A Behavioral Approach to Mental Disorders

On Monday, February 17, cannotsay, a regular commenter on this website, left a link to a White House petition on a recent post. The petition calls for an investigation into possible civil rights violations in the case of Justina Pelletier, 15, who is being held by court order in a residential unit in Framingham, Massachusetts. The issue is complicated and contentious. The psychiatrists apparently maintain that she has a psychiatric “illness” (somatoform pain disorder), whereas her parents and other physicians say that she suffers from mitochondrial disease. Wikipedia has an article on mitochondrial disease. ...

The 2012 book Drugging Our Children: How Profiteers Are Pushing Antipsychotics on Our Youngest, and What We Can Do to Stop It, is edited by Sharna Olfman PhD, and Brent Dean Robbins, PhD. It is a collection of ten articles, plus an Introduction and an Afterword by Sharna Olfman. Here are the chapter titles, with a quote from each: Introduction, by Sharna Olfman, PhD ...

On November 12, 2013, Molecular Psychiatry published online Evidence that duplications of 22q11.2 protect against schizophrenia, by Rees et al. The print version was published last month – January 2014. Here’s the authors’ summary: "A number of large, rare copy number variants (CNVs) are deleterious for neurodevelopmental disorders, but large, rare, protective CNVs have not been reported for such phenotypes. Here we show in a CNV analysis of 47 005 individuals, the largest CNV analysis of schizophrenia to date, that large duplications (1.5–3.0 Mb) at 22q11.2—the reciprocal of the well-known, risk-inducing deletion of this locus—are substantially less common in schizophrenia cases than in the general population (0.014% vs. 0.085%, OR=0.17, P=0.00086). 22q11.2 duplications represent the first putative protective mutation for schizophrenia." ...

On January 29, the APA’s online bulletin Psychiatric News, published Psychiatry Embraces Patient-Centered Care, by Jeffrey Lieberman, MD, and Lisa Dixon, MD. Dr. Lieberman is President of the APA, and chair of psychiatry at Columbia University. Dr. Dixon is a professor of psychiatry at Columbia. Here’s the opening statement: "Psychiatry has long been considered the medical specialty most attuned to listening to the patient." This is a little difficult to reconcile with the fifteen minute med-check that has been pretty much the standard of care in most psychiatric offices for the past 25 years. It is also difficult to reconcile with reports from psychiatric survivors. The authors are willing to concede, however, that “…the nature of the doctor-patient relationship was traditionally one-sided.” What they mean by this is: ...

In January of this year, Steven Hyman MD, former Director of NIMH and currently a leading psychiatric researcher at MIT and Harvard, published Revitalizing Psychiatric Therapeutics in Neuropsychopharmacology. The article is in the journal’s commentary section and is essentially an opinion piece. Here’s Dr. Hyman’s summary: "Despite high prevalence and enormous unmet medical need, the pharmaceutical industry has recently de-emphasized neuropsychiatric disorders as 'too difficult' a challenge to warrant major investment. Here I describe major obstacles to drug discovery and development including a lack of new molecular targets, shortcomings of current animal models, and the lack of biomarkers for clinical trials. My major focus, however, is on new technologies and scientific approaches to neuropsychiatric disorders that give promise for revitalizing therapeutics and may thus answer industry's concerns." ...

Psychiatric News is the APA’s online bulletin. On Jan 15, it ran an article by Vabren Watts (an APA staff writer). The article is called APA Gives Schizophrenia Research Capitol Hill Spotlight. It is reported in the article that on December 12, 2013, the APA, together with the Congressional Neuroscience Caucus and the American Brain Coalition, made a joint presentation to legislators and their staffs on ...

On January 27, NPR ran a short piece on a new treatment for clubfoot. Here’s a quote from the transcript: "Just a decade ago, up to 90 percent of babies…were treated with surgery that usually had to be repeated several times. That created a buildup of scar tissue that often left patients with a lifetime of chronic pain, stiffness, arthritis and medical bills. But with the help of a simple, noninvasive solution and an Internet campaign led by parents, the course of treatment and likely outcomes have changed completely." ...

On January 27, I posted Maternal Attachment in Infancy and Adult Mental Health. In this article I reviewed a longitudinal study by Fan et al. The main finding of the study was: “Infants who experience unsupportive maternal behavior at 8 months have an increased risk for developing psychological sequelae later in life.” In my article, I pointed out that the correlation between the low maternal attachment ratings and subsequent "mental health" issues was not perfect, so clearly this was not the only factor involved in the adult children's subsequent problems. But I also made the point that what we do as parents affects how our children function in adulthood. For me this is simply an obvious fact of life that tragically has been barred from discussion by the psychiatric mantra – that all significant problems of thinking, feeling, and/or behavior are genetic-linked brain illnesses, and that parents couldn’t have impacted the outcome one way or the other. ...

There's an interesting article by Angela Fan et al, in Comprehensive Psychiatry, October 28, 2013. It's titled Association between maternal behavior in infancy and adult mental health: A 30-year prospective study. The data for this investigation were gathered as part of a wider longitudinal study. PROCEDURE ...

In November 2013, the British Medical Journal published Attention-deficit/hyperactivity disorder: are we helping or harming? by Rae Thomas, PhD, Psychologist, Australia; Geoffrey K. Mitchell, MB BS, FRACGP, PhD, Professor of General Practice, Australia; and Laura Batstra, PhD, Psychologist, Netherlands. The article is part of a series on the dangers of overdiagnosis. Here are some quotes: "Prevalence and prescribing rates for attention-deficit/hyperactivity disorder (ADHD) have risen steeply over the past decade, partly in response to concerns about underdiagnosis and undertreatment." ...