March 2012 - Rossa Forbes

Another SSRI story?

Here are some highlights from the latest New York Times article on the ruckus on the Jet Blue aircraft.

Two years ago, the F.A.A. relaxed its longstanding ban on psychiatric medications for pilots, saying that new drugs for depression had fewer side effects than older drugs. The agency now grants waivers allowing pilots to fly while taking Prozac, Zoloft, Celexa or Lexapro, and their generic equivalents.

The F.A.A.’s administrator at the time, J. Randolph Babbitt, said the agency was relaxing its ban because it was concerned that some pilots with depression were not being treated, or were being secretive about it. “We need to change the culture and remove the stigma associate with depression,” Mr. Babbitt said then.

But the F.A.A. said in an e-mail on Wednesday that since April 2010, less than one-half of 1 percent (0.016 percent or 20 out of 120,000 pilots who have a first-class medical certificate) have taken advantage of the F.A.A.’s policy. Pilots on commercial airliners are required to have a first-class certificate.

A 2006 study by the F.A.A. of post-mortem toxicological evaluations of 4,143 pilots killed in accidents from 1993 to 2003 found that 223 were using mood-altering drugs like antidepressants, according to The Associated Press. Only 14 of the pilots who tested positive for the drugs reported a psychological condition on their medical forms, and only one reported using a mood-altering drug. None of the pilots determined to have used neurological medications had reported that on their medical forms, the AP reported.

Beware a public backlash against psychotherapists and a return to medications

I wrote a comment about the perils of blame on the Op-Ed page at the Mad in America blog. I’m wondering if either I have got it all wrong by seeing blame in the piece where no blame was intended, or else I’ve rightly sensed that psychologists are publicly back to blaming family for a relative’s mental illness because they are sensing a growing strength in numbers. At least one other blogger at the Mad in America site got jumped on recently for family bashing. He denied it of course, but like the Op-Ed author, he sprinkled his post with anecdotes about nasty family members of his patients. I call this kind third party relaying of a message “hear say.” Perhaps it’s hypocritical of me, but in my opinion, it’s okay for a patient to blame a family member for his suffering (as he’s 100% entitled to interpret the cause of his suffering the way he does because he knows his experience) but it’s different thing for a psychotherapist to turn around and publicly make negative attributions on individuals he’s probably never met outside of the therapy room. What purpose does this serve? There are ways of getting a healing message across that will not lead to charges of family bashing.

I think it’s appropriate for parents and relatives to examine their role in a family member’s mental illness (parents, especially), and I know how difficult it has been to get this message across in the era of no-blame antipsychotics, when parents would prefer to blame faulty biochemistry rather than venture out into more helpful ways of looking at mental illness. I do believe in personally looking in the mirror and then doing whatever it takes to changing aspects of the relationship that may have caused trauma for your relative. I do believe this and I encourage others to do the same thing because one really can help someone recover this way.

Selling the “look yourself in the mirror” message is a particular hard sell to parents because all parents feel guilty at some level about the way they have raised their children, whether there is a diagnosis of mental illness or not. Nobody likes criticism. Most people don’t react well to it, unless it’s done constructively. When psychiatrists or psychologists write or speak in a public forum, I believe they have a special duty to be non-inflammatory, and non-judgmental. This doesn’t mean that, if they believe the family environment is an important factor in the development of mental illness, they shouldn’t say so, but they should be super vigilant about how their words will be construed.

I’d like to know what you think about Albert Silver’s Op-Ed piece. Is he really family bashing or have I got it wrong? I’d like to hear what you think because I believe this topic is going to become increasingly debated as psychotherapy gains ground at the expense of medications. I contributed a lengthy comment at the end of his Op-Ed in which I pointed out that there may very well be a backlash if the role of family in mental illness isn’t handled constructively.

Check out NAMI Westside LA upcoming conference

They say change always starts in California (the birthplace of NAMI). The NAMI Westside LA agenda for its annual conference (April 22, 2012) includes Robert Whitaker (author, Anatomy of an Epidemic), Dr. Daniel Dorman (author, Dante’s Cure), Catherine Penny and Dr. Michael Livittan.

SESSION 1
Workshop 1 – Robert Whitaker
Evidence-Based Solutions that Promote Robust Recovery: Open Dialogue Therapy in Finland, Exercise for Depression, and Other Promising Therapies
In western Lapland in Finland, only a small percentage of first-episode psychiatric patients are treated with antipsychotics, with the focus instead on psychosocial care. The long-term outcomes for these patients are now the best in the Western World. Why does this approach work so well, and could it be adopted here? Meanwhile, in Britain, depressed patients can obtain a prescription for exercise, which has been shown to produce a much better long-term stay-well rate than antidepressants.

Here in the United States, there is a non-profit group that has formed, called the Foundation for Excellence in Mental Health Care, that is seeking to promote such evidence-based therapies that best promote robust recovery.Worshop 4 – Daniel Dorman, Catherine Penny

This workshop will explore therapeutic approaches that have proven to produce good long-term outcomes, and detail the efforts of the Foundation for Excellence in Mental Health Care to promote such evidence-based therapies here.

PSYCHOTHERAPY OF SCHIZOPHRENIA RESULTING IN FULL RECOVERY. Dr. Dorman and his former patient, Catherine Penney, will discuss “What worked.”
Catherine Penny, age nineteen was admitted to UCLA Hospital suffering from catatonic schizophrenia. Daniel Dorman, M.D., then a resident-in-training, was interested in treating those suffering from schizophrenia psychotherapeutically, without medication, hoping that a human connection oriented towards understanding his patients’ struggles might be curative. Ms. Penney and Dr. Dorman will discuss how their relationship served to help Ms. Penney establish a sense of self, thus relieving her of her terrors and poor self-esteem which allowed her to resume her life, free of the hallucinations and mental shut-down that characterized her years of suffering from schizophrenia. Dr. Dorman and Ms. Penney will also discuss how the current medical model of mental illness needs to be expanded to include a person’s meanings and efforts toward individuation and self-sufficiency.

SESSION 2
Workshop 10- Dr. Michael Livittan
HEALING TRAUMA: THE MIND, THE BRAIN, AND THE FAMILY
This seminar provides an understanding of trauma and its effects on the individual mind, brain, and the family as a whole. The definition, impact, symptoms, and dynamics of trauma are explored in simple yet in-depth terms. Mental and emotional processes, as well as new research on the brain, are explained to highlight the consequences of trauma. In addition, the impact on the family is examined in order to better understand post-traumatic behaviors. Methods and practical tools are provided to facilitate coping, healing, and moving forward with compassion, vitality, and wisdom.

A complete list of Robert Whitaker’s upcoming speaking engagements is found on the Mad in America site.

Schizophrenia research study hogwash

I dunno about you, but I have trouble figuring out what most psychiatric research studies are actually saying. The language is clinical gibberish. Here’s a typical example that I found at the Mad in America blog. My own take on this, not what the study actually says, is that depression accompanying high levels of insight correlate with people correctly interpreting the hopelessness conveyed by their diagnosis. (Note the study’s definition of recovery. This is not recovery in my books. What it is is managing your illness.)

The conclusions drawn from this study are some of the reasons I don’t believe in mental illness. I do believe that there are people who believe in mental illness, and they will do their best to convince you that you are hopeless. As long as someone else believes you are mentally ill, and you are in close proximity to that person, chances are you will remain mentally ill.

http://onlinelibrary.wiley.com/doi/10.1002/jclp.20872/abstract

The Role of Subjective Illness Beliefs and Attitude Toward Recovery Within the Relationship of Insight and Depressive Symptoms Among People With Schizophrenia Spectrum Disorders

Keywords:

psychosis;
awareness;
demoralization;
illness perception;
recovery;
hope

Objective

Low levels of insight are a risk factor for treatment nonadherence in schizophrenia, which can contribute to poor clinical outcome. On the other hand, high levels of insight have been associated with negative outcome, such as depression, hopelessness, and lowered quality of life. The present study investigates mechanisms underlying the association of insight and depressive symptoms and protective factors as potential therapeutic targets.

Methods

One hundred and forty-two outpatients with schizophrenia or schizoaffective disorder (35.2% women, mean age of 44.83 years) were studied using questionnaires and interviews to assess insight, depressive symptoms, recovery attitude, and illness appraisals with regard to course, functional impairments, and controllability. Psychotic and negative symptoms were assessed as control variables. The cross-sectional data were analyzed using structural equation models and multiple linear regression analyses with latent variables.

Results

Higher levels of insight and psychotic symptoms were associated with more depressive symptoms. The association of negative symptoms with depressive symptoms was not significant. The relationship between insight and depressive symptoms was mediated by the participants’ perception of their illness as being chronic and disabling, as well as suppressed by their expectation of symptom control due to treatment. Finally, the association of insight and depressive symptoms was less pronounced in the patients with a positive recovery attitude than in those without this protective factor.

Conclusions

To achieve recovery, which includes symptom reduction, functional improvement, and subjective well-being, it is necessary to prevent depressive symptoms as indicators of a demoralization process, which may arise as a consequence of growing insight. Possible treatment strategies focusing on changes of dysfunctional beliefs about the illness and the self and inducing a positive recovery attitude are discussed.

Clozapine’s new ambassador – Claire Danes

I actually wanted to have a nastier title, (two P words came to mind before I came up with “ambassador”) but I thought better of it. I wish Claire Danes had at least thought about the implications of what she is doing – but of course, money talks. May the Karma truck eventually drive up to her door and dump a load of excess calories her way.

Here’s a look behind the scenes at clozapine, courtesy of David Healy’s Mad in America post.

In the latest hit series Homeland Claire Danes plays Carrie Mathison a CIA agent with bipolar disorder taking Clozapine. She takes the drug to prevent herself tipping over into frank paranoia in a world where being paranoid is necessary for survival.

Anyone who knows anything about Clozapine knows Claire Danes is definitely not on it – she would not be as slim and svelte as she is if she were taking it. Weight gain is something Evident about clozapine that stands in contrast to the Evidence showing no weight gain that companies have gone out of their way to produce for Clozapine and related drugs like Zyprexa and Seroquel (see False Friends).

The question is what does Claire Danes know about Clozapine and should she get paranoid rather than just play the paranoid? As an actress is she killing people playing the part she plays? Is there anything else Evident about Clozapine being hidden by the Evidence?

Clozapine began life in 1958. It was given to the world’s leading psychopharmacologist Pierre Deniker to assess. At the time the neuroleptic/antipsychotic group of drugs was regarded as very safe. Several of Deniker’s patients died on Clozapine and startled by the number and range of deaths he said it was Evident that it should not be developed.

The company who made Clozapine (Wander) paid no heed to him; business and clinical evidence are two different things. Clozapine’s development continued even after Wander was taken over by Sandoz. Then in 1975 a series of deaths on Clozapine following drops in white blood cell counts happened in Finland. Clozapine was removed from markets in Europe and never made it to the US – Homeland Security (aka the FDA) intervened.

But it re-emerged in 1988 in the United States, in part because of efforts within Homeland Security. The history of clozapine’s return has been spun and respun – see The Creation of Psychopharmacology – in the course of which a myth has been created that clozapine is more effective than other antipsychotics (very important for someone on whose wits the fate of America depends) even though head to head trials in first episode psychoses show clozapine to be no better than older drugs like chlorpromazine.

Read the rest here.

Søren Kierkegaard on anxiety

From Opinionator
March 17, 2012, 2:30 pm

The Danish Doctor of Dread

By GORDON MARINO

The way we negotiate anxiety plays no small part in shaping our lives and character. And yet, historically speaking, the lovers of wisdom, the philosophers, have all but repressed thinking about that amorphous feeling that haunts many of us hour by hour, and day by day. The 19th-century philosopher-theologian Soren Kierkegaard stands as a striking exception to this rule. It was because of this virtuoso of the inner life that other members of the Socrates guild, such as Heidegger and Sartre, could begin to philosophize about angst.

It is in our anxiety that we come to understand feelingly that we are free, that the possibilities are endless.

Though he was a genius of the intellectual high wire, Kierkegaard was a philosopher who wrote from experience. And that experience included considerable acquaintance with the chronic, disquieting feeling that something not so good was about to happen. In one journal entry, he wrote, “All existence makes me anxious, from the smallest fly to the mysteries of the Incarnation; the whole thing is inexplicable, I most of all; to me all existence is infected, I most of all. My distress is enormous, boundless; no one knows it except God in heaven, and he will not console me….”

Is there any doubt that were he alive today he would be supplied with a refillable prescription for Xanax?

Read the rest here.

Same wood work, different meaning this time

This post is really not such much about changing my mind on how I felt about something at the time, but seeing the wisdom of doing something meaningful at the right time.

Chris recently started volunteering any spare time he has on the week-ends to help the amateur operatic group he sings with construct sets and props. The idea to volunteer for behind the scenes work was suggested by his occupational therapist. Under guidance from two older men in the group, Chris is swinging a hammer and sawing wood and doing whatever one must do to set the stage for April. He’s enjoying himself and he gets to hear all kinds of interesting stories from the men with whom he works.

The kind of work he is doing now is the kind of work that failed miserably —oh so many years ago after he had finished his two year day program. The day program hadn’t “fixed” him, and, as kind of a last resort, the psychiatrist at the program arranged for Chris to “apprentice” with a cabinet maker. The apprenticeship or sheltered workshop or whatever it was considered, was covered through our health insurance policy. Chris didn’t succeed as an apprentice cabinet maker or sheltered workshop worker, because, well, frankly, he didn’t do any work. He didn’t do any work not because he wasn’t encouraged to, but because he couldn’t. According to Chris, he just drank cups of coffee, spoke very little, and watched the cabinet maker hard at work sanding and buffing. Ian and I had to drive Chris to the door of the shop, otherwise he wouldn’t go in.

I believe that institutionalizing mental illness through day programs and sheltered workshops hinders recovery because it makes the person feel and act like a patient. The word “disabled” comes to mind.

Perhaps what the doctors in the program should have thought about, but probably didn’t, was that parents are still dealing with grief mixed with expectations about their relative. I felt the doctors were trying to turn my academically promising son into a disabled worker. They were lowering his expectations (and mine!) by having him sand wood in a gloomy workshop. Only two years earlier he was at university. Chris’s psychiatrist told me point blank that Chris would never again be the promising student that he once was. So, I feel I correctly interpreted what the wood studio meant for Chris’s future. Chances are Chris came to the same conclusions as I did.

Today, I can’t say I’m thrilled that Chris sees an occupational therapist, because I don’t see him as “handicapped” (and this, to me, is what having an occupational therapist implies) but at some point, I just stopped trying to run interference with his recovery and leave it to the wisdom of others. I never thought I had all the answers, but I also don’t believe they have all the answers either. I’m very pleased that Chris is happy hacking and sawing away to his heart’s content in a woodworking shop. The difference is that this time his being there is a natural outgrowth of his love of the musical theater work that he is doing.

Here’s an interesting perspective from Raymond’s Room on what’s happening vis a vis sheltered workshops in Oregon State.

David Healy in Toronto on promotional tour for new website

Thanks to Chris for spotting this article.

From The Globe and Mail
Drug-risk website aimed at consumers

anne mcilroy Published Wednesday, Mar. 14, 2012 4:05PM EDT

Julie and Peter Wood say they wish they had known more about the stimulant a doctor prescribed for their son to help him concentrate.

John David Wood, a student at the University of Toronto, became addicted to the medication and developed serious mental health problems after he abruptly went off it. He committed suicide in 2008, at the age of 26.

In an effort to help other families learn more about the potential downside of prescription drugs, his parents are working with David Healy, a high-profile critic of the pharmaceutical industry, on a new website – RxISK.org.

They hope the website will make it easy for people to research any drug that is approved for use in Canada or the United States, both brand names and generics. But they also want to build a grassroots database on side effects of these medications. For now, patients can search the new website, at no cost, for information about the adverse impact of drugs collected by the Food and Drug Administration in the U.S. But if all goes according to plan, in a few weeks the new website will ask patients to report side effects and allow them to see whether other people have experienced the same symptoms.

Read the rest here

International society removes ‘schizophrenia’ from its title

TUESDAY, 13 MARCH 2012

International society removes ‘schizophrenia’ from its title

A statement from the ISPS today reveals that the society has voted to remove the word ‘schizophrenia’ from its title due to the term being deemed ‘unscientific andstigmatizing’:

“Members of the International Society for the Psychological Treatments of the Schizophrenias and Other Psychoses (www.isps.org) have just voted, by an overwhelming majority, to change the society’s name to the International Society for Psychological and Social Approaches to Psychosis. The new logo and letterhead are to be adopted by the end of March.

The change comes at a time when the scientific validity of the term schizophrenia is being hotly debated in the lead up to the publication of the latest edition of the Diagnostic and Statistical Manual (see http://dxrevisionwatch.wordpress.com).

Dr. Drew said it

With a straight face, I may add. He said that before a psychiatric diagnosis is rendered, the doctor will systematically rule out potential biological causes.

What?

Like rule them out as in schizophrenia?

He’s got to be joking. Let’s see, no doctor ever suggested running some tests on Chris, “just to see if he had any underlying biological problems.” The only time Chris ever got blood tests on the doctor’s orders was when he was on antipsychotic medication.

The person who suggested that we “run some tests” on Chris was me. He got a brain scan only after I suggested he have one. The doctors didn’t just stop at not recommending biological testing. They also balked at sending him for complementary and alternative treatment.

Running tests to rule out underlying biological problems for cases of mental illness is a myth that goes down well with the public, especially on prime time television. It’s like believing that a judge is a neutral party who impartially weighs all the evidence and then delivers a verdict. Hah!