Tuesday, July 24, 2012

11:18 AM 7/24/2012 - The New York Times on issues of Behavior and Law - bundle created by Mike Nova

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10:38 AM 7/24/2012 - "Psychiatric News and Times" bundle created by Mike Nova

10:38 AM 7/24/2012

"Psychiatric News and Times" bundle created by Mike Nova

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via Psychiatric News Alert by noreply@blogger.com (Psychiatric News Alert) on 7/24/12

Results from a phase 3 clinical trial of a once-promising new medication to treat Alzheimer's disease (AD) showed that the drug failed to improve either cognition or daily functioning. Pfizer is developing the drug along with the Janssen Alzheimer Immunotherapy division of Johnson & Johnson. The clinical trial tested bapineuzumab in 1,100 people with mild to moderate AD, all of whom have the ApoE4 gene, which has been shown to increase the risk of developing the disease. In a July 23 press release, Pfizer said that while the company was disappointed in the results, further studies of bapineuzumab are planned, and data from a clinical trial in about 1,300 AD patients who do not carry the ApoE4 gene will be available soon. The drug is an antibody that binds to beta-amyloid in the brain—that protein is widely believed to be a cause of AD. The companies expected bapineuzumab to destroy beta-amyloid deposits. Commenting on the study results, Samuel Gandy, M.D., director of the Center for Cognitive Health at Mount Sinai School of Medicine, told the New York Times that since the brain plaques likely develop years or even decades before symptoms appear, "All these symptomatic trials are 25 years too late. I'm not terribly disappointed and I'm not discouraged" by the bapineuzumab data.

Read much more about bapineuzumab and the search for an Alzheimer's treatment in Psychiatric News here and here.

(image: Molekuul.be/Shutterstock.com)
For previous news alerts, click here.

via Twitter / NIMHgov on 7/24/12
NIMHgov: Attending the #AIDS2012 Intl Conf this week? Don't miss this session about mental disorders and HIV/AIDS on tues eve http://t.co/tjfJoIyK

via Twitter / APAPsychiatric on 7/23/12
APAPsychiatric: RT @APP_Publishing: A Parasite Is Linked With Suicide Risk: In a large prospective study of some 46,000 women in which levels of ant... ...

via Clinical Psychiatry News on 7/23/12
There was a piece in last Sunday’s New York Times written by an oncology nurse...

via Psychiatric Times on 7/18/12
Research is needed on the hypervigilant Narcissistic Personality Disorder subtype, which has been largely understudied in spite of clinicians’ warnings that this is the most frequent presentation in patients.

via Psychiatric News Alert by noreply@blogger.com (Psychiatric News Alert) on 7/23/12

In a large prospective study of some 46,000 women in which levels of antibodies to the parasite Toxoplasma gondii were measured at childbirth, researchers linked infection with the parasite to suicide during the subsequent decade or so after they gave birth. The lead scientist was Marianne Pedersen, M.Sc., of Aarhus University in Denmark. The results were reported online this month in the Archives of General Psychiatry.

In a previous prospective study conducted with the same large cohort of women, and in which levels of antibodies to T. gondii were also measured at childbirth, Pedersen and her team linked infection with T. gondii to the subsequent development of schizophrenia. For more information about this study, see Psychiatric News.

(Image: Jubal Harshaw/Shutterstock.com)
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via Twitter / APAPsychiatric on 7/23/12
APAPsychiatric: RT @APP_Publishing: Could Skin Cells Hold Answers to Alzheimer's?: Skin cells taken from patients with Alzheimer's disease can be re... ...

via Twitter / APAPsychiatric on 7/23/12
APAPsychiatric: Tips for Talking to Kids about #AuroraShooting http://t.co/Xc073CqH … via @APAHealthyMinds #Colorado #mentalhealth #grief #anxiety #mhsm

via Psychiatric News Alert by noreply@blogger.com (Psychiatric News Alert) on 7/23/12

Skin cells taken from patients with Alzheimer's disease can be reprogrammed into brain cells with the help of a particular stem cell research technique, Andrew Sproul, Ph.D., and colleagues at the New York Stem Cell Foundation reported at the Alzheimer's Association International Conference in Vancouver July 16. The reprogrammed cells can be used to explore the biology of Alzheimer's and for early-stage testing of potential Alzheimer's treatments, the scientists believe. One advantage of the technology, Sproul said, is that it can generate a nearly infinite supply of brain cells.

Other Alzheimer's advances were reported recently at a National Institutes of Health-sponsored Alzheimer's summit—notably, that results from three trials of experimental Alzheimer's drugs will be announced later this year. For more information about the search for weapons to fight Alzheimer's, see Psychiatric News.

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via Clinical Psychiatry News by m.schneider@elsevier.com on 7/23/12
The Affordable Care Act provided $1.5 billion through September 2015 to the National Health Service Corps to train more primary care providers via scholarships and loan repayment assistance. In...

via Clinical Psychiatry News on 7/23/12
Illicit drug use is common among heavy cigarette smokers in the general population, but among outpatients with schizophrenia who are heavy smokers, it is most common in the first decade of illness,...

via Clinical Psychiatry News by michele.sullivan@elsevier.com on 7/23/12
VANCOUVER, B.C. – An investigational drug has shown promise in improving memory and cognition in patients with mild to moderate Alzheimer’s disease in a 6-month, randomized, placebo-controlled trial...

via Twitter / NIMHgov on 7/23/12
NIMHgov: Research opportunities: Participants needed for study on pediatric obsessive compulsive disorder #OCD http://t.co/LfBLjpSS

via Twitter / NIMHgov on 7/23/12
NIMHgov: RT @IACC_Autism: Upcoming IACC Conference Call and Webinar - July 27, 2012 - 10:00a.m. to 2:00p.m. Eastern time - More information @ htt ...

via Clinical Psychiatry News on 7/23/12
VANCOUVER, B.C. – Medical foods and supplements designed to support neural health and function may soon expand treatment options for common forms of dementia based on the results of two studies.
One...

via Twitter / NIMHgov on 7/23/12
NIMHgov: Youths with #autism lack options after high school, need better transition planning & services @nimhgov http://t.co/s6JTg0V0

via Clinical Psychiatry News on 7/23/12
The landmark Supreme Court decision upholding the constitutionality of the Affordable Care Act (ACA) means that states can take the brakes off their implementation of the law. At least two states –...

via Twitter / APAPsychiatric on 7/22/12
APAPsychiatric: APA Job Central Psychiatrists - Lone Star Circle of Care - Central Texas, TX: http://t.co/BtkMfvJw #job

via Home | psychiatry.org on 7/20/12
Talking with Children about Tragedy
Tips for discussing the recent tragedy in Aurora, Colorado

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More Treatment Programs - By DAVID BROOKS - NYT

The New York Times


July 23, 2012

More Treatment Programs

Early in the morning of Sept. 4, 1913, Ernst Wagner murdered his wife and four children in the town of Degerloch, Germany. Then he went to Mühlhausen, where he feared the townsmen were mocking him for having sex with an animal. He opened fire and hit 20 people, killing at least nine.
This is believed to be one of the first spectacular rampage murders of the 20th century. Over the next 60 years, there was about one or two of these spree killings per decade. Then the frequency of such killings began to shoot upward. There were at least nine of these rampages during the 1980s, according to history Web sites that track such things, including the 1982 case of a police officer in South Korea who massacred 57 people.
In the 1990s, there were at least 11 spectacular spree killings. Over the past decade, by my count, there have been at least 26 rampages. These include Robert Steinhäuser’s murder of 16 people in Germany, Seung-Hui Cho’s murder of 32 at Virginia Tech, Anders Breivik’s shooting spree at a summer camp in Norway in which 69 died, and the killing of 12 moviegoers in Aurora, Colo., last week.
When you investigate the minds of these killers, you find yourself deep in a world of delusion, untreated schizophrenia and ferociously injured pride. George Hennard of Belton, Tex., was angry that women kept rejecting him. He drove his car through the window of a restaurant and began firing, killing 14 women and eight men.
Tim Kretschmer, 17, hoped to become a professional table tennis player but felt that the world didn’t appreciate his abilities, in that or anything else. He returned to the German school where he had graduated the year before, went straight for the top-floor chemistry labs, killed nine teenagers and then another six people during his escape.
It’s probably a mistake to think that we can ever know what “caused” these rampages. But when you read through the assessments that have been done by the F.B.I., the Secret Service and various psychologists, you see certain common motifs.
Many of the killers had an exaggerated sense of their own significance, which, they felt, was not properly recognized by the rest of the world. Many suffered a grievous blow to their self-esteem — a lost job, a divorce or a school failure — and decided to strike back in some showy way.
Many had suffered from severe depression or had attempted suicide. Many lived solitary lives, but most shared their violent fantasies with at least one person before they committed their crimes.
The killers generally felt tense before they acted but at peace and in control during the rampage. Some committed suicide when they were done. But a surprising number just gave up. They’d made the statement they wanted to make and hadn’t thought about what came after.
The crucial point is that the dynamics are internal, not external. These killers are primarily the product of psychological derangements, not sociological ones.
Yet, after every rampage, there are always people who want to use these events to indict whatever they don’t like about society. A few years ago, some writers tried to blame violent video games for a rash of killings. The problem is that rampage murderers tend to be older than regular murderers and they tend not to be heavy video game users. Besides, there’s very little evidence that violent video games lead to real life violence in the first place.
These days, people are trying to use the Aurora killings as a pretext to criticize America’s gun culture or to call for stricter gun control laws. (This doesn’t happen after European or Asian spree killings.) Personally, I’ve supported tighter gun control laws. But it’s not clear that those laws improve public safety. Researchers reviewing the gun control literature for the Centers for Disease Control and Prevention, for example, were unable to show the laws are effective.
And gun control laws are probably even less germane in these cases. Rampage killers tend to be meticulous planners. If they can’t find an easy way to get a new gun, they’ll surely find a way to get one of the 200 million guns that already exist in this country. Or they’ll use a bomb or find another way.
Looking at guns, looking at video games — that’s starting from the wrong perspective. People who commit spree killings are usually suffering from severe mental disorders. The response, and the way to prevent future episodes, has to start with psychiatry, too.
The best way to prevent killing sprees is with relationships — when one person notices that a relative or neighbor is going off the rails and gets that person treatment before the barbarism takes control. But there also has to be a more aggressive system of treatment options, especially for men in their 20s. The truly disturbed have always been with us, but their outbursts are now taking more malevolent forms.

Hasty and Ruinous 1972 Pick Colors Today’s Hunt for a No. 2 - NYT

via NYT > Psychiatry and Psychiatrists by By LAWRENCE K. ALTMAN on 7/22/12
George McGovern’s choice of Thomas F. Eagleton as his running mate, made inside of an hour and resulting in disaster, still overshadows the picking of vice presidential candidates.



Hasty and Ruinous 1972 Pick Colors Today’s Hunt for a No. 2

The New York Times Published 12-29-2008: Thomas F. Eagleton
Senator Thomas F. Eagleton, left, and Senator George McGovern at the Democratic National Convention in Miami Beach in 1972. More Photos »
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WASHINGTON — Scott Lilly was a young member of Senator George McGovern’s presidential campaign staff in the summer of 1972, and he remembers the satisfaction he felt when Mr. McGovern chose Mr. Lilly’s home-state senator to be the Democratic Party’s vice-presidential candidate.

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But a few days after the convention that nominated Mr. McGovern and his running mate, Senator Thomas F. Eagleton of Missouri, Mr. Lilly said, he came to a realization. “It suddenly struck me out of the blue that they didn’t know,” he said, that the decision to pick Mr. Eagleton had been made without some crucial facts.
And he was right. The information he had felt obligated to share with a top campaign aide several weeks before — that Mr. Eagleton had been hospitalized for mental health issues — had never been passed on. Mr. Lilly’s tip “did not register,” the aide, Frank Mankiewicz, said in an interview this year. “It was a very hectic time. I must have had not two things on my mind, but maybe 80.”
Today, one of the lasting legacies of Mr. McGovern’s choice of Mr. Eagleton — and the tumult it caused in his campaign — is the microscopic examination of the lives and records of potential vice-presidential candidates, a ritual involving teams of lawyers and consultants and reams of medical and financial records that the candidates are obligated to produce.
Mitt Romney, the presumptive Republican nominee, is now engaged in that vetting process. And while he is renowned for his love of data, as well as his caution, every presidential candidate since Mr. McGovern has had the same goal in the vice-presidential search: no surprises.
In the case of Mr. Eagleton, a number of other people besides Mr. Lilly had some inkling of his history, even if they did not have definitive proof. They included a prominent member of Mr. Eagleton’s staff, many political figures and reporters in Missouri, reporters for Time magazine and probably officials in the Nixon White House.
But Mr. McGovern, who had pledged to “avoid the messy way vice presidents had been picked in the past,” chose Mr. Eagleton after considering him for less than an hour. The conversation in which Mr. McGovern offered Mr. Eagleton the nomination lasted precisely 67 seconds, and there was no mention of Mr. Eagleton’s three hospitalizations for depression or the electroshock therapy during two of the stays.
Eighteen days later, Mr. Eagleton was forced to resign from the ticket in a debacle that culminated with Mr. McGovern’s enduring the worst defeat in presidential history.
Joel K. Goldstein, a St. Louis University law professor and an expert on the vice presidency, said that in 2012 “a candidate would never be asked to run without extensive prior scrutiny and private exchanges.”
Yet in 2008, Senator John McCain’s selection of Sarah Palin, a relatively unknown Alaska governor, as his running mate reinforced the inherent dangers of a selection process that mainly involves a presidential nominee and a small group of aides.
Steve Schmidt, who was involved in Ms. Palin’s selection and later publicly admitted that he regretted it, said that while McCain campaign aides were certainly aware of the consequences of the way Mr. Eagleton was selected, there was still “a tremendous tension that exists in the vetting process between the desire for secrecy and the ability to gather the type of information that would give you a sense about how the person functions under pressure or stress, for example.”
Over the years, Mr. McGovern, who turned 90 last week and has recently been ailing, has expressed regret that Mr. Eagleton, who died in 2007, when he was 77, was not more forthcoming about his health.
“I wish, of course, that Senator Eagleton had discussed his health problem with me before I selected him,” Mr. McGovern said in an interview in 2005. “I think that would happen nowadays.”
But Mr. McGovern also pointed out that it was a different time, when politicians felt it was unseemly to ask delicate questions about one another. “Almost no candidate for the vice presidency had ever been checked out before, with the exception of Lyndon Johnson, who checked out his colleague Hubert Humphrey very carefully,” Mr. McGovern said.
Forty years later, in an era of continuous news delivered on Twitter and the Internet and amplified by cable television, the slow and painful unfolding of Mr. Eagleton’s history and the reluctant response to it by Mr. McGovern and his aides seem unimaginable. But the story of the “18-day running mate” — as Mr. Eagleton is called in a new history of the episode by Joshua M. Glasser — remains a cautionary tale for candidates and their staffs.
For Mr. Eagleton, depression was an issue from the time he entered state politics. He was hospitalized for the first time in December 1960, less than a month after he was elected attorney general of Missouri. He was admitted to Barnes Hospital in St. Louis for what his father, Mark, a prominent lawyer, said was “a virus”; in reality, Mr. Eagleton received electroshock therapy. During his 1960 campaign, he also experienced an opposite extreme that involved a euphoric state of increased energy and activity known as hypomania. He said he lost 22 pounds and “became terrifically keyed up and terrifically exhausted.”
After being elected lieutenant governor in 1964, Mr. Eagleton was again hospitalized for depression. Two years later, he was admitted a third time, and he again received electroshock therapy. In the late 1970s, Mr. Eagleton received a diagnosis of bipolar II disorder from Dr. Frederick K. Goodwin, a psychiatrist who later directed the National Institute of Mental Health. Dr. Goodwin surmised that the same problem had plagued Mr. Eagleton in the previous decade.
As Mr. Eagleton worked his way up in Missouri politics and ultimately reached the Senate, he was careful not to disclose his medical history. From the first of his hospitalizations, news releases and euphemisms (like “undergoing tests”) were used to disguise the real reason for his stays.
Over the years, rumors about Mr. Eagleton’s health surfaced quietly and subsided without much consequence. The information stayed within Missouri journalistic circles and among the Eagletons’ friends.
“You would expect that if there was anything out there, The St. Louis Post-Dispatch would have it,” Gary Hart, Mr. McGovern’s campaign manager, who was later a senator and an unsuccessful candidate for president, said in an interview — an assumption that proved to be disastrous.
Some of Mr. Eagleton’s friends noted his drinking in the 1960s, according to James N. Giglio’s biography of the senator, “Call Me Tom.”
“He drank quite a bit,” said Mr. Lilly, who often socialized with Mr. Eagleton and who is now a senior fellow at the Center for American Progress in Washington. “Sometimes he was funny, sometimes he was frightening, sometimes he created some stirs about that. How much of what was going on was alcohol and how much bipolar? My guess is the fundamental problem was bipolar.”
While a small number of journalists, politicians and health workers heard rumors or knew that Mr. Eagleton suffered from depression and had a drinking problem, no one pursued the story because of a general reluctance to investigate the personal affairs of public figures. But at least one national news organization looked into the rumors.
An editor at Time magazine heard about Mr. Eagleton’s mental health issues in 1966, but the magazine did not pursue the story until 1968, when one of its reporters, Jonathan Z. Larsen, visited Missouri to report on its Senate race. Mr. Larsen was unable to confirm the rumors about Mr. Eagleton’s drinking and electroshock treatment, but he said that “we put it on record only for future reference, when and if Tom Eagleton assumes a position of higher authority.”
In July 1972, with Democrats gathered in Miami Beach for their convention and Mr. Eagleton being talked about as a possible choice for the ticket, Greg Wierzynski, then Time’s Chicago bureau chief, surprised an Eagleton campaign aide by asking about the electroshock rumors. The aide later delivered a denial. So did the senator’s brother, Mark, a doctor in St. Louis.
Exhausted after a long underdog campaign battling the Democratic Party establishment, Mr. McGovern and his aides spent the early days of the convention fighting off a last-minute challenge to the winner-take-all rule that had given him all the California delegates. On July 13, 1972, with the nomination finally his, Mr. McGovern turned his attention to selecting his running mate.
Until then, Mr. McGovern had focused on only one person, Senator Edward M. Kennedy of Massachusetts. After a long courtship, Mr. Kennedy rejected the offer a final time, and Mr. McGovern then tried and failed to interest two of his closest friends in the Senate, Walter F. Mondale of Minnesota and Gaylord A. Nelson of Wisconsin, in the position. His aides focused on the mayor of Boston, Kevin H. White, and Mr. Eagleton. They immediately realized that they had little information about either one.
Gordon Weil, Mr. McGovern’s Senate executive assistant, volunteered to check out both men. Mr. Weil had only an hour or so to inquire about a strong rumor that a journalist had passed on to a McGovern aide concerning Mr. Eagleton’s alcoholism or mental illness.
Mr. Weil’s quick check turned up rumors that Mr. Eagleton drank, but not seriously, and no evidence of mental health problems. Mr. McGovern dismissed the reports on Mr. Eagleton, and he instead put more stock in his Senate colleagues’ recommendations.
With a party-imposed deadline of that afternoon to pick his running mate, Mr. McGovern had to act quickly — and he did. He offered the nomination to a man with whom his longest meaningful conversation had lasted for 20 minutes, in the Senate steam room.
“I’m flattered, and I will do whatever I can,” Mr. Eagleton told Mr. McGovern in their decisive 67-second conversation, “and I hope I don’t let you down.”
Mr. McGovern then handed the phone to Mr. Mankiewicz, who asked Mr. Eagleton some questions but never explicitly raised the issue of his health. Mr. Eagleton, convinced that his mental health issues were behind him, later said he “took a calculated risk” in concealing his health information.
During a celebration that went on well into the next morning, Mr. Weil ran into Douglas J. Bennet, Mr. Eagleton’s chief of staff, and asked him about the drinking and mental health rumors. Mr. Bennet denied the drinking problem but did describe his boss’s hospitalizations and his electroshock therapy.
Mr. Weil said he “went straight upstairs after my conversation with Bennet, walked into a very crowded, noisy party and interrupted whatever discussion Gary Hart and Frank Mankiewicz were having” to tell them. They, in turn, went to Mr. McGovern, who said he assumed that the reports were the usual “kind of rumors that floated around.”
Roberta Weil, Mr. Weil’s wife, said her husband returned to their hotel room and told her that Mr. Eagleton had been treated for depression.
“I said, ‘That is not that bad,’ ” Mrs. Weil said. “And he said: ‘Yeah, but he has had shock treatment. It is all over.’ ”
By that time, Clark Hoyt, a reporter for The Miami Herald who would later become the public editor of The New York Times, was in St. Louis doing research for an article about Mr. Eagleton and was puzzled by the gaps when Mr. Eagleton dropped out of the news.
Mr. Hoyt’s interest shot up when his editors passed on a tip from a man who, identifying himself only as a McGovern supporter, called The Detroit Free-Press, part of the same chain as The Herald, on July 17, four days after Mr. Eagleton’s nomination. The caller had given the newspaper the name of a doctor knowledgeable about Mr. Eagleton’s case. When Mr. Hoyt went to the doctor’s home, she slammed the door in his face, and he knew the tip was correct.
On July 23, Mr. Hoyt and a colleague, Robert Boyd, flew to South Dakota to confront Mr. Mankiewicz. He told them their evidence was circumstantial and urged them to wait on the story, never letting on that he, too, had learned about Mr. Eagleton’s depression. But he promised them an interview with Mr. Eagleton.
Two days later, Mr. Eagleton and his wife, Barbara, also arrived in South Dakota. At breakfast with Mr. McGovern and his wife, Eleanor, Mr. Eagleton gave Mr. McGovern a full account of his illness for the first time, and they then held an impromptu news conference, depriving the journalists of their scoop.
Mr. McGovern and his principal aides still did not realize that Mr. Eagleton’s health would be a major issue. But on July 27, with criticism mounting over his selection, Mr. McGovern began consulting psychiatric experts.
One was Dr. Karl A. Menninger, who was blunt.
Mr. McGovern asked what the psychiatrist would do if he were in the politician’s shoes. Dr. Menninger’s reply: “You have to ask him to step down.”
While top aides and an increasing number of Democrats were urging Mr. McGovern to drop Mr. Eagleton, Mr. McGovern ordered his press secretary, Richard Dougherty, to issue a statement that he was “1,000 percent” behind Mr. Eagleton’s staying on the ticket — a phrase that would forever be associated with both men.
As the pressure mounted, Mr. McGovern vacillated, initially using others to send signals to Mr. Eagleton to carry out the pledge he had made when he said he would resign if his presence on the ticket embarrassed Mr. McGovern. On July 30, they met again, this time in Washington.
Mr. Eagleton resigned the next day, Aug. 1, after Mr. McGovern agreed that he would say the reason was not Mr. Eagleton’s mental health, but the public debate over Mr. Eagleton’s past mental health, which was diverting attention from important issues.
In his unpublished autobiography, Mr. Eagleton wrote that “electroshock was the political killer.”
But, for a presidential campaign, the real killer might be something else: the unknown.

Michael D. Shear contributed reporting.