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> Notes On Psychiatric Fascism, Notes on Psychiatric Fascism
Fremen Bryan
post Feb 2 2008, 05:49 PM
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Notes on Psychiatric Fascism
by Don Weitz - Toronto, Ontario

For almost 150 years, psychiatry has been masquerading as a medical science and as a branch of medicine. It is not and never was a science or a type of health care. Modern psychiatry is driven by unproved empirical assumptions, medical biases, and pseudo-scientific opinions. There are no scientifically established, independently proven facts in psychiatry. Psychiatry, in fact, has no laws or testable hypotheses and no coherent and comprehensive theory. Psychiatry conspicuously lacks scientific proof or evidence to support its news-media-parroted claims of "mental illness" or "disorders".

After about seventy years of psychiatric practices and research, there is still no diagnostic test for schizophrenia or any of the other three hundred so-called mental disorders listed in the current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is essentially a list of class-driven moral judgements of allegedly abnormal behaviour, published and propagandized by the American Psychiatric Association. The DSM is the official bible of organized psychiatry. The DSM is the equivalent of the Malleus Maleficarum in the middle ages, which Spanish inquisitors used to identify, target, stigmatize and burn witches and heretics. Today's witches, heretics, and scapegoats are labeled mentally ill or schizophrenic.

Hospital psychiatry with its emphasis on the control of inmate behaviour through high risk behaviour modification programs, biological "treatments", physical and mechanical restraints, locked doors and wards, and seclusion/isolation rooms, have always exhibited several fascist elements. I want to focus on three: fear, force and fraud. These are the guiding principles and policies used to control citizens and groups in the population whom government leaders and other authorities, including the police and so-called mental health experts, have judged to be dissident, problematic or difficult to control. Hospital psychiatry is very similar to the prison system. In the prison or correctional system psychiatrists have been used as consultants to design dangerous, unethical behaviour modification programs and to conduct high risk drug experiments on prisoners. Both the psychiatric system and the prison system systematically use fear, force and fraud for the purpose of social control and punishment - not for purposes of treatment or rehabilitation, both of which are euphemisms. It is or should be obvious that forced treatment is in fact punishment. It is frequently cruel and usual and should therefore be banned in the United States under that nation's Eighth constitutional amendment. Virtually all treatments in psychiatric facilities are forced or administered without informed consent. They are administered against the "patient's" (the prisoner's) will or with consent obtained by threatening the "patient" with worse consequences, or with consent obtained by keeping the "patient" unaware of important information about serious risks and alternatives. Informed consent in psychiatry is a cruel sham. It doesn't exist.

Fear/Terror - "Terror acts powerfully upon the body through the medium of the mind and should be employed in the cure of madness. Fear accompanied with pain and the sense of shame has sometimes cured the disease". That was written almost two centuries ago in 1818 by Dr. Benjamin Rush, father of American psychiatry, and the first president of the APA, whose face still appears on the official seal of the American Psychiatric Association. Dr. Rush advocated and practiced terror by designing and using the straitjacket, the tranquilizer chair and "fear of death" on numerous inmates in 19th century lunatic asylums. Rush once had his son locked up in an insane asylum - some father!

Fear is a powerful motivator in enforcing conformity, obedience and making people submit to authority. Historically, inducing and manipulating fear or masked terror has always been a key policy and practice in all fascist regimes, such as Italy under Mussolini, Nazi Germany under Hitler, and the Soviet Union under Stalin - in fact, under any dictatorship. The threat of punishment, torture and the threat of being killed is enough to cause fear, panic, and terror if most of us. We do as we're told or else.

As used in psychiatry, fear or terror is more selective but is widespread and powerful. In the institution, psychiatry frequently resorts to blackmail to control the more "uncontrollable" and difficult or non-compliant patient. Psychiatrists and other therapists threaten their patients with longer incarceration, higher doses of forced neuroleptics or "antidepressants", and/or threatened transfers to more severe maximum security institutions if they misbehave, fail to follow doctors' orders, refuse to take their "medication", refuse to follow institutional rules, or annoy their captors in other ways. Generally aimed at captive populations of involuntary patients, these threats typically strike fear in many of them, and psychiatrists know it. For example, some years ago, several patients and former patients of Queen Street Mental Health Centre, Toronto's notorious mental hospital or psycho-prison, told me and other activist-critics that psychiatrists have threatened, if they didn't calm down or control themselves, to transfer them to Penetang, the Oakridge division of Penetanguishene Mental Health Centre, a maximum security behaviour modification facility in Ontario, known for its harsh and brutal environment. Penetang was and still is recognized as punishment, one of the most barbaric psycho-prisons in Canada. It should have been shut down years ago, especially after a scathing report about many of its abuses by psychiatrist Steven Harper.

Threatening patients with physical restraints or solitary confinement is also extremely effective in arousing fear or panic in patients. On virtually every psychiatric ward or unit, there is a place, euphemistically called "The Quiet Room", a barren and forbidden cell-like room, with a mattress or sink, usually no toilet or blankets. While languishing the quiet room, patients are sometimes further restrained by leather cuffs, two-point and four-point restraints, tightly wrapped around their wrists and/or ankles so they can barely move, for hours at a time. The mere threat of loss of freedom, involuntary committal, or being locked up in a psychiatric ward or institution against your will, and without any trial or public hearing, is enough to frighten most of us. In virtually every province and territory in Canada, these are the main criteria or reasons for being locked up or committed to a psychiatric institution: judgement of mental illness or disorder; judgement of threatening to physically hurt yourself or another person; judgement of being unable to look after yourself. Note that these criteria are subjective moral judgements of dissident behaviour based on observation and opinion, not medical or scientific facts. Despite the fact that mental illness or mental disorder, which in my opinion is a metaphor for dissidence, has never been officially classified as a medical disease or illness, only physicians are legally authorized to make these non-medical and fateful judgements.

In Ontario, any doctor can sign a committal form which forces an individual to be locked up in any psychiatric facility for the first 72 hours for observation and assessment. Two other doctors can sign a form authorizing an individual's imprisonment for another 2-4 weeks. During the last few years, approximately 50% of thousands of people treated in Ontario's nine psychiatric hospitals were involuntarily committed.

The threat or fact of losing your freedom being locked up in a psychiatric facility for days or months at a time is terrifying. The minimal or non-existent advocacy currently provided in Ontario makes the right to appeal or protest a sham, and this serves to heighten people's fear and despair. The mere threat of forced psychiatric treatment as well as the treatment itself can be terrorizing - e.g., electroshock, also called electro-convulsive therapy (ECT), but more accurately called electro-convulsive brainwashing by shock survivor critics such as Leonard Frank. My close friend Mel told me of being dragged by several aids along the hallway to a hospital shockroom. I can imagine his terror and the terror of others who suffered the same fate. I suffered a similar terror when I was forcibly subjected to over 50 subcoma insulin shocks in the 1950s. To the surprise of many people, this barbaric brain-damaging and memory destroying treatment not only exists, but is expanding in Canada and the United States. Its main targets are women and the elderly, particularly elderly women.

There is also the threat of psychiatric drugs, euphemistically called "medication". These chemicals such as minor tranquilizers, antidepressants and the anti-psychotics such as Haldol, Thorazine, and the so-called mood modifier Lithium, are not natural substances but are manufactured poisons, aptly called neurotoxins by psychiatrist and psychiatry critic Peter Breggin in several of his books and Joseph Glenmullen, a clinical instructor in psychiatry at Harvard Medical School, in his book Prozac Backlash. These chemicals have no scientifically proven medical value or benefit. What they do is control or subdue any problematic or disturbing behaviour, mood and emotion. These toxins, particularly neuroleptics like Haldol, Modicate, Chlorpromazine, are so disabling, powerful and fearsome that many psychiatric survivors and other critics call them chemical lobotomies or chemical straitjackets. These drugs have many serious and disabling effects, called "side effects" to minimize how they are perceived, such as trembling, uncontrollable shaking or movement of the hands or other parts of the body (which occur in the neurological disorder such as Parkinsonism or tardive dyskenisia), powerful muscular cramps, blurred vision, restless pacing, nightmares, sudden outbursts of anger, agitation, memory loss, fainting, blood disorders, seizures, and sudden death. These so-called side effects are the drugs' intended effects. This fear of psychiatric drugs is compounded by ignorance and uncertainty, because psychiatrists and other doctors fail to inform patients of the drugs' horrific effects.

Without the use or threat of force, fascism could not exist. Machiavelli, Mussolini, Hitler knew this. All dictators, would-be dictators, and bullies know this basic fact. And this is the case with psychiatry. Without the use and threat of force, institutional psychiatry would die. Lots of psychiatrists would be out of a job. I wish that would happen! Psychiatry gets its authority and power to force, imprison, involuntarily commit, and treat individuals against their will from the state.

Mental health legislation gives psychiatrists and other physicians the power to involuntarily commit any person they "believe", after only minutes of examination, to be dangerous to themselves or others. This is problematic. The Mental Health Act wrongly assumes that doctors can predict dangerous and violent behaviour, which they cannot do. It is worth emphasizing that Ontario's Mental Health Act, as with other mental health acts across Canada and the United States, legally sanction the state to use force to detain or imprison people for days, weeks or months at a time. Unfortunately, there has never been a public outcry or protest over the fact that people judged or assumed to be crazy or dangerous, but not charged with any crime, can nevertheless be locked up without a trial or the legal rights accorded to people charged with crimes such as murder or rape. This is prevention detention, which is illegal in Canada and other so-called democratic countries, but it is legal and a common practice in all police states and totalitarian countries. I know of no lawsuit challenge to involuntary committal as preventive detention and therefore as unconstitutional.

In institutional psychiatry in fascist states, forced treatment is the rule, not the exception. Forced treatment and tortuous terminal medical experiments inflicted on thousands of Jews, gypsies, political prisoners, women and children, were carried out in death camps during World War II throughout Nazi Germany. There is now irrefutable, documentary evidence that it was the German psychiatrists, particularly prominent professors of psychiatry, and psychiatry department heads, who were chiefly responsible for initiating and administering the infamous T4 program, which involved the mass murder of over 200,000 mental patients and thousands of sick and disabled children and adults during the holocaust. The term euthanasia and mercy death to describe this murderous program is a cruel euphemism.

Much of biological psychiatry, which is largely based on unproved assumptions about the biological and genetic causes of schizophrenia and other mental disorders, can be traced back to the racist, eugenics-driven psychiatrist in Nazi Germany, Ernst Rudin, who propagated the myth that schizophrenia is a genetic disease. He, along with hundreds of other psychiatrists in the T4 program of mass murder of psychiatric patients, is still cited in some psychiatric journal articles, as documented by researcher-activist Lenny Lapon in his brilliant book, Mass Murderers in White Coats: Psychiatric Genocide in Nazi Germany. He states that several German psychiatrists from the Nazi era emigrated to the United States and Canada and succeeded in indoctrinating many of his colleagues in his biological, genetic and racist theories of mental illness. Heinz Layman who emigrated to Canada in 1937, is chiefly responsible for introducing Thorazine or Chlorpromazine, and propagated the use of psychiatric drugs in Canada.

We now have an epidemic of brain damage caused by psychiatric drugs, partly due to Layman and all the other doctors he taught. In one 1954 journal article, Layman admitted that Thorazine was a "pharmacological substitute for lobotomy". Despite publicly acknowledging this alarming fact, it never stopped Layman from using it on many "schizophrenic" patients in Montreal's Douglas Hospital. Layman also persuaded Ewen Cameron to administer chlorpromazine and many other drugs and massive amounts of electroshock. Chlorpromazine, considered an experimental drug at the time, was widely used on many patients during Cameron's infamous brainwashing experiments at the Allan Memorial Institute in the 1950s and 1960s.

There was no informed consent then, and there is none now. During the Nazi years, the doctors didn't seek permission. According to Nazi ideology, these were "useless eaters", "subhumans". This is a mindset that still rules in biological psychiatry throughout North America. Another legacy of psychiatry in Nazi Germany is the widespread acceptance and justification of abuse to break the will of non-compliant or rebellious patients. Physical or mechanical restraints such as straps, ropes, belts, handcuffs and solitary confinement are used in psychiatric institutions not to treat or protect but to punish people for dissident or rebellious behaviour. It is this naked display of force and threats against patients by hospital staff which resembles the awesome brutality of German psychiatric staff during the holocaust.

Fraud: A very apt quote by Leonard Roy Frank, author of Influencing Minds is "Mystification is psychiatry's defense against the danger of being found out". Many of the labels or diagnoses used by psychiatrists do not refer to real psychiatric problems or to actual illnesses. Psychiatry professor Thomas Szasz has exposed the fraud and the myth of the concept of mental illness in many books, starting with his classic The Myth of Mental Illness. This misrepresentation one of the greatest scientific scandals in our scientific age. The code words that are now used in biological psychiatry such as anti-depressants do not assist people with overcoming depression or get at the causes of depression. The term "Quiet Room" is a fraudulent code for solitary confinement. The word "medication" is also a misleading euphemism and misrepresentation for toxic substances to which many of us have been subjected.

I've tried to show that institutional, coercive psychiatry has a fascist history and that biological psychiatry as practiced today in psychiatric facilities in Canada and the United States is still based on fear, force and fraud. Psychiatry does not deserve public or government support. We must work to abolish psychiatry. We must also continue working to create self-help advocacy groups, more drop-in centers, and more affordable, supportive housing in our communities. We need to create our own alternatives to the monstrous and evil mental health system. By doing this, we empower ourselves. This is our work, our challenge, and our hope.

Copyright 2001 by Don Weitz - used by permission


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Fremen Bryan
post Apr 8 2009, 02:39 PM
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An interesting message:-
* * * * * * *

Doctors
(A) The number of physicians in the U.S. is 700,000.
(B) Accidental deaths caused by Physicians per year are 120,000.
© Accidental deaths per physician are 0.171.

Statistics courtesy of U. S. Dept of Health and Human Services.
>>>>>>>>>>>>

Now think about this:

Gun Owners
(A) The number of gun owners in the U.S. is 80,000,000. (Yes, that's 80 million)
(B) The number of accidental gun deaths per year, all age groups, is 1,500.
© The number of accidental deaths per gun owner is 0.000188.

Statistics courtesy of FBI

>>>>>>>>>>>> >>>>>>>>>

So, statistically, doctors are approximately 9,000 times more
dangerous than gun owners.

>>>>>>>>>>>> >>>>>>>>> >>>

Remember, 'Guns don't kill people, doctors do.'

>>>>>>>>>>>> >>>>>>>>

FACT: NOT EVERYONE HAS A GUN, BUT ALMOST EVERYONE HAS AT LEAST
ONE DOCTOR.

>>>>>>>>>>>> >>>>>>>>> >>>>>

Please alert your friends to this alarming threat. We must ban
doctors before this gets completely out of hand!!!!!

Out of concern for the public at large, I withheld the statistics on
lawyers for fear the shock would cause people to panic and seek medical attention!

This post has been edited by Fremen Bryan: Apr 8 2009, 02:42 PM


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dragnik
post Apr 9 2009, 02:35 AM
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http://en.wikipedia.org/wiki/McCarthyism





(what's the difference?)

This post has been edited by dragnik: Apr 13 2009, 05:09 AM
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Guest_Tearz4Fearz_*
post Apr 10 2009, 10:12 AM
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That is a very one-sided article, which focuses on very extreme cases. No doubt, this happens, and there is so much abuse in the system (I've witnessed it/experienced it personally). This is wrong, obviously, and some people who are not ill are forced into the hospitals and forced to take medication. Sometimes court orders are in place to force it on people, and sometimes restraints and other vicious methods (quietroom, isolation) are used. Anytime you infringe on someone's rights and treat them as less than a child of God or a human being it is wrong, and anytime a person is treated as a sub-human or degenerate it is wrong. So many of the things in that (Canada based) article are right on target. I've noticed that there is not a lot of "talk therapy" that occurs in these hospitals/asylums and that many of the problems patients are dealing with could be solved a lot better if they were to talk it out with someone, to know that there is someone who cares and can direct them. I believe that the system eliminates compassion and caring and the humanity which goes along with being ill and puts forth an empirical system based on cash, numbers, drugs, blood tests, urine tests, and pills. There is little (real) help offered to the person that is suffering. Mental illness affects the brain, I mean the mind of the person suffering and it can be torment, but when the person acts out or questions why they are (against their will) forced into a 'mental prison' aka hospital they are often rebuked or ignored, leading them to become further agitated and then possibly placed in seclusion or on restraints. This can be an incredibly confining experience that involves the stripping of ones freedom and rights. There are better ways to deal with someone who is really upset or borderline irrational, but often, these are the methods that are used. A little bit of compassion and education goes a long way. There are ways to learn about ones diagnosis and illness and ways to help the patient.

Yet I disagree with the one-sidedness of the article and some of its claims. For example, much of psychiatry or psychology is based on proven facts. There are many parts to the human mind and many ways that it functions, accordingly, there are many ways the brain can malfunction or not function correctly. PET scans show this, in a PET scan of an individual diagnosed with skitzophrenia, the colors in the brain show up red and yellow, not the colors of a normal functioning brain. In taking the medication for Skitzophrenia, the same brain can be a normal hue of green and blue. This shows that the medicine not only does something, but that it serves a function to normalize brain activity. Psychiatry is a new and evolving science. It is very fun to study, and if you have a great love of people and would like to help them it can be a very rewarding field. Psychology is the same way, both are a great way to learn about the mind and brain function and a way to help people, and a lot of people in the field(s) go into those fields to do just that. In some cases, the structure in place is used to the extreme in a detrimental way. The system is not perfect. Mankind is not perfect, either. Some of the techniches have not been perfected, but to call it a hoax or claim it never helped people is wrong. Many many people have been helped through therapy and medication. There is a lot to the theories studied in psychology and it has come a long (long) way since the 1800's, with more being learned every day. It is a great science and a very rewarding career.

The truth is that the brain is constantly doing different things. Not one day is entirely the same. It is full of neurotransmitters (dopamine, norepinephrine, serotonin, GABA) that fire constantly, and misfire as well. The medicine is used to get malfunctioning brains functioning normally. There is indeed an element of science to the whole process. Many times things improve for those on the medication. I would not go so far as to knock a whole field because abuses happen, abuses happen in many fields. I may be partial to this one as a student of psychology, however. In any case, I thought you should have 2 sides to this story, because there are two sides to every story.
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Fremen Bryan
post Apr 20 2009, 11:05 AM
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http://blogs.psychologytoday.com/print/4353


Bipolar disorder and its biomythology: An interview with David Healy

Christopher Lane, Ph.D. Created Apr 16 2009 - 3:11pm



David Healy, a former secretary of the British Association for Psychopharmacology, is the author of over 120 articles and 14 books, including The Antidepressant Era, The Creation of Psychopharmacology, and Mania, a fascinating new book on the history of bipolar disorder. His criticism of drug-company practices has put him at odds with colleagues in psychiatry and pharmacology. At the same time, his undisputed expertise as a leading academic, researcher, and clinician gives him a unique perspective on patterns and problems in Anglo-American psychiatry. He recently agreed to answer a number of questions about the growing prevalence and expanded definition of bipolar disorder.



Part of what you describe in your new book Mania: A Short History of Bipolar Disorder is a fair amount of "biomythology" about the illness. What aspects in particular do you have in mind?



Biomythology links to biobabble,
a term I coined in 1999 [1] to correspond to the widely-used expression psychobabble. Biobabble refers to things like the supposed lowering of serotonin levels and the chemical imbalance that are said to lie at the heart of mood disorders, ADHD, and anxiety disorders. This is as mythical as the supposed alterations of libido that Freudian theory says are at the heart of psychodynamic disorders.



While libido and serotonin are real things, the way these terms were once used by psychoanalysts and by psychopharmacologists now—especially in the way they have seeped into popular culture—bears no relationship to any underlying serotonin level or measurable chemical imbalance or disorder of libido. What's astonishing is how quickly these terms were taken up by popular culture, and how widely, with so many people now routinely referring their serotonin levels being out of whack when they are feeling wrong or unwell.



In the case of bipolar disorder the biomyths center on ideas of mood stabilization. But there is no evidence that the drugs stabilize moods. In fact, it is not even clear that it makes sense to talk about a mood center in the brain. A further piece of mythology aimed at keeping people on the drugs is that these are supposedly neuroprotective—but there's no evidence that this is the case and in fact these drugs can lead to brain damage.



How does our understanding of "mania" differ today from earlier conceptions of the phenomenon?



Bipolar disorder itself is a somewhat mythical entity. As used now the term bears little relation to classic manic-depressive illness, which required people to be hospitalized with an episode of illness, either depression or mania. The problems that currently are grouped under the heading "bipolar disorder" are akin to problems that, in the 1960s and 1970s, would have been called "anxiety" and treated with tranquilizers or, during the 1990s, would have been labeled "depression" and treated with antidepressants.



How did we move so rapidly in the 1990s from a psychotherapeutic treatment model for children to a largely drug-related one?



I think a key factor in this shift has been the availability of operational criteria. These were introduced in 1980 in DSM-III, the 3rd edition of the Diagnostic and Statistical Manual of Mental Disorders. The idea was to bridge the gap between the psychotherapists, on the one hand, and the neuroscientists on the other. It was hoped that if both camps could ensure that patients met 5 of 9 criteria for depression, for instance, then at least the patient groups would be homogenous, even if the views on what had led to the problems weren't.



It was still assumed, however, that there was a place for clinical judgment, so that a patient who met 5 of the 9 criteria for depression but had 'flu or was pregnant would be diagnosed as being pregnant rather than depressed. But in the face of company marketing, and with the advent of the Internet, clinical judgment has been eroded. Patients going on the Internet or faced with drug company materials now all too easily find that they meet criteria for a disorder and there is often nothing or no-one to tell them this is not equivalent to having the disorder.



In the extreme, I have had patients with highly social careers come to me and say they think they have Asperger's Syndrome because they've been on the Internet and find that they meet the criteria for this when, in fact, almost by definition, such a person cannot have Asperger's Syndrome. In the absence of clinical judgment there is a default towards a biological option and a drug solution. Criteria create a problem for which a drug is all too often the answer, in just the same way that measurements of your lipid levels create a problem that a statin is the answer to.



Operational criteria are interacting here with a certain loss of medical authority. It is not possible for a doctor today to say to a patient, "Based on my 15 to 20 years experience, you do not have PTSD," or whatever. She cannot say, "We do not need to continue this conversation; come back when you've had a medical training and 15 years of clinical experience."



The doctor has to engage with the patient on the level of the material that's out there in popular culture, and when she tries to do this she will find that she's up against an extraordinarily skilful deployment of those materials by pharmaceutical company marketing departments who are masters at populating the wider culture to suit their interests.



In the mid-1990s, you note, roughly half of all mood disorders were redefined as bipolar disorder rather than depression. What do you think accounts for that dramatic shift in perspective?



The key event in the mid-1990s that led to the change in perspective was the marketing of Depakote by Abbott as a mood stabilizer. Before that, the concept of mood stabilization didn't exist. And while in a popular TV series we can accept that Buffy the Vampire Slayer gets a new sister in Season Five that she had all the time but we didn't know about, we don't expect this to happen in academia.



The introduction of mood stabilization by Abbott and other companies who jumped on the bandwagon to market anticonvulsants and antipsychotics was in fact quite comparable to Buffy getting a new sister. Mood stabilization didn't exist before the mid-1990s. It can't be found in any of the earlier reference books and journals. Since then, however, we now have sections for mood stabilizers in all the books on psychotropic drugs, and over a hundred articles per year featuring mood stabilization in their titles.



In the same way, Abbott and other companies such as Lilly marketing Zyprexa for bipolar disorder have re-engineered manic-depressive illness. While the term bipolar disorder was there since 1980, manic-depression was the term that was still more commonly used until the mid-1990s when it vanishes and is replaced by bipolar disorder. Nowadays, over 500 articles per year feature bipolar disorder in their titles.



You just have to look at Lilly's marketing of Donna from
the Zyprexa documents on the Internet [2] to see what is going on here: "Donna is a single mom, in her mid-30s, appearing in your office in drab clothing and seeming somewhat ill at ease. Her chief complaint is 'I feel so anxious and irritable lately.' Today she says she has been sleeping more than usual and has trouble concentrating at work and at home. However, several appointments earlier she was talkative, elated, and reported little need for sleep. You have treated her with various medications including antidepressants with little success. . . You will be able to assure Donna that Zyprexa is safe and that it will help relieve the symptoms she is struggling with."



Donna could have featured in ads for tranquilizers from the 1960s to the 80s, or for antidepressants in the 1990s, and would have probably been more likely to respond to either of these treatment groups than to an antipsychotic, and less likely to be harmed by them than by an antipsychotic. What company marketers are so good at doing is framing the common symptoms people have—we almost all have—in a manner most likely to lead to a prescription for the remedy of the day. It flies in the face of a century of psychiatric thinking to see conditions that patients like Donna have as bipolar disorder. But while a century of psychiatric thinking used to count for something, it doesn't any longer.





Between 1996-2001, you explain, there was a fivefold increase in the use of antipsychotics (Zyprexa, Risperdal, Abilify, Seroquel, and others) in preschoolers and preteens. What role did DSM-IV play in that, with its introduction of the still-controversial category Bipolar II disorder?



The concept of juvenile bipolar disorder flies even more in the face of traditional wisdom in psychiatry than does calling Donna bipolar. As of 2008, upwards of a million children in the United States—in many cases preschoolers—are on "mood-stabilizers" for bipolar disorder, even though the condition remains unrecognized in the rest of the world.



I am not sure how much DSM-IV played a role in this switch. I think the companies would have found a way to engineer the switch even without the introduction of Bipolar II disorder in DSM-IV.





So then how much of that shift is attributable to SSRI antidepressants coming off patent while the antipsychotics were still major revenue earners?




I think this was in fact central to what happened. The antidepressants were due to come off patent whereas the anticonvulsants were older drugs that could be repatented for this purpose, and the antipsychotics—which also could be (and were) marketed as mood stabilizers—were early in their patent life.




A related point that's worth bringing out is that the switch happened because companies weren't able to make new and more effective antidepressants. Had they been able to do so, I think they would have probably stuck with the depression model rather than made the switch to bipolar disorder.



In terms of what is happening in the US, I think we have to look at how skillfully the drug companies have exploited doctors. Doctors have wanted to help. While the drugs are available on prescription only, doctors tend to see giving a medicine as the way to go, where previously they had been much more skeptical about the benefits of drug treatments.



The drug companies have engineered a situation in which academics have become the primary spokespeople for the drugs. We see the sales rep in the corner and think we can easily resist his or her charms—but we still let them pick up the drinks tab. But it's the academics who sell the drugs. Doctors who think they are uninfluenced by company marketing listen to the voices of academic psychiatrists when these, in the case of the antidepressants or antipsychotics given to children, have talked about the data from controlled trials, and by doing so have been witting or unwitting mouthpieces for company marketing departments.





In your opinion, did the FDA's 2004 decision to add black-box warnings to SSRIs over pediatric use lead to greater off-label prescriptions and even the move toward antipsychotics, on the presumption that the latter are safer to use on children?





I think this had very little effect on the switch from depression to bipolar disorder, but what was quite striking was how quickly companies were able to use the views of the few bipolar-ologists who argued that when children become suicidal on antidepressants it's not the fault of the drug. The problem, they said, stems from a mistaken diagnosis and if we could just get the diagnosis right and put the child on mood stabilizers then there wouldn't be a problem.





There is no evidence for this viewpoint, but it was interesting to see how company support could put wind in the sails of such a perspective.


It was also interesting to see how close to delusional people could get about an idea like this. Faced with details such as even healthy volunteers becoming suicidal on an antidepressant, committed bipolar-ologists were quite ready to say that this just shows that these normal people are latently bipolar.



In this case, I think most people will see that "latent bipolarity," as a concept, is functioning a little bit like the way latent homosexuality once functioned for the Freudians. Most people will also see that the first concept is impossible. What the companies have done is hand a megaphone to the proponents of that view on bipolar disorder, which was until very recently a distinctly minority one.



And are the antipsychotics in fact safer than antidepressants?



No, they are not. The antipsychotics are as dangerous as the antidepressants. Before the introduction of the antipsychotics, the rates of suicide in schizophrenia were extremely low—they were hard to differentiate from the rest of the population. Since the introduction of the antipsychotics
the rates of suicide have risen 10- or 20-fold [3].



Long before the antidepressants were linked with akathisia, the antipsychotics were universally recognized as causing this problem. It was also universally accepted that the akathisia they induce risked precipitating the patient into suicidality or violence.



They also cause a physical dependence. Zyprexa is among the drugs most likely to cause people to become physically dependent on it. As far as I am concerned, Zyprexa's license for supposed maintenance treatment in bipolar disorder stems from data that is in fact excellent evidence for the physical dependence it causes and the problems that can arise when the treatment is stopped.



In addition, of course, these drugs are known to cause a range of neurological syndromes, diabetes, cardiovascular problems, and other problems. It's hard to understand how blind clinicians can get to problems like these, especially in youngsters who grow obese and become diabetic right before their eyes.



But we have a field which, when faced with the obvious, instead chose to listen to Eli Lilly voices saying, "Oh no, there is no problem with Zyprexa. The psychosis is what causes diabetes—Henry Maudsley recognized that 130 years ago." Well Henry Maudsley hated patients, and saw very few of them at a time when diabetes was rare. We recently looked at admissions to the North Wales Hospital from 1875-1924, years spanning his career, and among the more than 1,200 cases admitted for serious mental illness, not one had diabetes and none went on to develop it.



We also looked at admissions to the local mental-health unit between 1994 and 2007, and in over 400 first admissions none had type 2 diabetes, but
the group as a whole went on to develop diabetes at twice the national rate [4].



This is not surprising. What is is how the entire field swallowed the Lilly line, especially when it was so implausible to begin with. We had great difficulties getting this article published—one journal refused even to have it reviewed.



One way of raising the profile of bipolar disorder in children, you note, was to argue that they'd been misdiagnosed with ADHD. What were the implications and effects of that claim?





In the case of children with ADHD, I think what one needs to appreciate is that in most of the world until very recently (and in countries like India still), ADHD is a very rare disorder where children, usually boys, are physically very overactive. This is a condition they grow out of in their teens. Treatment with a stimulant can make a difference in cases like this. Whether treatment is always called for, however, may depend on the circumstances of the child as opposed to the nature of any supposed condition.




It is only in a world where schooling or adherence to a particular set of social norms is compulsory that a condition like ADHD becomes a disorder. There was greater scope over a century ago than there is now for children to do other things in childhood and wait until they settled down in adolescence without being treated for their condition.


What we have today is not ADHD as it was classically understood, but rather a state of affairs we have had for centuries, which is "the problem child." Today the problem child is labeled as having ADHD. But having just one label is very limiting. Child psychiatry needed another disorder—and for this reason bipolar disorder was welcome.



Not all children find stimulants suitable, and just as with the SSRIs and bipolar disorder it has become very convenient to say that the stimulants weren't causing the problem the child was experiencing; the child in fact had a different disorder and if we could just get the diagnosis correct, then everything else would fall into place.





One fascinating phenomena at the moment is a clear looping effect with adult ADHD. Quite recently Britain's NICE [National Institute for Health and Clinical Excellence] guidelines for ADHD came out and stated that adult ADHD is a valid clinical disorder. I am quite sure that a few years ago, 85 to 90 percent of physicians in the UK would not have thought adult ADHD was a valid clinical disorder. One might expect guidelines to be somewhat conservative, but in this case what we appear to be seeing is the guideline process getting out ahead of the field, leading clinicians in a direction that seems to be quite surprising.




Drug companies understand all too well that those constructing guidelines are supposed to be value-neutral and to follow the data. This means they can readily engineer trials that may show minimal benefit for their drug for a condition they have called "adult ADHD." The makers of the guidelines have little option but to suspend judgment and to accept that the condition named must be real. So, for instance, as Lilly grasped, they end up endorsing the use of the agent like Strattera.




What's astonishing about the current situation is that there seems to be almost no way to get the guideline makers—who are sitting in the middle of the road, immobilized by the oncoming headlights—out of the way of the pharmaceutical juggernaut. You can point out how they are being manipulated but they shrug and ask, "What can we do?"


We have recently begun a survey, here in North Wales, looking at aspects of this situation. In response to questions, clinicians here have indicated that three years ago they were quite certain they would not have used adult ADHD as a valid condition, but that three years from now they anticipate that they probably will. I think this shows a realistic appreciation of company abilities to change the climate in which clinical practice takes place, and the relative futility of attempting to stand up to such changes.



You have to treat real patients. What do you tell them about these conditions and their treatment options?



Many clinicians, scientists, and patients have heard about postmodernism. They might have heard company criticism of someone like me along such lines as "Pay no heed to him, he's just a postmodernist." The implication is that postmodernism is all-but a psychiatric disorder in its own right, in which academics like me refuse to concede that there's any reality to human behaviors—or the physical underpinnings of disorders of human behavior. By contrast, the story goes, there are the hard scientists who work in or with drug companies who deal only with facts and hard data, and the proof is that they bring new and helpful drugs to the market.



Well, I think what Donna's story above illustrates is that pharmaceutical marketing departments are actually the postmodernists par excellence. They treat the human body (including its disorders and complaints) as texts to be interpreted one way this year and in just the opposite way a year or two later.



In contrast, when it comes to the hazards of these drugs—just like the tobacco companies before them—the motto of Pharma has become "doubt is our product"—they simply refuse to concede that their drugs are linked to any hazard at all . . . until the drug goes off patent. You cannot get a better definition of postmodernism than "doubt is our product."



So, to the matter of whose treatments are better: I'm quite happy that the patients coming to see me would in general get more effective and safer treatment for their problems than they'd get from physicians adhering to the latest guidelines. Trouble is, I only have to slip up once to have a big problem, whereas atrocities can be committed on the other side without anyone likely to be affected by blowback.





David Healy is the author of 14 books, including The Antidepressant Era, The Creation of Psychopharmacology, Let Them Eat Prozac: The Unhealthy Relationship between the Pharmaceutical Industry and Depression, and, most recently, Mania: A Short History of Bipolar Disorder [5]. Christopher Lane is the author most recently of Shyness: How Normal Behavior Became a Sickness. [6]




[b]Source URL: http://blogs.psychologytoday.com/blog/side-effects/200904/bipolar-disorder-and-its-biomythology-interview-david-healy

://http://blogs.psychologytoday.com/bl...w-david-healy

://http://blogs.psychologytoday.com/bl...w-david-healy

[/b]
[b]Links: [/b]
[1] http://www.bmj.com/cgi/content/full/318/7188/949/a

[2]http://www.furiousseasons.com/archives/2007/02/the_
zyprexa_chronicles_marketing_zyprexa_as_the_new_mood_stabilizer_
for_bipolar_disorder_and_downpla_1.html

://http://www.furiousseasons.com/archi...ownpla_1.html

[3] http://bjp.rcpsych.org/cgi/content/full/188/3/223

[4] http://www.biomedcentral.com/1471-244X/8/67

[5]http://www.amazon.com/Mania-History-Bipolar-Disorder
-Biographies/dp/0801888220/ref=sr_1_1?ie=UTF8&s=books&qid=
1239908094&sr=1-1

://http://www.amazon.com/Mania-History...94&sr=1-1

[6]http://www.amazon.com/Shyness-Normal-Behav...176/ref=ed_oe_p




FAIR USE NOTICE: This may contain copyrighted (© ) material the use of which has
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rights, democracy, scientific, moral, ethical, and social justice issues, etc. It is
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provided for in Title 17 U.S.C. section 107 of the US Copyright Law.

This material is distributed without profit.
The information herein shall not be
considered an endorsement of anyone discontinuing psychiatric drugs. If you
are stopping taking medication IT IS ADVISABLE TO REDUCE DOSES
GRADUALLY WITH EXTREME CAUTION, as it is difficult to predict who will
have problems withdrawing. It is worth getting as much information and
support as you can, and involving your doctor wherever possible.
You will
find withdrawal information here:

http://www.mind.org.uk/Information/Booklet...+of+coming+
off+
psychiatric+drugs.htm://http://www.mind.org.uk/Information
/...atric+drugs.htm


FOR MORE INFORMATION ON WITHDRAWAL:: Get Peter Lehmann's book,
Coming off Psychiatric Drugs: Successful Withdrawal from Neuroleptics,
Antidepressants, Lithium, Carbamazepine and Tranquilizers.

This valuable resource comes in US, UK, Greek. and German editions.


This post has been edited by Fremen Bryan: Apr 20 2009, 11:18 AM


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Guest_Tearz4Fearz_*
post Apr 22 2009, 06:45 AM
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My professor(s) told me never to trust any source from the internet. If its not in a book, honestly, it is rarely factual or relevant because ANYONE CAN PUT ANYTHING ON THE INTERNET.

I do not trust you or any other internet phonies. You are a con artist and out for (like every guy) ONE THING, proof of that in person (so busted in sexual fantasies and drug addictions you are blind to reality). You are a truly a mindless clone.

Anyway, as for this, total here-say, or should I say heresy. Complete and total hypocrisy. Claims that there's "no proof" that these disorders exist, but that is unfactual data. There is plenty of "proof" out there that hold its own in the medical and scientific community. If I were to sit here and waste my whole day pulling up factual articles and proof it would take forever, but this article is pure nonsense! Give me a break, perhaps you are also in denial about a psychiatric illness?

That being said, (why I continue this I don't even know), psychology/psychiatry is a relativily new and evolving science. It is not perfect yet and it is an exciting field because we are still discovering more about the human mind and its functions. It is very interesting to study. There are new things being discovered every day and new ways to treat people, plenty of ideas. The goal is to help people. However, that being said, what I've often seen out there is the opposite and I often liken the U.S. to Nazi Germany in the way it forces people into submission and restraints. This is not medicine at its finest, it is human torture and it is always wrong. Is that the fault of the medical/scientific community or is it simply society turning on its citizens? I'm sure a lot of students of this would be stunned if they really knew what happened within the walls and the confines of the system. However, that being said, isn't this the same system that legalized homicide aka abortion 1973 Roe v. Wade, if we legalized and sanctioned the death of our unborn children, if we turn our backs on justice and truth, if we continually are subjected to sex and violence on television, then we've created a culture of brutality and death and this is what we live in today, which is why the world, in all its great and modern day achievements is still a sickening place to live. It really is, and that is sad. I hope it changes because if enough people fight back then they can change this world for the better, it doesn't have to be this way, but it might take time.
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Sarielite
post Apr 22 2009, 12:48 PM
Post #7


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Our understanding of how the brain works is very incomplete. It's like you bought a puzzle from a toy store, but it doesn't tell you how many pieces there are, those pieces are very small, and there are a lot of them. You have no idea what it will look like when it's done, and you have no idea what shape it's supposed to be in. Neuroscientists have figured out a few of the inside pieces and have a lot of the edge pieces figured out, but how you fit those edges and middles together is a topic of a lot of debate.

The past 30 years has seen the rise and fall of the neurochemical diagnosis for depression and other mental disorders. More recent thinking is that chemical imbalances in the brain may be the mechanism by which mental disorders make themselves manifest, and that the disorder lies in the overall structure of neural communication. This theory is evidenced by non-drug therapies for many major mental disorders, and the wide variety of how illnesses present themselves.


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Guest_Tearz4Fearz_*
post Apr 23 2009, 08:28 AM
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Wow Mr/Ms "smarty pants" hits again! Brilliantly done .. you should go teach a class ..

(I would fall asleep, but I left school for a reason)

Anyway . .


In (real) college my professor(s) showed me slices of the human brain and there are many many parts they have labeled and figure out what they do (ex. the limbic system is responsible for emotional activity) anyway . .psychology is an evolving science and there is a lot more to be discovered and a lot we already know . .this conversation is vague and ambiguous and, quite frankly? Boring me to tearz so I think I'll go now .. thanks
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Fremen Bryan
post Apr 28 2009, 03:59 PM
Post #9


"The Sleeper must awaken"
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From: parents_against_teenscreen@earthlink.net

http://www.miamiherald.com/opinion/columni...ry/1021038.html

Child's death was anything but a suicide
By FRED GRIMM - Miami Herald
April 27, 2009 Calling the death of Gabriel Myers a ''suicide'' lets his killers off the hook.

The 7-year-old was propelled by a vast conspiracy of abuse and neglect and malpractice. The boy only finished the job on April 15, when he locked himself in the bathroom of his Margate foster home and coiled a shower hose around his neck.
We know that his mother, currently in jail in Ohio, her parental rights severed by the courts, seemed to be preoccupied with other matters, including drugs.

AN ALARMING PATHOLOGY

And we know that something awful in his short, sad life had triggered an alarming pathology of aggressive sexual behaviors. This stuff doesn't occur spontaneously. Someone, reportedly an older child, inflicted this kind of learned behavior on a small child. Gabriel was abused.

''Kids act out like this because someone hurt them,'' said Andrea Moore, the longtime child advocate in Broward County and director of Florida's Children First. ``And they are trying to tell us they're hurt.''

Gabriel was a child of obvious and urgent needs. He needed help, attention and therapy. What he got was Lexapro, Zyprexa and Symbyax (a combination of Zyprexa and Prozac). None of the three powerful psychotropic drugs doled out to Gabriel while he was a foster child was approved for children. All three drugs were known to raise the risk of ''suicidal tendencies'' in children.

And Moore points out that none of these anti-psychotic and anti-depressant drugs had a damn thing to do with repairing Gabriel's underlying problems. ``Give me a break. There is no drug that cures the pain of childhood sexual abuse.''

POSSIBLE SIDE EFFECTS

The drugs, which come with a long and sobering list of possible side effects in children, have been doled out to troublesome kids to make them more manageable. Eli Lilly was fined $1.4 billion -- that's billion with a B -- in March for nefariously marketing the unauthorized use of Zyprexa for children, despite the known risks. A big chunk of those kids, like Gabriel, were foster kids, whose lives by definition were inflicted with the kind of trauma apt to cause unruly behavior.

State officials across the country seemed happy to pay $25 a pill to keep their unruly wards quiet. Eli Lilly also targeted elderly Medicaid patients. The federal lawsuit cited a ``thinly veiled marketing of Zyprexa as an effective chemical restraint for demanding, vulnerable and needy patients.''

Foster kids were essentially guinea pigs in a vast, public-financed drug experiment.

Of course, safeguards supposedly protected foster kids. Florida requires so-called ''informed consent'' before some doctor pumps a kid up with psychotropics. Parents are asked first -- though most foster children would hardly be foster children if it wasn't for lousy decisions by irresponsible parents.

Absent a parent, a judge must give the OK for psychotropics. But the courts and case workers from the Department of Children & Families are all too overwhelmed by caseloads and beset by budget cuts to spend time contesting a doctor's judgment.

''No one was looking out for Gabriel,'' Moore said.

What Gabriel got, instead of real help, were powerful adult drugs laden with dangerous side effects. His cause of death was listed as suicide. It was just another misdiagnosis.
28,518 Signatures Against TeenScreen. Petition: [color="#0000ff"]http://www.petitiononline.com/TScreen/petition.html
Video: http://www.youtube.com/watch?v=RfU9puZQKBY

This post has been edited by Fremen Bryan: Apr 28 2009, 04:00 PM


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Fremen Bryan
post Apr 29 2009, 10:55 AM
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RUTHLESS MEDICAL CAPITALISM

"lahunken" <gellie618@...> wrote:

Before the Nineteen-Nineties it was said that no one knew what schizophrenia was. In the Nineteen-Nineties, to support the failing dopamine blocker industry, it was said that schizophrenia was having too much dopamine.

Before, the mental hospital gulags imprisoned millions of people and rendered them helpless with the devastation of dopamine blockers. The dopamine blocker industry grew and flourished.

Then due to the comparison of American with Soviet human rights abuses the patients of the mental hospital gulags were released to be homeless. With their bad records, neither employers nor landlords would have anything to do with them.

Johnny Cash's "Welfare Cadillac" wiped out welfare. The dopamine blocker industry took serious losses, and, the lie saying that schizophrenia was having too much dopamine was propagated.

With too much dopamine the nerve gaps are full of dopamine. With cocaine the nerve gaps are full of dopamine. Cocaine users don't act schizophrenic. I know. My room mate was a cocaine addict. Was? He finally killed himself.

He killed himself because he couldn't stand the smothering agony of not having enough dopamine when he couldn't get cocaine, the same feeling caused by dopamine blockers.

The brains dopamine producing system shuts down when there is cocaine to provide the nerve gaps with plenty of dopamine, And extra dopamine receptor sites grow which crave dopamine when it isn't there.

It is obvious that schizophrenia is not having too much dopamine! Schizophrenia is hallucinary like muscarine and LSD, which awaken too much of the brian. Also, too many links between the brain's neurons awakens too much of the brain.

It was discovered that a gene called DISC1 causes too many links between neurons of the brain. This has been correctly defined to be schizophrenia. Dopamine blockers do it no good. Dopamine blockers cause a smothering torment that can keep one's mind off the Underworld of an overawakened brain.

But, an overactive brain can actually be quieted. Glutamate blockers quiet the brain pleasantly. These are immediately available drugs for schizophrenia.

The failing dopamine blocker industry is so desperate that it is advertizing that dopamine blockers are good for restless leg syndrome and depression, while it causes depression, and changes restless leg syndrome into permanent tardive diskinesia, which is worse.

This dopamine blocker industry here is ruthlessly desperate and dangerous, and perhaps this administration can eliminate them.


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post Apr 30 2009, 10:10 AM
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Open Mind

This is an archived column. Click here to browse other archived topics.




I’ve seen pictures of PET scans of bipolar illness and schizophrenia. What exactly is a PET scan and how is it administered? Are these scans used to diagnose these illnesses?

Positron emission tomography (PET) is a sophisticated imaging technique that can effectively and non-invasively measure brain metabolism and cerebral blood flow (CBF), which are indicators of brain function. These studies can be conducted at rest or after a task or drug administration to show which areas of the brain become more active. The picture it shows of brain function is created when a molecule, such as glucose, is synthesized using tiny amounts of radioactive carbon, for example (sugars are made out of carbon and other atoms). The PET camera detects this tiny amount of radiation (a fraction of the amount of radiation that would be received simply by living in Denver for a year). All of this information about brain activity is assembled into a composite picture by the computer system. PET is a research tool. It cannot yet provide a yes/no diagnostic categorization in psychiatric disorders, although imaging is close to being able to do that with Alzheimer’s Disease.

However, PET provides quantitative information on many important physiological variables in the brain including neurotransmitters and receptors. This is of primary interest in the field of psychiatry, because the manifestations of psychiatric illness are thought to reflect biochemical and physiological dysfunction. PET has research potential for shedding light on the underlying mechanisms and for evaluating treatment effects of schizophrenia, depression and bipolar disorder. Studies of patients with major depression and bipolar disorder have demonstrated a reduction of glucose metabolism in the prefrontal brain cortex, which may correlate with severity of illness. Investigators have found a profound CBF decrease in prefrontal areas and a relative increase in metabolic activity in subcortical regions, particularly in the basal ganglia when schizophrenia is present. This pattern of decreased frontal activity, coupled with increase in subcortical regions in schizophrenia may be consistent with the model for the simultaneous generation of positive symptoms (such as hallucinations) and negative symptoms (such as less emotional expression).

Schizophrenia affects almost 1% of the world’s population with similar prevalence throughout different countries and geographic areas. The financial burden of schizophrenia exceeds that of all cancers in the USA and it was reported to be the world’s fourth leading cause of disability. Bipolar disorder, also called manic-depressive illness, is another very serious disorder of the brain. More than 2.3 million American adults, or about 1% of the population in a given year, have bipolar disorder. Abnormalities in brain biochemistry and in the structure and/or activity of certain brain circuits are responsible for the extreme shifts in mood, energy and functioning that characterize bipolar disorder. Finally, major depression affects approximately 15% of the population at any given point in time and produces a vast burden of suffering and decreased productivity. For these illnesses, PET can identify regional brain activity changes and identify how they change with treatment. In studies using labeled neurotransmitters, such as dopamine and serotonin, PET can provide information about what are the underlying abnormalities in neurotransmitters and the degree to which these abnormalities return to normal with a particular treatment. In our studies of depression, we have identified changes in brain serotonin binding which normalize with treatment.

Yvette Sheline, MD
Washington University
School of Medicine


FEATURE ARTICLE:
The Validity of Psychiatric Diagnosis Revisited: The Clinician�s Guide to Improve the Validity of Psychiatric Diagnosis
- by Ahmed Aboraya, MD, DrPH; Cheryl France, MD; John Young, MD; Kristina Curci, MD; James LePage, PhD


--------------------------------------------------------------------------------

Abstract Background: The authors reviewed the types and phases of validity of psychiatric diagnosis. In 1970, Robins and Guze proposed five phases to achieve valid classification of mental disorders: clinical description, laboratory study, exclusion of other disorders, follow-up study, and family study. Objectives: The objectives of this paper are to review what has been learned since Robins and Guze�s influential article as well as examine the impact of the new discoveries in neurosciences and neuroimaging on the practicing clinician. Method: The authors reviewed the literature on the concept of validity in psychiatry with emphasis on the role of clinical training, the use of structured interviews and rating scales, and the importance of the new discoveries in neurosciences. Results: Robins and Guze�s phases have been the cornerstone of construct validity in psychiatry at the level of researchers. In the absence of the gold standard of psychiatric diagnosis, Spitzer proposed the �LEAD,� which is an acronym for longitudinal evaluation, and is done by expert clinicians utilizing all the data available. The LEAD standard is construct validity at the level of experts; however, guidelines are lacking to improve the validity skills of the practicing clinicians. Conclusions: The authors propose the acronym DR.SEE, which stands for data, reference definitions, rating scales, clinical experience, and external validators. The authors recommend that clinicians use the DR.SEE paradigm to improve the validity of psychiatric diagnoses.


--------------------------------------------------------------------------------

introduction

Validity and reliability are two important topics vital to the development of modern psychiatry. Reliability refers to the extent to which an experiment, test or any measuring procedure yields the same results on repeated trials,[1] and is the topic of another paper. Validity is a more difficult term to define because its meaning differs based on the context. Validity, in a very general sense, refers to examining the approximate truth or falsity of scientific propositions.[2] When applied to measuring instruments, validity refers to how well the instrument measures what it purports to measure.[1] When applied to a disease entity, such as bacterial pneumonia, validity refers to the evidence that bacteria is the cause (verified by sputum culture), lung pathology exists (confirmed by x-ray findings), the symptoms (shortness of breath, fever, and cough), and signs (tachpnea, rales) are compatible with etiology and the disease responds to appropriate antimicrobial treatment. In a psychiatric illness, the patient comes with a subjective complaint (e.g., anxiety, depression, paranoia), and the trained clinician elicits signs of the illness through observation of the patient�s demeanor, behavior, and thought process. However, there are fewer definitive objective measures (akin to x-ray and sputum culture) that confirm the diagnosis.

During the first half of the 20th century, psychiatrists and other mental health clinicians were not particularly interested in making diagnoses, mainly due to an emphasis on a psychoanalytic approach. Beginning in the 1950s, clinicians began to label psychiatric disorders as particular diagnostic entities. At about the same time, psychiatry began to adopt the medical model. This model assumes that a disease, a syndrome, or a disorder has three components: an etiological agent, a pathological process, and symptoms and signs. The etiology, pathology, and even the treatment of any disease, syndrome, or disorder may be known or unknown.[3]

In order to adopt the medical model, the field of psychiatry needed a new and comprehensive classification system. The development of a classification system of mental diseases has been a major effort of the World Health Organization (WHO) from its publication of the sixth revision of the International Classification of Diseases (ICD-6) in 1948 until the present time.[4] The World Health Organization (WHO) has also published several manuals on the diagnostic criteria of mental disorders and the International Classification of Diseases (ICD); the 10th edition, published in 1993, is the latest.[5] On this continent, the American Psychiatric Association Committee on Nomenclature and Statistics developed and published in 1952 the first edition of the Diagnostic and Statistical Manual: Mental Disorders (DSM-I).[6] Several publications followed, and the latest is the fourth edition of the DSM (DSM-IV) published in 1994, which includes the diagnostic criteria of all psychiatric disorders.[7] Most of the psychiatric abnormalities are called disorders because the etiology is unknown. Nevertheless, effective treatments have been developed and utilized for mental disorders without the etiology or pathology being fully elicited.[3]

The goals of this paper are to learn about the new concepts on the validity of psychiatric diagnosis and the impact of the new discoveries in neurosciences on practicing clinicians, such as psychiatrists, clinical psychologists, and therapists.

METHODS

Computerized literature searches were conducted using MEDLINE and PsychInfo. Searches were conducted using entries from January, 1970, to December, 2004, that were published in English. Searches from Medline were conducted for entries that contained the words �Validity� and �Psychiatric Diagnosis.� This result yielded 85 citations. Similar searches from PsychInfo using the same search criteria yielded 145 citations. Searches from Medline were conducted for entries that contained the words �Validity� and �Structured Interviews.� This result yielded 249 citations. Similar searches from PsychInfo using the same search criteria yielded 545 citations. Additionally, relevant references attached to published papers were also reviewed while the authors identified more papers and books through consultations with colleagues and experts in the field. The authors were looking for new knowledge on the concept of validity of psychiatric diagnosis and how clinicians utilize validity skills in routine clinical practice.

RESULTS

Types of validity. There are four main types of validity: content, criterion, construct and procedural.
Content validity. Content validity refers to the degree to which an empirical measurement reflects a specific domain of content. An arithmetical operations test is content valid if it includes addition, subtraction, multiplication, and division.[1] In medicine and psychiatry, clinicians agree on important features that make up a disease, a syndrome, or a disorder. Neurologists agree that Parkinson�s disease has three main features: slow movement (bradykinesia), increased tone, and resting tremor. Psychiatrists agree that a patient with schizophrenia has delusions, hallucinations, disorganization, and bizarre behavior. Typically, the items that represent the domain or disorder are derived from the consensus of experts in the field. Content validity facilitates communication among clinicians and provides an initial framework for further validation.[3,8] The worldwide use of the DSM and ICD diagnostic criteria reflects great progress with regard to content validity because clinicians across the globe use the same nomenclature of mental disorders and know the specific criteria of each proposed disorder.[9 ]

Criterion validity. Criterion validity is measuring something that is external to the measuring instrument itself, called the criterion.[10] Internists agree that diabetes mellitus has four main symptoms: polyuria, polyphagia, polydipsia, and unexplained weight loss (content validity). In criterion validity, an external measure is used to validate the diagnosis that is made by content validity. For example in diabetes, findings would include an abnormal glucose tolerance test or fasting blood sugar. Depending on the timing of the measurements, the criterion validity can be postdictive, concurrent, or predictive. Postdictive validity entails correlating the criterion that happened in the past with the present (e.g., elementary school performance and high school grades). Concurrent validity correlates the measuring instrument with some criterion measured at the same time (e.g., x-ray finding of a broken humerus in a swollen painful arm). Predictive validity correlates a measuring instrument with a criterion that will be assessed in the future (e.g., college admission test scores and graduation four years later).

A biological marker was defined by Buchsbaum as a measurable indicator of a disease, which may or may not be causal,[11] and is a good example of criterion validity. Several biological markers have been studied in psychiatry, such as platelet monoamine oxidase (MAO), dexamethasone suppression test, metabolites of serotonin and noradrenaline in the cerebrospinal fluid, and others. Decades of research on biological markers have resulted in some promising results. However, no single biological marker has been unequivocally identified as a marker for mental disorders.[11�14] In light of the absence of biological markers for mental disorders, Spitzer proposed the LEAD standard.[15] LEAD is an acronym for longitudinal evaluation, and is done by expert clinicians who utilize all the data available. The LEAD standard is an important step toward obtaining the best estimate diagnosis by requiring expert clinicians to utilize all the available data over time, including information from family members, hospital records, psychological evaluation, and laboratory results. The requirement of LEAD to have expert clinicians make independent assessments, discuss diagnostic disagreement, and make a consensus diagnosis accounts for the difficulty in implementing the LEAD standard and its limited use.[15�17]

Construct validity. Construct validity refers to the extent to which a particular measure relates to other measures consistent with theoretically derived hypotheses.[1] Typically, researchers formulate a hypothesis (construct) that a variety of behaviors will correlate with one another. For example, the construct of diagnosis of schizophrenia relies on the young age onset, the presence of psychosis, the absence of organic cause of psychosis, and positive family history of schizophrenia. The construct of dementia relies on later onset of the illness, impairment of short- and long-term memory, disturbances of higher cortical function (e.g., aphasia), and psychological testing consistent with dementia. Construct validity is woven into the theoretical fabric of social sciences and psychiatry because of the absence of criterion validity.[1,18] Construct validity boils down to the circumstantial evidence for the usefulness of the construct or the hypothesis under study.[10]

In 1970, Robins and Guze proposed five phases to achieve valid classification of mental disorders: clinical description, laboratory study, exclusion of other disorders, follow-up study, and family study.[19] Robins and Guze actually were the first to articulate the elements of construct validity in psychiatry. They applied the criteria to schizophrenia and concluded that good prognosis schizophrenia is not a mild schizophrenia but a different illness. The point of Robins and Guze�s phases was to redefine psychiatric disorders over time so that the diagnostic criteria more and more closely approximate the true definition of the disorder, the ultimate goal of validity. Other authors have added more potential validators, such as treatment response and diagnostic consistency over time.[20�22] It is very important to note that construct validity is the product of clinical experience, clinical research, laboratory, epidemiological, and other research data. Construct validity requires a pattern of consistent findings across studies involving different samples and different settings.[18]

Procedural validity. Procedural validity refers to the adequacy of a new diagnostic procedure in replacing or simulating some existing procedure.[3] For example, one may use a structured interview to replace the existing procedure of an open-ended interview by a clinician. Because of the widespread use of DSM and ICD, many efforts were directed toward finding different procedures that approximate the �ideal� application of DSM and ICD criteria. Green and Price developed a short form of the Schedule for Affective Disorders and Schizophrenia (SADS) to encourage psychiatrists to be involved in clinical research.[23] It is very important to remember, though, what Spitzer said regarding these efforts: �Procedural validity speaks only to the issue of the validity of the evaluation procedure and not to the validity of the diagnostic categories themselves.� The validity of the diagnostic categories of the DSM and ICD is extensive and beyond the scope of this paper.[24�29]

PHASES of Validity

Ideally, the validity of psychiatric diagnosis has three phases.

Phase I. The patient has specific complaint(s) addressed to the clinician. The clinician needs to determine whether the patient has real symptoms or the patient is feigning symptoms for secondary gain. The clinician needs to measure the symptoms, observe the patient�s behavior, and make a provisional diagnosis. Content validity plays an important role in this phase.

Phase II. 1) The clinician collects more data (e.g., from family, old records) and orders laboratory, psychological, or imaging studies as indicated. 2) The clinician formulates an entity with suffix disease, syndrome, or disorder. 3) The clinician initiates treatment to alleviate the suffering of the patient.
Typically, phases I and II happen during the first visit of the patient because the patient needs immediate treatment and cannot wait for full validation. Moreover, it is important to remember that the clinician�s goal is not quest of knowledge per se, but the ability to use the available knowledge and skills to prevent and diminish the suffering and disabilities of the patient.[20] Content and construct validity play important roles in phases I and II.

Phase III. The clinician collects more evidence that may confirm or refute his initial diagnosis. The course and the progression of the illness and the response to treatment can provide more valuable information to the clinician. The new evidence collected in this phase can result in redefining or changing the diagnosis. Construct validity continues to play a major role in this phase. Validity is an ongoing process and may continue beyond the termination of a particular doctor-patient relationship.

DISCUSSION

Validity criteria and gold standard in diagnosis: New definitions. Validity criterion was defined by Aboraya as any knowledge, method (e.g., rating scale or structured interview), or procedure (e.g., blood test, lumbar puncture, or MRI) that can improve the accuracy of the disease, syndrome, or disorder measurement, help to rule out other diseases, syndromes, or disorders in the differential diagnosis, or validate a provisional diagnosis of the disease, syndrome, or disorder.9 Validity is a relative phenomenon and any knowledge provided by the validity criteria helps researchers and clinicians to validate the construct of the disease, syndrome, or disorder. As Nunnally has said, �Validity usually is a matter of degree rather than an all-or-none property, and validation is an unending process.�[10]

In psychiatry, the lack of biological markers has led many investigators to conclude that psychiatry lacks a �gold standard.�[30,31] We define the gold standard in diagnosis as the standard that utilizes all the validity criteria available at the time. In medicine and psychiatry, clinicians should use all the available validity criteria to obtain the most accurate diagnosis. The more validity criteria used, the more accurate the diagnosis. The psychiatrist who uses his or her clinical skills along with a structured interview can provide a more accurate diagnosis of schizophrenia in comparison with the psychiatrist who uses clinical skills alone. Similarly, the neurologist who uses clinical examination, lumbar puncture, and MRI can provide a more accurate diagnosis of multiple sclerosis in comparison with the neurologist who uses clinical examination alone.

Proposal to improve the validity skills of clinicians. The literature on the concept of validity lacks guidelines that can improve the validity skills of practicing clinicians. Aboraya and Compton proposed the acronym DR.SEEK, stands for data, reference definitions, standardized instruments, clinical experience, external validators, and knowledge to improve the accuracy of making psychiatric diagnoses.[9] In this paper, we propose the DR.SEE paradigm, which is the acronym for data and knowledge, reference definitions, rating scales, clinical experience, and external validators. The DR.SEE paradigm is a clinician�s form of the original DR.SEEK and LEAD paradigms with a focus on the day-to-day practice of clinicians. By using the DR.SEE paradigm, clinicians can improve procedural and construct validity.

Data and knowledge. In comparison to medicine, psychiatric information goes well beyond the individual patient. A patient who has paranoid delusions and shoots a shotgun at the neighbor may deny having any paranoid thoughts. Clinicians use their skills to build a rapport with patient, use the appropriate proxy information sources and observe the patient�s behavior to get the most valid data. Clinicians should obtain and utilize all data essential for an accurate diagnosis: the patient�s clinical picture, history and course of illness, family information, family history, psychological testing or any other pertinent data in the particular case. The use of all the available data can improve the diagnostic validity.[15,31,32] The knowledge and education of mental health clinicians is key to adequately make a diagnosis through this clinical assessment. A minimum master�s degree in a mental health field, such as psychology, with a clinical emphasis or a medical degree with psychiatry residency training is recommended to give the clinician adequate knowledge to make psychiatric diagnosis.

Reference guide. Reference definition refers to the definition of psychiatric symptoms and their levels of severity. First, clinicians need to define and agree among themselves on the definitions of psychiatric symptoms. Second, when clinicians ask patients questions, they should convey the meaning of the questions to their patients. Additionally, clinicians should understand the expression of symptoms in different cultures. Psychiatric symptoms reported by the patient, assessed and observed by the clinician are the main source of information the clinician utilizes to diagnose and treat the patient.[33] In other words, the measurement of psychiatric symptoms is still the main source to assess whether the diagnostic criteria of the disorder are met. Structured interviews and rating scales can help to define the meaning of terminology and differentiate the levels of severity of symptoms.[34,35]

Rating scales and structured interviews. The use of standardized or semistandardized instruments helps the clinician in many ways. First, standardization forces the clinician to cover all the areas of psychopathology under question. Second, standardization provides similarities in the way questions are asked and minimizes variability among clinicians. Standardization applies to the detailed structured or semistructured interviews, such as the Schedules for Clinical Assessment in Neuropsychiatry (SCAN), Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Diagnostic Interview for Genetic Studies (DIGS), Mini-International Neuropsychiatric Interview (MINI), and to the rating scales such as Positive and Negative Syndrome Scale (PANSS), Brief Psychiatric Rating Scale (BPRS), Hamilton Rating Scale for Depression (Ham-D), and others.[34�40]

Although the use of structured interviews can provide a more accurate diagnosis in comparison with routine clinical diagnosis, most clinicians do not use them for three main reasons. First, structured interviews are time-consuming; a SCAN or SCID interview lasts from 1 to 2 hours. Second, structured interviews are cumbersome, complicated, and interfere with establishing a rapport with the patient. Third, many structured interviews require lengthy and extensive training.

On the other hand, rating scales take less time and can help clinicians to obtain more accurate data. Many rating scales with good reliability are available.[41] Examples of these include the following: Hamilton Rating Scale for Depression (Ham-D), Abnormal Involuntary Movement Scale (AIMS), Conner�s Rating Scale-Revised (CRS-R), Instrumental Activities of Daily Living Scale (IADL), Mini Mental State Examination (MMSE), Young Mania Rating Scale (YMRS), Yale-Brown Obsessive Compulsive Scale (Y-BOCS), and others.[36,42�47] These rating scales can be especially useful when information needs to be obtained from others who observe the patient�s behavior (e.g., parents and teachers for the Connors, caretakers for the IADL) or to quantify observable signs of illness and measure changes with treatment (e.g., level of irritability for the YMRS or degree of depressed mood for the HAM-D). These also provide benchmarks for comparing a particular patient with those who have been studied in treatment trials.

Experience. Mental health clinicians may be psychiatrists, clinical psychologists, therapists, or others who have actual experience and contact with patients with mental disorders. Clinical experience with psychiatric abnormalities and the development of skills to elicit them and ascertain their significance have been viewed as the reference standard of psychopathology assessment.[48] As reading textbooks of medicine alone does not qualify the reader to diagnose medical disorders, reading textbooks of psychiatry does not qualify the reader to diagnose mental disorders. Clinical experience is indispensable when it comes to diagnoses of psychotic, bipolar, and personality disorders, especially with regard to judging the significance of symptoms.[49,50] This clinical experience cannot be replaced with a few weeks of training, nor is it exclusive to psychiatrists. Several years of experience with inpatient and outpatient populations are required to gain the appropriate experience to adequately diagnose psychiatric disorders. The longer the experience of the clinician, the more likely the diagnosis is accurate.

External validators. A biological marker was defined earlier as a measurable indicator of a disease, which may or may not be causal. External validators, on the other hand, are elements external to the disease definitions and are not restricted to biological markers. The past decade has witnessed an explosion in brain imaging techniques allowing scientists to study brain structures and function even at a cellular and molecular level. Structural magnetic resonance imaging (MRI), functional MRI (fMRI), magnetic resonance spectroscopy (MRS), single proton emission computed tomography (SPECT), and positron emission tomography (PET) are some of these new brain-imaging techniques. Andreasen has used the term new external validators for these brain imaging techniques and other new branches of neuroscience and has emphasized their importance in understanding the relationship between individual symptoms and the changes in structure and/or function of the brain.[51] Although these new techniques have yielded important research findings, these findings cannot yet generally be translated into clinical practice.[52] However, one area where neuroimaging is actually emerging as a diagnostic external validator is in the use of PET scans to detect early Alzheimer�s disease.[53] The new external validators hold promise of validating psychiatric diagnosis and predicting treatment response in psychiatry in the near future.[54]

Although the current available techniques are not useful as indicators of the presence of psychiatric disorders, they are useful to rule out other disorders in the differential diagnosis. For example, clinicians use the computed tomography (CT) and/or MRI to rule out trauma, stroke, or multiple sclerosis as the cause of depressive or psychotic symptoms. As another example, hormone levels (e.g., thyroid hormones) are measured to exclude hypothyroidism or hyperthyroidism as the cause of anxiety or depression.

The application of DR.SEE paradigm. The following three cases show that the use of DR.SEE paradigm helps in making a valid diagnosis.

Case one. The patient is a 33-year-old female with multiple psychiatric hospitalizations since the age of 19. The patient�s main psychiatric symptoms are paranoid delusions, auditory hallucinations, and manic symptoms (e.g., pressured speech, grandiosity, and racing thoughts). The patient had several psychiatric diagnoses, including paranoid schizophrenia, schizoaffective disorder, bipolar type, and bipolar disorder with psychotic features. During the last admission, her primary symptoms were paranoid and grandiose delusions and auditory hallucinations. The clinician gathered data by interviewing the patient and the family and reviewing the old records. This investigation indicated that the patient had hypomanic symptoms, such as pressured speech, grandiosity, and racing thoughts, which lasted a very short time compared to the duration of delusions and hallucinations. The clinician interviewed the patient using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN), and the patient had Schneider�s first-rank symptoms, such as voices arguing and voices commenting on the patient�s actions. The clinician used the reference definitions of the SCAN glossary. Organic work up for the patient was done and the results were normal. Using the DR.SEE paradigm, the final diagnosis was schizophrenia, paranoid. The patient was treated successfully with antipsychotic without any mood stabilizers.

Case two. Mr. P was a 58-year-old man referred to the neurology clinic by his primary care physician in July of 2004 for memory difficulties. Initial workup was begun, which included neuropsychological testing in August of 2004. The patient was hospitalized on the neurology service in February, 2005, when he presented with confusion, irritability, and progressing memory concerns. At this time psychiatry was consulted to assist with diagnosis. Mr. P himself was an extremely poor historian. He was unaware of any memory problems or concerns by his physicians or family. The majority of the history was provided by his wife and medical record. Mrs. P stated her husband began to have difficulties with memory approximately two years previously, when she noticed forgetfulness and changes in personality. He became less social, irritable, intrusive, disorganized, and disoriented to time and place. He was no longer able to work as a result and was unemployed for the past two years. She describes the progression to be gradual and a fairly rapid decline. Extensive neurological workup did not reveal neurological illness as a result of infection, white matter disease, vascular disease, seizure, or tumor. The diagnosis of dementia using DSM-IV criteria was provided after review of the data already acquired and interview of patient, family, and neurology staff. Laboratory data reviewed included MRI, CT scan, serology, lumbar puncture, infectious workup and prior neuropsychological testing. With the early onset and rapid decline of cognitive function, appropriate diagnosis was necessary for treatment and prognosis. The consultant psychiatrist was also a memory disorders clinician and was aware that a PET scan recently had been approved for the assessment of dementia. This exam was utilized in this case and was suggestive of dementia of Alzheimer�s type. Mr. P and his family were transitioned to memory disorders clinic for further evaluation of the severity of his cognitive dysfunction. Repeat neuropsychological testing was compared to prior exam. This demonstrated significant decline in the past six months. The Clinical Dementia Rating Scale was used to determine the stage of impairment.[55] Mr. P and his family were provided with the final diagnosis of dementia of Alzheimer�s type severe stage. Appropriate pharmacological, psychological, and social supports and interventions were provided to the family.

The clinician used the DR.SEE paradigm. Data were gathered using records, other physicians, and the patient�s wife because the patient was a poor historian and had serious memory problems. The clinician used the Clinical Dementia Rating Scale to determine the stage of cognitive impairment. External validators were used including MRI, CT scan, lumbar puncture, and PET scan. The experience of the psychiatrist, neurologist, and neuropsychologist were utilized in making a valid diagnosis.

Case three. The patient was a 42-year-old man who presented with feeling �depressed� for the past six months or longer. He felt like he had no energy and his wife esd concerned he was depressed. He went to work but felt he was having difficulty concentrating on his job. When he got home at night, all he wanted to do was lie on the couch and watch TV. He would fall asleep easily, but his sleep was fragmented. He noticed a steady increase in his weight and a decrease in his libido. Although he was not suicidal, he admited to feeling increasingly worthless about his current state. He was diagnosed with having a mild episode of major depression and was given a trial of an antidepressant.

During his follow-up visits there was no evidence of improvement in the patient�s symptoms. His wife joined him on his third follow-up appointment, and during routine questioning about sleep, she made a comment about his �horrible� snoring and how she often would sleep in another room because of it. With this element of history, a diagnosis of possible obstructive sleep apnea was entertained, and upon examination of his oral airway, there was obvious crowding by the tongue and soft palate. His neck circumference was 18 inches. An Epworth Sleepiness Scale (ESS) was administered, and he had a significantly elevated score of 20.[56] The examination findings and Epworth Sleepiness Scale (ESS) score supported the working diagnosis of obstructive sleep apnea. A polysomnographic study was performed and the patient had an apnea-hypopnea index of 40. This provided the objective evidence for the diagnosis of sleep apnea. He was treated with C-PAP therapy, and within days noted significant improvement in his fatigue and sleepiness, as well as his concentration, libido, and feelings of self esteem. The clinician used the DR.SEE paradigm. Data were gathered by interviewing the patient. Important data were gathered from the patient�s wife about his sleep problems. Physical examination of the neck, tongue, and palate also provided important data for the diagnosis. The clinician administered the Epworth Sleepiness Scale (ESS). External validators included a polysomnographic study. The experience of the neuropsychiatrist was utilized in making the valid diagnosis of sleep apnea and providing successful treatment.

Conclusions

Construct validity, consisting of validity criteria, is the core of psychiatry. The authors encourage clinicians to use as many validity criteria as possible to improve the validity of their diagnosis. Researchers and clinicians should utilize construct validity to revisit and redefine content validity of psychiatric disorders.




--------------------------------------------------------------------------------

References
1. Carmines EG, Zeller RA. Reliability and Validity Assessment. London: SAGE, 1979.
2. Cook T, Campbell D. Quasi-Experimentation: Design and Analysis Issues for Field Settings. Chicago: Rand McNally, 1979.
3. Spitzer RL, Williams J. Classification of mental disorders and DSM-III. In: Kaplan H, Freedman A, Sadock B (eds). Comprehensive Textbook of Psychiatry. Baltimore: Williams & Wilkins, 1980.
4. Manual of the International Classification of Diseases, Injuries and Causes of Death, Sixth Edition. Geneva: World Health Organization, 1948.
5. The ICD-10 Classification of Mental and Behavioral Disorders: Diagnostic Criteria for Research, Tenth Edition. Geneva: World Health Organization, 1993.
6. Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Publishing, 1952.
7. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC: American Psychiatric Publishing, 1994.
8. Feighner JP, Robins E, Guze SB, et al. Diagnostic criteria for use in psychiatric research. Arch Gen Psychiatry 1972;26(1):57�63.
9. Aboraya A, Compton III W. Biological markers and external validators in psychiatry: Progress report on the validity of psychiatric diagnosis. eCOMMUNITY: Int J Mental Health Addict 2004;3:1�6.
10. Nunnally JC. Psychometric Theory. New York: McGraw-Hill, 1978.
11. Buchsbaum MS, Haier RJ. Psychopathology: Biological approaches. Annu Rev Psychol 1983;34:401�30.
12. Hoes MJ. Biological markers in psychiatry. Acta Psychiatr Belg 1986;86(3):220�41.
13. Jablensky A. Epidemiological and clinical research as a guide in the search for risk factors and biological markers. J Psychiatr Res 1984;18(4):541�56.
14. Muscettola G, Di Lauro A, Giannini CP. Blood cells as biological trait markers in affective disorders. J Psychiatr Res 1984;18(4):447�56.
15. Spitzer RL. Psychiatric diagnosis: are clinicians still necessary? Compr Psychiatry 1983;24(5):399�411.
16. Antony MM, Barlow DH. Structured and Semistructured Diagnostic Interviews. Handbook of Assessment and Treatment Planning for Psychological Disorders. New York: Guilford Publication, Inc., 2002:3�37.
17. First MB, Gibbon M, Spitzer RL, Williams JBW. User�s Guide for the Structured Clinical Interview for DSM-IV Axis I Disorders: Research Version (SCID-I, Version 2.0, February 1996 Final Version). New York: Biometrics Research, 1996.
18. Tsuang MT, Tohen M. Textbook in Psychiatric Epidemiology. New York: Wiley-Liss, 2002.
19. Robins E, Guze SB. Establishment of diagnostic validity in psychiatric illness: Its application to schizophrenia. Am J Psychiatry 1970;126(7):983�7.
20. Kendell RE. Clinical validity. Psychol Med 1989;19(1):45�55.
21. Kendler KS. The nosologic validity of paranoia (simple delusional disorder). Arch Gen Psychiatry 1980;37:699
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Fremen Bryan
post Jul 29 2009, 12:27 PM
Post #12


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Wronged, incarcerated and involuntarily drugged juveniles are losing more than their right to sue

From: "Gary Kohls" <gkohls@cpinternet.com>

Quote from the article below: "...In February, Mr. Ciavarella and Michael T. Conahan, a judge on the county's Court of Common Pleas, pleaded guilty to tax evasion and wire fraud in a scheme that involved sending thousands of juveniles to two private detention centers in exchange for $2.6 million in kickbacks."
Dr. Kohls' Comment: Please read and ponder the hidden implications in this scandal described below. Cases like this are probably happening in every district in the US.

There is much more to be considered than the victimized juveniles' loss of legal rights in court. For example:


What kind and combinations of brain-altering psych drugs were used on these innocent kids who were railroaded into so-called "detention centers"?


What was the cost to society in terms of the profits that went to BigPharma and the hundreds of psychiatrists who "treated" them?

What will be the cost in terms of neurotoxic brain damage and, of course, withdrawal syndromes when the drugs are discontinued (symptoms that will be then misdiagnosed as "mental illnesses" and treated with even more toxic and dependency-inducing drugs)?

What will be the future cost to the innocent victims of psychiatry, BigPharma and the judicial system because of the likely dependence to the prescribed drugs which will in many cases lead to the use of illegal street drugs, because of the high cost of obtaining the addicting, fraudulently prescribed prescription drugs from unaffordable and inaccessible psychiatrists who won't understand that drugs weren't necessary in the first place)?


And, of course, what are the economic costs to taxpayers and what are the social costs to society when these damaged kids are released?


These issues are the aspects of this case that need to be brought to light, not just the judicial ones.

Hopefully MindFreedom International, (www.mindfreedom.org), the Citizens Commission on Human Rights (www.cchr.org) the International Center for the Study of Psychology and Psychiatry (www.icspp.org) and all justice-minded physicians, social workers, nurses (especially psychiatric nurses and nurse practitioners), teachers, lawyers, clergypersons, hospital boards, policy-makers, etc will launch investigations into this scandal and similar scandals that are likely in their own backyards and likely to be present in every region in every state that is still unaware of the psychotoxicity, neurotoxicity and dependency-inducing qualities of the ubiquitous, socially acceptable yet deadly, psychotropic drugs. Gary.

_________________________________


Wronged Juveniles May Lose Right to Sue


Written by Ian Urbina - The New York Times Jul 28, 2009 at 12:48 PM In a bizarre twist to a closely watched case that rocked the Pennsylvania legal system this year, thousands of youths who had to appear before a corrupt county judge are in danger of losing the ability to sue for damages and court fees.

The potential loss stems from a decision by the State Supreme Court in May that it would help the youths move on with their lives by destroying all documents related to their convictions that it deemed faulty. But doing so would hamper the public’s ability to investigate the corruption of the judge, Mark A. Ciavarella Jr., and limit the youths’ ability to sue him.

“This is about destroying evidence,” Marsha Levick, chief legal counsel for the Juvenile Law Center, a public interest law firm in Philadelphia, said after appearing on Monday before Judge A. Richard Caputo of Federal District Court in Scranton, Pa., to ask that the records be preserved.

“Without these documents,” Ms. Levick said, “it would make it nearly impossible for these kids to get justice.”

The Supreme Court has argued that under Pennsylvania law, all copies of a youth’s criminal record must be deleted for it to be expunged.

But last week the Supreme Court amended its May order and agreed to preserve, under seal, copies of the records for the estimated 400 juveniles who are named as plaintiffs in lawsuits against Mr. Ciavarella and had requested copies of the records by a June 1 deadline set by the court.

Lawyers for the youths, however, said that the amended order would not safeguard the records of about 6,100 remaining youths, who either had not been told of their rights stemming from the judicial corruption case or had yet to request their records.

The records deal with the convictions of more than 6,500 youths who appeared from 2003 to 2008 before Mr. Ciavarella, who ran the juvenile court of Luzerne County for 12 years.

In February, Mr. Ciavarella and Michael T. Conahan, a judge on the county’s Court of Common Pleas, pleaded guilty to tax evasion and wire fraud in a scheme that involved sending thousands of juveniles to two private detention centers in exchange for $2.6 million in kickbacks. They had been removed from the bench that month.

Mr. Ciavarella appeared Monday at the federal courthouse to file a motion to dismiss a federal lawsuit against him. He would not comment on whether the records should be preserved.

“I’m sorry that I brought such shame to the bench,” the former judge told a television reporter at the courthouse. “There’s a lot of good people who sit on the Luzerne County Court of Common Pleas who don’t deserve to be tarnished by what I did. And, unfortunately, they do get tarnished by that, and that’s wrong because they didn’t do anything wrong. I did; they didn’t.”

Four civil lawsuits, which have been consolidated before Judge Caputo, have already been filed against Mr. Ciavarella and Mr. Conahan.

Lawyers for the juveniles said Monday that the records might be important for them to identify and contact each potential member of the class. They are also needed so that investigators and the public can discern the extent of judicial misconduct, the lawyers said.

Zygmont A. Pines, the Pennsylvania court administrator, wrote in a June 25 letter to Judge Caputo that the main concern of the Supreme Court was “to ensure that tainted convictions of affected juveniles in Luzerne County be undone as expeditiously as possible.”

Mr. Pines also wrote that youths who had not joined any of the lawsuits might not want to have their records preserved.

This month, after Judge Caputo was asked to protect the records, the Supreme Court sent him a letter opposing the move.

On July 2, Judge Caputo denied the request to protect the records, citing federalism prerogatives and concluding that the issue was “best left to the Pennsylvania courts.”

Appearing before him on Monday, lawyers for the juveniles argued that the Supreme Court’s decision last week acknowledged that Pennsylvania law allowed for records to be expunged even if copies were kept under seal for the sake of evidence in later litigation.

“If they are going to preserve the evidence for 400 of the faulty convictions,” Ms. Levick said, “then they should preserve it for all of the faulty convictions.”




This post has been edited by Fremen Bryan: Jul 29 2009, 12:35 PM


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Dragana
post Sep 9 2009, 05:21 AM
Post #13


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QUOTE (Fremen Bryan @ Apr 8 2009, 11:39 PM) *
An interesting message:-
* * * * * * *

Doctors
(A) The number of physicians in the U.S. is 700,000.
(B) Accidental deaths caused by Physicians per year are 120,000.
© Accidental deaths per physician are 0.171.

Statistics courtesy of U. S. Dept of Health and Human Services.
>>>>>>>>>>>>

Now think about this:

Gun Owners
(A) The number of gun owners in the U.S. is 80,000,000. (Yes, that's 80 million)
(B) The number of accidental gun deaths per year, all age groups, is 1,500.
© The number of accidental deaths per gun owner is 0.000188.

Statistics courtesy of FBI

>>>>>>>>>>>> >>>>>>>>>

So, statistically, doctors are approximately 9,000 times more
dangerous than gun owners.

>>>>>>>>>>>> >>>>>>>>> >>>

Remember, 'Guns don't kill people, doctors do.'

>>>>>>>>>>>> >>>>>>>>

FACT: NOT EVERYONE HAS A GUN, BUT ALMOST EVERYONE HAS AT LEAST
ONE DOCTOR.

>>>>>>>>>>>> >>>>>>>>> >>>>>

Well, I am not happy with your statistics because you compare things that cannot be compared.
700 000 doctors that are treating patients. Suppose that on average a doctor treats 30 people per shift and works 9 hours per shift. If you wanted to compare this with people having gun you need the number of people frequently using this gun (people using their gun 9 hours a day). What use are 80 million people if ¾ of them never used their gun and keep it empty in a safe? Why would you calculate them?
If you singled out all people that are frequently using their guns, as doctors treat their patients, then we would have fair comparison.
Or reversing the argument, to have fair comparison you need to calculate everyone who is training to be a doctor, even children that want to be a doctor when they grow up. Since they are not treating any patients yet, they would compensate for those people who have a gun but never use it.
Then accidental death number is little bit dodgy since people having a gun accident are treated by doctors. Then 1500 people would be those who did not make it to hospitals and died instantly. On the other hand, if 4000 have successfully recovered from the ‘’gun accident’’ they wouldn’t count because they have survived. This doesn’t really justify guns as being the safer option.
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