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The BBC—new report challenges psychiatry’s billing bible, the DSM—”Mental Health: Are we all sick now?”

admin — Wed, 28 Jul 2010 17:58:14 +0000

BBC News
By Philippa Roxby
July 28, 2010

Diagnosing psychiatric illness has always been controversial, mental health experts say. Now some are worried that a new draft of the diagnostic ‘bible’ for mental health medicine could result in almost everyone being diagnosed with a mental condition.

The diagnostic ‘bible’ in question is the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association.

The US manual is used worldwide as a basis for diagnosis, research and medical education.

Its forthcoming fifth edition – known in the profession as as DSM-5 – is set to contain a range of new diagnoses, including conditions such as “mixed anxiety depression, psychosis risk syndrome and temper dysregulation disorder”, as well as the more mundane binge eating.

The danger, say experts writing in a special issue of the Journal of Mental Health, is that there has not been enough research to back up these changes.

Even the smallest shift in how to define something like depression could have huge implications.

Self-fulfilling

Dr Felicity Callard, senior research fellow at the Institute of Psychiatry, King’s College London, says it is crucial to understand what happens when people are over-diagnosed.

“There are very big potential implications on how people, particularly adolescents, respond to being told they have a mental illness. It’s likely there will be harmful consequences,” she said.

She cites the “at risk psychosis syndrome” diagnosis as an example of a label which is given to young people who ‘might’ have psychosis – characterised by abrupt changes in personality. It is a diagnosis of something which could result in a disorder, but only potentially. That can have complicated effects, she says.

“Imagine a young person being told that they are “at risk” of developing a mental illness. How would that affect that individual’s behaviour? Could it lead to increased stigma or even discrimination? And how might it affect the parents and family of that person too?”

Jerome Wakefield of New York University’s Department of Psychiatry writes: “One of the most frightening scenarios is the potential for medicating people – particularly children – who haven’t yet shown any signs of illness in a bid to ‘treat’ them.”

These concerns are shared by a number of clinical experts in the Journal of Mental Health.

Read entire article here: http://www.bbc.co.uk/news/health-10787342

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British psychiatrists warn APA’s new “mental disorders” will turn large numbers of normal people into psychiatric patients

admin — Tue, 27 Jul 2010 20:04:27 +0000

The Press Association
July 27, 2010

A further step in the Americanisation of mental healthcare threatens to turn large numbers of “normal” people into psychiatric patients, British experts warned.

Sweeping changes to a diagnostic “bible” that influences practitioners around the world could make it far easier to be labelled with a psychological problem, it is claimed.

One suggestion of the US authors is a new diagnosis of “psychosis risk syndrome” which singles out people thought to be at risk of developing a psychotic illness such as schizophrenia.

Individuals falling into this category might experience occasional mood changes, feelings of distress, anxiety or paranoia, or fleeting episodes of hearing voices.

In the past they might have been considered difficult or eccentric. Under the new proposals they could receive a diagnosis that affects their future lives and job prospects. Yet they may never develop “full blown” psychosis.

Other diagnoses under consideration include “mixed anxiety depression”, “binge eating, and “temper dysregulation disorder with dysphoria”. In addition, the bar could be lowered on some common existing disorders, such as depression, so that more people are considered to have symptoms that warrant a diagnosis.

Professor Til Wykes, from the Institute of Psychiatry at King’s College London, spoke of a trend that was “leaking into normality”. She said: “It shrinks the pool of normality to a puddle, and there are going to be fewer people who won’t end up having a diagnosis of mental illness.”

Prof Wykes edits the Journal of Mental Health which carries a “health warning” about the proposals in its latest issue. The changes have been put forward for discussion by a powerful group of US experts working on the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Read entire article here: http://www.google.com/hostednews/ukpress/article/ALeqM5gHnD0Z3xJQt8sJ8PEIComLTtomvg

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Incredibly, FDA urged Florida not to bar foster kids from drug trials, arguing “benefits” can outweigh risks.

admin — Tue, 27 Jul 2010 03:30:16 +0000

HeraldTribune.com

By Tom Lyons

Apparently the U.S. Food and Drug Administration had at least heard about the suicide of Gabriel Myers.

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The real reason: He was 7 years old.

Whatever else might have helped lead such a young child toward ending his life, one detail was impossible to ignore: The boy was being treated with three different psychotropic medications.

Medications of that sort make some people more depressed or even suicidal, and their effects when combined are harder to predict, especially in children.

So DCF did a quick check on how many foster children were being given such drugs. Troubling facts emerged.

Not only was the percentage high, it was not really known. And, in more than a third of known cases, required approval permission documents were missing.

DCF Secretary George Sheldon quickly acknowledged the problem and started a study group to learn more and give advice. And a year later, the picture is at least more clear. Very few files lack required documentation now. And when I asked for the most current numbers, they were available, and somewhat lower. In the Sarasota-Manatee-DeSoto county region, 11 percent of foster children are given psychotropic meds. Statewide, it is 13 percent.

Some critics insist too many foster parents, lacking the skill or patience to work with troubled children who arrive as strangers, are still too quick to see medication as the way to curb problem behavior or just keep foster children quiet, no matter the side effects.

But whatever the truth of that, the study group recommended some good changes, and one made sense immediately, I thought: Ban the use of foster kids in drug trials.

Drugs helpful to some adults can react differently in children, who may suffer more extreme and unintended side effects. And so, clinical trials on children are needed, but it it is a scary field of study. The most alert and caring parents are key for monitoring the children during such trials, I would think.

So I was surprised at the FDA’s response when Sheldon wrote to ask how many Florida foster children were involved in drug studies as they bounce from foster family to foster family.

Jill Hartzler, an associate FDA commissioner, responded that the FDA — which oversees the studies to make sure children’s involvement is approved and understood by parents or guardians — didn’t have an exact number. Or even an estimate. The FDA, in fact, doesn’t have the slightest idea how many Florida foster kids are or have been involved in its drug studies.

But that wasn’t the weirdest part. Hartzler and the FDA also urged that Florida not bar foster kids from drug trials, arguing that benefits can outweigh risks.

I’m happy to say Sheldon is not taking that advice. But as he explains his reasoning more tactfully than does Richard Wexler of the National Coalition for Child Protection Reform, I’ll quote Wexler, who says the FDA’s position is absurd.

Myers’ death by hanging happened in a Florida foster home last year, but that wasn’t the main reason it triggered a major reaction at Florida’s Department of Children and Families.

Read entire article here: http://www.heraldtribune.com/article/20100725/COLUMNIST/7251032/2055/NEWS?p=1&tc=pg

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Government is daring to keep kids on drugs

admin — Tue, 27 Jul 2010 03:09:03 +0000