Monday, May 21, 2012
Dr. Robert L. Spitzer, Noted Psychiatrist, Apologizes for Study on Gay ‘Cure’ - NYTimes.com
Dr. Robert L. Spitzer, Noted Psychiatrist, Apologizes for Study on Gay ‘Cure’ - NYTimes.com
Psychiatry Giant Sorry for Backing Gay ‘Cure’
By BENEDICT CAREY
PRINCETON, N.J. — The simple fact was that he had done something wrong, and at the end of a long and revolutionary career it didn’t matter how often he’d been right, how powerful he once was, or what it would mean for his legacy.
Dr. Robert L. Spitzer, considered by some to be the father of modern psychiatry, lay awake at 4 o’clock on a recent morning knowing he had to do the one thing that comes least naturally to him.
He pushed himself up and staggered into the dark. His desk seemed impossibly far away; Dr. Spitzer, who turns 80 next week, suffers from Parkinson’s disease and has trouble walking, sitting, even holding his head upright.
The word he sometimes uses to describe these limitations — pathetic — is the same one that for decades he wielded like an ax to strike down dumb ideas, empty theorizing and junk studies.
Now here he was at his computer, ready to recant a study he had done himself, a poorly conceived 2003 investigation that supported the use of so-called reparative therapy to “cure” homosexuality for people strongly motivated to change.
What to say? The issue of gay marriage was rocking national politics yet again. The California State Legislature was debating a bill to ban the therapy outright as being dangerous. A magazine writer who had been through the therapy as a teenager recently visited his house, to explain how miserably disorienting the experience was.
And he would later learn that a World Health Organization report, released on Thursday, calls the therapy “a serious threat to the health and well-being — even the lives — of affected people.”
Dr. Spitzer’s fingers jerked over the keys, unreliably, as if choking on the words. And then it was done: a short letter to be published this month, in the same journal where the original study appeared.
“I believe,” it concludes, “I owe the gay community an apology.”
Disturber of the Peace
The idea to study reparative therapy at all was pure Spitzer, say those who know him, an effort to stick a finger in the eye of an orthodoxy that he himself had helped establish.
In the late 1990s as today, the psychiatric establishment considered the therapy to be a nonstarter. Few therapists thought of homosexuality as a disorder.
It was not always so. Up into the 1970s, the field’s diagnostic manual classified homosexuality as an illness, calling it a “sociopathic personality disturbance.” Many therapists offered treatment, including Freudian analysts who dominated the field at the time.
Advocates for gay people objected furiously, and in 1970, one year after the landmark Stonewall protests to stop police raids at a New York bar, a team of gay rights protesters heckled a meeting of behavioral therapists in New York to discuss the topic. The meeting broke up, but not before a young Columbia University professor sat down with the protesters to hear their case.
“I’ve always been drawn to controversy, and what I was hearing made sense,” said Dr. Spitzer, in an interview at his Princeton home last week. “And I began to think, well, if it is a mental disorder, then what makes it one?”
He compared homosexuality with other conditions defined as disorders, like depression and alcohol dependence, and saw immediately that the latter caused marked distress or impairment, while homosexuality often did not.
He also saw an opportunity to do something about it. Dr. Spitzer was then a junior member of on an American Psychiatric Association committee helping to rewrite the field’s diagnostic manual, and he promptly organized a symposium to discuss the place of homosexuality.
That kicked off a series of bitter debates, pitting Dr. Spitzer against a pair of influential senior psychiatrists who would not budge. In the end, the psychiatric association in 1973 sided with Dr. Spitzer, deciding to drop homosexuality from its manual and replace it with his alternative, “sexual orientation disturbance,” to identify people whose sexual orientation, gay or straight, caused them distress.
The arcane language notwithstanding, homosexuality was no longer a “disorder.” Dr. Spitzer achieved a civil rights breakthrough in record time.
“I wouldn’t say that Robert Spitzer became a household name among the broader gay movement, but the declassification of homosexuality was widely celebrated as a victory,” said Ronald Bayer of the Center for the History and Ethics of Public Health at Columbia. “ ‘Sick No More’ was a headline in some gay newspapers.”
Partly as a result, Dr. Spitzer took charge of the task of updating the diagnostic manual. Together with a colleague, Dr. Janet Williams, now his wife, he set to work. To an extent that is still not widely appreciated, his thinking about this one issue — homosexuality — drove a broader reconsideration of what mental illness is, of where to draw the line between normal and not.
The new manual, a 567-page doorstop released in 1980, became an unlikely best seller, here and abroad. It instantly set the standard for future psychiatry manuals, and elevated its principal architect, then nearing 50, to the pinnacle of his field.
He was the keeper of the book, part headmaster, part ambassador, and part ornery cleric, growling over the phone at scientists, journalists, or policy makers he thought were out of order. He took to the role as if born to it, colleagues say, helping to bring order to a historically chaotic corner of science.
But power was its own kind of confinement. Dr. Spitzer could still disturb the peace, all right, but no longer from the flanks, as a rebel. Now he was the establishment. And in the late 1990s, friends say, he remained restless as ever, eager to challenge common assumptions.
That’s when he ran into another group of protesters, at the psychiatric association’s annual meeting in 1999: self-described ex-gays. Like the homosexual protesters in 1973, they too were outraged that psychiatry was denying their experience — and any therapy that might help.
Reparative Therapy
Reparative therapy, sometimes called “sexual reorientation” or “conversion” therapy, is rooted in Freud’s idea that people are born bisexual and can move along a continuum from one end to the other. Some therapists never let go of the theory, and one of Dr. Spitzer’s main rivals in the 1973 debate, Dr. Charles W. Socarides, founded an organization called the National Association for Research and Therapy of Homosexuality, or Narth, in Southern California, to promote it.
By 1998, Narth had formed alliances with socially conservative advocacy groups and together they began an aggressive campaign, taking out full-page ads in major newspaper trumpeting success stories.
“People with a shared worldview basically came together and created their own set of experts to offer alternative policy views,” said Dr. Jack Drescher, a psychiatrist in New York and co-editor of “Ex-Gay Research: Analyzing the Spitzer Study and Its Relation to Science, Religion, Politics, and Culture.”
To Dr. Spitzer, the scientific question was at least worth asking: What was the effect of the therapy, if any? Previous studies had been biased and inconclusive. “People at the time did say to me, ‘Bob, you’re messing with your career, don’t do it,’ ” Dr. Spitzer said. “But I just didn’t feel vulnerable.”
He recruited 200 men and women, from the centers that were performing the therapy, including Exodus International, based in Florida, and Narth. He interviewed each in depth over the phone, asking about their sexual urges, feelings and behaviors before and after having the therapy, rating the answers on a scale.
He then compared the scores on this questionnaire, before and after therapy. “The majority of participants gave reports of change from a predominantly or exclusively homosexual orientation before therapy to a predominantly or exclusively heterosexual orientation in the past year,” his paper concluded.
The study — presented at a psychiatry meeting in 2001, before publication — immediately created a sensation, and ex-gay groups seized on it as solid evidence for their case. This was Dr. Spitzer, after all, the man who single-handedly removed homosexuality from the manual of mental disorders. No one could accuse him of bias.
But gay leaders accused him of betrayal, and they had their reasons.
The study had serious problems. It was based on what people remembered feeling years before — an often fuzzy record. It included some ex-gay advocates, who were politically active. And it did not test any particular therapy; only half of the participants engaged with a therapist at all, while the others worked with pastoral counselors, or in independent Bible study.
Several colleagues tried to stop the study in its tracks, and urged him not to publish it, Dr. Spitzer said.
Yet, heavily invested after all the work, he turned to a friend and former collaborator, Dr. Kenneth J. Zucker, psychologist in chief at the Center for Addiction and Mental Health in Toronto and editor of the Archives of Sexual Behavior, another influential journal.
“I knew Bob and the quality of his work, and I agreed to publish it,” Dr. Zucker said in an interview last week. The paper did not go through the usual peer-review process, in which unnamed experts critique a manuscript before publication. “But I told him I would do it only if I also published commentaries” of response from other scientists to accompany the study, Dr. Zucker said.
Those commentaries, with a few exceptions, were merciless. One cited the Nuremberg Code of ethics to denounce the study as not only flawed but morally wrong. “We fear the repercussions of this study, including an increase in suffering, prejudice, and discrimination,” concluded a group of 15 researchers at the New York State Psychiatric Institute, where Dr. Spitzer was affiliated.
Dr. Spitzer in no way implied in the study that being gay was a choice, or that it was possible for anyone who wanted to change to do so in therapy. But that didn’t stop socially conservative groups from citing the paper in support of just those points, according to Wayne Besen, executive director of Truth Wins Out, a nonprofit group that fights antigay bias.
On one occasion, a politician in Finland held up the study in Parliament to argue against civil unions, according to Dr. Drescher.
“It needs to be said that when this study was misused for political purposes to say that gays should be cured — as it was, many times — Bob responded immediately, to correct misperceptions,” said Dr. Drescher, who is gay.
But Dr. Spitzer could not control how his study was interpreted by everyone, and he could not erase the biggest scientific flaw of them all, roundly attacked in many of the commentaries: Simply asking people whether they have changed is no evidence at all of real change. People lie, to themselves and others. They continually change their stories, to suit their needs and moods.
By almost any measure, in short, the study failed the test of scientific rigor that Dr. Spitzer himself was so instrumental in enforcing for so many years.
“As I read these commentaries, I knew this was a problem, a big problem, and one I couldn’t answer,” Dr. Spitzer said. “How do you know someone has really changed?”
Letting Go
It took 11 years for him to admit it publicly.
At first he clung to the idea that the study was exploratory, an attempt to prompt scientists to think twice about dismissing the therapy outright. Then he took refuge in the position that the study was focused less on the effectiveness of the therapy and more on how people engaging in it described changes in sexual orientation.
“Not a very interesting question,” he said. “But for a long time I thought maybe I wouldn’t have to face the bigger problem, about measuring change.”
After retiring in 2003, he remained active on many fronts, but the reparative study remained a staple of the culture wars and a personal regret that wouldn’t leave him be. The Parkinson’s symptoms have worsened in the past year, exhausting him mentally as well as physically, making it still harder to fight back pangs of remorse.
And one day in March, Dr. Spitzer entertained a visitor. Gabriel Arana, a journalist at the magazine The American Prospect, interviewed Dr. Spitzer about the reparative therapy study. This was not just any interview; Mr. Arana went through reparative therapy himself as a teenager, and his therapist had recruited the young man for Dr. Spitzer’s study (Mr. Arana did not participate).
“I asked him about all his critics, and he just came out and said, ‘I think they’re largely correct,’ ” said Mr. Arana, who wrote about his own experience last month. Mr. Arana said that reparative therapy ultimately delayed his self-acceptance as a gay man and induced thoughts of suicide. “But at the time I was recruited for the Spitzer study, I was referred as a success story. I would have said I was making progress.”
That did it. The study that seemed at the time a mere footnote to a large life was growing into a chapter. And it needed a proper ending — a strong correction, directly from its author, not a journalist or colleague.
A draft of the letter has already leaked online and has been reported.
“You know, it’s the only regret I have; the only professional one,” Dr. Spitzer said of the study, near the end of a long interview. “And I think, in the history of psychiatry, I don’t know that I’ve ever seen a scientist write a letter saying that the data were all there but were totally misinterpreted. Who admitted that and who apologized to his readers.”
He looked away and back again, his big eyes blurring with emotion. “That’s something, don’t you think?”
A New Attack on Alzheimer’s - NYTimes.com
A New Attack on Alzheimer’s - NYTimes.com
A New Attack on Alzheimer’s
The Obama administration has announced a bold research program to test whether a drug can prevent the onset of Alzheimer’s disease well before any symptoms appear. It is a long shot, but the payoff could be huge.
Currently, there is no cure for Alzheimer’s, which steadily robs patients of their memory, followed by full-blown dementia. There is also no diagnostic test to identify who has it, and no treatment to slow patients’ deterioration for more than a few months.
While work continues on those fronts, the new clinical trial will test whether the drug, Crenezumab, made by Genentech, can prevent the disease in a group of people whose genetic heritage guarantees that they will develop it. If the drug successfully prevents the loss of mental capacities as measured by a sensitive new cognitive test there is hope — but no guarantee — that it could do the same for members of the general public. As Pam Belluck described in The Times last week, the trial will focus on members of an extended family in Colombia who carry a rare genetic mutation that causes them to develop Alzheimer’s early in life. They typically experience cognitive impairment at about age 45 and dementia by 51. The trial will also include a smaller number of individuals in the United States with the same genetic mutation.
Instead of recruiting thousands of volunteers and following them for an extended period as in a customary prevention trial, the researchers in Colombia will give the drug to only 100 people with the early-onset genetic mutation. They will give placebos to another 100 people with the mutation and to 100 family members who do not carry the deadly gene.
The study will cost more than $100 million and is being financed mostly by Genentech, buttressed by $16 million from the National Institutes of Health and $15 million raised by the Banner Alzheimer’s Institute in Phoenix, which is leading the study.
The prevailing, but not universally accepted, hypothesis is that amyloid plaques in the brain play a major role in causing Alzheimer’s. Crenezumab attacks the formation of such plaques, apparently by binding to amyloid proteins and clearing them from the brain. If the drug fails to work, the trial will probably demolish the amyloid hypothesis and set researchers scrambling to find other targets to attack.
A prevention trial of a different drug that was also intended to slow formation of amyloid plaques actually made patients’ symptoms worse, possibly because it interfered with various other proteins needed by the brain. Researchers believe that Crenezumab will be safer and more effective, but again there are no guarantees. The risk is justified given that without the treatment the recipients will inevitably get Alzheimer’s in the prime of their lives. The truly big payoff will come if the drug succeeds in this group and lays the groundwork for preventing or slowing the progress of Alzheimer’s that appears late in life. The researchers will be gathering data on a variety of biomarkers — glucose activity in the brain, shrinkage of the brain, certain proteins in cerebral spinal fluid, for example — to see which if any are related to preventing amyloid plaques and the loss of mental abilities.
If the drug prevents the deterioration of particular biomarkers and ultimately sustains mental capacity, then the same markers might be useful in identifying and treating older people likely to develop the disease. And federal regulators might be willing to approve other prevention drugs based on their short-term effects on biomarkers, speeding the conduct of clinical trials.
More than five million Americans currently have Alzheimer’s. Without an effective preventive, the number will rise steadily as the population ages.
Sunday, May 20, 2012
MISSION BEHIND BARS AND BEYOND - Home Page
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SUPPORT, MODEL, MENTOR
Behind the Bars . . .
SUPPORT, MODEL, MENTORIn 2009, one in every 31 adults in the United States was either in prison, in jail, or on supervised release. That translates to 7.3 million people. State corrections costs now top $52 billion annually and consume one in every 15 discretionary dollars. Nationally, 43 percent of prisoners released in 2004 were reincarcerated within three years. In Kentucky, 43 percent of those released in 2007 were reincarcerated within three years. It is estimated over 60% of those released from prison find themselves in prison again. Within the first year, 44% return to prison. This figure increases to 70% after three years.
COST TO INCARCERATE
The cost of incarcerating an inmate in Kentucky is close to $19,000 per inmate per year. There are approximately 21,000 men and women incarcerated in Kentucky prisons and jails. Kentucky spends about $450 million annually on corrections. Spending on corrections has quadrupled over the past two decades. Over the course of time, 95% of those who are incarcerated will be released and will return to our communities. Unfortunately, support systems that prepare ex-offenders to return and to live healthy, productive, crime-free lives are limited.
Prison Psychiatry News Review - 5/20/2012 | “If you are going to put them in prison, you have to keep them safe.”: US Issues Far-Reaching Rules to Stem Prison Rape - New York Times | Mentally ill inmates sue to get out of solitary - Boston.com - 8:49 AM 5/20/2012 - Mike Nova's starred items
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Prison Psychiatry News Review - 5/20/2012
8:49 AM 5/20/2012 - Mike Nova's starred items
“If you are going to put them in prison, you have to keep them safe.”
US Issues Far-Reaching Rules to Stem Prison Rape - New York Times
via prisons - Google News on 5/17/12
 New York Daily News | New York Times WASHINGTON — The Justice Department on Thursday issued the first comprehensive federal rules aimed at “zero tolerance” for sexual assaults against inmates in prisons, jails and other houses of detention. The regulations, issued after years of ... Justice: Prisons to step up anti-rape effortsWashington Post“Sexual violence, against any victim, is an assault on human dignity and an affront to American values,” President Obama said.Obama announced that the Prison Rape Elimination Act would apply to all federal confinement facilities, and all other agencies with such facilities had to have protocols within a year to fight prison rape. — Associated PressCrimes in prisonWatertownDailyTimes.com all 344 news articles » |
via prisons - Google News on 5/19/12
New rules aim to reduce prison rapes
Lawrence Journal World By Shaun Hittle New regulations issued by the Obama administration Thursday could affect how Kansas prisons handle sexual assaults. The new regulations — under development since the passage of the 2003 Prison Rape Elimination Act, or PREA — include ... and more » |
via prisons - Google News on 5/17/12
Justice: Prisons to step up anti-rape efforts
KSRO WASHINGTON (AP) — The Obama administration ordered federal, state and local officials Thursday to adopt zero tolerance for prison rape as it issued mandatory screening, enforcement and prevention regulations designed to reduce the number of inmates ... |
via Prison News on 5/18/12
The Obama administration ordered federal, state and local officials Thursday to adopt zero tolerance for prison rape as it issued mandatory screening, enforcement and prevention regulations designed to reduce the number of inmates who suffer sexual victimization at the hands of other prisoners and prison staff.
via prisons - Google News on 5/19/12
 MLive.com |
Law Talk: How President Obama plans to reduce prison rape
MLive.com By Barton Deiters | bdeiters@mlive.com AP File Photo This week, the US Department of Justice announced it was stepping up efforts under the 2003 Prison Rape Elimination Act to end prison rape. The Justice Department recognized that prison rape is a ... Feds: Prisons to step up anti-rape effortsLongview News-Journal Crimes in prisonWatertownDailyTimes.com Rape trial: Obama forces prisons to get tough on assaultsPittsburgh Post Gazette all 344 news articles » |
via prisons - Google News on 5/20/12
"The “war on drugs” cost billions of dollars and has been a failure. There is the same number of people addicted to drugs now as when this war began. The consequence of this war has been an ever-increasing rise in incarceration with a disproportionate number of people of color being arrested and incarcerated. For a sobering and startling examination of this phenomenon, please read Michelle Alexander’s book, “The New Jim Crow: Mass Incarceration in an Age of Colorblindness.”There is hope, however.The Kentucky General Assembly passed a bill last year that will begin relieving our overburdened corrections system. This will move those who need treatment for addiction into recovery and rehabilitation programs where they belong. This is only one small part of the solution."
For prisoners, hope and help behind bars and beyond
The Courier-Journal Serving as pastor of Luther Luckett Christian Church (Disciples of Christ), the only prison congregation in Kentucky, I am faced with incarcerated men like Russell, the man in Mr. Pitts' column, who ask the very same question as he did: “What are you ... "Grounded in the principles of restorative justice that hold people accountable for their actions as they seek to find healing and wholeness in their lives, we train small, faith-based groups of six to eight volunteers to work with men released from prison. These groups meet with one ex-offender weekly and contact him daily. They help him set goals, develop action plans and hold him accountable to the actions he takes. The groups listen, support and provide mentoring. In addition, the groups direct the ex-offender to helpful resources in the community. The goal is to equip, not enable. It is working. Each of us grows and matures through healthy relationships and with good role models. Many who have been incarcerated have never been blessed with either. One missing link in reducing recidivism and ending the cycle that has been sadly named “the school-to-prison pipeline,” is a compassionate community willing to work with those who have paid their debt to society. To expect them to turn their lives around without outside community support is naïve." and more » |
via forensic psychiatry international - Google Blog Search by Mike Nova on 5/13/12
Comprehensive interdisciplinary collection of links to news and journal articles on General, Forensic and Prison Psychiatry and Psychology and the issues of Behavior and Law with occasional notes and comments by Michael Novakhov, M.D. ( Mike Nova). .... Psychiatric Mislabeling Is Bad For Your Mental Hea... Introduction to this Issue: International Perspect... Psychopathic traits and change on indicators of dy... A Kindler, Gentler Psychiatrist « candidaabrahamso.
via prisons - Google Blog Search by Bert Useem on 5/19/12
U.S. Prisons and the Myth of Islamic Terrorism. by Bert Useem. There is a great deal of concern that U.S. prisons are generating high levels of Islamic extremism. Sociologist Bert Useem argues that the evidence fails to support this fear.
via Behavior and Law by Mike Nova on 5/19/12
Punishment Outside Prison - NYTimes.com
May 19, 2012
Punishment Outside Prison
By LINCOLN CAPLAN
Probation and parole for convicted offenders are complex and growing problems in criminal justice. Scholars and others with the American Law Institute, meeting in Washington this week, are to present draft proposals on ways to reform laws about offenders who serve these out-of-custody sentences.
The draft recommends fewer such community-based sentences, with shorter terms and fewer conditions imposed so that supervision is better defined. When finalized, the plan will be a model for state penal codes.
In 2010, more than 2.3 million people were behind bars in the United States. More than twice that number, 4.9 million, were under probation or parole. Such sentences — imposed either for lesser offenses like shoplifting, or after release from prison for more serious offenses — are considered easy time compared with incarceration and a first step toward a fresh start. But often, that turns out to be wrong.
Increasingly, these offenders are not reintegrated into society. Often, so many conditions are imposed on their probation or parole — like not being allowed to drink alcohol after being convicted of passing a bad check — that it is easy to violate just one and end up in custody. And the consequences of community sentences even for those never imprisoned — like not being permitted to vote or to qualify for, say, a beautician’s license — make it difficult to find a job. Under a sound justice system, most offenders should do their time and get a second chance. For many, probation and parole lead to prison, not back to a normal life.
via forensic psychiatry international - Google Blog Search by Sam Snyder on 5/18/12
Relationship between comorbidity and violence risk assessment in forensic psychiatry – the implication of neuroimaging studies. (Link). • Relationship of IQ to suicide and homicide rate: an international perspective. (Link) ...
via prisons - Google News on 5/17/12
 abc13.com |
Prisons system ordered to release details on execution drugs
Austin American-Statesman By Mike Ward In a victory for open government, Texas prison officials on Thursday lost their latest attempt to keep secret details about its stock and suppliers of lethal injection drugs. In an opinion dated Monday, Attorney General Greg Abbott ... Texas prisons must disclose execution drug detailsKIII TV3 State Prisons Must Disclose Execution Drug InfoCBS Local all 39 news articles » |
via prisons - Google News on 5/17/12
 Boston.com |
Mentally ill inmates sue to get out of solitary
Boston.com Prison officials defend the practice, saying administrative segregation, which can include up to 23 hours a day alone in a concrete cell, is a fundamental part of security. Art Leonardo, executive director of the North American Association of Wardens ... and more » |
via forensic psychiatry - Google News on 5/16/12
Army launches review of PTSD diagnoses
U.S. News & World Report The latest reviews were triggered by revelations that the forensic psychiatry unit at Madigan Army Medical Center at Joint Base Lewis-McChord in Washington state may have reversed diagnoses based on the expense of providing care and benefits to members ... |
via prison mental health - Google Blog Search by unknown on 5/17/12
They are glad not to be in a state prison, where there is more violence and where their mental health problems would go mostly untreated. Their fondest hope is to be transferred to a lower security facility, or, even better, to a ...
via forensic psychiatry - Google Blog Search by unknown on 5/17/12
The latest reviews were triggered by revelations that the forensic psychiatry unit at Madigan Army Medical Center at Joint Base Lewis-McChord in Washington state may have reversed diagnoses based on the expense of ...
via Faktensucher by curi56 on 5/18/12
<script type=”text/javascript” src=”http://video.foxnews.com/v/embed.js?id=1225132147001&w=466&h=263″></script><noscript>Watch the latest video at <a href=”http://video.foxnews.com”>video.foxnews.com</a></noscript>
via prisons - Google News on 5/17/12
 BBC News |
Inmate killed in fight inside Honduran prison
The Associated Press TEGUCIGALPA, Honduras (AP) — Inmates at a violence-prone Honduran prison seized hostages and battled among themselves, leaving at least one inmate dead and 11 wounded, authorities said Thursday. Prison director Orlando Leyva said some women were held ... Women held hostage in Honduran prison riotsNew Zealand Herald all 89 news articles » |
via forensic psychiatry - Google News on 5/18/12
Mental health an issue near end of stabbings trial
WSET Brewer, who works at the state-run Center for Forensic Psychiatry, said whatever demons Abuelazam had two years ago shouldn't absolve him of responsibility in Minor's death. Abuelazam is accused of faking car trouble or seeking directions before he ... and more » |
News and Journals Review - 7:49 AM 5/20/2012 - Mike Nova's starred items
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7:49 AM 5/20/2012 - Mike Nova's starred items
Effectiveness of transcranial magnetic stimulation in clinical practice post-FDA approval in the United States: results observed with the first 100 consecutive cases of depression at an academic medical center.
J Clin Psychiatry. 2012 Apr;73(4):e567-73
Authors: Connolly RK, Helmer A, Cristancho MA, Cristancho P, O’Reardon JP
Abstract
INTRODUCTION: Transcranial magnetic stimulation (TMS) is a US Food and Drug Administration-approved treatment for major depressive disorder (MDD) in patients who have not responded to 1 adequate antidepressant trial in the current episode. In a retrospective cohort study, we examined the effectiveness and safety of TMS in the first 100 consecutive patients treated for depression (full DSM-IV criteria for major depressive episode in either major depressive disorder or bipolar disorder) at an academic medical center between July 21, 2008, and March 25, 2011.
METHOD: TMS was flexibly dosed in a course of up to 30 sessions, adjunctive to current medications, for 85 patients treated for acute depression. The primary outcomes were response and remission rates at treatment end point as measured by the Clinical Global Impressions-Improvement scale (CGI-I) at 6 weeks. Secondary outcomes included change in the Hamilton Depression Rating Scale (HDRS); Quick Inventory of Depressive Symptomatology, self-report (QIDS-SR); Beck Depression Inventory (BDI); Beck Anxiety Inventory (BAI); and the Sheehan Disability Scale (SDS). Enduring benefit was assessed over 6 months in patients receiving maintenance TMS treatment. Data from 12 patients who received TMS as maintenance or continuation treatment after prior electroconvulsive therapy (ECT) or TMS given in a clinical trial setting were also reviewed.
RESULTS: The clinical cohort was treatment resistant, with a mean of 3.4 failed adequate trials in the current episode. Thirty-one individuals had received prior lifetime ECT, and 60% had a history of psychiatric hospitalization. The CGI-I response rate was 50.6% and the remission rate was 24.7% at 6 weeks. The mean change was -7.8 points in HDRS score, -5.4 in QIDS-SR, -11.4 in BDI, -5.8 in BAI, and -6.9 in SDS. The HDRS response and remission rates were 41.2% and 35.3%, respectively. Forty-two patients (49%) entered 6 months of maintenance TMS treatment. Sixty-two percent (26/42 patients) maintained their responder status at the last assessment during the maintenance treatment. TMS treatment was well tolerated, with a discontinuation rate of 3% in the acute treatment phase. No serious adverse events related to TMS were observed during acute or maintenance treatment.
CONCLUSIONS: Adjunctive TMS was found to be safe and effective in both acute and maintenance treatment of patients with treatment-resistant depression.
PMID: 22579164 [PubMed - in process]
Race and long-acting antipsychotic prescription at a community mental health center: a retrospective chart review.
J Clin Psychiatry. 2012 Apr;73(4):513-7
Authors: Aggarwal NK, Rosenheck RA, Woods SW, Sernyak MJ
Abstract
OBJECTIVE: There has been concern that racial minorities are disproportionately prescribed long-acting injectable antipsychotic drugs.
METHOD: Comprehensive administrative data and clinician survey were used to identify all patients with a DSM-IV diagnosis of schizophrenia who received long-acting antipsychotic prescriptions from July 2009 to June 2010 at a community mental health center. Charts were reviewed retrospectively to validate long-acting antipsychotic prescription (eg, medication, dosage) and merged with administrative data from all center patients documenting sociodemographic characteristics (ie, age, race, gender) and comorbid diagnoses. We used bivariate χ2, t tests, and multivariate logistic regression to compare the subsample of patients receiving long-acting injectable drugs (n = 102) to patients not receiving long-acting injectable drugs (n = 799) who were diagnosed with schizophrenia for the same period.
RESULTS: White patients were significantly less likely to receive long-acting antipsychotic prescriptions than minority patients (OR = 0.52, P < .007); ie, nonwhites were 1.89 times more likely to receive such drugs. Age, gender, and comorbid diagnoses, including substance abuse, were unrelated to long-acting injectable prescription, and race/ethnicity was not associated with use of specific agents (haloperidol decanoate, fluphenazine decanoate, or risperidone microspheres) (P = .73).
CONCLUSIONS: Racial minorities are more likely than other patients with schizophrenia to receive long-acting injectionable antipsychotics, a finding that suggests their prescribers may consider them less adherent to antipsychotic prescriptions.
PMID: 22579151 [PubMed - in process]
The psychiatric manifestations of mitochondrial disorders: a case and review of the literature.
J Clin Psychiatry. 2012 Apr;73(4):506-12
Authors: Anglin RE, Garside SL, Tarnopolsky MA, Mazurek MF, Rosebush PI
Abstract
OBJECTIVE: Mitochondrial disorders are caused by gene mutations in mitochondrial or nuclear DNA and affect energy-dependent organs such as the brain. Patients with psychiatric illness, particularly those with medical comorbidities, may have primary mitochondrial disorders. To date, this issue has received little attention in the literature, and mitochondrial disorders are likely underdiagnosed in psychiatric patients.
DATA SOURCES: This article describes a patient who presented with borderline personality disorder and treatment-resistant depression and was ultimately diagnosed with mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS) 3271. We also searched the literature for all case reports of patients with mitochondrial disorders who initially present with prominent psychiatric symptoms by using MEDLINE (from 1948-February 2011), Embase (from 1980-February 2011), PsycINFO (from 1806-February 2011), and the search terms mitochondrial disorder, mitochondria, psychiatry, mental disorders, major depression, anxiety, schizophrenia, and psychosis.
STUDY SELECTION: Fifty cases of mitochondrial disorders with prominent psychiatric symptomatology were identified.
DATA EXTRACTION: Information about the psychiatric presentation of the cases was extracted. This information was combined with our case, the most common psychiatric manifestations of mitochondrial disorders were identified, and the important diagnostic and treatment implications for patients with psychiatric illness were reviewed.
RESULTS: The most common psychiatric presentations in the cases of mitochondrial disorders included mood disorder, cognitive deterioration, psychosis, and anxiety. The most common diagnosis (52% of cases) was a MELAS mutation. Other genetic mitochondrial diagnoses included polymerase gamma mutations, Kearns-Sayre syndrome, mitochondrial DNA deletions, point mutations, twinkle mutations, and novel mutations.
CONCLUSIONS: Patients with mitochondrial disorders can present with primary psychiatric symptomatology, including mood disorder, cognitive impairment, psychosis, and anxiety. Psychiatrists need to be aware of the clinical features that are indicative of a mitochondrial disorder, investigate patients with suggestive presentations, and be knowledgeable about the treatment implications of the diagnosis.
PMID: 22579150 [PubMed - in process]
Are antipsychotics or antidepressants needed for psychotic depression? a systematic review and meta-analysis of trials comparing antidepressant or antipsychotic monotherapy with combination treatment.
J Clin Psychiatry. 2012 Apr;73(4):486-96
Authors: Farahani A, Correll CU
Abstract
OBJECTIVE: To perform a meta-analysis of antidepressant-antipsychotic cotreatment versus antidepressant or antipsychotic monotherapy for psychotic depression.
DATA SOURCES: We performed an electronic search (from inception of databases until February 28, 2011) in PubMed/MEDLINE, Cochrane Library, and PsycINFO, without language or time restrictions. Search terms were (psychosis OR psychotic OR hallucinations OR hallucinating OR delusions OR delusional) AND (depression OR depressed OR major depressive disorder) AND (random OR randomized OR randomly).
STUDY SELECTION: Eight randomized, placebo-controlled acute-phase studies in adults (N = 762) with standardized criteria-defined psychotic depression (including Research Diagnostic Criteria, DSM-III, DSM-IV, or ICD-10) were meta-analyzed, yielding 10 comparisons. Antidepressant-antipsychotic cotreatment was compared in 5 trials with 6 treatment arms (n = 337) with antidepressant monotherapy and in 4 trials with 4 treatment arms (n = 447) with antipsychotic monotherapy.
DATA EXTRACTION: Primary outcome was study-defined inefficacy; secondary outcomes included all-cause discontinuation, specific psychopathology ratings, and side effects. Using random effects models, we calculated relative risk (RR) with 95% confidence intervals (CIs), number-needed-to-treat/harm (NNT/NNH), and effect size (ES).
RESULTS: Antidepressant-antipsychotic cotreatment outperformed antidepressant monotherapy regarding less study-defined inefficacy (no. of comparisons = 6; n = 378; RR = 0.76; 95% CI, 0.59-0.98; P = .03; heterogeneity [I2] = 34%) (NNT = 7; 95% CI, 4-20; P = .009) and Clinical Global Impressions-Severity of Illness scores (no. of comparisons = 4; n = 289; ES = -0.25; 95% CI, -0.49 to -0.02; P = .03; I2 = 0%), with trend-level superiority for depression ratings (no. of comparisons = 5; n = 324; ES = -0.20; 95% CI, -0.44 to 0.03; P = .09; I2 = 10%), but not regarding psychosis ratings (no. of comparisons = 3; n = 161; ES = -0.24; 95% CI, -0.85 to 0.38; P = .45; I2 = 70%). Antidepressant-antipsychotic cotreatment also outperformed antipsychotic monotherapy regarding less study-defined inefficacy (no. of comparisons = 4; n = 447; RR = 0.73; 95% CI, 0.63-0.84; P < .0001; I2 = 0%) (NNT = 5; 95% CI, 4-8; P < .0001) and depression ratings (no. of comparisons = 4; n = 428; ES = -0.49; 95% CI, -0.75 to -0.23; P = .0002; I2 = 27%), while anxiety (P = .11) and psychosis (P = .06) ratings only trended toward favoring cotreatment. All-cause discontinuation and reported side-effect rates were similar, except for more somnolence with antidepressant-antipsychotic cotreatment versus antidepressants (P = .02). Only 1 open-label, 4-month extension study (n = 59) assessed maintenance/relapse-prevention efficacy of antidepressant-antipsychotic cotreatment versus antidepressant monotherapy, without group differences.
CONCLUSIONS: Antidepressant-antipsychotic cotreatment was superior to monotherapy with either drug class in the acute treatment of psychotic depression. These results support recent treatment guidelines, but more studies are needed to assess specific combinations and maintenance/relapse-prevention efficacy.
PMID: 22579147 [PubMed - in process]
Would broadening the diagnostic criteria for bipolar disorder do more harm than good? implications from longitudinal studies of subthreshold conditions.
J Clin Psychiatry. 2012 Apr;73(4):437-43
Authors: Zimmerman M
Abstract
BACKGROUND: The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), is a categorical system that provides descriptive diagnostic criteria for psychiatric syndromes. These syndrome descriptions are imperfect representations of an underlying behavioral, psychological, or biological dysfunction; thus, the criteria could be conceptualized as a type of test for the etiologically defined illnesses. Accordingly, as with any other diagnostic test, diagnoses based on DSM-IV criteria produce some false positive and some false negative results. That is, some patients who meet the criteria will not have the illness (ie, false positives), and some who do not meet the criteria because their symptoms fall below the diagnostic threshold will have the illness and incorrectly not receive the diagnosis (ie, false negatives). In this context, I consider the controversy over whether the diagnostic threshold for bipolar disorder should be lowered.
METHOD: Longitudinal studies of the prognostic significance of subthreshold bipolar disorder are considered.
RESULTS: Subthreshold bipolarity is a risk factor for the future emergence of bipolar disorder, but the majority of individuals with subthreshold bipolarity do not develop a future manic or hypomanic episode.
CONCLUSIONS: The diagnostic threshold for bipolar disorder should not be lowered for 4 reasons: (1) the results of longitudinal studies suggest that lowering the diagnostic threshold for bipolar disorder will result in a greater increase in false positive than true positive diagnoses; (2) there are no controlled studies demonstrating the efficacy of mood stabilizers in treating subthreshold bipolar disorder; (3) if a false negative diagnosis occurs and bipolar disorder is underdiagnosed, diagnosis and treatment can be changed when a manic/hypomanic episode emerges; and (4) if bipolar disorder is overdiagnosed and patients are inappropriately prescribed a mood stabilizer, the absence of a future manic/hypomanic episode would incorrectly be considered evidence of the efficacy of treatment, and the unnecessary medications that might cause medically significant side effects would not be discontinued.
PMID: 22579144 [PubMed - in process]
Mike Nova's starred items
Suicidality and sexual orientation among men in Switzerland: Findings from 3 probability surveys.
J Psychiatr Res. 2012 May 14;
Authors: Wang J, Häusermann M, Wydler H, Mohler-Kuo M, Weiss MG
Abstract
Few population-based surveys in Europe have examined the link between suicidality and sexual orientation. The objective of this study was to assess the prevalences of and risk for suicidality by sexual orientation, especially among adolescent and young adult men. Data came from three probability-based surveys in Switzerland from 2002: 1) Geneva Gay Men’s Health Survey (GGMHS) with 571 gay/bisexual men, 2) Swiss Multicenter Adolescent Survey on Health (SMASH) with 7,428 16-20 year olds, and 3) Swiss Recruit Survey (ch-x) with 22,415 new recruits. In GGMHS, suicidal ideation (12 months/lifetime) was reported by 22%/55%, suicide plans 12%/38%, and suicide attempts 4%/19%. While lifetime prevalences and ratios are similar across age groups, men under 25 years reported the highest 12-month prevalences for suicidal ideation (35.4%) and suicide attempts (11.5%) and the lowest attempt ratios (1:1.5 for attempt to plan and 1:3.1 for attempt to ideation). The lifetime prevalence of suicide attempts among homo/bisexual men aged 16-20 years varies from 5.1% in ch-x to 14.1% in SMASH to 22.0% in GGMHS. Compared to their heterosexual counterparts, significantly more homo/bisexual men reported 12-month suicidal ideation, plans, and attempts (OR = 2.09-2.26) and lifetime suicidal ideation (OR = 2.15) and suicide attempts (OR = 4.68-5.36). Prevalences and ratios vary among gay men by age and among young men by both sexual orientation and study population. Lifetime prevalences and ratios of non-fatal suicidal behaviors appear constant across age groups as is the increased risk of suicidality among young homo/bisexual men.
PMID: 22591853 [PubMed - as supplied by publisher]
7:49 AM 5/20/2012 - Mike Nova's starred items
via Medicine JournalFeeds » Psychiatry by admin on 5/18/12
J Clin Psychiatry. 2012 Apr;73(4):e567-73
Authors: Connolly RK, Helmer A, Cristancho MA, Cristancho P, O’Reardon JP
Abstract
INTRODUCTION: Transcranial magnetic stimulation (TMS) is a US Food and Drug Administration-approved treatment for major depressive disorder (MDD) in patients who have not responded to 1 adequate antidepressant trial in the current episode. In a retrospective cohort study, we examined the effectiveness and safety of TMS in the first 100 consecutive patients treated for depression (full DSM-IV criteria for major depressive episode in either major depressive disorder or bipolar disorder) at an academic medical center between July 21, 2008, and March 25, 2011.
METHOD: TMS was flexibly dosed in a course of up to 30 sessions, adjunctive to current medications, for 85 patients treated for acute depression. The primary outcomes were response and remission rates at treatment end point as measured by the Clinical Global Impressions-Improvement scale (CGI-I) at 6 weeks. Secondary outcomes included change in the Hamilton Depression Rating Scale (HDRS); Quick Inventory of Depressive Symptomatology, self-report (QIDS-SR); Beck Depression Inventory (BDI); Beck Anxiety Inventory (BAI); and the Sheehan Disability Scale (SDS). Enduring benefit was assessed over 6 months in patients receiving maintenance TMS treatment. Data from 12 patients who received TMS as maintenance or continuation treatment after prior electroconvulsive therapy (ECT) or TMS given in a clinical trial setting were also reviewed.
RESULTS: The clinical cohort was treatment resistant, with a mean of 3.4 failed adequate trials in the current episode. Thirty-one individuals had received prior lifetime ECT, and 60% had a history of psychiatric hospitalization. The CGI-I response rate was 50.6% and the remission rate was 24.7% at 6 weeks. The mean change was -7.8 points in HDRS score, -5.4 in QIDS-SR, -11.4 in BDI, -5.8 in BAI, and -6.9 in SDS. The HDRS response and remission rates were 41.2% and 35.3%, respectively. Forty-two patients (49%) entered 6 months of maintenance TMS treatment. Sixty-two percent (26/42 patients) maintained their responder status at the last assessment during the maintenance treatment. TMS treatment was well tolerated, with a discontinuation rate of 3% in the acute treatment phase. No serious adverse events related to TMS were observed during acute or maintenance treatment.
CONCLUSIONS: Adjunctive TMS was found to be safe and effective in both acute and maintenance treatment of patients with treatment-resistant depression.
PMID: 22579164 [PubMed - in process]
via Medicine JournalFeeds » Psychiatry by admin on 5/18/12
J Clin Psychiatry. 2012 Apr;73(4):513-7
Authors: Aggarwal NK, Rosenheck RA, Woods SW, Sernyak MJ
Abstract
OBJECTIVE: There has been concern that racial minorities are disproportionately prescribed long-acting injectable antipsychotic drugs.
METHOD: Comprehensive administrative data and clinician survey were used to identify all patients with a DSM-IV diagnosis of schizophrenia who received long-acting antipsychotic prescriptions from July 2009 to June 2010 at a community mental health center. Charts were reviewed retrospectively to validate long-acting antipsychotic prescription (eg, medication, dosage) and merged with administrative data from all center patients documenting sociodemographic characteristics (ie, age, race, gender) and comorbid diagnoses. We used bivariate χ2, t tests, and multivariate logistic regression to compare the subsample of patients receiving long-acting injectable drugs (n = 102) to patients not receiving long-acting injectable drugs (n = 799) who were diagnosed with schizophrenia for the same period.
RESULTS: White patients were significantly less likely to receive long-acting antipsychotic prescriptions than minority patients (OR = 0.52, P < .007); ie, nonwhites were 1.89 times more likely to receive such drugs. Age, gender, and comorbid diagnoses, including substance abuse, were unrelated to long-acting injectable prescription, and race/ethnicity was not associated with use of specific agents (haloperidol decanoate, fluphenazine decanoate, or risperidone microspheres) (P = .73).
CONCLUSIONS: Racial minorities are more likely than other patients with schizophrenia to receive long-acting injectionable antipsychotics, a finding that suggests their prescribers may consider them less adherent to antipsychotic prescriptions.
PMID: 22579151 [PubMed - in process]
via Medicine JournalFeeds » Psychiatry by admin on 5/18/12
J Clin Psychiatry. 2012 Apr;73(4):506-12
Authors: Anglin RE, Garside SL, Tarnopolsky MA, Mazurek MF, Rosebush PI
Abstract
OBJECTIVE: Mitochondrial disorders are caused by gene mutations in mitochondrial or nuclear DNA and affect energy-dependent organs such as the brain. Patients with psychiatric illness, particularly those with medical comorbidities, may have primary mitochondrial disorders. To date, this issue has received little attention in the literature, and mitochondrial disorders are likely underdiagnosed in psychiatric patients.
DATA SOURCES: This article describes a patient who presented with borderline personality disorder and treatment-resistant depression and was ultimately diagnosed with mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS) 3271. We also searched the literature for all case reports of patients with mitochondrial disorders who initially present with prominent psychiatric symptoms by using MEDLINE (from 1948-February 2011), Embase (from 1980-February 2011), PsycINFO (from 1806-February 2011), and the search terms mitochondrial disorder, mitochondria, psychiatry, mental disorders, major depression, anxiety, schizophrenia, and psychosis.
STUDY SELECTION: Fifty cases of mitochondrial disorders with prominent psychiatric symptomatology were identified.
DATA EXTRACTION: Information about the psychiatric presentation of the cases was extracted. This information was combined with our case, the most common psychiatric manifestations of mitochondrial disorders were identified, and the important diagnostic and treatment implications for patients with psychiatric illness were reviewed.
RESULTS: The most common psychiatric presentations in the cases of mitochondrial disorders included mood disorder, cognitive deterioration, psychosis, and anxiety. The most common diagnosis (52% of cases) was a MELAS mutation. Other genetic mitochondrial diagnoses included polymerase gamma mutations, Kearns-Sayre syndrome, mitochondrial DNA deletions, point mutations, twinkle mutations, and novel mutations.
CONCLUSIONS: Patients with mitochondrial disorders can present with primary psychiatric symptomatology, including mood disorder, cognitive impairment, psychosis, and anxiety. Psychiatrists need to be aware of the clinical features that are indicative of a mitochondrial disorder, investigate patients with suggestive presentations, and be knowledgeable about the treatment implications of the diagnosis.
PMID: 22579150 [PubMed - in process]
via Medicine JournalFeeds » Psychiatry by admin on 5/18/12
J Clin Psychiatry. 2012 Apr;73(4):486-96
Authors: Farahani A, Correll CU
Abstract
OBJECTIVE: To perform a meta-analysis of antidepressant-antipsychotic cotreatment versus antidepressant or antipsychotic monotherapy for psychotic depression.
DATA SOURCES: We performed an electronic search (from inception of databases until February 28, 2011) in PubMed/MEDLINE, Cochrane Library, and PsycINFO, without language or time restrictions. Search terms were (psychosis OR psychotic OR hallucinations OR hallucinating OR delusions OR delusional) AND (depression OR depressed OR major depressive disorder) AND (random OR randomized OR randomly).
STUDY SELECTION: Eight randomized, placebo-controlled acute-phase studies in adults (N = 762) with standardized criteria-defined psychotic depression (including Research Diagnostic Criteria, DSM-III, DSM-IV, or ICD-10) were meta-analyzed, yielding 10 comparisons. Antidepressant-antipsychotic cotreatment was compared in 5 trials with 6 treatment arms (n = 337) with antidepressant monotherapy and in 4 trials with 4 treatment arms (n = 447) with antipsychotic monotherapy.
DATA EXTRACTION: Primary outcome was study-defined inefficacy; secondary outcomes included all-cause discontinuation, specific psychopathology ratings, and side effects. Using random effects models, we calculated relative risk (RR) with 95% confidence intervals (CIs), number-needed-to-treat/harm (NNT/NNH), and effect size (ES).
RESULTS: Antidepressant-antipsychotic cotreatment outperformed antidepressant monotherapy regarding less study-defined inefficacy (no. of comparisons = 6; n = 378; RR = 0.76; 95% CI, 0.59-0.98; P = .03; heterogeneity [I2] = 34%) (NNT = 7; 95% CI, 4-20; P = .009) and Clinical Global Impressions-Severity of Illness scores (no. of comparisons = 4; n = 289; ES = -0.25; 95% CI, -0.49 to -0.02; P = .03; I2 = 0%), with trend-level superiority for depression ratings (no. of comparisons = 5; n = 324; ES = -0.20; 95% CI, -0.44 to 0.03; P = .09; I2 = 10%), but not regarding psychosis ratings (no. of comparisons = 3; n = 161; ES = -0.24; 95% CI, -0.85 to 0.38; P = .45; I2 = 70%). Antidepressant-antipsychotic cotreatment also outperformed antipsychotic monotherapy regarding less study-defined inefficacy (no. of comparisons = 4; n = 447; RR = 0.73; 95% CI, 0.63-0.84; P < .0001; I2 = 0%) (NNT = 5; 95% CI, 4-8; P < .0001) and depression ratings (no. of comparisons = 4; n = 428; ES = -0.49; 95% CI, -0.75 to -0.23; P = .0002; I2 = 27%), while anxiety (P = .11) and psychosis (P = .06) ratings only trended toward favoring cotreatment. All-cause discontinuation and reported side-effect rates were similar, except for more somnolence with antidepressant-antipsychotic cotreatment versus antidepressants (P = .02). Only 1 open-label, 4-month extension study (n = 59) assessed maintenance/relapse-prevention efficacy of antidepressant-antipsychotic cotreatment versus antidepressant monotherapy, without group differences.
CONCLUSIONS: Antidepressant-antipsychotic cotreatment was superior to monotherapy with either drug class in the acute treatment of psychotic depression. These results support recent treatment guidelines, but more studies are needed to assess specific combinations and maintenance/relapse-prevention efficacy.
PMID: 22579147 [PubMed - in process]
via Medicine JournalFeeds » Psychiatry by admin on 5/18/12
J Clin Psychiatry. 2012 Apr;73(4):437-43
Authors: Zimmerman M
Abstract
BACKGROUND: The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), is a categorical system that provides descriptive diagnostic criteria for psychiatric syndromes. These syndrome descriptions are imperfect representations of an underlying behavioral, psychological, or biological dysfunction; thus, the criteria could be conceptualized as a type of test for the etiologically defined illnesses. Accordingly, as with any other diagnostic test, diagnoses based on DSM-IV criteria produce some false positive and some false negative results. That is, some patients who meet the criteria will not have the illness (ie, false positives), and some who do not meet the criteria because their symptoms fall below the diagnostic threshold will have the illness and incorrectly not receive the diagnosis (ie, false negatives). In this context, I consider the controversy over whether the diagnostic threshold for bipolar disorder should be lowered.
METHOD: Longitudinal studies of the prognostic significance of subthreshold bipolar disorder are considered.
RESULTS: Subthreshold bipolarity is a risk factor for the future emergence of bipolar disorder, but the majority of individuals with subthreshold bipolarity do not develop a future manic or hypomanic episode.
CONCLUSIONS: The diagnostic threshold for bipolar disorder should not be lowered for 4 reasons: (1) the results of longitudinal studies suggest that lowering the diagnostic threshold for bipolar disorder will result in a greater increase in false positive than true positive diagnoses; (2) there are no controlled studies demonstrating the efficacy of mood stabilizers in treating subthreshold bipolar disorder; (3) if a false negative diagnosis occurs and bipolar disorder is underdiagnosed, diagnosis and treatment can be changed when a manic/hypomanic episode emerges; and (4) if bipolar disorder is overdiagnosed and patients are inappropriately prescribed a mood stabilizer, the absence of a future manic/hypomanic episode would incorrectly be considered evidence of the efficacy of treatment, and the unnecessary medications that might cause medically significant side effects would not be discontinued.
PMID: 22579144 [PubMed - in process]
via Behavior and Law by Mike Nova on 5/19/12
Punishment Outside Prison - NYTimes.com
May 19, 2012
Punishment Outside Prison
By LINCOLN CAPLAN
Probation and parole for convicted offenders are complex and growing problems in criminal justice. Scholars and others with the American Law Institute, meeting in Washington this week, are to present draft proposals on ways to reform laws about offenders who serve these out-of-custody sentences.
The draft recommends fewer such community-based sentences, with shorter terms and fewer conditions imposed so that supervision is better defined. When finalized, the plan will be a model for state penal codes.
In 2010, more than 2.3 million people were behind bars in the United States. More than twice that number, 4.9 million, were under probation or parole. Such sentences — imposed either for lesser offenses like shoplifting, or after release from prison for more serious offenses — are considered easy time compared with incarceration and a first step toward a fresh start. But often, that turns out to be wrong.
Increasingly, these offenders are not reintegrated into society. Often, so many conditions are imposed on their probation or parole — like not being allowed to drink alcohol after being convicted of passing a bad check — that it is easy to violate just one and end up in custody. And the consequences of community sentences even for those never imprisoned — like not being permitted to vote or to qualify for, say, a beautician’s license — make it difficult to find a job. Under a sound justice system, most offenders should do their time and get a second chance. For many, probation and parole lead to prison, not back to a normal life.
via psychiatry - Google Blog Search by Benedict Carey, NY Times on 5/18/12
The simple fact was that he had done something wrong, and at the end of a long and revolutionary career it didn't matter how often he'd been right, how powerful he once was, or what it would mean for his legacy. Dr. Robert L.
via psychiatry - Google Blog Search by Alan on 5/19/12
Dr. Robert L. Spitzer favored gay reparative therapy, but now realizes he was wrong. …he was at his computer, ready to recant a study he had done himself, a poorly conceived 2003 investigation that supported the use of ...
via psychiatry - Google News on 5/19/12
'Behavioral addiction' affects us all ReporterHerald.com Should the American Psychiatric Association expand its Diagnostic and Statistical Manual of Mental Disorders as proposed, then compulsive shopping, sex, time on the Internet and playing of video games could be considered medical conditions, ... New Scientist reports on protest of psychiatric labelingExaminer.com Can someone be mildly alcoholic? | The RepublicThe Republic 'Label jars, not people': Lobbying against the shrinksNew Scientist The Conversation all 9 news articles » |
Mike Nova's starred items
via Medicine JournalFeeds » Psychiatry by admin on 5/19/12
J Psychiatr Res. 2012 May 14;
Authors: Wang J, Häusermann M, Wydler H, Mohler-Kuo M, Weiss MG
Abstract
Few population-based surveys in Europe have examined the link between suicidality and sexual orientation. The objective of this study was to assess the prevalences of and risk for suicidality by sexual orientation, especially among adolescent and young adult men. Data came from three probability-based surveys in Switzerland from 2002: 1) Geneva Gay Men’s Health Survey (GGMHS) with 571 gay/bisexual men, 2) Swiss Multicenter Adolescent Survey on Health (SMASH) with 7,428 16-20 year olds, and 3) Swiss Recruit Survey (ch-x) with 22,415 new recruits. In GGMHS, suicidal ideation (12 months/lifetime) was reported by 22%/55%, suicide plans 12%/38%, and suicide attempts 4%/19%. While lifetime prevalences and ratios are similar across age groups, men under 25 years reported the highest 12-month prevalences for suicidal ideation (35.4%) and suicide attempts (11.5%) and the lowest attempt ratios (1:1.5 for attempt to plan and 1:3.1 for attempt to ideation). The lifetime prevalence of suicide attempts among homo/bisexual men aged 16-20 years varies from 5.1% in ch-x to 14.1% in SMASH to 22.0% in GGMHS. Compared to their heterosexual counterparts, significantly more homo/bisexual men reported 12-month suicidal ideation, plans, and attempts (OR = 2.09-2.26) and lifetime suicidal ideation (OR = 2.15) and suicide attempts (OR = 4.68-5.36). Prevalences and ratios vary among gay men by age and among young men by both sexual orientation and study population. Lifetime prevalences and ratios of non-fatal suicidal behaviors appear constant across age groups as is the increased risk of suicidality among young homo/bisexual men.
PMID: 22591853 [PubMed - as supplied by publisher]
Saturday, May 19, 2012
Punishment Outside Prison - NYTimes.com
Punishment Outside Prison - NYTimes.com
Punishment Outside Prison
By LINCOLN CAPLAN
Probation and parole for convicted offenders are complex and growing problems in criminal justice. Scholars and others with the American Law Institute, meeting in Washington this week, are to present draft proposals on ways to reform laws about offenders who serve these out-of-custody sentences.
The draft recommends fewer such community-based sentences, with shorter terms and fewer conditions imposed so that supervision is better defined. When finalized, the plan will be a model for state penal codes.
In 2010, more than 2.3 million people were behind bars in the United States. More than twice that number, 4.9 million, were under probation or parole. Such sentences — imposed either for lesser offenses like shoplifting, or after release from prison for more serious offenses — are considered easy time compared with incarceration and a first step toward a fresh start. But often, that turns out to be wrong.
Increasingly, these offenders are not reintegrated into society. Often, so many conditions are imposed on their probation or parole — like not being allowed to drink alcohol after being convicted of passing a bad check — that it is easy to violate just one and end up in custody. And the consequences of community sentences even for those never imprisoned — like not being permitted to vote or to qualify for, say, a beautician’s license — make it difficult to find a job. Under a sound justice system, most offenders should do their time and get a second chance. For many, probation and parole lead to prison, not back to a normal life.
Goodwin and Guzes Psychiatric Diagnosis von Carol S. North
Goodwin and Guzes Psychiatric Diagnosis von Carol S. North
" . . . (the first edition) . . . . was one of the great dementia the field . . . The fifth edition of Psychiatric Diagnosis hews to the authors' previous high standards. Once again, we are treated to a clearly written, empirically based compilation of basic knowledge about 11 major categories of mental disorder. And, once again, the authors' commitment to agnosticism remains as pure as ever. In a field that continues to be tendentious, these authors steadfastly resist temptations to advance any agenda beyond the scientific."
-Contemporary Psychology
"Twenty-two years after first being published, this significant book continues its role as an important work in the area of psychiatric diagnosis. It offers conciseness, clarity, and simplicity while providing a quick overview of the most essential core of psychiatric disorders." -JAMA
"The book was clearly written, entertaining... The book retains its original style-readability combined with a no-nonsense approach that is refreshingly jargon-free. I highly recommend this book." -- ANNALS OF CLINICAL PSYCHIATRY
Some specific areas of new material include the long term course of mood disorders, genetics and neuro-imaging of schizophrenia and mood and other disorders, cognitive changes in relation to depression and dementia, brain stimulation techniques, outcome studies of eating disorders, and epidemiology of drug use disorders. In accordance with current medical community interest and research, entirely new chapters on posttraumatic stress disorder and borderline personality disorder have been included. Additionally, a new introduction reviews the background of medical model psychiatry and the empirical approach to psychiatric nosology. With this new edition, medical students and psychiatric residents will continue to discover that no other text provides such a lucid, well-documented and critically sound overview of the major syndromes in psychiatry.
- Autor: Carol S. North
- Preis: EUR37,99
- Subjekts: Französische Bücher > Medizin
- Taschenbuch: 432 Seiten
- Verlag: Oxford University Press, U.S.A.; Auflage: 0006
- Sprache: Englisch
- ISBN-10: 0195144295
- ISBN-13: 978-0195144291
- Größe und/oder Gewicht: 23,4x15,4x2,4cm
Pressestimmen
"This book has been and continues to be a superb contribution to psychiatry and medicine. Outstanding reviews of the literature for the various psychiatric disorders including mood, schizophrenic, panic and phobic, post-traumatic stress, obsessive-compulsive, eating, somatization, antisocial personality, borderline personality, alcoholism, drug dependence, delirium and dementia...should be required reading for all psychiatrists." -- Doody's Review Service" . . . (the first edition) . . . . was one of the great dementia the field . . . The fifth edition of Psychiatric Diagnosis hews to the authors' previous high standards. Once again, we are treated to a clearly written, empirically based compilation of basic knowledge about 11 major categories of mental disorder. And, once again, the authors' commitment to agnosticism remains as pure as ever. In a field that continues to be tendentious, these authors steadfastly resist temptations to advance any agenda beyond the scientific."
-Contemporary Psychology
"Twenty-two years after first being published, this significant book continues its role as an important work in the area of psychiatric diagnosis. It offers conciseness, clarity, and simplicity while providing a quick overview of the most essential core of psychiatric disorders." -JAMA
"The book was clearly written, entertaining... The book retains its original style-readability combined with a no-nonsense approach that is refreshingly jargon-free. I highly recommend this book." -- ANNALS OF CLINICAL PSYCHIATRY
Kurzbeschreibung
With two new lead authors, the sixth edition of Psychiatric Diagnosis continues its thirty-five year tradition of providing a clear, critical and well-documented overview of major psychiatric syndromes, with minimum inclusion of unwieldy theories or clinical opinions. Medical students and psychiatric residents will continue to find this new edition to be a unique guide to the field-a volume that concisely yet comprehensively dissects major psychiatric disorders. Well-known for providing a thorough yet concise view of the natural history of basic psychiatric disorders, this popular text has been extensively updated, chapter by chapter, in this sixth edition. Terminology has been made consistent with DSM-IV-TR and updates made to include recent genetic and neurobiological findings. In the classification of psychiatric disorders, new data on follow-up and family/genetic studies, confirming and extending previous research, are provided. As in previous editions, each chapter systematically covers the definition, historical background, epidemiology, clinical picture, natural history, complications, family studies, differential diagnosis, and clinical management of each disorder.Some specific areas of new material include the long term course of mood disorders, genetics and neuro-imaging of schizophrenia and mood and other disorders, cognitive changes in relation to depression and dementia, brain stimulation techniques, outcome studies of eating disorders, and epidemiology of drug use disorders. In accordance with current medical community interest and research, entirely new chapters on posttraumatic stress disorder and borderline personality disorder have been included. Additionally, a new introduction reviews the background of medical model psychiatry and the empirical approach to psychiatric nosology. With this new edition, medical students and psychiatric residents will continue to discover that no other text provides such a lucid, well-documented and critically sound overview of the major syndromes in psychiatry.
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