freakoutcrazy

Blog des AK Psychiatriekritik der NFJ Berlin

Monat: März, 2013

The DSM-5 Field Trials: Inter-Rater Reliability Ratings Take a Nose Dive

The American Journal of Psychiatry (January, 2103) recently published a series of articles that analyzed the outcomes of the field trials that were conducted by the DSM-5 Task Force, to determine the inter-rater reliability of the multiple diagnostic categories that will comprise the DSM-5. For those who might not be familiar with the concept, inter-rater reliability refers to the extent to which two clinicians agree on a diagnosis when presented with the same clinical picture.

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Do Antipsychotics Worsen Long-term Schizophrenia Outcomes? Martin Harrow Explores the Question.

Martin Harrow and Thomas Jobe have a new article coming out in Schizophrenia Bulletin that I wish would be read by everyone in our society with an interest in mental health. Harrow and Jobe, who conducted the best study of long-term schizophrenia outcomes that has ever been done, do not present new data in this article, but rather discuss the central question raised by their research: Does long-term treatment of schizophrenia with antipsychotic medications facilitate recovery? Or does it hinder it?

This is a paper that needs to be widely known. I wish every psychiatrist in the country would read it, and I wish that it would be widely discussed in the media too.

Now, Harrow’s study produced findings that belied common wisdom.  He and Jobe followed schizophrenia patients for 20 years, and those who got off antipsychotics, as a group, had much better outcomes. Over the long term, they were much more likely to be recovered, much more likely to work; they were much less likely to be experiencing psychotic symptoms; and they had better cognitive function and they were much less anxious. So how can you square that finding with research showing that when patients are withdrawn from antipsychotic medications, they relapse at a much higher rate? That is the evidence for long-term use of antipsychotics, and here is what Harrow and Jobe write:  “We view the results from these discontinuation studies as involving a paradox.”

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Most Frequent Conditions in U.S. Hospitals, 2010

A report from the Healthcare Cost and Utilization Project finds that hospital stays for a diagnosis of bipolar disorder in children aged 5-9 increased 696% from 1997 to 2010, 475% in children aged 10-14, and 345% in those aged 15-17. By 2010, mood disorders had become the most frequent principal diagnosis in children aged 1-17.

The Trouble with Twin Studies

As most readers are aware, it is widely believed that both within and without of psychiatry genetic factors play an important role in causing major psychiatric disorders such as schizophrenia, bipolar disorder, major depression, ADHD, autism, anxiety, and even post-traumatic stress disorder (PTSD). Twin studies provide the main pillar of support for this belief which is often, though mistakenly, presented as a scientific fact.

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Components for a Good Neuroleptic Withdrawal Program

The United States desperately needs good programs to help people withdraw from neuroleptics, that is, antipsychotic drugs.  From all I have seen and heard, there aren’t any — none at least that can reputably claim to get good results on a fairly consistent basis.  Again and again I find myself challenged to envision such a program, and in reply to the challenge I have broken down this hypothetical program into various components, each of which I will explore in turn.  I do not believe that any particular withdrawal program needs to have all of these components, though I do see some of them, as I will explain, as vital.

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