More Cutting Edge but With an Amazingly Dull Knife Research

As I did on my posts of November 30, 2011,  October 2, 2012,September 17, 2013, June 3, 2014, February 24, 2015, December 15, 2015, and September 13, 2016, it’s time once again to look over the highlights of the latest issue of one of my two favorite psychiatry journals, Duh! and No Sh*t, Sherlock. We'll take a look at the unsurprising findings published in the latest issue of the former. My comments are in bronze.

As I pointed out in those earlier posts, research dollars are very limited and therefore precious. Why waste good money trying to study new, cutting edge or controversial ideas that might turn out to be wrong, when we can study things that that are already known to be true but have yet to be "proven"? Such an approach increases the success rate of studies almost astronomically. And studies with positive results are far more likely to be published than those that come up negative.

Clinical Psychiatric News article, June, 2016.  Data from a longitudinal study reported at the World Congress on Osteoarthritis show that weight gain in young women is an independent predictor of future low back pain. Well, maybe their backs would do better if they carried around a sack of bricks slung over their shoulders 24 hours a day.

7/21/16. Apparently these researchers don't watch the evening news.Addiction To Prescription Opioids May Be Tied To Creation Of Market For Cheaper, Potent Heroin, Analysis Suggests. The Washington Post (7/20, Humphreys) “Wonkblog” reports that the relationship between restricting access to prescription opioids and increasing heroin use is more complicated than some critics of the Comprehensive Addiction and Recovery Act believe, according to a systemic analysis of the matter that was published in the New England Journal of Medicine. The analysis was led by the National Institute on Drug Abuse’s Wilson Compton who says that restricting access to prescription opioids does not automatically increase heroin use, but that having many people addicted to prescription opioids may be tied to the creation of a market for cheap, potent heroin that appeals to people addicted to prescription opioids, which may explain the increase in heroin use in recent years.

7/21/16.  And these researchers apparently don't get out much. Alcohol Intoxication Increases Aggression While Cannabis Use Reduces Such Feelings, Study Finds. The Washington Post (7/20) reports research published in the journal Psychopharmacology suggest “alcohol intoxication increased subjective aggression” while those who smoke marijuana “became less aggressive when they were high.” Researchers concluded that the “results in the present study support the hypothesis that acute alcohol intoxication increases feelings of aggression and that acute cannabis intoxication reduces feelings of aggression.” The findings are in line with other research.

7/25/16. People exposed to addictive substances found to have higher chance of getting addicted to them. Greater Pain Found to Increase Risk of Opioid Use Disorder.Researchers have long suspected that the level of pain experienced by a patient may increase his or her risk of developing an opioid use disorder. A study in AJP in Advance has for the first time taken a prospective look at this link, revealing a significant association between pain and prescription opioid use disorder at baseline and three years later. The researchers found that people with moderate or severe pain had a 41 percent higher risk of developing prescription opioid use disorders than those without, independent of demographics or other potential contributing factors. Males, younger adults (of either gender), and those with a family history of antisocial personality disorder were also found to be more likely to develop opioid use disorder.

8/2/16. Being sedentary bad for the heart? Who knew? Watching TV longer increases risk of fatal blood clot, study finds. The New York Times (8/1, Bakalar) reports a new study published in the journal Circulation by Japanese researchers analyzing “86,024 generally healthy people who filled out questionnaires with items about health and lifestyle, including time spent watching television,” found that more time watching television increases the risk for a fatal blood clot. Researchers estimated that, after adjusting for other factors, “watching for two and a half to five hours increased the risk for a fatal clot by 70 percent, and watching more than five hours increased the risk by 250 percent,” compared to watching for less than two and half hours each day.

 

8/2/16. Less serious disorders found to have better prognosis. Predictors of outcomes in outpatients with anorexia nervosa: Results from the ANTOP study. Psychiatry Research, 08/01/2016  Clinical Article. Wild B, et al. – Researchers explored the factors that may predict outcomes in outpatients with anorexia nervosa (AN). They concluded that better outcome was achieved in those who had a higher baseline BMI [Body Mass Index] and shorter illness duration.

8/24/16.  Traumatic brain injuries seen in many domestic assault survivors. The AP (8/23, Tanner) reports that, according to the Centers for Disease Control and Prevention, “about one-quarter of U.S. women and 14 percent of men have experienced severe physical assaults by a partner in their lifetime, including hitting, punching, being slammed against something hard or pushed down stairs.” Meanwhile, according to a research review published this year in the journal Family & Community Health, “head and neck injuries are among the most common, and data suggest that domestic assaults may cause traumatic brain injuries in at least 60 percent of survivors.” Being assaulted can lead to head trauma! OH NO!

9/6/16. Taking care of someone who can't tell you what's wrong should be a breeze! Relatives Who Care For Patients With Dementia Often Experience Frustration Due To Poor Communication, Study Suggests. The Washington Post (9/4, Bluth) reported relatives who care for patients with advanced dementia often experience difficulty because they can no longer communicate with their loved ones, according to a study published in the American Journal of Alzheimer’s Disease & Other Dementias. Researchers found that many family caretakers were often frustrated with their relatives with dementia because they could no longer communicate what they needed or when they were in pain.

9/16/16. But what about all those codgers I see running out on the streets? Many older US adults are physically inactive, CDC study finds. The CBS News (9/15, Welch) website reports, “More than a quarter of Americans age 50 and older do not move beyond basic everyday activities,” research indicates. TIME (9/15, Oaklander) reports that according to an “analysis of 2014 surveillance data, 28% of Americans ages 50 and over are inactive – meaning that 31 million adults are moving no more than necessary to perform the most basic functions of daily life.” HealthDay (9/15, Dotinga) reports that such inactivity increases the risk for “heart disease, diabetes, and cancer,” researchers from the CDC’s Physical Activity and Health Branch found. What’s more, “the older Americans get, the less exercise they get,” investigators found. “Thirty-five percent of people aged 75 and older were inactive, as were 27 percent of those between 65 and 74, and 25 percent of those aged 50 to 64,” the study revealed. 

12/13/16. Risk For Opioid Relapse May Be Lower After Voluntary Treatment Than After Compulsory Treatment, Small Study Indicates. Healio (12/12, Oldt) reports patients “with opioid dependence who were treated in compulsory drug detention centers were significantly more likely to relapse after release than those treated with methadone in voluntary drug treatment centers,” researchers found after conducting “a parallel, two-arm, prospective observational study of individuals with opioid dependence treated in Malaysia.” The findings of the study, which included 184 participants, were published online Dec. 7 in The Lancet Global Health. The author of an accompanying editorial observed that the study findings “provide solid evidence in support of an urgent need to expand availability of, and access to, evidence-based voluntary drug-dependence treatment approaches to all individuals affected by drug dependence.” Because motivation for treatment is irrelevant to its success.

12/12/16. Pain is associated with poorer grades, reduced emotional well-being, and attention problems in adolescents The Clinical Journal of Pain, 12/12/2016  Clinical Article  - Voerman JS, et al. – Findings imply that the association between pain and Dutch adolescents grades is intervened by reduced emotional well–being and attention problems. The association between pain and math grades is mediated by emotional problems. The outcomes recommend that an intervention targeted at the pain in adolescents could have a positive effect on their emotional well–being, attention, and school performance. What a shock!Being in pain has effects on your emotional and cognitive functioning.

2/21/16. Impact of somatic severity on long-term mortality in anorexia nervosa 
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity, 12/21/2016  Clinical Article, Stheneur C, et al. – The present study sought to survey whether time in somatic intensive care unit, justified by a patient’s somatic condition in the course of hospital care, has any association with patient outcome in terms of mortality in the long term. The findings suggest that the clinical seriousness of the somatic condition during hospitalisation for AN is a risk factor for excess mortality in the medium term. In the present study, 195 patients were hospitalised for AN between April 1996 and May 2002, 97 were re-assessed 9 years later on average. Researchers observed that out of 195 patients hospitalised for AN between April 1996 and May 2002, 29 had required transfer to intensive care. Findings revealed that mortality at 9 years was 20 times higher in the group having been transferred to intensive care, irrespective of the duration of follow-up.  You mean, the sickest patients had the worst prognosis? How can that be?

Impaired Social Functioning Appears To Be Most Common In Schizophrenia, Study Indicates.

Healio (1/4, Oldt) reports that among people “with schizophrenia spectrum disorders, major depressive disorder with psychosis and bipolar disorder with psychosis, impaired social functioning was most common in schizophrenia,” researchers found in a study including “individuals with schizophrenia spectrum disorders (n = 269), major depressive disorder with psychosis (n = 77), bipolar disorder with psychosis (n = 139), and a comparison group without psychotic disorders.” Participants were followed for 20 years. The findings were published online Dec. 16 in the American Journal of Psychiatry, a publication of the American Psychiatric Association. Have these people ever even been to a psychiatric ward?

1/11/17. And here we thought booze was a cure all: Using Alcohol To Deal With Unpleasant Memories May Worsen Certain Mental Health Conditions, Mouse Study Indicates. The New York Daily News (1/10, Jagannathan) reports that instead of easing the pain of “distressing memories,” alcohol may “actually make it more difficult to cope with distressing memories,” researchers found.  Medical Daily (1/10, Dovey) reports that using alcohol as a coping mechanism “to deal with unpleasant memories...doesn’t work, and may actually worsen certain mental health conditions, such as” post-traumatic stress disorder (PTSD), researchers found. Working with mice, investigators found that “alcohol consumption did not help to ease fearful emotional memories, and may have strengthened them.”

1/23/17. Because no one ever drinks to forget. Spousal Loss Found to Increase Risk of Alcohol Use Disorder.  Spousal loss due to divorce or death appears to be associated with an enduring risk of alcohol use disorder (AUD), but remarriage may help to reduce this risk, according to a study published today in AJP in Advance. “The pronounced elevation in AUD risk following divorce or widowhood, and the protective effect of both first marriage and remarriage against subsequent AUD, speaks to the profound impact of marriage on problematic alcohol use and the importance of clinical surveillance for AUD among divorced or widowed individuals,” lead author Kenneth Kendler, M.D., of Virginia Commonwealth University and colleagues wrote.  And on a related note: Getting A Divorce May Increase The Risk Of Developing An Alcohol Use Disorder For Both Genders, Study Indicates. Medscape (1/26, Anderson) reports, “Getting a divorce increases the risk of developing an alcohol use disorder (AUD) by more than sevenfold for women and almost sixfold for men,” researchers found after identifying and then following “942,366 individuals born in Sweden between 1960 and 1990 who were married and residing with their spouse in or after 1990 and who had no AUD prior to marriage.” The findings were published online Jan. 20 in the American Journal of Psychiatry, a publication of the American Psychiatric Association.

1/24/17. Stress and anxiety were always thought to be totally unrelated. Stress Of Managing Breast Cancer Care May Provoke Symptoms Of Anxiety In Partners, Caregivers, Study Suggests. HealthDay (1/23, Thompson) reports that research suggests “the stress of managing breast cancer care provokes symptoms of anxiety in more than 42 percent of partners and caregivers.” Investigators found that “this stress-induced anxiety can last years after their loved one’s illness.” Investigators came to these conclusions after surveying “289 partners of patients diagnosed with breast cancer at age 40 or younger.” The findings are scheduled to be presented at a meeting of the American Society for Clinical Oncology. 

This will certainly come as a surprise to no psychotherapist ever.  February 24, 2017.  A Lancet study reports that deprivation and neglect in early childhood can have a lasting psychological effect into adulthood. Using findings from a study that assessed children adopted from Romanian institutions into families in the United Kingdom, The Lancet reports that deprivation and neglect in early childhood can have a lasting psychological effect into adulthood.

A Little More on Conformity vs Resistance

Last week I talked a little about how easily we are influenced by our situations, and I wanted to say just a little more about it this week in response to some email questions I got (send questions any time! I love them!). The topic of obedience, conformity, and resistance has been the subject of numerous books, essays, experiments, and articles, so I'm just summarizing a few bits and pieces:

That shock experiment I referred to last week is almost 50 years old! The question is--has our society progressed at all? We're a lot more nonconformist these days, right? We understand the value of human life. We know our rights. We'd tell that experimenter where to shove that shock box.

Well, this experiment has been replicated as recently as 2006 (modified to meet modern ethical requirements). And guess what?

The results were the same. Most of the participants in the study shocked the "learner" until the highest voltage possible, no matter the participants' gender, ethnicity, age, and education. They all showed similar rates of obedience to instructions to shock the learner.

So--was there anything that made a difference? Yes. People who felt more empathy for the learner's pain showed higher rates of refusal. There's also some indication that people who seek more control over situations will resist. But the replications of that old study aren't the only indication that ordinary people sometimes behave in evil ways:



Abu Ghraib is a tragic, real-life example.

 Here are some conditions that make it more likely that people will conform--even when the outcome is evil behavior:

1. When children are taught to obey all authority (and not specifically instructed that it's OK to disobey unjust authority)
2. When human diversity is not respected (easier to abuse someone you think of as less than human)
3. When people feel anonymous and not personally responsible for their actions
4. When it's not acceptable to admit mistakes
5. When we sacrifice personal freedom for promised security
6. When we tolerate bullying and teasing

More on both conformity and resistance here.

I think Schindler's List is a great movie that shows both the power of resistance and of conformity. If you're in the mood for a documentary, Ghosts of Abu Ghraib examines how American soldiers became cruel torturers. Writers are supposed to be astute studies of human behavior--so we need to understand both internal, personal characteristics AS WELL AS how our immediate situation influences us. I'll bet you folks can come up with other suggestions from books, movies, and real life--please share them!

More Of my Best Ways to Relax!

It was fun writing yesterday's post but it also got me thinking that I left out many of my own personal favorite best ways to relax. I'll share them with you now.

Hey, these are my personal favs and they really work to reduce my anxiety!

1) Horseback riding - You may wonder why I list this as I have already confessed that riding horses is something I have become fearful of doing! Yes it is true that I get very anxious often when I ride. But when I actually do go riding and actually make it through and get on my horse and ride a bit, and even challenge myself, I am just so relieved when it is over I feel completely relaxed and get a feeling of euphoria! Best feeling ever!

2) Watching CSI - there is no reason why this should be relaxing given the content, but it's somehow very relaxing for me LOL! I just love Grissom!

3) Foot Massage - This can be one of the most relaxing experiences ever! I have heard that all the nerves in your body are connected to your feet!

4) Shampoo and Blow Dry - Yes, yet another salon method to get over feeling stressed, anxious and panic. I don't like to talk - just feel the sensations and get calm!

5) Blog - I am finding blogging very relaxing. I am not sure if it's the soothing feeling I get from engaging in a repetitive habit or the relief from expressing my feelings, so I can let them go.

Who knows I may have more to add to my list of best ways to relax tomorrow. What about you?

Getting to Know More about Dementia

"It wasn't until 1995 that I first noticed that Peter was acting strangely. I thought he wasn't interested in his business any more. He appointed a manager and took early retirement at the age of 54. From then on, he became a different person…” These are the words of a woman whose husband was diagnosed with Alzheimer’s Disease- the most common type of dementia. To read the full story and get to know the every day struggles of people who suffer from dementia and their loved ones.

Dementia is a general term to describe symptoms involving difficulties with cognitive functions such as memory, language, reasoning, planning, recognizing, or identifying people or objects.

Symptoms of dementia

 

Based on the website for medical news today, the most common symptoms of dementia are:

• Frequent and progressive memory loss. People with dementia begin to forget more and more, and the most recent events seem to be forgotten most quickly. Occasionally though, clear "pockets of memory" are still present, and these are usually triggered by familiar faces, smells, touches, songs, or rituals.
• Language difficulties: People with dementia are often unable to understand instructions or to follow the logic of moderately complex sentences. He or she may not understand his or her own sentences, and have difficulty forming thoughts into words. Occasionally, everyone has trouble finding the right word, but a person with dementia often forgets simple words or substitutes unusual words, making speech or writing hard to understand.
• Confusion: This behavior causes a person with dementia to become "estranged" from others and to be unpredictable in interactions. Confusion can also occur "acutely", that is, suddenly and limited in time (for example, triggered by a hospital stay). In addition to this general confusion, people with dementia are disoriented in time and place. They often forget the current time and get lost in a familiar environment.
• Inability to perform familiar tasks. People with dementia often find it hard to complete everyday tasks that are so familiar we usually do not think about how to do them. In particular, people with dementia have great problems carrying out activities in the proper sequence. For instance, they may not know in what order to put on their clothes.
• Difficulty with abstract thinking. People with dementia often show unusual difficulty performing mental tasks. For instance, planning tasks, making decisions, or organizing projects become more and more difficult. They also lose the ability to make simple monetary transactions such as paying a bill.
• Misplacing belongings. Anyone can temporarily misplace his/her wallet or keys. A person with dementia may put things in unusual places such as an iron in the fridge or a wristwatch in the sugar bowl.
• Rapid mood swings: People with dementia become extremely moody, switching between emotions within a matter of seconds for no apparent reason. Alternatively, a person with dementia may show less emotion than s/he used to do previously.
• Behavioural changes: A person with dementia may seem different from his/her usual self in ways that are difficult to identify or explain. A person may become suspicious, irritable, depressed, apathetic, anxious, or agitated, especially in situations where memory problems are causing difficulties.
• Apathy/ lack of initiative: A person with dementia may become very passive, sitting in front of the television for hours, sleeping more than usual, or appear to lose interest in hobbies.

While there are some common symptoms of dementia, it is important to remember that everyone is unique. Some people may show all of these symptoms, while other may only exhibit some of them, but to a greater extent.

Progression of Dementia through its three stages

 Mild or Early-Stage dementia

Dementia usually begins gradually with very minor changes in the person's abilities or behaviour. In this phase, such signs are often attributed to stress or bereavement or, in older people, to the normal process of aging. Mostly, one only realizes by looking back that these signs marked the beginning of dementia. During the early phase of dementia, the person may:

• Become more forgetful of details of recent events
• Be more likely to repeat themselves or lose the thread of a conversation
• Be slower to grasp complex ideas and take longer to complete routine jobs
• Have difficulty handling money
• Show poor judgement and make poor decisions
• Blame others for 'stealing' lost items
• Lose interest in hobbies or activities
• Be unwilling to try new things
• Be unable to adapt to change
• Become more self-centered and less concerned with others and their feelings
• Be more irritable or upset if they fail at something
• Appear more apathetic, with less sparkle

Moderate or mid- stage Dementia

As dementia progresses, the changes become more marked and disabling.

People with dementia slowly move from forgetfulness into confusion. The person lives more and more in his/her own, dreamlike world in which present and past blend together and in which the rules and structures of the 'old world' - what is right, what is important - lose importance. At this stage people with dementia increasingly see themselves not as confused in a logical environment, but as oriented in a very unfamiliar environment.

During the moderate phase of dementia, the person may:

• Be increasingly forgetful of recent events. Memory for the distant past seems better, but some details may be forgotten or confused
• Repeat the same question or phrase over and over
• Be confused regarding time and place
• Become lost if away from familiar surroundings
• Forget names of family or friends
• Fail to recognize people or confuse them with others
• Forget saucepans and kettles on the stove. May leave gas unlit
• Wander around streets, perhaps at night, sometimes becoming lost
• Behave inappropriately - for example, going outdoors in their nightwear
• See or hear things that are not there (hallucinations)
• Become very repetitive
• Be neglectful of hygiene or eating
• Become angry, upset or distressed through frustration

Some people at this stage become very easily upset, angry or aggressive, perhaps owing to frustration, or they may become overly attached to a certain person.

At this moderate stage, the person will need more support to help them manage their day-to-day living. They may need frequent reminders or help to eat, wash, dress and use the toilet.

Severe or Late-Stage dementia 

At this stage, a person with dementia becomes severely disabled and will need even more help, gradually becoming totally dependent on others for nursing care.

Loss of memory may be almost complete, with the person unable to recognize familiar objects or surroundings or even those closest to them, although there may be sudden flashes of recognition. Patients are also less able to establish and maintain eye contact and appear to see through people. They may even stop recognizing themselves in the mirror.

Access to their 'bubble'-like world in which they hide and retreat becomes more difficult as language deteriorates. Repetitive movements might emerge, like rocking, undressing, or walking up and down.

Although they can't speak anymore, they are sometimes able to sing hymns and say prayers (automatism).

At this stage, the person may:

• Be unable to remember - for even a few minutes - that they have had, for example, a meal
• Gradually lose their ability to understand or use speech
• Be incontinent
• Show no recognition of friends and family
• Need help with washing, bathing, using the toilet or dressing
• Show difficulty in eating and sometimes swallowing
• Fail to recognize everyday objects
• Be disturbed at night
• Be restless, sometimes looking for a long dead relative
• Be distressed and aggressive, especially when feeling threatened or closed in
• Become increasingly physically weak, starting to shuffle or walk unsteadily, eventually becoming confined to a wheelchair
• Have uncontrolled movements

Eventually, immobility will become permanent and, in the final weeks or months, the person will be bedridden.

References

http://www.medicalnewstoday.com/articles/142214.php

http://www.nhs.uk/Conditions/dementia-guide/Pages/living-with-dementia-real-story.aspx

More Bipolar Disease Mongering in a Respected Journal

“The drug companies learned a while back that the best way to sell drugs was to sell diagnoses… selling the diagnosis is a way of opening up the new market. New diagnoses are as dangerous as new drugs, at least in psychiatry.”~ Dr Allen Frances, chair of DSM IV task force - Selling Sickness conference, 2011.

One of the main themes of both my book How Dysfunctional Families Spur Mental Disorders and this blog has been the incredible expansion of the bipolar diagnosis to anyone who is moody, chronically depressed and irritable, or chronically agitated. 

This has been done predominantly by some egocentric blowhard psychiatrists trying to make a name for themselves in conjunction with a well-documented and highly successful plan by several pharmaceutical companies to enlarge the market for their brand named, so-called atypical antipsychotics.  This marketing plan was documented with the release of Eli Lilly's own company marketing memos as part of a US Justice Department investigation - the so called Zyprexa Documents. These medicines are potentially toxic and do nothing to solve the interpersonal and psychological problems of many of the mental health patients to whom they are prescribed.

My colleague in Australia, Peter Parry, told me,  "Our director of training for psychiatry in our state quipped sarcastically that we may as well subsitute “mental disorder” with “bipolar disorder” and have the “DSM of Bipolar Disorders” and then recategorise subtypes like ‘adjustment bipolar disorder,’‘personality-based bipolar’ etc."  With some of the psychiatrists I know personally, this would actually be considered a good idea!

Many of the adults misdiagnosed with bipolar actually carry the diagnosis of borderline personality disorder and not bipolar. While medication can help these folks with some symptoms, most of these patients are in dire need of good psychotherapy.  Unfortunately, a lot of therapists do not like to work with them, so many end up seeing psychiatrists who use antipsychotics basically to shut them up.

"Disease mongering" is a term used for marketing techniques designed to accomplish what Dr. Frances alluded to at the top of this post.  The ongoing mongering of bipolar disorder by the pharmaceutical companies uses many tricks.  Often so-called researchers and practitioners alike do totally inadequate diagnostic evaluations using highly inaccurate and misleading symptom checklists; others employ the completely unvalidated concept of bipolar spectrum, or b.s. as I like to call it.

Bipolar ver. 4.1

A highly transparent example of disease-mongering was just published in a respected psychiatric journal, the Archives of General Psychiatry.  521 hospital-based or community psychiatrists in 18 countries in Asia, Europe, and Africa between April 1, 2008, and April 30, 2009 were involved in a “research” project which was designed to shape their thinking and diagnosing, and altering diagnostic paradigms in those countries.



The article is titled “Prevalence and Characteristics of Undiagnosed Bipolar Disorders in Patients With a Major Depressive Episode” and was “designed, conducted and prepared” by Sanofi-Aventis. Sanofi-Aventis markets an atypical antipsychotic named Solian, which is the brand name of the drug amisulpride.  It is not FDA-approved in the United States, which is probably one reason why this study was done overseas.

The supposed "results" of the study:

“These results are from a large, 3-continent, culturally generalizable study conducted by practicing psychiatrists. The data indicate that, whereas with application of the DSM-IV-TR criteria, 16.1% of patients with Major Depressive Episodes met criteria for either bipolar I or bipolar II disorder, this rate rose to 47% with application of the bipolarity-specifier criteria.

These results suggest that bipolar features are more frequent in patients with MDE than indicated by DSM-IV-TR criteria. Almost half of the entire 5098 cohort presented the core symptoms of bipolarity (elevated mood, irritable mood, or increased activity), and these symptoms led to unequivocal changes in behavior that were observable by others in a similar proportion of patients.”

What this means is that, if this were true, half of patients who exhibit Major Depressive Episodes are actually bipolar and should  be taking “mood stabilizers.” Not lithium, I suppose, but antipsychotics. 

The article  goes on to state: “Major depressive disorder, the most common psychiatric illness, is often chronic and a major cause of disability. Many patients with major depressive episodes who have an underlying but unrecognized bipolar disorder receive pharmacologic treatment with ineffective regimens that do not include mood stabilizers.”

All of the "researchers" recruited received fees, on a per patient basis, from Sanofi-Aventis in recognition of their participation in the study. The key lead authors, all with significant Pharma connections, did not disclose their personal ties. Quite a transparent example of how cultural beliefs are manufactured, and how direct involvement with Pharma is normalised.

So what's wrong with the study?  Well that hinges on the meaning of the term "bipolarity specifier" that was added to the usual, DSM criteria for bipolar disorder.  This assumes that this additional test has been validated as being predictive of actual bipolar disorder, which is a "fact" not in evidence.  It sounds in the study as if this were an established and valid measure.

Here's the defintion:

“This bipolarity specifier attributes a diagnosis of bipolar disorder in patients who experienced an episode of elevated mood, an episode of irritable mood, or an episode of increased activity with at least 3 of the symptoms listed under Criterion B of the DSM-IV-TR associated with at least 1 of the 3 following consequences: (1) unequivocal and observable change in functioning uncharacteristic of the person’s usual behavior, (2) marked impairment in social or occupational functioning observable by others, or (3) requiring hospitalization or outpatient treatment. No minimum duration of symptoms was required and no exclusion criteria were applied.”

People sleeping less, talking more, and doing more. This is how mental illness is now being defined in psychiatry’s leading journal.

One of the dead giveaways that this article is bipolar diseases mongering is the sentence:
“No minimum duration of symptoms was required and no exclusion criteria were applied.”
This means that any person who has a suddenly angry, agitated, or elated response to an environmental trigger (like a big fight with a family member or winning the lottery) could be labeled bipolar.

This would also mean that if they had an episode of emotional dysregulation for the same reason, the reaction would be labeled a bipolar episode. This makes almost anyone who has borderline personality disorder suddenly bipolar.

23.2% of their subjects had experienced episodes of elevated or irritable mood triggered by antidepressants and were also defined as bipolar.  This is almost comical. Irritibility is a common side effect of drugs like prozac and has absolutely nothing to do with bipolar disorder (unless tranquilizers cure mania, because they sure do cure that side effect). This incredible nonsense is straight out of Hagop Akiskal’s dishonest playbook. I heard him say once that if someone who is depressed gets agitated on an SSRI, he just “knows” that person is bipolar.

The word bipolar, in the sense advocated by this piece-of-you-know-what study, is showing up in common discourse everywhere, particularly among young people describing their unpredictable and volatile classmates.  You can even hear the word in pop songs used as a synonym for moody (e.g. “Hot and Cold” by Katy Perry).

Someone... call the doctor
Got a case of love bi-polar

The drug companies have really done a masterful job in bastardizing the diagnosis of real bipolar disorder, which is a serious mental illness.  The harm to both the field and to patients alike has been staggeringly immense.

ADHD More Misleading Propaganda

In the never ending effort to con the world in general, and physicians in particular, into thinking that most inattentive and rambunctious children and adults have a neurobiological disease, a Dr. Samuele Cortese and his colleagues presented yet another MRI study that they allege shows that children and adults who have been diagnosed with ADHD have abnormalities in their brains. 

Dr. Cortese is listed as a consultant for Shire Pharmacueticals, a major manufacturer of stimulant drugs for “ADHD.” Or as some might say in ordinary language, Shire is a drug dealing syndicate. One of the most egregious examples of same, at that. Shire’s interests are served by having the largest number of people taking their “legal” amphetamines as possible, while also spreading the word that their competition, “illegal” amphetamines, are dangerous and highly abused drugs.

I use the word “diagnosed” with ADHD in the first paragraph above rather than “have” ADHD because, as I have demonstrated in previous posts, the evaluation of patients who seem to have these problems leaves out an entire and absolutely essential part of their lives – the behavior of their families that provides a context for the child’s “symptoms.” 

No effort, or only a half-baked one, is made in these studies to differentiate acting out from other possible causes for the patient’s hyperactive behavior or difficulties in maintaining focus.

The new study, published in the issue of the American Journal of Psychiatry, proves the following point beyond a shadow of a doubt: people who are not paying good attention to a particular task in which they are engaged exhibit less activity in those brain centers involved in paying attention to tasks than people who are paying strong attention.  Wow. Who’d’a thunk it?

And as we all know, any difference simply must be an abnormality.

In fact, the study says absolutely nothing about whether these research subjects cannot pay attention or simply are not paying attention.

The study in question (Cortese et al, “Toward Systems Neuroscience of ADHD: A Meta-Analysis of 55 fMRI Studies,” Am J Psychiatry 2012; 169:1038-1055) combines statistics from 55 different studies of ADHD, many of which use very different diagnostic “tests” which are merely symptom report lists and pay little attention to the pervasiveness of the symptoms, let alone the psychosocial context in which the symptoms take place.

Here are the results. Hypoactivation is a term meaning that the affected part of the brain is less active, on average, than it might be in a comparison subject. Of course, how active such a brain part might depends strongly on the motivations of the particular subjects. (This is analogous to the results of IQ tests, which are biased against those people who don’t give a damn about how well they do on the test).  Hyperactivation means the opposite.  

Surely, whether more or less activity in a region of the brain is pathological is entirely pre-supposed by the authors without any valid justification. It is basically a value judgment.

“Fifty-five studies were included (39 for children and 16 for adults). In children, hypoactivation in ADHD relative to comparison subjects was observed mostly in systems involved in executive function (frontoparietal network) and at­tention (ventral attentional network). Sig­nificant hyperactivation in ADHD relative to comparison subjects was observed predominantly in the default, ventral at­tention, and somatomotor networks. In adults, ADHD-related hypoactivation was predominant in the frontoparietal system, while ADHD-related hyperactivation was present in the visual, dorsal attention, and default networks. SignificantADHD-related dysfunction largely reflected task features and was detected even in the absence of comorbid mental disorders or a history of stimulant treatment.

Conclusions: A growing literature pro­vides evidence of ADHD-related dysfunc­tion in multiple neuronal systems involved in higher-level cognitive functions but also in sensorimotor processes, including the visual system, and in the default net­work. This meta-analytic evidence extends early models of ADHD pathophysiology that were focused on prefrontal-striatal circuits.”

The studies being "meta-analyzed" are designed on purpose to make it appear that normal differences mean something other than their just being normal differences.

Let us look at the distribution of how strongly people “pay attention” to boring tasks to which they have no particular motivation to do well (other than their desire to be co-operative with an experimenter). Most of the tasks during which brain activity is measured are, let’s face it, at least somewhat uninteresting.

This distribution, like almost everything else in nature, will look like a bell-shaped curve, or what is called normal distribution. We don’t even have to invoke the fact that some people may habituallypay less attention to most activities because they might be compulsively and habitually playing a role ["unambitious"] within their family of origin that allows them to get labeled as having ADHD.

The self report instruments and diagnostic interviews through which a diagnosis of ADHD is made will, in effect, sort the patients so that those labeled with ADHD will fall, on average, at point A on the bell shaped curve in the figure above. Since those individuals will then be taken out of the pool of study subjects, those that remain will have an above average tendency to pay attention to boring tasks – their average will be at point B in the diagram.

Everything else being equal, the “ADHD” subjects and the control control subjects could all be completely normal, and the study result would be identical to a study in which a real disease were being studied! The authors have no way of knowing which of these possibilities their study is demonstrating. They do not clearly acknowledge the above considerations as a weakness of the study, although they do concede, “fMRI data cannot define an absolute or quantitative baseline of activation…” (p. 1053).

That disclaimer is added to give the authors plausible deniability, and will of course be completely ignored by readers if it is noticed at all.

The authors start their discussion of their results with the sentence, “ADHD is increasingly being conceived of as a disorder underpinned by dysfunctions in multiple large scale brain networks.” Yeah, because of pseudo-scientific conclusions made from a multiplicity of studies done the way this one was.

Are Scientists More Objective and Rational than the Rest of Us

No.  Not particularly.

 

In watching the new version of Carl Sagan’s Cosmos on TV, it was interesting to hear host and astrophysicist Neil deGrasse Tyson wax eloquently how science is based almost entirely on empirical evidence – seemingly unbiased observation and clear experiments – as opposed to the ideas of the majority of the people who are under the sway of religious dogma and mythology as well as other forms of groupthink. 

But then the show began to give hints that scientists could be every bit as biased as anyone else. There was the bit about Robert Hooke trying to take credit for some of Isaac Newton's work. And then there was the story about Robert Kehoe, a respected scientist who became an oil industry lackey who pushed the idea that lead in gasoline was not dangerously polluting the environment and was not being found in increasing concentrations everywhere. It took the stubborn persistence of another scientist, Clare Patterson, to get the truth out.

When I was a kid, I wanted to be a scientist, and I idealized scientists as having the very qualities Dr. Tyson seemed to first imply that they had. Of course, that was long before I entered academia.

I had heard about how cutthroat and vicious academic politics could be. I should have asked myself why that was. 

I didn’t think of scientists in terms of outsized egos, outsized greed, biased experimental designs that were being used to guarantee the results of an experiment before it was even done, the shunning of those with data that seemed to contradict conventional wisdom - with scientists finding ways to prevent such folks from getting their data published in “respectable” journals through the misuse of the peer review process, or by preventing them from getting funding for further research - the use of propaganda and marketing techniques to disseminate pseudo-scientific “facts,” and the powerful effects of political correctness gone amok on what scientists can and cannot say or propose to study.

 

How stupid could I have been to idealize these folks as somehow above all that? When I finally made it to academia, I got to witness all that up close and personal. But it was even worse that I thought. When I started doing research for my last book, How Dysfunctional Families Spur Mental Disorders, I was totally shocked by how far all this went. Many of the issues involved have been the subjects of previous posts on this blog.

 

I came across an article by Michael Specter in the New Yorker about how one prominent scientist, Pasko Rakic, had set the field of neurobiology back a full decade by refusing to believe a lot of data coming out that disproved the prevailing idea that sophisticated animals – and certainly humans – are born with essentially every brain cell they will ever have, and that no new neurons develop during adulthood.  

Pasko Rakic

Scientists who found this data were ignored, and some had to leave the field in frustration. It took the persistence of a willful female scientist named Elizabeth Gould to break through this scientific version of stonewalling.

Elizabeth Gould

The whole subject of scientific groupthink and misbehavior will be covered in a book I recently became involved with as a co-editor – the sequel to the book Pathological Altruism. (It probably will not be out for a couple of years).

One of the most egregious examples of political correctness stymieing science is at the heart of my understanding of self sacrifice in dysfunctional families: the work of E.O. Wilson on sociobiology and kin selection. I had once had a conversation with an evolutionary biologist who told me that only about 20% of evolutionary biologists believed in kin selection, but he strongly implied (without actually saying so) that this was due more to politics that to the science.

E.O. Wilson

As I later learned, I had guessed exactly what was going on in the field, but I had no idea it stemmed from an official published opinion piece from 1975! In reading my colleague Gregg Henrique’s book, A New Unified Theory of Psychology, I learned the following on page 166:

“…on November 13, 1975, a group of fifteen or so scholars, teachers, and students from the Boston, area (most notably among them were Wilson's Harvard colleagues, Stephen J. Gould and Richard Lewontin) formed a group called Science for the People and published a let­ter in the New York Review of Books that said that any applications of sociobiology to humans were to be condemned because they were too politically, dangerous. The letter linked examining biological bases of human behavior to Social Darwinism and Nazi Germany. Even hypotheses stemming from such ideas...

‘consistently tend to provide a genetic justification of the status quo and of existing privileges for certain groups according to class, race or sex. Historically, powerful countries or ruling groups within them have drawn support for the maintenance or extension of their power from these products of the scientific community. . .These theories provided an important basis for the enactment of sterilization laws.. .and also the eugenics policies which led to the establishment of the gas chambers in Nazi Germany.’”

Stephen J. Gould

OK. So because a scientific idea might conceivably be misused in the service of some fascist’s political agenda, we cannot talk about it?!? And one of my previous heroes, Stephen J. Gould, signed on to this? 

How ironic that ideological groupthink, which is itself a manifestation of the biological force of kin selection, is being used to intimidate those who would study kin selection.

Such objectivity. Such empiricism. Rational scientists who deal with nothing but actual evidence?  I’m sure glad that there are at least a few of them still out there.