A Behavioral Approach to Mental Disorders

Last month (December 2013) the American Journal of Psychiatry published Antidepressant-Induced Liver Injury: A Review for Clinicians, by Voican C.S. et al. The study was a literature search from 1965 onwards. Here are the authors’ results: All antidepressants can induce hepatotoxicity, especially in elderly patients and those taking more than one drug Liver damage is generally unpredictable and unrelated to dose Liver damage can occur within a few days of initiation Antidepressant-induced liver failure can be life threatening Antidepressants with higher risk for liver failure include: iproniazid, nefazodone, phenelzine, imipramine, amitriptyline, duloxetine, bupropion, trazodone, tianeptine, and agomelatine Antidepressants with lower risk: citalopram, escitalopram, paroxetine, and fluvoxamine Although an infrequent event, antidepressant-induced liver injury may be irreversible   ...

A short editorial piece by James Bradshaw in the current issue (Jan/Feb) of the National Psychologist discusses the trial of a 16-year-old male who killed four people and severely injured two others while driving under the influence of Valium (diazepam) and alcohol. He had stolen the alcohol from a store earlier, and his blood alcohol level was three times the legal adult limit. He was driving 70 mph in a 40 mph zone at the time of the incident. ...

BACKGROUND On December 23, I wrote a post called DSM-5 - Dimensional Diagnoses - More Conflicts of Interest? In the article I sketched out the role of David Kupfer, MD, in promoting the concept of dimensional assessment in DSM-5, and I speculated that at least part of his motivation in this regard might have stemmed from the fact that he is a major shareholder in a company that is developing a computerized assessment instrument. I ended the piece with a general criticism of psychiatry: ...

On January 3, on CommonHealth I saw the following headline: A Phrase To Renounce For 2014: ‘The Mentally Ill’, written by Carey Goldberg. My first impression was that the author was debunking the concept of mental illness, but I was sadly mistaken. The theme of the article was the so-called person-first terminology that has been promoted by various bodies and agencies since about the mid-eighties. The idea is that one shouldn’t say “a developmentally disabled child.” Instead, one should say “a child with a developmental disability.” Similarly, a person should not be referred to as an “alcoholic,” but rather as a “person with alcoholism.” And so on. The idea is to avoid giving the impression that the individual is to be defined by the presence of a disabling condition. The individual is first and foremost a person, and the problem or disability is semantically tacked on to indicate that it is a quality of the person rather than the defining feature. ...

BOOK PREVIEW Richard C. Saul, MD ADHD Does Not Exist: The Truth About Attention Deficit and Hyperactivity Disorder Publication date: February 18, 2014 ************************ Those of us on this side of the psychiatry debate have been saying for decades that the condition known as ADHD is not an illness, but is rather an arbitrarily delineated cluster of vaguely defined problems that children have acquired in various ways. We have also pointed out that psychiatry's labeling of this condition as an illness is simply another instance of their inexorable turf expansion, and that their widespread drugging of the individuals so labeled is destructive and disempowering. And, also for decades, psychiatry has been marginalizing us as unscientific mental illness deniers, who seek to put the clock back and deprive people suffering from this “illness” of the vital “treatment” that they so desperately need. ...

On December 27, 2013, Connecticut State Police issued a 7,000-page, heavily redacted, report on the massacre that occurred at Sandy Hook Elementary School just over a year earlier (December 14, 2012). For the record, I have not read the 7,000-page report, but I have read the Wikipedia article Sandy Hook Elementary School shooting, last updated January 4, 2013, and several media reports on the matter, including reports from the New York Times, the Hartford Courant, and the Washington Post. ...

I recently read The NIMH-CATIE Schizophrenia Study: What Did We Learn? by Jeffrey Lieberman, MD, and T. Scott Stroup, MD, MPH. The article was published in the American Journal of Psychiatry 168:8, August 2011. Here are two quotes: "When the CATIE study was designed in 1999-2000, the prevailing opinion of researchers and clinicians alike was that the newer (second-generation) antipsychotic drugs were vastly superior to the older (first-generation) antipsychotic drugs in efficacy and safety. This largely reflected the results of studies sponsored by the manufacturers of the new drugs…, marketing messages of pharmaceutical companies and the hopes of many who wanted better treatments." ...

In November, Joanna Moncrieff, MD, a British psychiatrist who works as a Senior Lecturer in psychiatry at University College London and a practicing consultant psychiatrist, started her own blog. What’s remarkable about this blog is that it is highly critical of psychiatry. Dr. Moncrieff marshals important facts and arguments in this area, and it is probably safe to say that her popularity among her peers is in decline. The facts that she adduces, however, are indisputable, and her qualities of honesty, courage, and integrity are evident in everything she writes. ...

I have just read a very interesting and insightful article on this topic. It’s called After DSM-5: A Critical Mental Health Research Agenda for the 21st Century. It was written by Jeffrey Lacasse, PhD, and is a guest editorial published in Research on Social Work Practice. Here are some quotes: "At times, it has seemed that the APA has behaved very much like a corporation seeking profit and influence rather than a scientific organization charged with the crucially important task of defining mental disorders." ...

Jeffrey Lieberman, MD, is the President of the APA, and every two weeks or so he writes psychiatric propaganda articles on Psychiatric News (the APA’s online bulletin). On December 26, his piece was titled APA Successful in Attaining Higher Work Values for Psychiatry. Here’s the first paragraph: "In an ideal world, value and price would be closely aligned. This alignment doesn’t occur, however, when the value of a service or good isn’t understood. One only has to look at the huge disparity between the salaries of teachers compared with entertainers and sports figures to appreciate this incongruity; or between compensation in the financial-services industry and medicine. For too long, this has especially been the case for psychiatric services. Mental illness is a health care disparity, and mental health care has been stigmatized and undervalued, as have been the physicians who provide it. The result has been inappropriately low reimbursement rates for psychiatric treatment and a corresponding lack of access to mental health care for too many patients." ...