A Behavioral Approach to Mental Disorders

On September 12, Jeffry Lieberman, MD, President of the APA, posted an article on Psychiatric News titled IPS to Feature Patrick Kennedy, Celebrate Community Psychiatry. The article is a preview of an APA conference scheduled for October 10-13 in Philadelphia: “Transforming Psychiatric Practice, Reforming Health Care Delivery.” Dr. Lieberman tells us that he is very excited about the conference, and that the theme is particularly relevant "…given the changes we are experiencing in the profession and some of the exciting program events that I hope will support APA’s goal of being in the forefront of changes in the profession under health care reform." ...

A mass murder occurred yesterday, September 16, at the U.S. Navy Yard in Washington D.C. There are reports of at least 12 dead, and several wounded. Early news stories describe the perpetrator as having “mental issues,” and it is reported that he “…had been treated since August by the Veterans Administration for his mental problems.” It is likely that this “treatment” involved the prescription of psychiatric drugs. And still no government inquiry into the link between psycho-pharmaceutical products, especially SSRI’s, and acts of violence/suicide. ...

In my view, one of the most destructive developments in psychiatry in recent years is the prescribing of neuroleptic drugs to children. Much of this prescribing is off-label, meaning that the prescribed use is not approved by the FDA. Off-label drug prescribing is legal, however. Once the FDA has approved a drug for one purpose, a physician may prescribe it for another purpose. But under Medicaid rules, the physician is not permitted to bill Medicaid for writing this prescription unless the use of the drug in the specific circumstances is endorsed by any of the three pharmaceutical compendia approved by Congress for this purpose. A physician who deliberately submits a bill to Medicaid and, thereby, effectively causes Medicaid to pay for, a prescription that is both off-label and unapproved by any of the compendia is open to a charge of Medicaid fraud. Medicaid, incidentally, is the US government’s health insurance system for poor people. Eligibility is based on income. ...

Thanks to Graham Davey and Richard Pemberton on Twitter for the link to an interesting article in the August 29, 2013 issue of the Lancet. It’s titled Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010, and was written by Harvey A. Whiteford, et al. The Global Burden of Disease survey is a systematic, scientific attempt to quantify the comparative magnitude of disease, injuries, and risk factors by age, sex, and geography over time. ...

There’s a new post on Peter Kinderman’s blog. It’s called Time for a paradigm change, and it’s dated September 2. The article is based on a speech that Dr. Kinderman gave to North Wales Clinical Psychology Programme, Annual Stakeholders’ Meeting on the same date. Here are some quotes: "But mental well-being is fundamentally a psychological and social phenomenon, with medical aspects. It is not, fundamentally, a medical phenomenon with additional psychological and social elements." ...

There’s a new article on Frontiers in Psychiatry. It’s titled Electroconvulsive treatment: hypotheses about mechanisms of action. The authors are Roar Fosse, Division of Mental Health and Addiction, Vestro Viken State Hospital Trust, Lier, Norway, and John Read, Institute of Psychology, Health, and Society, University of Liverpool, UK. Thanks to Mick Bramham on Twitter for the link. The authors reviewed a large number of human studies in which the brains of people receiving shock treatment were observed using EEG, PET, SPECT, and fMRI. ...

There’s an interesting article by Sonja Grover, PhD, CPsych, of Lakehead University, Ontario, Canada. It’s titled: Reification of psychiatric diagnoses as defamatory: Implications for ethical clinical practice. Thanks to Becky on Twitter for the link. It’s an old article (2005), but definitely deserves another look. It was published in the journal Ethical Human Psychology and Psychiatry. Here’s the abstract: "While the mental health professional generally has beneficent motives and an honest belief in the DSM diagnoses assigned to clients, such diagnoses may yet be defamatory when communicated to third parties. Mental health diagnoses invariably lower the individual's reputation in the eyes of the community. At the same time, DSM diagnoses are but one out of a myriad of possible interpretive frameworks. DSM descriptors for the client's distress thus cannot be said to capture the essence of the client's personhood. When a diagnosis is published as if it captured a definitive truth about an individual psychiatric client, it is, in that important regard, inaccurate. That is, such a communication meets the criterion for a reckless disregard for the truth or an honest belief but without reasonable basis insofar as it is considered to be anything more than a working hypothesis. Hence, in certain cases, DSM labeling may constitute defamation." ...

It’s that time of the month, and Dr. Lieberman has written another post, Change, Challenge and Opportunity: Psychiatry in Age of Reform and Enlightenment, on the APA’s website, Psychiatric News. He tells us that these are changing times, and that he, for one, is choosing to see these changes as positive. He leads with a quote from Bob Dylan: "The line it is drawn, The curse it is cast The slow one now, Will later be fast As the present now, Will later be past" ...

Last Monday (August 26), Lauren Spiro published a post on Mad in America. The post is titled The Today Show and ECT: The Full Story & Informed Consent. Here’s the gist of Lauren’s article. On August 20, the Today Show ran a segment on ECT (electric shock “treatment”). Lauren contends that the coverage was not balanced, but was pitched heavily in favor of shock “treatment.” Lauren provides a link to the segment, and also a transcript. I have watched the video, and read the transcript, and I agree that the coverage was very much pro-ECT, and that side effects were trivialized. ...

There’s an interesting article, Poverty Impedes Cognitive Function, by Anandi Mani et al in the current issue of Science. Here’s the abstract: "The poor often behave in less capable ways, which can further perpetuate poverty. We hypothesize that poverty directly impedes cognitive function and present two studies that test this hypothesis. First, we experimentally induced thoughts about finances and found that this reduces cognitive performance among poor but not in well-off participants. Second, we examined the cognitive function of farmers over the planting cycle. We found that the same farmer shows diminished cognitive performance before harvest, when poor, as compared with after harvest, when rich. This cannot be explained by differences in time available, nutrition, or work effort. Nor can it be explained with stress: Although farmers do show more stress before harvest, that does not account for diminished cognitive performance. Instead, it appears that poverty itself reduces cognitive capacity. We suggest that this is because poverty-related concerns consume mental resources, leaving less for other tasks. These data provide a previously unexamined perspective and help explain a spectrum of behaviors among the poor. We discuss some implications for poverty policy." ...