Schizophrenia

INTRODUCTION On May 5, 2017, Donald Goff, MD and seven other psychiatrists, including the very eminent Jeffrey Lieberman, MD, published an article in the American Journal of Psychiatry. The title is: The Long-Term Effects of Antipsychotic Medication on Clinical Course in Schizophrenia. Here’s the abstract: "Concerns have been raised that treatment with antipsychotic medication might adversely affect long-term outcomes for people with schizophrenia. The evidence cited for these concerns includes the association of antipsychotic treatment with brain volume reduction and with dopamine receptor sensitization, which might make patients vulnerable to relapse and illness progression. An international group of experts was convened to examine findings from clinical and basic research relevant to these concerns. Little evidence was found to support a negative long-term effect of initial or maintenance antipsychotic treatment on outcomes, compared with withholding treatment. Randomized controlled trials strongly support the efficacy of antipsychotics for the acute treatment of psychosis and prevention of relapse; correlational evidence suggests that early intervention and reduced duration of untreated psychosis might improve longer-term outcomes. Strategies for treatment discontinuation or alternative nonpharmacologic treatment approaches may benefit a subgroup of patients but may be associated with incremental risk of relapse and require further study, including the development of biomarkers that will enable a precision medicine approach to individualized treatment." ...

On January 10, 2017, I put up a post titled The Biological Evidence for “Mental Illness”. It was published simultaneously on Mad in America. The post was a response to an earlier comment from Carolina Partners in Mental Healthcare PLLC, which included the assertion “mental illnesses have a long history of biological evidence.” In my January 10 article, I challenged this assertion and pointed out that no such evidence existed. The article generated some comments, most of which were favorable. There was one comment, however, from Michael, who asserted: ...

On January 2, 2017, I published a short post titled Carrie Fisher Dead at Age 60 on Behaviorism and Mental Health. The article was published simultaneously on Mad in America. On January 4, a response from Carolina Partners was entered into the comments string on both sites. Carolina Partners in Mental Healthcare, PLLC, is a large psychiatric group practice based in North Carolina. According to their website, they comprise 14 psychiatrists, 7 psychologists, 34 Advanced Practice Nurse Practitioners/Physicians Assistants, and 43 Therapists and Counselors. They have 27 North Carolina locations. ...

On February 1, Allen Frances, MD, published an interesting article on the Huffington Post blog. The article is called Do Antipsychotics Help or Harm Psychotic Symptoms?, and is a response to Robert Whitaker’s post of January 27: “Me, Allen Frances, and Climbing Out of a Pigeonhole. This post, in turn, was a response to Dr. Frances’s Psychiatric Medicines Are Not All Good or All Bad, which was published in the Huffington Post on January 15. Readers may remember that I published a critique of this latter article on February 9. ...

Steven Reidbord MD is a board-certified psychiatrist who practices in San Francisco. He writes a blog called Reidbord’s Reflections. On December 12, 2015, he posted an article titled Are psychiatric disorders brain diseases? It’s an interesting and thought-provoking piece, with many twists and turns. Here are some quotes, interspersed with my comments and reflections. "Of the conditions deemed inherently psychiatric, some seem rooted in biological brain dysfunction. Schizophrenia, autism, bipolar disorder, and severe forms of obsessive compulsive disorder and melancholic depression are often cited. It’s important to note that their apparently biological nature derives from natural history and clinical presentation, not from diagnostic tests, and not because we know their root causes. Schizophrenia, for example, runs in families, usually appears at a characteristic age, severely affects a diverse array of mental functions, looks very similar across cultures, and brings with it reliable if non-specific neuroanatomical changes. Even though schizophrenia cannot be diagnosed under the microscope or on brain imaging, it is plausible that a biological mechanism eventually will be found. (The same type of reasoning applied to AIDS before the discovery of HIV, and to many other medical diseases.) A similar argument can be made for other putatively biological psychiatric disorders." ...

BACKGROUND DSM-5 defines delusions as “…fixed beliefs that are not amenable to change in the light of conflicting evidence.” (p 87). The manual lists six kinds of delusions: persecutory; referential; grandiose; erotomanic; nihilistic; and somatic. The APA provides another definition of delusions on p 819. It’s substantially the same as the one above, but offers the additional varieties: bizarre; delusional jealousy; mixed type; mood-congruent; mood-incongruent; of being controlled; thought broadcasting; and thought insertion. Interestingly, nihilistic delusions are omitted from the second list. These, we are told on page 87, “…involve the conviction that a major catastrophe will occur.” ...

BACKGROUND On June 19, 2015, I published a post titled Allen Frances’ Ties to Johnson & Johnson. In that post, I set out some very serious allegations against Dr. Frances. I drew these allegations from a document titled Special Witness Report dated October 15, 2010. The report was written by David Rothman, PhD, Professor of Social Medicine at Columbia College of Physicians and Surgeons. Dr. Rothman’s report was produced in the context of a lawsuit filed by the State of Texas against Janssen Pharmaceutica, a subsidiary of Johnson & Johnson. ...

INTRODUCTION I recently came across an article titled Diagnosisgate: Conflict of Interest at the Top of the Psychiatric Apparatus, by Paula Caplan, PhD. The article was published in Aporia, the University of Ottawa nursing journal, in January 2015. Aporia is “a peer-reviewed, bilingual, and open access journal dedicated to scholarly debates in nursing and the health sciences.” Dr, Caplan is a clinical and research psychologist, and an Associate at Harvard’s DuBois Institute. She worked as a consultant to the DSM-IV task force in the 1980’s, but resigned from this position after two years. Here’s a quote from her February 2014 post on Mad in America The Great “Crazy” Cover-up: Harm Results from Rewriting the History of DSM: ...

In November of last year, the Schizophrenia Bulletin published online a research study: Antipsychotic Treatment and Mortality in Schizophrenia, by Minna Torniainen et al. The research was conducted in Sweden. The authors offer the following background for the study: "It is generally believed that long-term use of antipsychotics increases mortality and, especially, the risk of cardiovascular death. However, there are no solid data to substantiate this view." and the following conclusions: "Among patients with schizophrenia, the cumulative antipsychotic exposure displays a U-shaped curve for overall mortality, revealing the highest risk of death among those patients with no antipsychotic use. These results indicate that both excess overall and cardiovascular mortality in schizophrenia is attributable to other factors than antipsychotic treatment when used in adequate dosages." ...

On March 16, Ronald Pies, MD, published an article in the Psychiatric Times. The article is titled The War on Psychiatric Diagnosis, and the sub-title synopsis on the pdf version reads: “A recent report that argues against descriptive diagnosis in medicine is historically ill-informed and medically naive, in the opinion of this psychiatrist.” Dr. Pies is a very prestigious and eminent psychiatrist. He is a professor of psychiatry at both Syracuse and Tufts. He was the first editor of Psychiatric Times, which, by its own account, provides “News, Special Reports, and clinical content related to psychiatry” for “…psychiatrists and allied mental health professionals who treat mental disorders…Circulation of the monthly print publication is approximately 40,000.” ...