5 to 9 in Philadelphia, where much of the discussion will focus on the drafts of the DSM-5 and the results of “Field Trials”—dry runs of the new diagnostic criteria in clinical settings. I am attending the conference to learn more and, next week, my colleague Ingrid Wickelgren at Scientific American MIND and I will bring you a series of blogs about the DSM-5 authored by ourselves and some well-known researchers and psychiatrists. For the duration of next week, we will also publish my feature article about DSM-5 in its entirety on our website. After next week, you can still read the feature in the May/June issue of MIND. Stay tuned!
Schizophrenia
A. Characteristic symptoms: Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated):
(1) delusions
(2) hallucinations
(3) disorganized speech (e.g., frequent derailment or incoherence)
(4) grossly disorganized or catatonic behavior
(5) negative symptoms, i.e., affective flattening, alogia, or avolition
Throughout the book, similarly organized lists of symptoms follow the names of every officially recognized mental disorder—bipolar disorder, autistic disorder, generalized anxiety disorder and so on. My slim silver volume is an abridged version of the Diagnostic and Statistical Manual for Mental Disorders IV-TR (DSM-IV-TR), the most current edition of the standard reference guide for psychiatrists. It’s the book that many psychiatrists consult when deciding what ails their patients.
For the past 11 years, the American Psychiatric Association (APA), which publishes the DSM, has been working on a brand new version of the manual, the DSM-5 (no more Roman numerals, now that we have fully entered the age of digital publishing). Psychiatry’s new “bible” is slated for publication in May, 2013.
The APA has overhauled the DSM several times in the past—always a laborious and controversial process. This time, the association is doing things a little differently. Psychiatrists within and outside the APA have long criticized the revision process for its opacity. So the APA has made drafts of the new DSM-5 available on their website for public comment and has amended the drafts based on feedback from the psychiatrists, psychologists and the general public.
The latest drafts of the DSM-5 are now available online and open to comment for the next six weeks. Here are the most significant updates:
-The APA is no longer considering “Attenuated Psychosis Syndrome” as a new official disorder in the DSM-5. The proposed diagnosis was supposed to help identify children at risk for developing a psychotic disorder, but research has shown that 2/3 of children who qualify as “at risk” never progress to true psychosis.
-The APA is no longer considering “Mixed Anxiety Depressive Disorder” as a new official disorder in the DSM-5. Many psychiatrists worried that the new diagnosis was too vague and that too many people would qualify.
-The APA has added a footnote to the Major Depressive Disorder criteria “to clarify the difference between normal bereavement associated with a significant loss and a diagnosis of a mental disorder.” Previous changes to the depression criteria reframed grief that lasted longer than 2 months as a sign of depression, even if someone had recently lost a loved one—a mistake that drew intense criticism.
Over at Time magazine, Maia Szalavitz has a great discussion of the newest changes. She also points to Allen Frances’s critical analysis at Psychology Today.
This year, the APA is holding its annual meeting from May 5 to 9 in Philadelphia, where much of the discussion will focus on the drafts of the DSM-5 and the results of “Field Trials”—dry runs of the new diagnostic criteria in clinical settings. I am attending the conference to learn more and, next week, my colleague Ingrid Wickelgren at Scientific American MIND and I will bring you a series of blogs about the DSM-5 authored by ourselves and some well-known researchers and psychiatrists. For the duration of next week, we will also publish my feature article about DSM-5 in its entirety on our website. After next week, you can still read the feature in the May/June issue of MIND. Stay tuned!
APA Announces New Changes to Drafts of the DSM-5, Psychiatry’s New “Bible” | Observations, Scientific American Blog Network
APA Announces New Changes to Drafts of the DSM-5, Psychiatry’s New “Bible” | Observations, Scientific American Blog Network
Opinion, arguments & analyses from the editors of Scientific American
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PrintI have this slim silver book on my desk called the “Quick Reference to the Diagnostic Criteria From DSM-IV-TR.” Page 153 reads:
Schizophrenia
A. Characteristic symptoms: Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated):
(1) delusions
(2) hallucinations
(3) disorganized speech (e.g., frequent derailment or incoherence)
(4) grossly disorganized or catatonic behavior
(5) negative symptoms, i.e., affective flattening, alogia, or avolition
Throughout the book, similarly organized lists of symptoms follow the names of every officially recognized mental disorder—bipolar disorder, autistic disorder, generalized anxiety disorder and so on. My slim silver volume is an abridged version of the Diagnostic and Statistical Manual for Mental Disorders IV-TR (DSM-IV-TR), the most current edition of the standard reference guide for psychiatrists. It’s the book that many psychiatrists consult when deciding what ails their patients.
For the past 11 years, the American Psychiatric Association (APA), which publishes the DSM, has been working on a brand new version of the manual, the DSM-5 (no more Roman numerals, now that we have fully entered the age of digital publishing). Psychiatry’s new “bible” is slated for publication in May, 2013.
The APA has overhauled the DSM several times in the past—always a laborious and controversial process. This time, the association is doing things a little differently. Psychiatrists within and outside the APA have long criticized the revision process for its opacity. So the APA has made drafts of the new DSM-5 available on their website for public comment and has amended the drafts based on feedback from the psychiatrists, psychologists and the general public.
The latest drafts of the DSM-5 are now available online and open to comment for the next six weeks. Here are the most significant updates:
-The APA is no longer considering “Attenuated Psychosis Syndrome” as a new official disorder in the DSM-5. The proposed diagnosis was supposed to help identify children at risk for developing a psychotic disorder, but research has shown that 2/3 of children who qualify as “at risk” never progress to true psychosis.
-The APA is no longer considering “Mixed Anxiety Depressive Disorder” as a new official disorder in the DSM-5. Many psychiatrists worried that the new diagnosis was too vague and that too many people would qualify.
-The APA has added a footnote to the Major Depressive Disorder criteria “to clarify the difference between normal bereavement associated with a significant loss and a diagnosis of a mental disorder.” Previous changes to the depression criteria reframed grief that lasted longer than 2 months as a sign of depression, even if someone had recently lost a loved one—a mistake that drew intense criticism.
Over at Time magazine, Maia Szalavitz has a great discussion of the newest changes. She also points to Allen Frances’s critical analysis at Psychology Today.
This year, the APA is holding its annual meeting from May 5 to 9 in Philadelphia, where much of the discussion will focus on the drafts of the DSM-5 and the results of “Field Trials”—dry runs of the new diagnostic criteria in clinical settings. I am attending the conference to learn more and, next week, my colleague Ingrid Wickelgren at Scientific American MIND and I will bring you a series of blogs about the DSM-5 authored by ourselves and some well-known researchers and psychiatrists. For the duration of next week, we will also publish my feature article about DSM-5 in its entirety on our website. After next week, you can still read the feature in the May/June issue of MIND. Stay tuned!
Schizophrenia
A. Characteristic symptoms: Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated):
(1) delusions
(2) hallucinations
(3) disorganized speech (e.g., frequent derailment or incoherence)
(4) grossly disorganized or catatonic behavior
(5) negative symptoms, i.e., affective flattening, alogia, or avolition
Throughout the book, similarly organized lists of symptoms follow the names of every officially recognized mental disorder—bipolar disorder, autistic disorder, generalized anxiety disorder and so on. My slim silver volume is an abridged version of the Diagnostic and Statistical Manual for Mental Disorders IV-TR (DSM-IV-TR), the most current edition of the standard reference guide for psychiatrists. It’s the book that many psychiatrists consult when deciding what ails their patients.
For the past 11 years, the American Psychiatric Association (APA), which publishes the DSM, has been working on a brand new version of the manual, the DSM-5 (no more Roman numerals, now that we have fully entered the age of digital publishing). Psychiatry’s new “bible” is slated for publication in May, 2013.
The APA has overhauled the DSM several times in the past—always a laborious and controversial process. This time, the association is doing things a little differently. Psychiatrists within and outside the APA have long criticized the revision process for its opacity. So the APA has made drafts of the new DSM-5 available on their website for public comment and has amended the drafts based on feedback from the psychiatrists, psychologists and the general public.
The latest drafts of the DSM-5 are now available online and open to comment for the next six weeks. Here are the most significant updates:
-The APA is no longer considering “Attenuated Psychosis Syndrome” as a new official disorder in the DSM-5. The proposed diagnosis was supposed to help identify children at risk for developing a psychotic disorder, but research has shown that 2/3 of children who qualify as “at risk” never progress to true psychosis.
-The APA is no longer considering “Mixed Anxiety Depressive Disorder” as a new official disorder in the DSM-5. Many psychiatrists worried that the new diagnosis was too vague and that too many people would qualify.
-The APA has added a footnote to the Major Depressive Disorder criteria “to clarify the difference between normal bereavement associated with a significant loss and a diagnosis of a mental disorder.” Previous changes to the depression criteria reframed grief that lasted longer than 2 months as a sign of depression, even if someone had recently lost a loved one—a mistake that drew intense criticism.
Over at Time magazine, Maia Szalavitz has a great discussion of the newest changes. She also points to Allen Frances’s critical analysis at Psychology Today.
This year, the APA is holding its annual meeting from May 5 to 9 in Philadelphia, where much of the discussion will focus on the drafts of the DSM-5 and the results of “Field Trials”—dry runs of the new diagnostic criteria in clinical settings. I am attending the conference to learn more and, next week, my colleague Ingrid Wickelgren at Scientific American MIND and I will bring you a series of blogs about the DSM-5 authored by ourselves and some well-known researchers and psychiatrists. For the duration of next week, we will also publish my feature article about DSM-5 in its entirety on our website. After next week, you can still read the feature in the May/June issue of MIND. Stay tuned!
About the Author: Ferris Jabr is an associate editor focusing on neuroscience and psychology. Follow on Twitter @ferrisjabr.
DSM-5 Debate: Committee Backs Off Some Changes, Re-Opens Comments | Healthland | TIME.com
DSM-5 Debate: Committee Backs Off Some Changes, Re-Opens Comments | Healthland | TIME.com
Share Only the Stories You WantTIME will alert you each time a story is shared and you'll have the option to keep or remove each story from your Facebook Timeline. Plus, view "Your Activity" to see a history of stories you've read and remove stories from your Timeline.
The committee responsible for revising the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders — psychiatry’s diagnostic “bible” commonly referred to as the DSM — has dropped the inclusion of two controversial new diagnoses that it had previously proposed, and re-opened its website for public comment on other potential revisions.
The moves are a sign that the public uproar over some of the changes has hit home, but many of the most contentious amendments still remain.
“For the first time in its history, DSM-5 has shown some flexibility and capacity to correct itself. Hopefully, this is just the beginning of what will turn out to be a number of other necessary DSM-5 retreats,” wrote Dr. Allen Frances, chair of the DSM-4 task force, on his blog at Psychology Today, in response to the committee’s turnabout. Frances is a major critic of the DSM-5.
(MORE: Good Grief! Psychiatry’s Struggle to Define Mental Illness Goes Awry)
The DSM defines and classifies all mental illnesses and is widely used by practitioners and insurance companies to determine what conditions are considered abnormal, which treatments should be covered by insurance companies, and which warrant special educational services. Consequently, changes to the precise content of the DSM have major social implications.
One of the new diagnoses that the editors chose to exclude is “attenuated psychosis syndrome,” a condition designated to describe youth who are at high risk of developing schizophrenia — before they develop the full-fledged disorder.
Problem is that only 8% of those categorized as “high risk” because they having close relatives with the disorder or have suggestive symptoms actually went on to develop schizophrenia, according to a recent study. Many critics of the new diagnosis feared that it would legitimize the potentially dangerous practice of administering powerful antipsychotic drugs to youths. With every major manufacturer of antipsychotics already paying out hundreds of millions or billions of dollars in fines for mismarketing these medications to youth and the elderly, the problem of overprescribing is already rampant — particularly in vulnerable populations like foster care children.
Frances wrote:
The committee also dropped a new diagnosis called “mixed anxiety depressive disorder,” an unnecessary designation that could have further encouraged prescription of medications. (It also made for a seriously unfortunate acronym.)
But other major controversies remain unaddressed. Although some language was changed, the committee still seems determined to include bereavement in the definition of depression, which could allow someone who is going through normal grief after a loss to be diagnosed with major depression. In previous editions of the DSM, bereavement was excluded from the definition: depressive symptoms during grieving were not considered abnormal if they were better explained by the person’s loss and were not extremely prolonged.
Another change that remains is the elimination of the diagnosis of Asperger’s syndrome, which will be subsumed under autism spectrum disorders in the DSM-5. Autism advocates oppose the change because they are concerned that families affected by Asperger’s will lose critical educational and other services. They also contend that the revision will diminish clarity of diagnoses, both for research purposes and personal understanding.
(MORE: Ending the Autism Epidemic: If the Definition Changes, Will Some Kids Lose Services?)
Further, the committee kept the provision to collapse two currently separate diagnoses, “substance abuse” and “substance dependence,” into “substance use disorder,” which will have varying levels of severity. While most leading addiction experts support doing away with the stigmatizing term “abuse” and the confusing term “dependence” (after all, simply being dependent on a drug to function does not define addiction), combining them into one disorder poses other problems.
Most people who have been diagnosed with substance abuse — misusing alcohol or other drugs — never go on to develop full-blown addiction and can learn moderation. However, the new definition would classify them as having “mild substance use disorder,” which would imply that they are already addicted and require abstinence-only treatment. Such a diagnosis could deter many young people from seeking help for problems like binge drinking, for example, and labeling those who do seek help as “addicts” could lead to a self-fulfilling prophecy.
The public is invited to make comments on these and other changes on the DSM-5 website from now until June 15. The new edition is still slated for publication in May 2013.
“The comments we have received over the past two years have helped sharpen our focus, not only on the strongest research and clinical evidence to support DSM-5 criteria but on the real-world implications of these changes,” American Psychiatric Association President Dr. John Oldham said in a statement. “We appreciate the public’s interest and continued participation in the DSM-5 development process.”
Maia Szalavitz is a health writer at TIME.com. Find her on Twitter at @maiasz. You can also continue the discussion on TIME Healthland’s Facebook page and on Twitter at @TIMEHealthland.
Read more: http://healthland.time.com/2012/05/03/dsm-5-debate-committee-backs-off-some-changes-re-opens-comments/#ixzz1ttnOZt8I
Psychology
Read more: http://healthland.time.com/tag/dsm-v/#ixzz1ttnzEK8k
DSM-5 Debate: Committee Backs Off Some Changes, Re-Opens Comments
The committee responsible for revising the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders — psychiatry’s diagnostic “bible” commonly referred to as the DSM — has dropped the inclusion of two controversial new diagnoses that it had previously proposed, and re-opened its website for public comment on other potential revisions.
Read more: http://healthland.time.com/tag/dsm-v/#ixzz1ttnzEK8k
DSM-5 Debate: Committee Backs Off Some Changes, Re-Opens Comments
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The moves are a sign that the public uproar over some of the changes has hit home, but many of the most contentious amendments still remain.
“For the first time in its history, DSM-5 has shown some flexibility and capacity to correct itself. Hopefully, this is just the beginning of what will turn out to be a number of other necessary DSM-5 retreats,” wrote Dr. Allen Frances, chair of the DSM-4 task force, on his blog at Psychology Today, in response to the committee’s turnabout. Frances is a major critic of the DSM-5.
(MORE: Good Grief! Psychiatry’s Struggle to Define Mental Illness Goes Awry)
The DSM defines and classifies all mental illnesses and is widely used by practitioners and insurance companies to determine what conditions are considered abnormal, which treatments should be covered by insurance companies, and which warrant special educational services. Consequently, changes to the precise content of the DSM have major social implications.
One of the new diagnoses that the editors chose to exclude is “attenuated psychosis syndrome,” a condition designated to describe youth who are at high risk of developing schizophrenia — before they develop the full-fledged disorder.
Problem is that only 8% of those categorized as “high risk” because they having close relatives with the disorder or have suggestive symptoms actually went on to develop schizophrenia, according to a recent study. Many critics of the new diagnosis feared that it would legitimize the potentially dangerous practice of administering powerful antipsychotic drugs to youths. With every major manufacturer of antipsychotics already paying out hundreds of millions or billions of dollars in fines for mismarketing these medications to youth and the elderly, the problem of overprescribing is already rampant — particularly in vulnerable populations like foster care children.
Frances wrote:
The world is a safer place now that ‘Psychosis Risk’ will not be in DSM-5. Its rejection saves our kids from the risk of unnecessary exposure to antipsychotic drugs (with their side effects of obesity, diabetes, cardiovascular problems, and shortened life expectancy). ‘Psychosis Risk’ was the single worst DSM-5 proposal — we should all be grateful that DSM-5 has finally come to its senses in dropping it.(MORE: Drugging the Vulnerable: Atypical Antipsychotics in Children and the Elderly)
The committee also dropped a new diagnosis called “mixed anxiety depressive disorder,” an unnecessary designation that could have further encouraged prescription of medications. (It also made for a seriously unfortunate acronym.)
But other major controversies remain unaddressed. Although some language was changed, the committee still seems determined to include bereavement in the definition of depression, which could allow someone who is going through normal grief after a loss to be diagnosed with major depression. In previous editions of the DSM, bereavement was excluded from the definition: depressive symptoms during grieving were not considered abnormal if they were better explained by the person’s loss and were not extremely prolonged.
Another change that remains is the elimination of the diagnosis of Asperger’s syndrome, which will be subsumed under autism spectrum disorders in the DSM-5. Autism advocates oppose the change because they are concerned that families affected by Asperger’s will lose critical educational and other services. They also contend that the revision will diminish clarity of diagnoses, both for research purposes and personal understanding.
(MORE: Ending the Autism Epidemic: If the Definition Changes, Will Some Kids Lose Services?)
Further, the committee kept the provision to collapse two currently separate diagnoses, “substance abuse” and “substance dependence,” into “substance use disorder,” which will have varying levels of severity. While most leading addiction experts support doing away with the stigmatizing term “abuse” and the confusing term “dependence” (after all, simply being dependent on a drug to function does not define addiction), combining them into one disorder poses other problems.
Most people who have been diagnosed with substance abuse — misusing alcohol or other drugs — never go on to develop full-blown addiction and can learn moderation. However, the new definition would classify them as having “mild substance use disorder,” which would imply that they are already addicted and require abstinence-only treatment. Such a diagnosis could deter many young people from seeking help for problems like binge drinking, for example, and labeling those who do seek help as “addicts” could lead to a self-fulfilling prophecy.
The public is invited to make comments on these and other changes on the DSM-5 website from now until June 15. The new edition is still slated for publication in May 2013.
“The comments we have received over the past two years have helped sharpen our focus, not only on the strongest research and clinical evidence to support DSM-5 criteria but on the real-world implications of these changes,” American Psychiatric Association President Dr. John Oldham said in a statement. “We appreciate the public’s interest and continued participation in the DSM-5 development process.”
Maia Szalavitz is a health writer at TIME.com. Find her on Twitter at @maiasz. You can also continue the discussion on TIME Healthland’s Facebook page and on Twitter at @TIMEHealthland.
Read more: http://healthland.time.com/2012/05/03/dsm-5-debate-committee-backs-off-some-changes-re-opens-comments/#ixzz1ttnOZt8I
Traumatic brain injury and criminality in adolescent psychiatric inpatients - General Psychiatry News
Google Reader - General Psychiatry News
via ScienceDirect Publication: Psychiatry Research on 5/4/12
Publication year: 2012
Source:Psychiatry Research
Saku Luukkainen, Kaisa Riala, Matti Laukkanen, Helinä Hakko, Pirkko Räsänen
The association of traumatic brain injuries (TBI) with criminality, substance-related disorders and conduct disorders has mainly been studied in adult populations. In our study we examine the association in an adolescent population. We used a population-based clinical sample of 508 psychiatric inpatient adolescents from Northern Finland. The prevalences of TBI and criminality were 26 (5.1%) and 85 (16.7%), respectively. The information on TBI was acquired from the Finnish Hospital Discharge Register and on criminality from the Legal Register Center. DSM-IV diagnoses were obtained by interviewing the subjects using the semi-structured Schedule for Affective Disorder and Schizophrenia for School-Age Children, Present and Lifetime (K-SADS-PL). Adolescents with TBI had significantly more often committed crimes compared to adolescents without TBI (53.8% vs. 14.7%, respectively). Prevalences of both violent crimes (42.9% vs. 9.1%) and non-violent crimes (29.4% vs. 6.8%) were also higher in the TBI group. TBI during childhood and adolescence increased the risk of any criminality 6.8-fold (95% 3.0–15.2), conduct disorder 5.7-fold (95% 2.1–15.4) and concomitant criminality and conduct disorder 18.7-fold (95% 4.3–80.1). Our results suggest that clinicians working with mentally ill adolescents who have experienced head injuries should be aware of the increased risk for delinquency and violent tendencies occurring later in the adolescents' lives.
Source:Psychiatry Research
Saku Luukkainen, Kaisa Riala, Matti Laukkanen, Helinä Hakko, Pirkko Räsänen
The association of traumatic brain injuries (TBI) with criminality, substance-related disorders and conduct disorders has mainly been studied in adult populations. In our study we examine the association in an adolescent population. We used a population-based clinical sample of 508 psychiatric inpatient adolescents from Northern Finland. The prevalences of TBI and criminality were 26 (5.1%) and 85 (16.7%), respectively. The information on TBI was acquired from the Finnish Hospital Discharge Register and on criminality from the Legal Register Center. DSM-IV diagnoses were obtained by interviewing the subjects using the semi-structured Schedule for Affective Disorder and Schizophrenia for School-Age Children, Present and Lifetime (K-SADS-PL). Adolescents with TBI had significantly more often committed crimes compared to adolescents without TBI (53.8% vs. 14.7%, respectively). Prevalences of both violent crimes (42.9% vs. 9.1%) and non-violent crimes (29.4% vs. 6.8%) were also higher in the TBI group. TBI during childhood and adolescence increased the risk of any criminality 6.8-fold (95% 3.0–15.2), conduct disorder 5.7-fold (95% 2.1–15.4) and concomitant criminality and conduct disorder 18.7-fold (95% 4.3–80.1). Our results suggest that clinicians working with mentally ill adolescents who have experienced head injuries should be aware of the increased risk for delinquency and violent tendencies occurring later in the adolescents' lives.
Elsevier Selected as New Publisher of The American Journal of Geriatric Psychiatry - General Psychiatry News
Google Reader - General Psychiatry News
via psychiatry research - Google News on 5/2/12
Elsevier Selected as New Publisher of The American Journal of Geriatric Psychiatry Sacramento Bee Dilip V. Jeste, MD, Editor-in-Chief, is the Estelle and Edgar Levi Chair in Aging, Distinguished Professor of Psychiatry and Neurosciences, Director of the Sam and Rose Stein Institute for Research on Aging, and Chief of the Geriatric Psychiatry ... and more » |
Sports Psychiatry: "players need to get their brains examined before they play and after they stop and at any time they get a concussion" - Daniel G. Amen, MD Responds to Junior Seau - PR Newswire - The Sacramento Bee
Daniel G. Amen, MD Responds to Junior Seau - PR Newswire - The Sacramento Bee
Daniel G. Amen, MD Responds to Junior Seau
"These players need to know there is HELP for them!"
Published: Thursday, May. 3, 2012 - 9:26 am
NEWPORT BEACH, Calif., May 3, 2012 -- /PRNewswire/ -- While Junior Seau's apparent suicide breaks the hearts of football fans nationwide, Daniel G. Amen, MD pleads with other football players and athletes that "there's help from chronic traumatic brain injuries, depression, irritability and memory problems they suffer."
Dr. Amen, founder and CEO of Amen Clinics, Inc., and two-time Board Certified psychiatrist, has conducted three clinical studies with 115 active and former players from the National Football League. Each study shows that it's not only possible, it's likely, that with a brain-directed health protocol, significant improvement can be experienced in decision-making, reasoning, depression, mood and memory.
"Junior Seau was a legend. But even legends cannot escape the ravages of chronic brain damage," said Dr. Amen, who is the lead researcher on three published studies on NFL players and brain damage. He is also a leading researcher on a brain imaging study called SPECT (single photon emission computed tomography) and has looked at over 73,000 scans.
"My message to the football community is that players need to get their brains examined before they play and after they stop and at any time they get a concussion. I often say how do you know unless you look," said Dr. Amen.
Dr. Amen began studying the effects of football on brain health in 1999 when Brent Boyd, a former NFL player, came to the Amen Clinics. After Anthony Davis came to the clinic in 2007 his work with active and former NFL players took off. He has partnered with the Los Angeles Chapter of the Retired NFL Players Association to perform the world's largest brain imaging/brain rehabilitation study.
"Our studies found significant evidence that, fortunately, there are treatment protocols that can often reverse many of the symptoms caused by brain damage and improve brain function," said Dr. Amen. The studies include:
"Junior may have damaged his pre-frontal cortex, which is responsible for decision-making," Dr. Amen said, also noting that Seau was arrested in 2010 for domestic violence, which also may have been a result of poor decision-making. "Brain trauma symptoms can appear decades after the playing days and can include dementia, memory loss, violent behavior, obesity, mental illness and depression. And unfortunately, suicide is more common in people who have experienced brain trauma."
The Amen Clinics, Inc. (ACI) was founded in 1989 by Daniel G. Amen, M.D. Amen Clinics now has locations in Newport Beach and San Francisco, California; Bellevue, Washington; and Reston, Virginia (www.amenclinics.com). ACI specializes in using detailed clinical histories, brain imaging, and lab testing for innovative diagnosis and treatment for a wide variety of problems, including weight issues, ADD, anxiety, depression, autistic spectrum disorders, and memory problems. Dr. Amen is a physician, child and adult psychiatrist, brain-imaging specialist, Distinguished Fellow of the American Psychiatric Association, and author of five New York Times best-selling books, including his latest, "Use Your Brain to Change Your Age." For more information, call (888) 564-2700.
Media Contact: David Jahr, (949) 874-2667, davidjahr@mac.com
This press release was issued through eReleases(R). For more information, visit eReleases Press Release Distribution at http://www.ereleases.com.
SOURCE Amen Clinics, Inc.
Dr. Amen, founder and CEO of Amen Clinics, Inc., and two-time Board Certified psychiatrist, has conducted three clinical studies with 115 active and former players from the National Football League. Each study shows that it's not only possible, it's likely, that with a brain-directed health protocol, significant improvement can be experienced in decision-making, reasoning, depression, mood and memory.
"Junior Seau was a legend. But even legends cannot escape the ravages of chronic brain damage," said Dr. Amen, who is the lead researcher on three published studies on NFL players and brain damage. He is also a leading researcher on a brain imaging study called SPECT (single photon emission computed tomography) and has looked at over 73,000 scans.
"My message to the football community is that players need to get their brains examined before they play and after they stop and at any time they get a concussion. I often say how do you know unless you look," said Dr. Amen.
Dr. Amen began studying the effects of football on brain health in 1999 when Brent Boyd, a former NFL player, came to the Amen Clinics. After Anthony Davis came to the clinic in 2007 his work with active and former NFL players took off. He has partnered with the Los Angeles Chapter of the Retired NFL Players Association to perform the world's largest brain imaging/brain rehabilitation study.
"Our studies found significant evidence that, fortunately, there are treatment protocols that can often reverse many of the symptoms caused by brain damage and improve brain function," said Dr. Amen. The studies include:
- Effects of Elevated Body Mass in Professional American Football Players on rCBF and Cognitive Function, Transl Psychiatry (2012) 2, eK, doi:10.1038/tp.2011.67.
- Impact of Playing Professional American Football on Long Term Brain Function. Journal of Neuropsychiatry and Clinical Neurosciences, J Neuropsychiatry Clin Neurosci 23:1, Winter 2011, 98-106.
- Reversing Brain Damage in Former NFL Players: Implications for TBI and Substance Abuse Rehabilitation. Journal of Psychoactive Drugs, 43 (1), 2011 Online publication date: 08 April 2011.
"Junior may have damaged his pre-frontal cortex, which is responsible for decision-making," Dr. Amen said, also noting that Seau was arrested in 2010 for domestic violence, which also may have been a result of poor decision-making. "Brain trauma symptoms can appear decades after the playing days and can include dementia, memory loss, violent behavior, obesity, mental illness and depression. And unfortunately, suicide is more common in people who have experienced brain trauma."
The Amen Clinics, Inc. (ACI) was founded in 1989 by Daniel G. Amen, M.D. Amen Clinics now has locations in Newport Beach and San Francisco, California; Bellevue, Washington; and Reston, Virginia (www.amenclinics.com). ACI specializes in using detailed clinical histories, brain imaging, and lab testing for innovative diagnosis and treatment for a wide variety of problems, including weight issues, ADD, anxiety, depression, autistic spectrum disorders, and memory problems. Dr. Amen is a physician, child and adult psychiatrist, brain-imaging specialist, Distinguished Fellow of the American Psychiatric Association, and author of five New York Times best-selling books, including his latest, "Use Your Brain to Change Your Age." For more information, call (888) 564-2700.
Media Contact: David Jahr, (949) 874-2667, davidjahr@mac.com
This press release was issued through eReleases(R). For more information, visit eReleases Press Release Distribution at http://www.ereleases.com.
SOURCE Amen Clinics, Inc.
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