Expansion of Psychiatric Turf

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." ...

Jeffrey Lieberman, MD, President of the APA, has expressed concern about the rise in the number of people being assigned a “diagnosis” of ADHD. He has put up a video on Medscape, Explaining the Rise in ADHD. There is a transcript with the video. Dr. Lieberman is responding to a December 14, 2013, New York Times article The Selling of Attention Deficit Disorder, by Alan Schwarz, and a December 18 editorial in the same paper titled An Epidemic of Attention Deficit Disorder. ...

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. ...

Yesterday, December 26, at 8:25 p.m., the following comment was posted on my December 16 post on the Murphy Mental Health Bill. "Read the article in today's Wall Street Journal (12/26/13), 'A Mental-Health Overhaul', and you cannot help but be in favor of the Murphy Bill. It is a huge misrepresentation to say it is about 'coercive tactics'. Take the bill piece by piece and debate it. If you have experienced the mental healthcare system you would recognize that this legislation is badly needed and long over due." ...

BACKGROUND On November 20, JAMA Psychiatry (formerly Archives of General Psychiatry) published an interesting letter. It was headed: Failure to Report Financial Disclosure Information, and was signed by Robert D. Gibbons PhD, David J Weiss PhD, Paul A. Pilkonis PhD, Ellen Frank, PhD , and David J. Kupfer MD. The letter is an apology for failing to disclose a financial interest in an article, Development of a Computerized Adaptive Test for Depression, that had appeared in Archives of General Psychiatry a year earlier (November 2012). The article described a computerized questionnaire for depression (the CAT-DI) and was generally positive with regards to the potential usefulness of the test in clinical settings. In the article, the authors had clearly stated that they had no conflicts of interest, but that: ...

On December 10, Vice President Joe Biden announced that $100 million of new Federal money is to be injected into the US mental health system “…to expand community-based services and treatment centers.” There’s a short article about this in the Washington Post. It’s written by Scott Wilson, the Post’s chief White House correspondent. The article states that the “…inadequacy of mental health and addiction care…” is a topic that “…gained urgency after the school shooting in Newtown, Connecticut, a year ago, a crime carried out by a mentally disturbed gunman.” This is a reference to 20-year-old Adam Lanza, who killed 20 children and 6 adult staff, himself, and his mother in the incident. ...

Jeffrey Lieberman, MD, President of the APA and Chair of Psychiatry at Columbia University, published a post on November 26 on Psychiatric News. The article is called Training the Psychiatrists of the Future, and is co-authored by Richard Summers, MD. Dr. Summers is a Professor of Psychiatry at the University of Pennsylvania. Drs. Lieberman and Summers open by telling us that psychiatrists’ roles “…are changing and will continue to change.” That sounds great, but don’t expect too much. There will still, they tell us, be a need for: ...

In December 2012, Mark Olfson, MD, et al, published an article in the Archives of General Psychiatry. The title is National Trends in the Office-Based Treatment of Children, Adolescents, and Adults with Antipsychotics. The authors collected data from the National Ambulatory Medical Care Surveys for the period 1993-2009, and looked for trends in antipsychotic prescribing for children, adolescents, and adults in outpatient visits. Here are the results: Age Increase in no. of antipsychotic prescriptions per 100 population (1993-2009) 0-13 0.24-1.83 (almost 8-fold) 14-20 0.78-3.76 (almost 5-fold) 21+ 3.25-6.18 (almost 2-fold)   The authors provide a breakdown of the diagnoses assigned to the children and adolescents during the antipsychotic visits. ...