Wednesday, February 10, 2010

The 2010 preemption/promotion tour band wagon begins for "Alice in Pharma-land" The DSM-V Story


The 2010 preemption/promotion tour band wagon begins for "Alice in Pharma-land" The DSM-V Story

Yes, those devious and evil greedy clowns in Modern Psychiatry are already on the promotion tour to make sure “You” get a diagnosis and are expensively treated for whatever they happen to make up in the APA’s new fantasy adventure “Alice in Pharmaland” DSM-V “the pre-sequel”.

There is really only one practical and rational change that really needs to be made to the DSM manual (Besides using it for tinder/kindling at a campfire marsh mellow roast) that could make a marked improvement in usability/believability, that has mounting heaps of hard scientific evidence, and also makes undeniable/logical sense; that the sociopath and psychopath criteria/diagnosis needs to be revamped to include Psychiatry and those practicing its voodoo medicine in this latest addition.

I won’t go into my favorite and most recommended treatment options for this despicable incurable illness in this particular post, so not to skew the DSM-5 committee’s pristine unbiased Pharma funded/tainted scholastic process.

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off the AP news wires and @ seattletimes

Doctors may alter psychiatric diagnoses

The American Psychiatric Association is proposing major changes Wednesday to its diagnostic bible, the manual that doctors, insurers and scientists use in deciding what's officially a mental disorder and what symptoms to treat.

The Associated Press

WASHINGTON — Don't say "mental retardation" — the new term is "intellectual disability." No more diagnoses of Asperger's syndrome — call it a mild version of autism instead. And while "behavioral addictions" will be new to doctors' dictionaries, "Internet addiction" didn't make the cut.

The American Psychiatric Association (APA) is proposing major changes Wednesday to its diagnostic bible, the manual that doctors, insurers and scientists use in deciding what's officially a mental disorder and what symptoms to treat. In a new twist, it is seeking feedback via the Internet from both psychiatrists and the general public about whether the changes will be helpful before finalizing them.

The manual suggests some new diagnoses. So far, gambling is the lone identified behavioral addiction, but in the new category of learning disabilities are problems with both reading and math. Also new is binge eating, distinct from bulimia because the binge eaters don't purge.

Sure to generate debate, the draft also proposes diagnosing people as being at high risk of developing some serious mental disorders — such as dementia or schizophrenia — based on early symptoms, even though there's no way to know who will worsen into full-blown illness. It's a category the psychiatrist group's own leaders say must be used with caution because scientists don't yet have treatments to lower that risk but also don't want to miss people on the cusp of needing care.

Another change: The draft sets scales to estimate both adults and teens most at risk of suicide, stressing that suicide occurs with numerous mental illnesses, not just depression.

But overall the manual's biggest changes eliminate diagnoses that it contends are essentially subtypes of broader illnesses — and urge doctors to concentrate more on the severity of their patients' symptoms.

The psychiatric group expects that overarching change could actually lower the numbers of people thought to suffer from mental disorders.

"Is someone really a patient, or just meets some criteria like trouble sleeping?" said APA President Dr. Alan Schatzberg, a Stanford University psychiatry professor. "It's really important for us as a field to try not to over diagnose."

The update of this manual called the DSM-5 — the Diagnostic and Statistical Manual of Mental Disorders, fifth edition — is the first update since 1994, and brain research during that time period has soared.

That work is key to give scientists new insight into mental disorders with underlying causes that often are a mystery and that cannot be diagnosed with, say, a blood test or X-ray.

The draft manual, posted at www.DSM5.org, is up for public debate through April.



Comment made @ Seattle Times on this article:

If you were able to read this article and have not become nauseous, irritated, or questioned where the real madness actually resides; you are probably almost maybe showing the beginning serious signs of an undetectable made up major mental illness.

Please rush in to see your doctor, where you will get placed on very expensive mind altering medications that can behaviorally control your normality and quash any lingering remnant fragments of common sense for goodness sake.

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The following article comes right out of the dangerous and crippling Dr. Biederman “Boy Boobs” and “We must aggressively treat children with poison anti-psychotics before any illness presents itself, this isn’t therapeutic Tushy Massage after all damn it”.

The Notorious Dr. Biederman camp @ Harvard, CABF, and Big Pharma keeps coming up with this new way to package an old/new made up disease with the Big bucks conflict of interest gravy train and Key Opinion leaders propaganda written all over it once more.

“Where have all the Flowers gone, long time passing. When will we ever learn, when will we ever learn”

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From NPR News

Children Labeled 'Bipolar' May Get A New Diagnosis

by Alix Spiegel

February 10, 2010

Since the mid-1990s, the number of children diagnosed with bipolar disorder has increased a staggering 4,000 percent. And that number has caused a lot of controversy in the world of child psychiatry.


Doctors faced with kids struggling with explosive moods felt the diagnosis was appropriate and said that the bipolar medications they gave to children worked. Research psychiatrists worried that the children were being given a label that wasn't right for them, and saddled with the sentence of a serious mental illness for the rest of their lives.

In a move that could potentially change mental health practice all over America, the American Psychiatric Association has announced that it intends to include a new diagnosis in its upcoming fifth edition of the Diagnostic and Statistical Manual — and hopes that new label will be used by clinicians instead of the bipolar label. The condition will be called temper dysregulation disorder, and it will be seen as a brain or biological dysfunction, but not as a necessarily lifelong condition like bipolar.

Reworking The Book Of Mental Disorders

When clinicians see a patient with mental health issues, part of their job is to determine if the patient is experiencing temporary emotional struggles or if the patient has an illness. To do this, doctors rely on the bible of psychiatry, a book called the Diagnostic and Statistical Manual of Mental Disorders. The DSM lists all the mental disorders recognized by the American Psychiatric Association.

The book is also used by insurance companies to decide which treatments they'll pay for, and by courts to help determine insanity or other mental conditions.

The APA is releasing a new draft of the DSM Wednesday, the first major revision since 1994. This latest version of the book, the DSM-V, proposes some significant changes to the following disorders:

The DSM is the official dictionary of mental disorders recognized by the American Psychiatric Association. Doctors use the DSM to diagnose patients, and insurance companies use it to decide on reimbursement, so it's incredibly important in the profession of psychiatry.

By adding this new entry, the American Psychiatric Association is trying to use the considerable institutional power of the DSM to curb use of the pediatric bipolar label.

But it will take some time to determine whether psychiatrists and psychologists will actually change their ways. "I don't know what they'll do," said Dr. David Shaffer, one of the psychiatrists on the DSM-V childhood committee that is behind this change. "Maybe the practitioners will be such firm believers in it that they'll continue to use [bipolar]. But, you know, I guess there are a lot of people that have been involved in reviewing this."

The Beginning Of 'Bipolar' Children

The notion that children might suffer from bipolar disorder in large numbers is new, dating back only to the mid-1990s.

Dr. Janet Wozniak, an assistant professor of psychiatry at Harvard Medical School, was one of the people who first popularized this idea.

Wozniak says that when she was starting out, most psychiatrists placed the prevalence of bipolar disorder in children somewhere between "never" and "vanishingly rare."

"Papers about bipolar disorder in children would usually start out with the phrase, 'Here's a disorder that's so rare maybe you'll see one or two in your entire lifetime in practice,' " Wozniak says.

Wozniak herself only started thinking about pediatric bipolar disorder when she got a job as a researcher in the clinic of a famous Harvard child psychiatrist named Dr. Joseph Biederman. Biederman was studying kids with attention deficit hyperactivity disorder and felt that there was a portion of the kids in his clinic whose problems with anger seemed to go way beyond normal ADHD. So he asked Wozniak to look into it.

She did. And what she found were kids who continued to struggle with intense, uncontrollable outbursts of anger — violent hitting and screaming and kicking — even after they passed through the preschool years.

She felt these outbursts were substantively different from the kind of outbursts you saw among ADHD kids, who often had problems regulating their impulses. Then one day, she says she had an insight.

"This child that I was thinking of as having really difficult-to-treat ADHD and a lot of parent-child interaction problems, I really was ignoring the serious mood component of their problem." In other words, it wasn't that the kids just had problems with their impulse control; there was a more serious problem of mood. These kids were bipolar.

Redefining A Defining Characteristic

Wozniak wrote all this up in a now famous paper proposing that some of the kids characterized as having ADHD were actually bipolar.

The paper won awards. Clinicians began to approach Wozniak at meetings saying her insights made intuitive sense. She had helped transformed their practice.

But Shaffer says that to see these children as bipolar, Wozniak and her co-author, Joseph Biederman, had to change one critical component of the traditional definition of bipolar disorder. "The defining feature of manic-depression was that it was episodic," says Shaffer. "You had episodes of depression and episodes of mania and episodes of normal mood, and that was really, its defining characteristic."

But the kids Wozniak described rarely, if ever, had these kind of discrete weeklong or month-long episodes. So to make them fit the traditional concept of bipolar disorder, Shaffer says, she and Biederman made the argument that in children, episodes presented themselves in a radically different way.

"They said maybe in childhood the episodes would be very brief and very frequent," says Shaffer. "These are called 'ultra diem,' you know, 'many times a day.' If you regarded every time children changed their mood, every time they lost their temper or became overexcited, as a mood episode, then they were really being misdiagnosed and were really cases of bipolar disorder."

Critics countered that bipolar should look the same in kids and adults, that there wasn't good evidence that these kids grew up to be bipolar, and that if you looked backward at bipolar adults, they didn't necessarily have these uncontrolled anger issues when they were young, Shaffer says.

Nevertheless, pediatric bipolar disorder took off. Today, it's estimated that at least 1 million children in the United States have been diagnosed with the disease. Wozniak is convinced that she knows why. "The diagnosis took off because it made clinical sense," she says. "Because we opened our eyes."

A Second Look At Bipolar Diagnoses

Gabrielle Carlson, a child psychiatrist at Stony Brook University, doesn't agree that the bipolar label took off simply because the diagnosis allowed clinicians to finally categorize children in a way that made sense. She points to a host of other reasons.

For example, she says many of the kids now categorized as bipolar were, once upon a time, diagnosed as having conduct disorder. Kids with conduct disorder are seen as very combative, aggressive, and prone to destructive behavior. But the treatments for conduct disorder are woefully limited, says Carlson. "Mostly prayer and fasting," she says. "We don't have good treatments for it. We've got parent-training kinds of treatment, very strict behavioral modification kinds of things, but the evidence that therapy makes a big difference is not wonderful."

Which is why when every day psychiatrists were told that they could now think of this set behaviors as manic-depression, not as conduct disorder, they got so excited, says Carlson. "They thought, 'Heck, if that's what it is, we have a bunch of medicines that are supposed to be helpful for mania — maybe I can make it better,' " she says. This has deep appeal to doctors face to face with parents who are heartbroken over the difficult time their child is having.

Another advantage to the bipolar label, Carlson points out, is that the insurance industry saw bipolar as a biological or medical problem, while conduct disorder was seen more as a parenting problem, so insurance companies were reluctant to reimburse for it.

"If you've got something that says it's not a medical problem," says Carlson, insurance is not going to pay for it. "Conduct disorder is bad parenting, lousy environment, poor supervision, you're a bad seed. It ain't a medical problem. Bipolar they'll pay for."

Finally, Carlson argues, parents themselves were relieved on some level. Because this set of behaviors was no longer seen as conduct disorder, the psychiatrist sitting across the desk from them was no longer blaming them for the terrible things that were happening to their child.

"Part of the acceptance of the bipolar if you're a parent is, 'Hey I'm off the hook on this one. It's not 'cause I'm a bad parent, I've just got this kid with a genetic problem. It's not my fault,' " says Carlson. "You know, there's some pros and cons to that, but the fact remains many people found that liberating."

A Lifelong Label

So clearly there are some real advantages to using the bipolar label. The problem, says Carlson, is that because bipolar disorder is understood as a chronic lifelong problem, you really want to be very careful about how you apply it.

"If you have a child who's got this behavior but you're not sure how it's going to evolve, to say to somebody, 'You've got to be on this medication for the rest of your life' is sentencing someone to something that's premature. And in the case of some of these medications, where we're not sure of some of the metabolic side effects; you may be exposing them to a risk that they don't need to have."

In fact, the problems with medication was foremost in the mind of the people put in charge of the childhood disorder section of the manual, says Shaffer. Particularly, Shaffer says, atypical, anti-psychotic medications, which, he says, "we think have quite profound effects on important mechanisms on the brain that may influence growth and development of the nervous system."

So, Shaffer and his DSM colleagues set out to create a new diagnosis — temper dysregulation disorder — that they hope clinicians will use instead of the bipolar label, he says. "We were trying to find a way to adequately describe the really quite serious behaviors that many of the children who've been given [the bipolar label] have. So what we thought would be valuable would be to carve out a group with the most severe reactions: [children] who when they do lose their temper, do so with great force, and who are having [tantrums] frequently — two or three times a week — and between the big episodes, have an abnormal mood."

Getting The Diagnosis Right

Of course there is no way to predict what practical effects creating the TDD category might have. For instance, Carlson points out that even if they are successful at changing the label that clinicians use, it could be that the kids all get the same medications as before. "They may get many of the same. Absolutely," she says. "But the difference is going to be that you won't have to take this for the rest of your life."

Carlson doesn't necessarily see this as a bad thing. She emphasizes that these children have very serious problems, and though there's been trouble naming it, there's clearly some sort of dysfunction in their brain. Shaffer agrees. "I don't think anyone is arguing that these are perfectly normal children that get the label [bipolar] — far from it," he says. "We're saying these kids are very sick. But they probably don't have bipolar disorder. And they probably do deserve a name that adequately describes what they're doing."

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One pill makes you larger
And one pill makes you small
And the ones that mother gives you
Don't do anything at all
Go ask Alice
When she's ten feet tall



Further reading @ soulful sepulcher

Pediatric Bipolar Disorder & DSM-5 : "Temper Dysregulation Disorder"

5 comments:

Stan said...

A lively discussion resulted from the Seattle-times article in the comment section. So I thought I would post some of the back and forth here just for fun.

Yes, I do agree with the Cakewalk opinions
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Cakewalk comment -
If you were able to read this article and have not become nauseous, irritated, or questioned where the real madness actually resides; you are probably almost maybe showing the beginning serious signs of an undetectable made up major mental illness.

Please rush in to see your doctor, where you will get placed on very expensive mind altering medications that can behaviorally control your normality and quash any lingering remnant fragments of common sense for goodness sake.

SW comment –
Have I entered a forum full of Scientologists? I can't imagine any other reason for such uneducated comments about the field of psychology...

Although I'm a student of psychology, I have no love for labels and "psycho-babble".

However, until we do away with the current health insurance system and the requirement to make a concrete diagnosis in order to categorize and authorize payment for treatment, the DSM is necessary.

Cakewalk comment –
SW in Lake Forest Park said: "Have I entered a forum full of Scientologists? I can't imagine any other reason for such uneducated comments about the field of psychology..."

Why is it every-time the CULT followers of Psychology/Psychiatry are called out for their "so called educated guess pseudo science, and nothing more".

Those that are so heavily vested in following this marketing scheme always get their cage rattled and start calling everyone that may disagree with them "Scientologists".

I would call that trying to find an easy scapegoat to protect your own deeply flawed modality and belief system.

SW comment –
Wow, cakewalk... "cult followers"?

I have no use for psychiatric drugs, but I do recognize that they are appropriate in *some* cases. However, this isn't about drugs.

You are maligning the entire field of psychology, which is indeed a legitimate science that utilizes the scientific method to study not only human behavior and interactions, but also human brain chemistry as it interacts with all body systems.

I hold a Bachelor of Science degree in Health Psychology. What kind of credentials do you have to back up your opinion? I'm really hoping you have a degree in Comparitive Cults or something similarly interesting to support your claims...

Stan said...

continued -

Cakewalk comment –
SW in Lake Forest Park said:
"Wow, cakewalk... "cult followers"?"

Cult: a system for the cure of disease based on dogma set forth by its promulgator : great devotion to a person, idea, object, movement, or work (as a film or book); especially a: such devotion regarded as a literary or intellectual fad b : the object of such devotion c : a usually small group of people characterized by such devotion

Are you really that naive'?

The DSM-V committees (as with those of the prior DSM committees) are steeped in Big Pharma ties and conflict of interest problems (aka Harvard University, Mass General Hospital, and the Dr. Biederman Group that have created a "cult" in childhood disease mongering as just one of many examples).

I can only surmise this awaking factual reality does not concern you in the least as a well educated intellectual.

As for your "Scientific methods" which lead to subjective hypothetical conclusions, and the "brain chemistry imbalance" theories which neither you or the modern psychiatric modality can provide concrete scientific proof to validate. I stand by my former comments.

As for having a BS in Health Psychology supposedly making you an expert (whatever will be, will be). Would you also like to detail your vast clinical experience and direct everyone here to your many published and peer reviewed research papers in the opinion section of the Seattle-times.

I happen find no need, or do I desire to validate or qualify my comments here for you with a resume of my personal educational background and expertise thank you very much.

Once more you show some naivety in your irrational boastfulness by a flawed determination that a simple under graduate college degree somehow qualifies someone such as yourself to "Know Better".

Freedom a buck five comment –
cakewalk: I find it interesting that you consider yourself an expert and can amazingly look up a word and cut and paste it into your comment....and still not provide any real insight into why you believe psychiatry to be a false science. I won't bore you with my credentials, however, I will comment on my years of experience working with the mentally ill. This is a legitimate area of study and people are suffering from these illnesses around the world everyday. There are a lot of people out there that have dedicated their lives to supporting these individuals for little in return monetarily. You show that you have little concern for those who are suffering and appear to suffer of delusions of your own grandeur, which judging by your incompetent comments are not accurate. Keep using words like "modality" and false statements like, "As for your "Scientific methods" which lead to subjective hypothetical conclusions, and the "brain chemistry imbalance" theories which neither you or the modern psychiatric modality can provide concrete scientific proof to validate." They can be proven, read the literature, take a look a brain scan of someone with schizophrenia, and wake up from your delusional state of ignorance.

Stan said...

continued -

Cakewalk comment –
Freedom five and dime said:
"They can be proven, read the literature, take a look a brain scan of someone with schizophrenia, and wake up from your delusional state of ignorance"
*Slap* *Slap* waking up from my hallucinatory delusional state now
Thank you so much for that intervention. Are you practicing psychiatrist or neurologist "freedom for a buck five"(making an assumption, lol). I get the distinct impression that status labels are somehow very important to you.
I have read a lot of the literature, boring and mundane as much of it is. What I have personally derived from much of the published papers you proclaim as proof, is repeated rhetorical conjecture based in statically analysis of probabilities, theory, and hypothesis.
Please go back and re-read those studies, paying special attention to conclusions that say things like "maybe to tied to this gene", "possibly has a connection", "we have found a correlation" "statistical data leads us to conclude ‘A sweet tooth in youth may lead to depression’", "out preformed placebo" ,“Used standardized questionnaires to determine”, "genetics or a gene may be a factor or was not eliminated as a factor" and the really dangerous "We have concluded we need to aggressively treat this disease before it becomes an actually illness in those we suspect of having a high or increased risk factors for potential development".
I'm just checking to see if this is the hard science proof you’re talking about. Maybe you would like to share a link to the research paper and study that has proved your wild pronouncement here? Every study that has ever claimed to have this so called proof, has failed to hold up under peer review and repeated/further examination.
Brain scans (MRI, PET) are far from proof of any DSM mental health condition my friend. But I'm sure as a scholar, you already knew that no one has ever been given a diagnosis of schizophrenia from any brain imaging scan. They are high tech enhanced computer rendered images that gives us pretty much no reliable or concrete data concerning mental health disorders categorized in the DSM. There are quite useful in picking up structural abnormalities and tumors though.
Can please show me the chemical imbalance in your scan, or do any other biological/organic/pathological test where an absolute diagnostic conclusion for a DSM malady can be reached. I would truly like to see the exact gene or groups of genes that have shown rock solid proof also while you’re at it.
So after all the wondrous claims you are still only left at the end of the day with the DSM as your diagnostics tool. Definitely no irrefutable proof in the DSM to be found; since if this was a reliable tool, then there wouldn’t be so many missed diagnosis, misdiagnosis, and constantly changing diagnosis in Psychology and Psychiatry. Don’t get to short winded now; it’s still a great billing tool.
Though, I have never made a claim to be an “expert” in any comment thread. I have expressed my personal opinion, which you are under no obligation to agree with.
But then NAMI (Show me the money) types like yourself are so sensitive about keeping your cash cows alive and kicking, no matter how much evidence mounts against you. (See how I can make assumptions also) Now since you wouldn't bore us with your impressive credentials, how about just sharing the ties and conflicts of interest you may have with the Pharmaceutical Industry.
You’re entitled to your opinion "freedom cost $1.05". Though it is a little ironic how you speak so highly of freedom in your posting name sake, and then supports a modality that wants so desperately to remove those same freedoms (forced medication) and liberties (incarceration) from many of those you deem and label mentally deficient.
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such entertainment value to be found in opinions

Meg said...

I know with my son we have never put bipolar in any of his school records or his medical records of any recent years (we pay out of pocket for mental health) because that label can very much limit a child's career opportunities later in life. And if the diagnosis is wrong, good luck getting it out of the records. You get rid of (and are legally required to be free of) a juvenile criminal record but not as easily a mental health diagnosis.

Stan said...

Dear Meg:

The unfortunate reality in our modern day mental health modality, is once someone is labeled, they are always labeled; pending a very lengthy and costly legal process to have those particular records purged.

I wish you good luck keeping those medical records truly private, as they should be. Then again in today's move toward more electronic oriented and inclusive medical records; once you sign a insurance/hospital/new doctor/school/employer release for prior medical records; you really have to be weary that you stipulate exactly how much of that record can actually be accessed and by whom.

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