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Sunday, 28 June 2015

The Psychological Misuse of Solitude with Children in Society- A NEW OPINION PIECE BY DAVE TRAXSON - June 2015

SOLITUDE


 " Children's seeking of emotional warmth is the very 'driver' that pushes their foot down on the 'accelerator pedal' of their 'car of life' and which they undoubtedly 'steer' towards hopefully trusted others."
 Dave Traxson, 2015.

If the function of children's sometimes challenging behaviour is to seek emotional warmth as I and many other child mental health professionals now believe and not just attention seeking, then why as do we as a society and particularly schools often give them the very opposite response to what they are striving to find?

"We know professionally and personally the pivotal importance of meaningful attachments and how they give children the security to explore a very challenging world."

COMMON PARENTAL OR SOCIETAL RESPONSES:




- "Sit on the naughty step." (ALONE)
- "Sit at the back of the class." (ALONE)
- "Go into the corridor."(ALONE)
- "Go to isolation." Now regularly used in schools (where you will sit in a cold sterile room they sit ALONE possibly for whole days)
- AND ultimately solitary confinement.( used with juveniles in the U.S. to 'protect' 16 year olds to 'protect' them in a Safeguarding sense from predatory inmates.
+ ALSO now all too frequently biochemical solitude with psychotropic drugs.

THE REAL DANGER IS THE PATHOLOGISATION OF SOLITUDE
using solitude as a punishment which then conditions young people in later life to not perceive or realise the therapeutic benefits of solitude achieved for thousands of years by SOLITUDE using 'retreats' and meditation etc. etc.

We should not traumatise a child with punitive isolation or aversive solitude  as each time they consider it or experience it in the future they may be retraumatised.

What should we be doing instead?

- Building any form of human to human therapeutic support / relationship.
- 'Human Bridge' relationships to help them cross their current river of stress.
- Starting with 'Special Minutes' with a carer, teaching assistant or 'behaviour buddy.'
- Tell them you 'love them' but not certain behaviours + consequences.
- 1:1 coaching or mentoring with an adult or peer.
- 'Incident Debriefs' including feelings for others.
- Therapeutic mentoring with someone they attach to.
- "Quality Time' with a trusted adult.
- A walk in the countryside with a trusted adult or peer tutor.
- Forest School strategies in a safe environment with a skilled leader.
- Adventure Therapy with a skilled leader.
- Counselling within school.
- External 1:1 therapeutic support.

POINT OF CLARIFICATION - 'Time Out' in Behavioural Theory is the removal of rewards for a short period of time and NOT a physical isolation of a child in a solitary space.

This is clearly a revolutionary reverse of existing practice in schools and society at large.

"Emotion is often what we all rely upon to carry us across the unfathomable voids in our intelligence," Bridget Wright.

Thursday, 25 June 2015

How Parents Can Protect Their Kids From too Many Pills Beware of pill pushing by drug companies and doctors.Post published by Allen J Frances M.D.and Child Psychologist Dave Traxson in Psychology Today

We are turning our kids into pill poppers. The rate of ADHD has tripled in just 20 years - it is now diagnosed in 11 percent of all children aged four to 17 and is medicated in six percent of them. And the percentages get really crazy for teenage boys- 20 pecent are diagnosed and 10 percent are medicated.
There is also compelling evidence that most of this "ADHD" comes from careless diagnosis. How else to explain that a child's date of birth is the best predictor of whether he gets the label- the youngest kid in the class is almost twice as likely as the oldest to be diagnosed with ADHD. Misplaced diagnostic exuberance has turned age-appropriate immaturity into a psychiatric disease and treats it with a pill, rather than just letting the kid grow up.
The drug companies are delighted. Their annual revenue from ADHD drugs has exploded- it is now 50 times greater than 20 years ago, up to almost $10 billion a year. Wouldn't most of this money be better spent not on pills but rather to reduce class sizes and provide more gym periods so that fidgety kids could blow off steam?
It gets worse. Prescribed stimulants are now a favorite drug of abuse in colleges and high schools. Visits to emergency rooms because of overdoses have quadrupled in the last few years as ADHD pills provide easy access to legal speed.
And it gets scary ridiculous- 10,000 toddlers under age three are receiving ADHD drugs. How can this possibly make any sense?
The kiddie pill pushing is not restricted to ADHD. Having saturated the adult market for antidepressants, the drug companies began recruiting kids. Children are ideal long term customers because they start early and may stay on pills for life. An amazing four percent of teenagers are already on antidepressants despite the fact that these meds are less effective and more risky in this age group.
Antipsychotics round out the marketing nightmare. They are prescribed loosely and without clear indication for all sorts of childhood behavioral problems- even though they can turn kids into zombies, promote massive obesity, and raise the risk of diabetes and heart disease. Some kids are taking a whole cocktail combination of different pills with additive side effects and risks.
The drug companies successfully penetrated and then saturated the kiddie market by employing aggressive marketing to doctors and a massive direct advertising campaign to consumers (note that this shameful practice is permitted only in the US and New Zealand). They have sold the misleading message that psychiatric problems were under diagnosed in kids, easy to diagnose, caused by a chemical imbalance, and easily treated with a pill.
The marketing was mostly aimed at primary care doctors who now do the bulk of prescribing of psychiatric medicines. They usually write quick and unnecessary scrip after a very brief visit, seeing the child on his worst day. Kids change a lot from month to month without intervention and are the toughest patients to diagnose. Medication should be a last resort used only for the clearest, most impairing, and most persistent disorders. Instead the meds are often prescribed carelessly- almost like candy.
The pill pushing, disease mongering, fear inducing advertising has been aimed at parents, teachers, and the kids. It is everywhere on TV, the internet, and print and usually ends with "Ask your doctor!'' If you do, he is primed by drug salesmen to write a scrip or give you a free sample.
This is great for profits, terrible for kids. The long term benefits of inappropriately prescribed meds are questionable, the long term risks real. We are in effect doing an uncontrolled experiment bathing immature brains with powerful chemicals- without knowing what will be their ultimate impact.
Because parents are the best protection against this glut of kiddie medicating, I have asked Dave Traxson to offer his advice. Dave is a practising Educational Psychologist, a member of the Division of Educational Psychology Committee of the British Psychological Society, and a tireless campaigner against the over-prescription of psychotropic drugs for school aged children. Here are his tips for parent to safeguard their children from excessive diagnosis and medication treatment:

1) If the ADHD behavior is not severe and does not occur in all settings, then medication may well be inappropriate. Try ‘watchful waiting’ instead- i.e. see if improvements occur naturally or with changes in environment, exercise, expectations, diet, schedules, routines, and parenting. Counselling and relaxation training can really help and should be tried before medication.
2) Increasing physical activity can help fidgety kids. Enroll them in a teamsport, swimming, yoga, martial arts, dance or tumbling - anything to let the kid blow off steam and acquire discipline.
3) Realize that there is a wide range of normal when it comes to activity and focus. Not every difference is a sign of disease.
4) Kids also differ in the pace of their development. Immaturity is not a disease.
5) Many drug advisory bodies around the world say avoid medication if your child is under the age of five.
6) Children on psychotropic pills for longer than two years should have a ‘drug holiday' to see if they still need them.
7) If you are worried about the cumulative toxicity from a ’drug cocktail’ ask the advice of both your pharmacist and your physician. The more opinions the better.
8) If you or your child’s school have noticed adverse side effects, consult your physician and also inform yourself by internet search (e.g. enter ‘Factsheet – Ritalin side effects’). The factsheet gets you started and also provides good additional references.
9) If your child has high levels of anxiety, psycho-stimulants can raise agitation levels.
10) Do you regularly worry about the wisdom of your action to co-operate with your child’s medication for behavioral issues - then a good ‘rule of thumb’ is to discuss the situation with a range of people whose opinion you trust and then reflect on the courses of action available.
11) When your school is pressing for your child to be medicated, first, don’t be railroaded. They are worried most about quieting the class; you need to worry most about the welfare of your child.
12) When you make a well informed decision to withdraw your child from a medication due to concerns about side effects etc. always do it under medical supervision and based on information provided by reliable sources. Medicine should always be started carefully, but should also always be withdrawn carefully.
Thanks Dave for the great advice.
Parents need to know that psychiatric drugs are being way over-prescribed for kids and that common sense changes in life style and parenting are much better than a headlong rush to pills. There is, for example, no evidence that pills improve long term academic achievement and every reason to fear long term complications.
This is not to say pills are never needed. They can be helpful, sometimes essential, for clear cut and severe cases when all else has failed- as a last resort, not a careless panacea.
Nelson Mandela said: “There can be no keener revelation of a society's soul than the way in which it treats its children.”
We should be treating our kids with fewer drug company pushed pills and with moreloveunderstanding, and exercise.

Wednesday, 24 June 2015

OFFICIAL STATEMENT of The Collective Initiative for the Clinic of the Subject STOP DSM: - Courtesy of Patrick Landeman, Child Psychiatrist, Paris




OFFICIAL STATEMENT of  The Collective Initiative for the Clinic of the Subject STOP DSM:

On the occasion of the publication of the French version of the DSM 5 (fifth edition of the Diagnostic and Statistical Manual of Mental Disorders), we wish to reaffirm our radical opposition to the foundations and use of the Manual. For more than thirty years, DSM has dominated the world’s psychiatric community. Originally a statistical tool intended to serve epidemiological and pharmacological research, it progressively invaded the entire field of psychiatry and especially its teaching to the different mental health actors, as well as its clinical practice. The DSM has failed in its effort to renew and modernize the diagnostic procedure and its reliability: the diagnostic categories listed in it are neither reliable nor valid, as the generalization of comorbid disorders clearly shows. Moreover, their usefulness for scientific research is equally dubious. The DSM has helped destroy the foundations of traditional clinical psychiatry, in the name of a hope for a soon-to-come discovery of biological markers, a hope that has failed to materialize. In supporting this belief, it has created a fertile ground for the worst kind of scientific reductionism, favoring the biological and medical model over the social environment and psychic reality.  Its approach, based on the systematic behaviorist exploitation of mental disorders, has blurred the lines between the normal and the pathological, giving rise to false epidemics and chimeras, encouraging the over-pathologizing of emotions and behavior, including the extremes that are part of human life, as well over-diagnosis, especially concerning children. Separated from the context in which they manifest, mental disorders have become the priority targets of medication, leading to over-prescription by lowering the inclusion thresholds. The DSM, which lacks any kind of solid scientific basis, has nevertheless become the reference tool for the entire healthcare economy and the assessment methods used by healthcare authorities. It has encouraged the development of a uniform way of thinking and a kind of newspeak, destroying the conditions of a honest scientific debate in the field of mental health; because the numerous conflicts of interests in its history, it has also created a severe crisis of trust, of legitimacy and reliability within the world’s psychiatric community. For all these clinical, ethical, scientific and public health reasons, we call for a rejection of the DSM as a reference. Instead, we encourage clinicians to refer to the CFTMEA (The French Classification of Child and Adolescent Mental Disorders), as well as the future CFTMA (French Classification of Adult Mental Disorders), which will be issued in late 2015, and open up a wide public debate on the questions surrounding these classifications.

Saturday, 13 June 2015

75% of addicts to heroin start on prescribed opiates NOT street drugs - The Medical Model Discovers Heroin Addiction By JILL LITTRELL, PH.D. - Courtesy of the Mad in America Website



75% of addicts to heroin start on prescribed opiates NOT street drugs
The Medical Model Discovers Heroin Addiction


Heroin Epidemic
The United States is experiencing an epidemic of heroin addiction and a sharp rise in opiate over-dose death.  Contrary to addicts being introduced to opiate addiction through street heroin, 75% of new addicts became addicted through prescription opiates.  When the OxyContin becomes too expensive ($80/pill), people switch to the cheaper street heroin ($5-10/hit).  Nora Volkow of NIDA, Tom Frieden of the CDC, and Michael Botticelli of the President’s Office of Drug Control Policy have advocated the expansion of methadone programs and buprenorphine treatment to respond to the epidemic.  SAMSHA, the federal agency which regulates methadone maintenance programs, suggests that we call these interventions “Medication Assisted Treatment” (MAT) rather than opiate substitution programs so as not to stigmatize people.
SAMSHA’s New Rules
Methadone programs have been around since the mid-1950s in New York State.  Under the Narcotic Treatment Act of 1974, methadone maintenance clinics became legal in the United States, although states vary in state regulations.  What is new is that SAMSHA has effectively rewritten the rules on how methadone maintenance clinics are run.  Whereas the law of 1974 limited methadone to those who had been addicted for a year, the SAMSHA (2012, Tip 43) guidelines allow for those who are not physically dependent on opiates to receive methadone.  While initially the goal was to wean patients off, SAMSHA (2012) advises directors of clinics when a patient requests a dosage reduction that they should “educate” the patients on the importance of staying on their Medication Assisted Treatment.  There is no duration limit on MAT.  Moreover, there is no longer a limit on dosage.  Given that stress is a reliable precipitant to relapse in drug abusers, SAMSHA discusses increasing dosage during stressful times (see page 77, in SAMSHA’s Tip 43, Medication-Assisted Treatment).
Buprenoprhine is a Partial Agonist?
The newcomer on the scene for treatment of opiate addiction is buprenorphine.  The drug company characterizes buprenorphine as a “partial agonist” at a mu-receptor and an antagonist at a kappa receptor.  In the body, there are 3 types of receptors for opiates: mu receptors, kappa receptors, and delta receptors.  Mu receptors produce the pleasurable effects and the compulsion to use opiates.  Kappa receptors counter the mu-effects.  Upon hearing that buprenorphine is a partial agonist, I wondered “how?”  I’m always amazed at the amount of information available to biologists.  For almost all receptors, someone knows the shape of the receptor, the amino acids in the receptor that a ligand (neurotransmitter or drug) interacts with, the proteins in the body of the neuron that are influenced when the ligand binds, and the downstream effects on the ligand/receptor binding.  So what is making buprenorphine different from methadone, morphine, and OxyContin?  It did not take long to find out.
Turns out that buprenorphine not only interacts with the mu-receptor but also another protein called a “Regulator of G-protein Signaling” which turns off activity at the mu-receptor.  The problem is that tissues and brain areas vary in terms of whether the neuron contains the “Regulator of G-protein Signaling.”  As such, buprenorphine will only demonstrate an effect on some outcome measures but not on others.  Thus it will be a “partial agonist” on some measures but not on others. The case has been made that buprenorphine is less likely to produce an overdose via respiratory depression than other opiates.  However, all bets are off if buprenorphine is used with another drug.  Many people on buprenorphine die when they combine “bup” with alcohol.
Opiate Agonists Are Very Dangerous Drugs
Methadone and buprenorphine compete for the same enzymes as many antibiotics, antidepressants, and antipsychotics for their metabolism (removal from the body). As such the effective dose of methadone is much higher than when people are not on these other medications.  In addition, methadone can result in cardiac arrhythmias because of a change in electrical conduction in the heart (QTc prolongation), although buprenorphine is supposed to be a safe on this outcome.  However, many antidepressants and antipsychotics can also increase QTc prolongation.  With regard to danger associated with cardiac arrhythmias, the probability of an adverse event increments with each additional drug.  Studies of opiate overdoses find that antidepressants, benzodiazepines, and antipsychotic drugs are associated with lethal overdoses.  The SAMSHA guidelines recommend screening for co-occurring disorders.  The Tip 43 guidelines do mention those medications which compete for the same enzymes as methadone but don’t discuss risks associated with multiple medications that increase risk of cardiac arrhythmias.
Dilemma of Other Addictive Drugs in Methadone Maintenance
It has been known for a long time that many heroin addicts do not limit their drug consumption to heroin.  When people are in methadone maintenance, they often don’t quit using cocaine, marijuana, or alcohol.  (In terms of drug interactions, there is some suggestion in the literature that concurrent use of marijuana actually decreases the opiate dosage required to curtail cravings.)  While SAMSHA does suggest that Opiate Treatment Programs screen for other drugs, SAMSHA is unclear about what should happen if the urine tests positive.  (According to SAMSHA instructions, we are to use the language ‘tests positive’ rather than ‘dirty urines.’)  SAMSHA is clear that patients should not be dis-enrolled from the program.  Sanctions can include limiting take-home dosages of methadone.  They also suggest switching the patient to naloxone.
Naloxone, Seriously?
When I read the suggestion to switch to Naloxone, I was really confused.  SAMSHA seems to want to avoid an addict’s use of street heroin at all costs.  Naloxone will displace all opiates (buprenorphine, heroin, morphine, methadone) from the mu-receptor but won’t induce any signaling in the neuron.  In fact, naloxone will displace natural opiates (endorphins) from the receptor as well such that even any placebo effect on pain suppression is lost.  In terms of listed side effects, naloxone causes anxiety, a decrease in pain tolerance, joint and muscle pain, and induces immediate withdrawal signs if taken by someone who is dependent on opiates.  There’s a history of poor compliance among addicts with naloxone.  SAMSHA knows this.  Why would they introduce a drug option that could undermine all their efforts to set up a self-sustaining high compliance program?
To be fair here, naloxone does decrease relapses in alcoholics who are trying to maintain sobriety.  So we can call it “evidence-based treatment.”  Drug addicts are not going to crave their drug(s) of choice when taking naloxone.  The problem is that with naloxone patients aren’t going to want anything else either, such as food, going to work, etc.  (Yes, naloxone has been considered as a potential treatment for obesity.)  Of course the drug companies don’t include measures such as lethargy and apathy when they publish the drug trials, but the impact is clear in the animal literature.
So we’re back to the real problem of what to do about methadone and “bup” patients that use other drugs.  Especially when used in combination with alcohol, methadone and buprenorphine can induce overdose.  Another complicating factor with the SAMSHA’s goal of increasing the numbers on MAT is the paucity of knowledgeable clinicians who approve of MAT in America.  About 45% of the non-physician clinicians in substance abuse treatment in this country are persons in recovery.  They generally are strong adherents to Twelve Step Principles.  The goal for Twelve Steppers is freedom from all mood and mind altering drugs.  They don’t generally approve of MAT.  Historically, physicians in Addiction Medicine often are recovering people as well.  So where are all these substance abuse professionals to staff methadone maintenance clinics going to come from?  The danger in by-passing the current work force and developing a new work-force is that it will take some time for the new recruits to develop expertise in detecting when a client is abusing alcohol and knowing the population.
Methadone for Pain Versus Methadone for Addiction
Ironically, while the government’s response to the opiate epidemic is to increase MAT with more liberal dosing practices, they are also more closely monitoring pain clinic doctors.  At a recent International Opioid Conference I attended in Boston, most of the presenters were doctors working in hospice or pain clinics.  The lawyers talked about pain-management doctors being entrapped by clients working for the DEA and then facing criminal charges and fines.  (The director of prestigious Stanford pain-management clinic was recently visited by the DEA.)  At the conference, the director of the Stanford clinic talked about his clinic’s response to the DEA scrutiny.  They have developed very rigorous screening batteries to detect those pain clinic patients most likely to become addicts; they have developed elaborate informed consent procedures entailing a 20 minute video presentation for all prospective patients; they implemented drug screening procedures with point of care methods followed by laboratory screening involving very expensive assays.  The bottom line is that costs have increased dramatically, further contributing to the cost of medical care, which presently is already the most expensive system in the world.  This all seemed ironic to me, because if given a pain patient is indeed an addict, then the protocol is to refer to methadone or buprenorphine treatment for addiction.  Once the patient becomes a methadone or buprenorphine patient, doctors are to “educate” the patient about the dangers of ever trying to become abstinent.  Moreover, the rationale for methadone is that the dosage is to be sufficiently high so that tolerance develops such that heroin, at any dose, will fail to produce an effect (opiate blockade).
Given that buprenorphine is now in a clinical trial to treat medication resistant depression, we’re probably going to have a lot of people taking opiates.  Then we’ll have many dilemmas over what to do if the patient escalates the “bup” dose without permission or uses an unapproved medication.  Physician may wonder whether they need parole officer training.  But, whatever the outcome for the patient, more money will be spent on drugs, monitoring, and auxiliary personnel.  Thus, the U.S. is embarking on another big experiment with the drug companies and another big increase in the cost of medical care in this country.

* * * * *

References:
Leece, P., Cavacuiti, C., Macdonald, e. M., Gomes, T., Kahan, M., Srivastava, A., Steele, L., Luo, H., Mamdani, M. M., & Juurlink, D. N.  (2015).  Predictors of opioid-related death during methadone therapy.  Journal of Substance Abuse Treatment, in press.
McCance-Katz, E. F., Sullivan, L., Nallani, S.  (2010).  Drug interactions of clinical importance among the opioids, methadone and buprenorphine, and other frequently prescribed medications: a review.  American Journal of the Addictions, 19(1), 4-16.
Zedler, B., Xie, L., Wang, L., Joyce, A., Vick, C., Brigham, J., Kariburyo, F., Baser, O., Murrelle, L.  (2015).  Development of a risk index for serious prescription opioid-induced respiratory depression or overdose in Veterans’ Health Administration patients.  Pain Medicine, in press.
Zedler, B., Xie, L., Wang, L. Joyce, A., Vick, C., Kariburyo, F., Rajan, P., Baser, O., & Murrelle, L.  (2014).  Risk factors for serious prescription opioid-related toxicity or overdose among Veterans Health Administration patients.  Pain Medicine, 15, 1911-1929.

Thursday, 11 June 2015

Informed Consent for All Medication? It would greatly reduce 'overzealous prescribing,' in children.(Sir Simon Wellesley - President of the Royal College of Psychiatry) Courtesy of 'Saving Normal' website

Doctors prescribe way too many medicines for patients who don't really need them. A lot of the pressure comes from intense drug company marketing. Some comes from patients who aren't happy leaving the office without a pill. And doctors have too little time with each patient to explain non-pill solutions to problems. Wild prescribing is not new. For thousands of years, doctors have given patients useless (and often quite harmful) drugs and patients have taken them.
Modern medicine was meant to be different- it would be based on scientific evidence that could tease out real effect from placebo effect. Unfortunately, evidence-based medicine is only as good as the evidence it is based on. And in many instances our evidence is not very good because it comes from biased drug company studies.
This is particularly true for the "off label" prescription of medicines- use based not on the systematic study required for an FDA indication. Off-label prescribing is the wild west of medicine- any doctor can prescribe any drug for any problem.
Kim Witczak became involved as an ardent drug safety advocate after the death of her husband, Tim “Woody” Witczak, in 2003 as a result of a drug side effect that had not been disclosed to him. She has taken her personal experience and launched a national drug safety campaign through www.woodymatters.com(link is external).
"Doctors routinely give powerful drugs off-label to their patients, without strong scientific evidence proving the drugs will be safe or effective, and sometimes despite warnings that such prescribing could cause serious harm.
All the while, patients have no idea that the drug that’s being recommended to them does NOT have FDA approval for the particular condition. They just assume and trust their doctor.
Once a drug has been approved for sale for one purpose, physicians are free to prescribe it for any other purpose. They are not limited to official, FDA-approved indications. Off-label prescription use is very common. Up to one-fifth of all drugs are prescribed off-label and amongst psychiatric drugs, off-label use rises to 31 percent.
A recent study reveals that one third of children in foster care diagnosed with ADHDhave been treated off-label with an atypical antipsychotic medication. As a parent, would you consent to your child being prescribed an antipsychotic medication? The name alone should raise a red flag. And most atypical antipsychotics are NOT approved by the FDA for use by children.
Drugs are often used off-label, with nearly 80 percent of off-label prescriptions lacking “strong scientific evidence,” which means we do not know if their risks outweigh their benefits. Ultimately, its buyer beware.
It’s one thing if you have a rare disease and are desperate to try something that might offer hope. Its another thing if you went into your doctor because you’re having troublesleeping due to stress of a new job. Again, it’s a fine (yet potentially deadly) line patients are walking. We need to be told if the FDA has approved the product or if its being used off-label based on an article that appeared in some journal. Otherwise, we are just guinea pigs.
The FDA may soon make matters worse. It is considering new policies on distributing reprints of medical and scientific journal publications. In its new draft guidance entitled, “Distributing Scientific and Medical Publications on Unapproved New Uses–Recommended Practices." The drug industry will be allowed to distribute journal articles and clinical practice guidelines (CPGs) regarding off-label use of their products to the medical community. This is basically a loophole for the pharmaceutical companies to promote their products off-label.
In recent years, over $13 billion in fines have been paid by major drug companies to settle lawsuits against them for their fraudulent marketing practices, including off-label promotion of their drugs/devices not approved by the FDA.
It’s a fine line between the drug company informing doctors about a new potential benefit in an off-label indication and the illegal promotion of product for increasing sales.
In my opinion, this new guidance sends mixed messages. On the one hand, the FDA states that it “recognizes the value to health care professionals of truthful and non-misleading scientific or medical publications on unapproved new uses.”
But as everyone knows, medical journal articles are often biased because the authors or ghostwriters are paid by the company whose product is being studied. This should be very concerning to the doctors and patients alike.
Now more than ever, Informed consent is needed. Its a great opportunity for patients and/or their caregivers to have an intentional conversation with their doctor about their medications. Armed with ALL the information, including if the drug is being used off-label, patients are then able to make an educated and informed decision about their drugs.
Sure seems like we could all get behind this concept and demand informed consent for drugs being given off-label. It just makes common sense for everyone, patients and doctors, alike."
Thanks, Kim. This is a great suggestion that I would extend even further. Why not require doctors to get written informed consent from their patients for all use of medication. This would make for much better informed consumers and reduce careless over prescription of medication.
Off label prescribing is much better for drug company profits than for patient welfare. Using medicines for unapproved uses on balance probably does much more harm than good. The doctor has no reason to think the medicine will work, every reason to know it will have side effects. Prescribing for indicated uses is over done, prescribing for off label use is rarely justified.
It would be a great mistake for the FDA to loosen its already weak control over drug company salesmanship. Drug companies have in past sustained large fines for illegal off label marketing because the rewards are so great. FDA would be opening the gates to even more unscrupulous drug marketing. We need to restrict misleading marketing not promote it.
The argument that drug sales people are educating physicians doesn't pass the laughtest. Their compensation is based on how much product they can move, not on appropriateness of prescription. And no study funded by a drug company can ever be trusted.

Monday, 8 June 2015

The Survival of Psychiatric Diagnosis - Prof. David Pilgrim -Professor of Mental Health Policy, University of Central Lancashire UK and Consultant Clinical Psychologist Lancashire Care NHS Trust.

The Survival of Psychiatric Diagnosis - Prof. David Pilgrim

At the inaugural Centre for Applied Psychology lecture series at the University of Canberra today, David Pilgram presented a valuable overview of the history of psychiatric diagnosis, highlighting the anti-psychiatric criticisms of the dominant addiction to biomedical model.

Personally, I've always been kind of puzzled by psychiatric and clinical psychological committment to categorisation. Perhaps this was revealed by the audience questions which seemed to struggle with Pilgrim's suggestion that we might try approaching clinical psychological work without such heavy reliance on the social constructs of psychiatric diagnosis.

With our recent talk in the social psychology unit about schemas, I could more readily see how schemas apply to, and explain both the convenience and potential consequences of psychiatric categorisation. Diagnosis seems to offer the illusion of cognitive control over the behaviour of others. Kingsley Tonkin (one of the new clinical psych. staff at UC) made the point, for example, that diagnosis was being used as a way of acting on fear and uncertainty about indigenous people's potential future actions in Queensland.

It is easy to talk about this from a philosophical view, but I thought it was great that in the audience were individuals with so-called psychiatric issues who responded to Pilgrim's provocative views. This gave the session an extra, challenging, realism.

As an undergraduate psychology student, I remember writing an article for the university newspaper about the rapid expansion in the diagnostic categories for mental illness which have occurred in the last 100 or so years. In comparison, our vocabulary and understanding about psychological well-being had progressed little. I suggested that it might be time invest more energy in exploring and mapping out the realms of psychological well-being such as, for example, the work Ken Wilber has been doing.

Interestingly, we don't tend to diagnose and categorise well-being, but do tend to with distress. We tend to allow for diverse forms of psychological well-being without imposing artificial labels but when threatened by bouts of so-called madness, Western psychological and psychiatric culture seems to default to labeling in order to achieve a sense of control and protection.

This is not to say Western psychology hasn't achieved much and many parts of it have clearly helped many people towards improved psychological well-being and effectiveness. But many seem to forget that psychology is a young science, with much of its psychological practice heavily embedded in political and cultural agendas. So, I found it refreshing to hear David Pilgrim's warning about the potentially blinkering, limiting, and even inhumane effects of our psychiatric and clinical psychological industries and professions currently being dominated in their weltanschauung by a culturally constructed set of debatable symptom categories.

-------
Professor David Pilgrim
Professor of Mental Health Policy, University of Central Lancashire UK and Consultant Clinical Psychologist Lancashire Care NHS Trust.

SHOCK HORROR - RITALIN FOR CHILDREN IS BIOCHEMICALLY ANALAGOUS TO COCAINE FOR ADULTS - American street name ='Kiddy Coke' - Now we can see why! - Courtesy of the Journal of the American Medical Association




http://jama.jamanetwork.com/article.aspx?articleid=194125#.VXWIvktOJqY.facebook

Washington—Advanced imaging research has answered a 40-year-old question about methylphenidate (Ritalin), which is taken daily by 4 million to 6 million children in the United States: how does it work? The answer may unsettle many parents, because the drug acts much like cocaine, albeit cocaine dripped through molasses (J Neurosci. 2001;21:RC121).

Taken orally in pill form, methylphenidate rarely produces a high and has not been reported to be addictive. However, injected as a liquid it sends a jolt that "addicts like very much," said Nora Volkow, MD, psychiatrist and imaging expert at Brookhaven National Laboratory, Upton, NY. "They say it's like cocaine."