Wednesday, May 9, 2012

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

Google Reader - General Psychiatry News



Psychiatry Manual Drafters Back Down on Diagnoses



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


____________________________________________________


Psychiatry Manual Drafters Back Down on Diagnoses - New York Times


Scientific American (blog)



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

____________________________________________________________________


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




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

Science Remains a Stranger to Psychiatry’s New Bible



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

 

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

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

via NYT > Health

by By BARRY MEIER on 5/8/12

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

_________________________________________________________________________


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

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

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

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

Tuesday, May 8, 2012

"I argue that clinical medicine can best be understood not as a purified science but as a hermeneutical enterprise: that is, as involved with the interpretation of texts." - Theoretical Medicine and Bioethics, Volume 11, Number 1 - SpringerLink

Theoretical Medicine and Bioethics, Volume 11, Number 1 - SpringerLink


Abstract


I argue that clinical medicine can best be understood not as a purified science but as a hermeneutical enterprise: that is, as involved with the interpretation of texts. The literary critic reading a novel, the judge asked to apply a law, must arrive at a coherent reading of their respective texts. Similarly, the physician interprets the lsquotextrsquo of the ill person: clinical signs and symptoms are read to ferret out their meaning, the underlying disease. However, I suggest that the hermeneutics of medicine is rendered uniquely complex by its wide variety of textual forms. I discuss four in turn: the ldquoexperiential textrdquo of illness as lived out by the patient; the ldquonarrative textrdquo constituted during history-taking; the ldquophysical textrdquo of the patient's body as objectively examined; the ldquoinstrumental textrdquo constructed by diagnostic technologies. I further suggest that certain flaws in modern medicine arise from its refusal of a hermeneutic self-understanding. In seeking to escape all interpretive subjectivity, medicine has threatened to expunge its primary subject — the living, experiencing patient.
Key words clinical interpretation - embodiment - hermeneutics - history of medicine


Behavior and Law - 5/8/12 - Mike Nova's starred items: The Hermeneutic (Interpretational) Model Of Clinical Mental Health-Illness Assessment - and other posts

Google Reader - Mike Nova's starred items

Mike Nova's starred items

via Behavior and Law by Mike Nova on 5/8/12

The Hermeneutic (Interpretational) Model Of Clinical Mental Health-Illness Assessment

Mental health and psychopathology on individual, group and social levels, along their biopsychosocial continuum, can be viewed and assessed with hermeneutic method of continuous analysis and interpretation by going from the whole picture to its particulars and back to the whole picture in the attempt to understand their connections, relationships and meanings.

This approach, viewing mental health-illness as a unitary homeostatic conceptual system is more suited for clinical mental health-illness assessment than traditional, medical, categorical diagnostic approach (vs. dimensional, widely used in psychology). The human being as object of this assessment, in medical, interpersonal and social contexts, is always more than the sum of these parts and certainly more than his/her presumed "psychiatric diagnosis".
The goal of this assessment is three-prong: to identify target symptoms, syndromes and disorders for psychopharmacological, psychotherapeutic and psychosocial interventions.
Thus, psychiatric diagnosis per se becomes the process and conceptual outcome of identification of syndromologically based psychopharmacological targets, which can be transcribed into any of existing categorical diagnostic systems (ICD-10, DSM-4, 5; etc.).
The task then becomes to organise, classify and systematise the historically formed and recognised general psychopathological syndromes (e.g. psychosis, affective states, etc.) as psychopharmacological dimensional targets, regardless of their presumed, hypothetical or known nosology, which corresponds with existing customs of psychopharmocological practice.

hermeneutic method - Google Search

Hermeneutics - Wikipedia

Sociology
In sociology, hermeneutics means the interpretation and understanding of social events by analysing their meanings to the human participants and their culture. It enjoyed prominence during the sixties and seventies, and differs from other interpretative schools of sociology in that it emphasizes the importance of the context[28] as well as the form of any given social behaviour. The central principle of hermeneutics is that it is only possible to grasp the meaning of an action or statement within the context of the discourse or world-view from which it originates. For instance, putting a piece of paper in a box might be considered a meaningless action unless put in the context of democratic elections, and the action of putting a ballot paper in a box. One can frequently find reference to the 'hermeneutic circle': that is, relating the whole to the part and the part to the whole. Hermeneutics in sociology was most heavily influenced by German philosopher Hans-Georg Gadamer.[29]

via Behavior and Law by Mike Nova on 5/8/12

Mike Nova: American Psychiatry At The Crossroads


Last Update: 4:55 PM 5/7/2012

American Psychiatry should broaden its theoretical and conceptual outlook beyond the narrow professional concerns about diagnostic systems and classifications (at this time, with all the enormous importance of these issues, we are not ready for the true scientific approach towards resolving them; and the practical problems with "reimbursements" and "parities" should be left for actuaries and medical records departments to resolve). Recent controversies about DSM-5 indicate that the whole conceptual direction of improving and perfecting diagnostic pseudonosological labeling system (and the professional and social power of labeling that comes with it) hit a roadblock and is in "no exit" blind alley. How can we introduce a true, medically scientific and evidence based classification system for mental disorders if we still know so little about their nature and origins? The attempts to codify the current clinical labels are methodologically and epistemologically dangerous because they reinforce the current clinical belief system with its multitude of misconceptions. The history of science and medicine in particular is replete with these kind of errors. Preoccupation with improving the reliability by forced agreement (which by itself proved to be impractical and next to impossible) does not affect the much more important issues of validity of psychiatric diagnosis, and, if anything, leads to their neglect and displacement (not only in psychodynamic, but real sense) from our area of interests and scientific horizons, almost relegating these issues to the province of "conspiracy of silence". How can we agree on something, if we don't really know what this "something" is or if it even really and "truly scientifically" exists? And why should we agree on this "unknown something?"
Medicine and psychiatry are empirical and "practical sciences"; we are not just "talkers" and "labellers"; we are "doers": our task is to ease mental pain and suffering (of which this world is aplenty) for individuals, groups and societies. We do it in the dark, our knowledge is still limited and trues are hidden. We should not reinforce these limitations, presenting "blind spots" as medical facts, but should accept them, be aware of them and work further, relentlessly, and completely with an open mind to resolve them. Narrow professional concerns with "parities and reimbursements" should not be a consideration and should not stand in the way of scientific research and progress in modern psychiatry. This probably was the "primal and original sin" which lead the whole DSM improvement effort astray.
American Psychiatry should assume its rightful leadership role in World Psychiatry with its bold and broad, open and independent minded, scientifically eclectic stance, discarding the outdated stereotypes, not reinforcing them; the stance worthy of this great nation and its spirit.

References and Links:

theoretical and conceptual outlook - Google Search

theoretical outlook - Google

conceptual outlook - Google Search

theory - Google Search

Theory - From Wikipedia, the free encyclopedia

concept - Google Search

Concept - From Wikipedia, the free encyclopedia

*
methodology - Google Search

Methodology - From Wikipedia, the free encyclopedia

Methodology is generally a guideline system for solving a problem, with specific components such as phases, tasks, methods, techniques and tools.[1] It can be defined also as follows:
  1. "the analysis of the principles of methods, rules, and postulates employed by a discipline";[2]
  2. "the systematic study of methods that are, can be, or have been applied within a discipline";[2]
  3. "the study or description of methods".[3]
A methodology can be considered to include multiple methods, each as applied to various facets of the whole scope of the methodology.

Why Most Published Research Findings Are False by John P. A. Ioannidis

Why Most Published Research Findings Are False

PLoS Med. 2005 August; 2(8): e124.
Published online 2005 August 30. doi: 10.1371/journal.pmed.0020124
PMCID: PMC1182327
Copyright : © 2005 John P. A. Ioannidis. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Why Most Published Research Findings Are False
John P. A. Ioannidis
John P. A. Ioannidis is in the Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece, and Institute for Clinical Research and Health Policy Studies, Department of Medicine, Tufts-New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts, United States of America. E-mail: jioannid@cc.uoi.gr
Competing Interests: The author has declared that no competing interests exist.

Summary
There is increasing concern that most current published research findings are false. The probability that a research claim is true may depend on study power and bias, the number of other studies on the same question, and, importantly, the ratio of true to no relationships among the relationships probed in each scientific field. In this framework, a research finding is less likely to be true when the studies conducted in a field are smaller; when effect sizes are smaller; when there is a greater number and lesser preselection of tested relationships; where there is greater flexibility in designs, definitions, outcomes, and analytical modes; when there is greater financial and other interest and prejudice; and when more teams are involved in a scientific field in chase of statistical significance. Simulations show that for most study designs and settings, it is more likely for a research claim to be false than true. Moreover, for many current scientific fields, claimed research findings may often be simply accurate measures of the prevailing bias. In this essay, I discuss the implications of these problems for the conduct and interpretation of research.
*
epistemology - Google Search

Epistemology - From Wikipedia, the free encyclopedia

Stanford Encyclopedia of Philosophy articles:

*

belief system - Google Search

Belief system - From Wikipedia, the free encyclopedia

*

errors in history of science - Google search


errors in history of science - Wikipedia Search


Philosophy of science - From Wikipedia, the free encyclopedia


Scientific method - From Wikipedia, the free encyclopedia


Pseudoscience - From Wikipedia, the free encyclopedia


Karl Popper - From Wikipedia, the free encyclopedia


errors in history of medicine - Google Search

*
http://www.historyworld.net/wrldhis/PlainTextHistories.asp?groupid=474&HistoryID=aa52&gtrack=pthc

HISTORY OF MEDICINE

www.historyworld.net/.../PlainTextHistories.asp?...474&HistoryID...Cached - Similar
You +1'd this publicly. Undo
Jump to Influential errors of Galen‎: His error, which will become the established medical orthodoxy for centuries, is to assume that the blood goes back ...


The influential errors of Galen: 2nd century AD

The newly appointed chief physician to the gladiators in Pergamum, in AD 158, is a native of the city. He is a Greek doctor by the name of Galen. The appointment gives him the opportunity to study wounds of all kinds. His knowledge of muscles enables him to warn his patients of the likely outcome of certain operations - a wise precaution recommended in Galen's Advice to doctors.

But it is Galen's dissection of apes and pigs which give him the detailed information for his medical tracts on the organs of the body. Nearly 100 of these tracts survive. They become the basis of Galen's great reputation in medieval medicine, unchallenged until the anatomical work of Vesalius.

Through his experiments Galen is able to overturn many long-held beliefs, such as the theory (first proposed by the Hippocratic school in about 400 BC, and maintained even by the physicians of Alexandria) that the arteries contain air - carrying it to all parts of the body from the heart and the lungs. This belief is based originally on the arteries of dead animals, which appear to be empty.

Galen is able to demonstrate that living arteries contain blood. His error, which will become the established medical orthodoxy for centuries, is to assume that the blood goes back and forth from the heart in an ebb-and-flow motion. This theory holds sway in medical circles until the time of Harvey.

Read more: http://www.historyworld.net/wrldhis/PlainTextHistories.asp?groupid=474&HistoryID=aa52&gtrack=pthc#ixzz1uDtUF4Ls

*

Science-Based Medicine » Lessons from History of Medical Delusions

16 Feb 2012 by Brennen McKenzie
A brief reference on the web site The Quackometer recently drew my attention to a very short book (really more of a pamphlet, in the historical sense) by Dr. Worthington Hooker, Lessons from the History of Medical Delusions, which I thought might be of interest to readers of this blog. ... However, the focus of this booklet is to illustrate more generally the sorts of errors in thinking that lead even otherwise intelligent and reasonable people to believe such nonsense.

*
errors in history of medicine - Pubmed Search

  • Performing your original search, errors in history of medicine, in PubMed will retrieve 930 records.
J Invest Surg. 2008 Mar-Apr;21(2):53-6.

Lessons from the history of medicine.

Source

Lyman Briggs College at Michigan State University, East Lansing, Michigan 48824, USA. Wallerj1@msu.edu

Abstract

What is the point of teaching the history of medicine? Many historians and clinicians find it regrettable that some medical students today will graduate knowing almost nothing of such "greats" of the past as Hippocrates, Galen, Vesalius, Harvey, Lister, and Pasteur. But does this really matter? After all, traditional history of medicine curricula tended to distort medicine's past, omitting the countless errors, wrong turns, fads, blunders, and abuses, in order to tell the sanitized stories of a few scientific superheroes. Modern scholarship has seriously challenged most of these heroic dramas; few of our heroes were as farsighted, noble, or obviously correct as once thought. Joseph Lister, for example, turns out to have had filthy wards, whereas William Harvey was devoted to the Aristotelianism he was long said to have overthrown [1]. But as the history of medicine has become less romanticized, it has also become much more relevant, for it promises to impart useful lessons in the vital importance of scientific scepticism.

PMID:
18340620
[PubMed - indexed for MEDLINE]
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  • Performing your original search, validity of psychiatric diagnosis, in PubMed Central will retrieve 13290 records.
Psychiatry (Edgmont). 2005 September; 2(9): 48–55.
PMCID: PMC2993536
The Validity of Psychiatric Diagnosis Revisited
The Clinician's Guide to Improve the Validity of Psychiatric Diagnosis
Ahmed Aboraya, MD, DrPH,corresponding author Cheryl France, MD, John Young, MD, Kristina Curci, MD, and James LePage, PhD
All from Department of Behavioral Medicine and Psychiatry, Robert C. Byrd Health Sciences Center of West Virginia University, Morgantown, West Virginia
corresponding authorCorresponding author.
ADDRESS CORRESPONDENCE TO: Ahmed Aboraya, MD, DrPH, Department of Behavioral Medicine and Psychiatry, Robert C. Byrd Health Sciences Center of West Virginia University, PO Box 9137, Morgantown, WV 26506-9137 Phone: (304) 269-1210; Fax: (304) 269-5849; E-mail: aaboraya@hsc.wvu.edu
Background: The authors reviewed the types and phases of validity of psychiatric diagnosis. In 1970, Robins and Guze proposed five phases to achieve valid classification of mental disorders: clinical description, laboratory study, exclusion of other disorders, follow-up study, and family study. Objectives: The objectives of this paper are to review what has been learned since Robins and Guze's influential article as well as examine the impact of the new discoveries in neurosciences and neuroimaging on the practicing clinician. Method: The authors reviewed the literature on the concept of validity in psychiatry with emphasis on the role of clinical training, the use of structured interviews and rating scales, and the importance of the new discoveries in neurosciences. Results: Robins and Guze's phases have been the cornerstone of construct validity in psychiatry at the level of researchers. In the absence of the gold standard of psychiatric diagnosis, Spitzer proposed the “LEAD,” which is an acronym for longitudinal evaluation, and is done by expert clinicians utilizing all the data available. The LEAD standard is construct validity at the level of experts; however, guidelines are lacking to improve the validity skills of the practicing clinicians. Conclusions: The authors propose the acronym DR.SEE, which stands for data, reference definitions, rating scales, clinical experience, and external validators. The authors recommend that clinicians use the DR.SEE paradigm to improve the validity of psychiatric diagnoses.
Validity and reliability are two important topics vital to the development of modern psychiatry. Reliability refers to the extent to which an experiment, test or any measuring procedure yields the same results on repeated trials,1 and is the topic of another paper. Validity is a more difficult term to define because its meaning differs based on the context. Validity, in a very general sense, refers to examining the approximate truth or falsity of scientific propositions.2 When applied to measuring instruments, validity refers to how well the instrument measures what it purports to measure.1 When applied to a disease entity, such as bacterial pneumonia, validity refers to the evidence that bacteria is the cause (verified by sputum culture), lung pathology exists (confirmed by x-ray findings), the symptoms (shortness of breath, fever, and cough), and signs (tachpnea, rales) are compatible with etiology and the disease responds to appropriate antimicrobial treatment. In a psychiatric illness, the patient comes with a subjective complaint (e.g., anxiety, depression, paranoia), and the trained clinician elicits signs of the illness through observation of the patient's demeanor, behavior, and thought process. However, there are fewer definitive objective measures (akin to x-ray and sputum culture) that confirm the diagnosis
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via Behavior and Law by Mike Nova on 5/7/12

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.

via Behavior and Law by Mike Nova on 5/8/12
Mike Nova: Individual, group and social psychopathology can be viewed and conceptualised on the same

biopsychosocial continuum (Google Search).

biopsychosocial model - Google Search

Biopsychosocial model - Wikipedia
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.

NYT > Psychology and Psychologists - Behavior and Law

Behavior and Law

NYT > Psychology and Psychologists


The Outsourced Life - NYTimes.com

The Outsourced Life - NYTimes.com

Behavior and Law: Psychodynamic aspects of Delusional Disorders - Topic Review Update - 9:26 AM 5/8/2012

Behavior and Law

Psychodynamic aspects of Delusional Disorders


Social Work Theories

Social Work Theories