Links to Papers Disproving Medical Psychiatric Paradigm

The following is a list of papers disproving the current medical psychiatric paradigm.  Also, I am providing a book along with the publisher's book review on Amazon.com about the truth about genetic science.

• http://freepdfhosting.com/5e72814913.pdf:   falacy of 50% concordance rate in twin
• http://freepdfhosting.com/f4ebd8c8f4.pdf:  biological psychiatry a practice in search of a science.
• http://freepdfhosting.com/2ed6e4c63f.pdf:  critique of the status of biological psychiatry
• http://freepdfhosting.com/f719f05133.pdf:  Large European Gene Pool Study - Schizophrenia not genetic.
• http://freepdfhosting.com/9b9c0c37a1.pdf:  The crumbling pillars of behavioral genetics   

Book - Genetic Explanations:  Sense and Nonsense.
Publisher's Book Review from Amazon.com:

"Can genes determine which fifty-year-old will succumb to Alzheimer’s, which citizen will turn out on voting day, and which child will be marked for a life of crime? Yes, according to the Internet, a few scientific studies, and some in the biotechnology industry who should know better. Sheldon Krimsky and Jeremy Gruber gather a team of genetic experts to argue that treating genes as the holy grail of our physical being is a patently unscientific endeavor. Genetic Explanations urges us to replace our faith in genetic determinism with scientific knowledge about how DNA actually contributes to human development.

The concept of the gene has been steadily revised since Watson and Crick discovered the structure of the DNA molecule in 1953. No longer viewed by scientists as the cell’s fixed set of master molecules, genes and DNA are seen as a dynamic script that is ad-libbed at each stage of development. Rather than an autonomous predictor of disease, the DNA we inherit interacts continuously with the environment and functions differently as we age. What our parents hand down to us is just the beginning. Emphasizing relatively new understandings of genetic plasticity and epigenetic inheritance, the authors put into a broad developmental context the role genes are known to play in disease, behavior, evolution, and cognition.


Rather than dismissing genetic reductionism out of hand, Krimsky and Gruber ask why it persists despite opposing scientific evidence, how it influences attitudes about human behavior, and how it figures in the politics of research funding."

http://www.amazon.com/gp/product/0674064461/ref=cm_cr_dpvoterdr?ie=UTF8&keywords=Genetic%20Explanations%3A%20Sense%20and%20Nonsense%20By%20Sheldon%20Krimsky%2C%20Jeremy%20Gruber&qid=1389943878&sr=8-1&thanksvoting=cr-vote-RZ6TLY611UDSZ#RZ6TLY611UDSZ.2115.Helpful.Reviews

Enjoy!

The Rosenhan Experiment Meets Reality TV

 With contestants lined up on the lawn of a grand house and looking as if they mean business, the opening sequence of Horizon: How Mad Are You? could be mistaken for The Apprentice. But the 10 "contestants" in the BBC2 programme aren't competing for prizes. They are willingly being scrutinised by psychiatric professionals who have to spot which five have a diagnosed mental illness.

Three professionals observe the group over a number of days, during which they complete tasks designed to expose signs of mental illness. One task involves performing stand-up comedy so the professionals can detect anxiety disorders. It makes for interesting viewing as the professionals struggle to pinpoint those with a condition and are frequently prompted to question their own "clinical intuition". The premise is that viewers are encouraged to question their own notions of mental illness and to recognise the effects of stigma.

At the end of the first episode, misconceptions are challenged when someone the professionals are certain has no history of mental illness reveals they have a psychiatric condition.

The programme is likely to raise many questions about how mental illness is diagnosed. And by reminding the public that even professionals get it wrong, it may offer a boost for people who have been judged because of their condition.

• How Mad Are You? is on BBC2 at 9pm on November 11 and 18. Details at bbc.co.uk/headroom

http://www.guardian.co.uk/society/tvandradioblog/2008/nov/05/horizon-how-mad-are-you/print

The Psychiatric Drug Crisis

September 3, 2013

Posted by Gary Greenberg

over twenty-five years since Prozac came to market, and more than twenty per cent of Americans now regularly take mind-altering drugs prescribed by their doctors. Almost as familiar as brands like Zoloft and Lexapro is the worry about what it means that the daily routine in many households, for parents and children alike, includes a dose of medications that are poorly understood and whose long-term effects on the body are unknown. Despite our ambivalence, sales of psychiatric drugs amounted to more than seventy billion dollars in 2010. They have become yet another commodity that consumers have learned to live with or even enjoy, like S.U.V.s or Cheetos
 

Yet the psychiatric-drug industry is in trouble. “We are facing a crisis,” the Cornell psychiatrist and New York Times contributor Richard Friedman warned last week. In the past few years, one pharmaceutical giant after another—GlaxoSmithKline, AstraZeneca, Novartis, Pfizer, Merck, Sanofi—has shrunk or shuttered its neuroscience research facilities. Clinical trials have been halted, lines of research abandoned, and the new drug pipeline has been allowed to run dry. 

Why would an industry beat a hasty retreat from a market that continues to boom? (Recent surveys indicate that mental illness is the leading cause of impairment and disability worldwide.) The answer lies in the history of psychopharmacology, which is more deeply indebted to serendipity than most branches of medicine—in particular, to a remarkable series of accidental discoveries made in the fifteen or so years following the end of the Second World War. 

In 1949, John Cade published an article in the Medical Journal of Australia describing his discovery that lithium sedated people who experienced mania. Cade had been testing his theory that manic people were suffering from an excess of uric acid by injecting patients’ urine into guinea pigs, who subsequently died. When Cade diluted the uric acid by adding lithium, the guinea pigs fared better; when he injected them with lithium alone, they became sedated. He noticed the same effect when he tested lithium on himself, and then on his patients. Nearly twenty years after he first recommended lithium to treat manic depression, it became the standard treatment for the disorder. 

In the nineteen-forties and fifties, schizophrenic patients in some asylums were treated with cold-induced “hibernation”—a state from which they often emerged lucid and calm. In one French hospital, the protocol also called for chlorpromazine, a new drug thought to increase the hibernation effect. One day, some nurses ran out of ice and administered the drug on its own. When it calmed the patients, chlorpromazine, later named Thorazine, was recognized in 1952 as the first drug treatment for schizophrenia—a development that encouraged doctors to believe that they could use drugs to manage patients outside the asylum, and thus shutter their institutions.

In 1956, the Swiss firm Geigy wanted in on the antipsychotics market, and it asked a researcher and asylum doctor, Roland Kuhn, to test out a drug that, like Thorazine, was an antihistamine—and thus was expected to have a sedating effect. The results were not what Kuhn desired: when the schizophrenic patients took the drug, imipramine, they became more agitated, and one of them, according to a member of the research team, “rode, in his nightshirt, to a nearby village, singing lustily.” He added, “This was not really a very good PR exercise for the hospital.” But it was the inspiration for Kuhn and his team to reason that “if the flat mood of schizophrenia could be lifted by the drug, then could not a depressed mood be elevated also?” Under the brand name Elavil, imipramine went on to become the first antidepressant—and one of the first blockbuster psychiatric drugs.

American researchers were also interested in antihistamines. In 1957, Leo Sternbach, a chemist for Hoffmann-La Roche who had spent his career researching them, was about to throw away the last of a series of compounds he had been testing that had proven to be pharmacologically inert. But in the interest of completeness, he was convinced to test the last sample. “We thought the expected negative pharmacological results would cap our work on this series of compounds,” one of his colleagues later recounted. But the drug turned out to have muscle-relaxing and sedative properties. Instead of becoming the last in a list of failures, it became the first in a series of spectacular successes—the benzodiazepenes, of which Sternbach’s Librium and Valium were the flagships. 

By 1960, the major classes of psychiatric drugs—among them, mood stabilizers, antipsychotics, antidepressants, and anti-anxiety drugs, known as anxiolytics—had been discovered and were on their way to becoming a seventy-billion-dollar market. Having been discovered by accident, however, they lacked one important element: a theory that accounted for why they worked (or, in many cases, did not). 

That didn’t stop drug makers and doctors from claiming that they knew. Drawing on another mostly serendipitous discovery of the fifties—that the brain did not conduct its business by sending sparks from neuron to neuron, as scientists previously thought, but rather by sending chemical messengers across synapses—they fashioned an explanation: mental illness was the result of imbalances among these neurotransmitters, which the drugs treated in the same way that insulin treats diabetes. 

The appeal of this account is obvious: it combines ancient notions of illness (specifically, the idea that sickness resulted from imbalanced humors) with the modern understanding of the molecular culprits that make us suffer—germs. It held out the hope that mental illness could be treated in the same way as pneumonia or hypertension: with a single pill. Drug companies wasted no time in promulgating it. Merck, the manufacturer of Elavil, commissioned the psychiatrist Frank Ayd to write a book called Recognizing the Depressed Patient, in which he extolled the “chemical revolution in psychiatry” and urged doctors to reassure patients they weren’t losing their minds, but rather suffering a “common illness” with a “physical basis” and a pharmacological cure. Merck sent Ayd’s book to fifty thousand doctors around the country. In 1965, Joseph Schildkraut, a psychiatrist at the National Institute of Mental Health, reverse-engineered antidepressants and offered an actual theory: at least when it came to depression, the imbalances were to be found in the neurotransmitters he thought were affected by the drugs, dopamine and norepinephrine. Seven years after antidepressants were invented, and five years after Ayd asserted that depression was a chemical problem, psychiatrists finally had a precise, scientific explanation for why they worked. The paper quickly became one of the most cited articles in the medical literature.

But Schildkraut was wrong. Within a few years, as technology expanded our ability to peer into the brain, it became clear that antidepressants act mostly by increasing the availability of the neurotransmitter serotonin—rather than dopamine and norepinephrine, as previously thought. A new generation of antidepressants—the selective serotonin reuptake inhibitors (S.S.R.I.s), including Prozac, Zoloft, and Paxil—was developed to target it. The ability to claim that the drugs targeted a specific chemical imbalance was a marketing boon as well, assuring consumers that the drugs had a scientific basis. By the mid-nineties, antidepressants were the best-selling class of prescription medications in the country. Psychiatry appeared to have found magic bullets of its own.

The serotonin-imbalance theory, however, has turned out to be just as inaccurate as Schildkraut’s. While S.S.R.I.s surely alter serotonin metabolism, those changes do not explain why the drugs work, nor do they explain why they have proven to be no more effective than placebos in clinical trials. Within a decade of Prozac’s approval by the F.D.A. in 1987, scientists had concluded that serotonin was only a finger pointing at one’s mood—that the causes of depression and the effects of the drugs were far more complex than the chemical-imbalance theory implied. The ensuing research has mostly yielded more evidence that the brain, which has more neurons than the Milky Way has stars and is perhaps one of the most complex objects in the universe, is an elusive target for drugs.

Despite their continued failure to understand how psychiatric drugs work, doctors continue to tell patients that their troubles are the result of chemical imbalances in their brains. As Frank Ayd pointed out, this explanation helps reassure patients even as it encourages them to take their medicine, and it fits in perfectly with our expectation that doctors will seek out and destroy the chemical villains responsible for all of our suffering, both physical and mental. The theory may not work as science, but it is a devastatingly effective myth.

Whether or not truthiness, as one might call it, is good medicine remains to be seen. No one knows how important placebo effects are to successful treatment, or how exactly to implement them, a topic Michael Specter wrote about in the magazine in 2011. But the dry pipeline of new drugs bemoaned by Friedman is an indication that the drug industry has begun to lose faith in the myth it did so much to create. As Steven Hyman, the former head of the National Institute of Mental Health, wrote last year, the notion that “disease mechanisms could … be inferred from drug action” has succeeded mostly in “capturing the imagination of researchers” and has become “something of a scientific curse.” Bedazzled by the prospect of unraveling the mysteries of psychic suffering, researchers have spent recent decades on a fool’s errand—chasing down chemical imbalances that don’t exist. And the result, as Friedman put it, is that “it is hard to think of a single truly novel psychotropic drug that has emerged in the last thirty years.” 

Despite the BRAIN initiative recently announced by the Obama Administration, and the N.I.M.H.’s renewed efforts to stimulate research on the neurocircuitry of mental disorder, there is nothing on the horizon with which to replace the old story. Without a new explanatory framework, drug-company scientists don’t even know where to begin, so it makes no sense for the industry to stay in the psychiatric-drug business. And if loyalists like Hyman and Friedman continue to say out loud what they have been saying to each other for many years—that, as Friedman told Times readers, “just because an S.S.R.I. antidepressant increases serotonin in the brain and improves mood, that does not mean that serotonin deficiency is the cause of the disease”—then consumers might also lose faith in the myth of the chemical imbalance. 

Gary Greenberg is a practicing psychotherapist and the author of “The Book of Woe: The DSM and the Unmaking of Psychiatry.”

http://www.newyorker.com/online/blogs/elements/2013/09/psychiatry-prozac-ssri-mental-health-theory-discredited.html

Correction: Due to an editing error, the antidepressant Tofranil was originally identified as Elavil.

And They Blame it on McDonald's!

More Proof Antipsychotics Boost Kids' Diabetes Risk

Deborah Brauser

Aug 22, 2013

 Antipsychotic medications place children and young adults at serious risk for type 2 diabetes, new research suggests.

The retrospective cohort study of more than 43,000 individuals between the ages of 6 and 24 years adds to mounting evidence showing that these medications cause rapid metabolic change in young patients, putting them at increased risk for diabetes, overweight, and obesity and subsequent cardiovascular disease.

In this latest report, investigators found that study participants who were prescribed antipsychotics were significantly more likely to develop type 2 diabetes within the first year of use compared with matched control individuals who were not prescribed these medications.

In addition, the researchers found there was a dose-response relationship so that the risk increased with higher medication doses and remained elevated for up to 1 year after the medications were discontinued.

When the investigators assessed only participants who were younger than 18 years, the association between antipsychotic use and type 2 diabetes remained highly significant.

"We found a 3-fold increased risk for type 2 diabetes in the children who were antipsychotic users when compared to a very closely matched group of control children receiving other psychotropic drugs with a similar psychiatric profile," principal investigator Wayne A. Ray, PhD, professor in the Department of Health Policy at the Vanderbilt University School of Medicine in Nashville, Tennessee, told Medscape Medical News.

"This surprised us. Not that the risk was increased but that the magnitude was so great," he added.
Dr. Ray added that the key take-home message for clinicians is to carefully consider the risk/benefit of antipsychotics in this vulnerable population.

"For conditions in which there are other therapeutic alternatives, clinicians and parents should consider those. In some case they may end up using the antipsychotic, but at least they have considered the other options," he said.

The study was published online August 21 in JAMA Psychiatry.


A Perfect Storm
 
According to the investigators, antipsychotics for children and adolescents used to be prescribed primarily to treat schizophrenia and other psychotic disorders.

However, with the introduction of atypical antipsychotics, the use of this class of medication has "expanded to include bipolar disorders, affective disorders, and symptoms related to behavior and conduct, which now account for the majority of prescriptions."

Previous research has shown that these medications are associated with increased metabolic risks, including weight gain, increased glucose levels, and insulin resistance in this young patient population.

As reported by Medscape Medical News, investigators led by Susan Andrade, ScD, from the University of Massachusetts, published a retrospective study in 2011 in Pediatrics. They found that use of antipsychotics increased the risk for diabetes in a group of children and adolescents between the ages of 5 and 18 years. Out of 9636 of the participants who were taking second-generation antipsychotics (SGAs), 57 were diagnosed with incident diabetes.

"Although we found a potentially 4-fold increased rate of diabetes among children exposed to SGAs, the findings were inconsistent and depended on the comparison group and the outcome definition," the researchers wrote at the time, adding that the small number of cases was a potential study limitation.

The current investigators sought to examine these associations in a larger trial. Dr. Ray noted that the "dramatic increase" in antipsychotic use by children and an increase in pediatric diabetes cases has led to a possible "perfect storm" of problems.

"We thought it was important to clarify this issue for clinicians and for parents. And if this increased risk was really there, they needed to take that information into account when choosing a drug," he explained.

The investigators evaluated records from the Tennessee Medicaid program of 28,858 first-time users of antipsychotic medications and 14,429 1-for-2 matched control individuals who had recently initiated use of a psychotropic other than an antipsychotic. All of the participants were 6 to 24 years of age between 1996 and 2007 (mean age, 14.5 years; 56% boys).

Those who had received a previous diagnosis of diabetes, schizophrenia, or some other condition for which antipsychotics are "the only generally recognizable therapy" were excluded.
Antipsychotics used included risperidone, quetiapine, aripiprazole, and olanzapine; and the median starting dose was 67 mg of chlorpromazine equivalents. Medications used by the control group included mood stabilizers such as lithium, as well as antidepressants, psychostimulants, α-agonists, and benzodiazepines.


Lowest Possible Dose, Shortest Possible Time
 
Results showed that 106 of the young people receiving antipsychotics were diagnosed and treated for type 2 diabetes (mean age, 16.7 years; 63% girls). This translated into 18.9 cases per 10,000 person-years.

"That's why this study had to be so large, in order to detect clinically meaningful differences in the risk of type 2 diabetes, a relatively uncommon but serious condition for children and youth," explained Dr. Ray in a release.

Still, the group of antipsychotic users had a 3-fold increased risk of developing type 2 diabetes by the end of the study compared with the group of nonusers (hazard ratio [HR], 3.03; 95% confidence interval [CI], 1.73 - 5.32).

And this risk was significant within the first year of follow-up (HR, 2.49; 95% CI, 1.27 - 4.88).
The risk also increased with cumulative dose. For less than 5 grams of chlorpromazine equivalents, the HR was 2.13; for 5 to 99 grams, the HR was 3.42; and for 100 grams or more, the HR was 5.43.
One year after discontinuing use of any antipsychotic, the risk for type 2 diabetes remained elevated (HR, 2.57; 95% CI, 1.34 - 4.91).

Overall risk also remained significant when investigators only evaluated the subgroup of children between the ages of 6 and 17 years (HR, 3.14; 95% CI, 1.50 - 6.56).

A total of 87% of the antipsychotic users used atypicals; and use of this medication classification was associated with significant risk (HR, 2.89).

Risperidone, which was associated with an HR of 2.20 for type 2 diabetes in this study, was also the most frequently prescribed antipsychotic (n = 10,718), followed by quetiapine (n = 5807) and olanzapine (n = 5671).

Interestingly, the difference between HRs for risperidone and aripiprazole was strongly significant (P < .001).

Dr. Ray noted that the results show the need for examining alternatives to antipsychotic use. He added that this is especially important for high-risk children, such as those who are overweight.
"Children should be monitored carefully for metabolic effects predisposing them to diabetes, and use of the drug should be at the lowest possible dose for the shortest possible time," he said.


"Important, Landmark Study"
 
"Overall, I think this is a really important study. Some would call it a landmark study," Dina Panagiotopoulos, MD, associate professor of pediatrics at the University of British Columbia (BC) and endocrinologist at the BC Children's Hospital in Vancouver, told Medscape Medical News.
It's the largest sample size to date to look at this question, they did very complex statistical analyses to adjust for 151 covariates, and they did very careful subgroup and sensitivity analyses," she said.
She was also impressed that the investigators ensured that the matched control group was as mentally and physically ill as the study group.

"Clearly, these findings are important and clinically relevant."

Dr. Panagiotopoulos, who was not involved with this research, was codeveloper of the Canadian Alliance for Monitoring Effectiveness and Safety of Antipsychotics in children (known as CAMESA) guidelines. She and her colleagues also published a study in 2012 that examined the link between SGAs and cardiometabolic risks in kids.

"My only concern about this study, and it's been echoed by other local and international colleagues, because we've had quite a bit of email interaction about this study already, is with the way the diagnosis of diabetes was made," she said.

She noted that the investigators relied upon a clinical diagnosis, "using an administrator code that a doctor would use for diabetes with use of a medication." However, most cases were not confirmed with blood work.

"So you can't say that there was true ascertainment of diabetes in all of those patients. But because they used the same definition in both groups, you can say that the relative risk has still been increased," said Dr. Panagiotopoulos.

Even with this limitation, she said that the analysis was important especially because the investigators were able to look at such a young age group.

"This study is adding to the body of literature suggesting that using atypical antipsychotics in children increases diabetes risk. We cannot ignore that," she said.

"There are some very important findings here for clinicians, emphasizing once again that these drugs are dangerous, they should be used only for appropriate indications, and that kids need careful monitoring."

The study was funded by a grant from the Agency for Healthcare Research and Quality, Centers for Education and Research on Therapeutics. The study authors and Dr. Panagiotopoulos have disclosed no relevant financial relationships.
 
JAMA Psychiatry. Published online August 21, 2013. Abstract

'Psychiatric Asbos' Were an Error Says Key Advisor

Former champion says public safety fears seriously curtailed patients' freedoms

Sanchez Manning

Sunday, 14 April 2013

Controversial powers to treat mental health patients in the community while seriously curtailing their freedoms have been criticised by one of their strongest supporters.

Popularly known as "psychiatric Asbos", Community Treatment Orders (CTOs) were introduced five years ago after a series of high-profile cases that involved mentally ill people attacking members of the public. The draconian measures have now been shown to make no clinical difference – and the psychiatrist who championed them is calling for their immediate suspension.
CTOs gave doctors legal authority to impose conditions on their patients after they are released from hospital such as where they must live, what drugs they must take and even how much alcohol they could consume.

If they broke any of these stipulations they could be immediately recalled and sectioned to a psychiatric unit.

It was hoped that the orders would strengthen psychiatrists' ability to ensure patients stuck to their treatment programmes after being discharged.

According to NHS figures, the number of people placed on CTOs has risen steadily since they were first brought in five years ago. The latest statistics show that in 2012 there were 4,764 people subject to orders – 473 more than in 2011, which amounts to an 11 per cent rise.
Now Tom Burns, the psychiatrist who originally advised the government on CTOs, has also come to the conclusion they are ineffective and unnecessary. Professor Burns, once a strong supporter of the new powers, said he has been forced to change his mind after a study he conducted proved the orders "don't work".

CTOs were introduced with the aim of reducing the number of readmissions of patients who were regularly in and out of hospital by compelling them to take their medication.

But after leading the UK's largest randomised trial of CTOs, Professor Burns has discovered that they made absolutely no difference to these so-called "revolving door" patients.

"The evidence is now strong that the use of CTOs does not confer early patient benefits despite substantial curtailment of individual freedoms," said Professor Burns, who is head of the social psychiatry department at Oxford University.

"Their current high usage should be urgently reviewed. I think there should be a moratorium on their use at least for a year or so while we think through how we can improve on the quality of evidence we've got. If we can't do that I think it really is unjustified to continue to use them."
In the study, researchers compared two separate groups of mentally ill patients to test if they experienced fewer hospital admissions. The first set of 166 patients were under CTOs, which can initially last for up to six months and can be renewed at the end of this period. Meanwhile, the other 167 participants tested had been placed on Section 17 leave, which is intended to be only a very short-term solution and can last a matter of days.

Their findings, published in The Lancet this month, revealed that 36 per cent of patients in both groups were readmitted to hospital within one year. There were no significant differences between the two groups in terms of the frequency and duration of admissions, the study found.
Both sets of patients were also remarkably similar in their social and medical outcomes.

Professor Burns added: "We were all a bit stunned by the result, but it was very clear data and we got a crystal clear result. So I've had to change my mind. I think sadly – because I've supported them for 20-odd years – the evidence is staring us in the face that CTOs don't work."

The legislation was conceived in the late 1990s in the wake of growing public anxiety about mentally ill patients committing unprovoked attacks because they were failing to take their medication.
This climate of fear had been fuelled by a series of high-profile attacks on unsuspecting victims by patients who had been released into the community. The most famous case was that of the paranoid schizophrenic Christopher Clunis who killed commuter Jonathan Zito on a train platform in London in 1992.

It was against this backdrop that CTOs were brought in as a central plank of the government's controversial 2007 Mental Health Act. But opponents to the legislation – including this newspaper – argued that the restrictions CTOs placed on patients' basic freedoms were unjustified.

A major objection was that research into their use in other countries had shown they had little effect when it came to keeping people on their medication and out of hospital. Matilda Macattram, director of Black Mental Health UK, said the latest findings came as no surprise. Concerns have previously been raised about CTOs being given to disproportionate numbers of black and ethnic minority patients.

"One of our key concerns when they were introduced was they would extend compulsion and erode the liberty of people who are currently subject to the most coercive treatment in the service. They are just a wholesale violation of the human rights of one of society's most vulnerable groups," she said.

Simon Lawton-Smith, head of policy at the charity the Mental Health Foundation, said the decision to bring in CTOs had been politically driven by the public's fear of attacks. He said the government pressed ahead with the plan in the face of huge opposition and research commissioned by the Department of Health which concluded the orders brought little benefit. He said: "Stranger danger was a serious element behind it."

The Care Quality Commission has also expressed worries about the overuse of CTOs. In February, it concluded the orders had contributed to an increase in the number of mental health patients being detained because patients were being kept on them for long periods. Patients subject to orders expressed concerns that it was difficult to get off them and regain control of their own lives.

But Mr Lawton-Smith cautioned that while Professor Burns's research has shown there are no overall benefits from the wide use of CTOs, the orders will still have helped some patients stay well in the community. "For one or two people, it may actually be doing the job it's meant to do, which is to keep them well, help them recover, help them have a social life, get into training and employment," he said.

A Department of Health spokesman said they welcomed the Burns report. He said: "We will consider the implications of this report carefully."


'My Community Treatment Order was the mental health equivalent of having a tag'

Paul Chapman had just got married when he was first placed on a Community Treatment Order (CTO) in 2009. He had a history of mental illness and had been admitted to hospital some 25 times since first being diagnosed with bipolar disorder and other forms of psychosis in 1991.

On this occasion, he had been sectioned to a psychiatric ward after he began hearing voices and his psychotic episodes re-ignited. After he absconded from the ward, his wife persuaded the hospital that he would be better cared for at home, so he was discharged on the CTO.

However, Paul, from Brigg in Lincolnshire, says what had first seemed like an attractive option turned into something less positive. The 46-year-old describes how being put on a CTO changed his relationship with his family and carer: rather than being based on empathy, it became a much more legalistic arrangement.

"Instead of them being concerned out of care and compassion for the problem I was having, there was reason for them to be responsible and have authority over me," he says.
"I think I had to be seen by my specialist care worker once a fortnight and there was a lockdown on medication – there was no messing with my medication. It was the mental health equivalent of having a tag. If I became unwell again or stopped taking my medication – like re-offending – I would have gone straight back into hospital."

After a few months, he inquired about being taken off the CTO but was turned down: "I felt stigmatised by it. Because of the nature of my condition, I felt other people might know and think, 'He must be bad, he's on a CTO'."

Paul was readmitted to a hospital last June after his psychosis returned.

Sanchez Manning

http://www.independent.co.uk/life-style/health-and-families/health-news/psychiatric-asbos-were-an-error-says-key-advisor-8572138.html#

ADHD Drug Emergencies Quadrupled In 6 Years, Says Government Report

8/13/2013 @ 8:45AM

National data released by the Substance Abuse and Mental Health Services Administration (SAMHSA) show that Ritalin, Adderall, and other ADHD drugs sent almost 23,000 young adults to the emergency room in 2011, a more than four-fold increase from 2005, when just 5,600 such visits were reported.The population group studied was 18-34, but the rise was most dramatic among 18- to 25-year-olds, Federal officials say.

The report, which was published August 8th in The DAWN Report, a SAMSA publication, also warned that heart and blood vessel damage has been linked with “nonmedical” use of the stimulant drugs, based on a 2012 study reported in Brain and Behavior.

The medications listed in the report include Ritalin (Novartis), Adderall (Shire), Strattera (Eli Lilly), Vyvanse (Shire) and their generic equivalents. But it’s important to note that the numbers also include caffeine pills and energy drinks, so ADHD drugs are not solely to blame.

Also included in these numbers were cases in which alcohol was also involved. For example, of the 22,949 cases reported for 2011, 30 percent involved alcohol as well as stimulants, while 70 percent were stimulants alone. This percentage held relatively steady over the years, ranging from 22 percent of cases in 2005 to a high of 38 percent of cases in 2007 involving alcohol as well as stimulants.
Particularly concerning was what the report revealed about how the largely college-aged group of young people obtained the drugs – more than 50 percent got them from a friend or relative at no charge, while an additional 17 percent bought them from someone they knew.

While the SAMHSA report highlighted unprescribed medication abuse, other reports show prescriptions for ADHD meds are spiking too. Data from I.M.S. Health found that 48.4 million prescriptions for ADHD stimulants were written in 2011, a 39 percent jump from 2007. More importantly, close to 14,000 new monthly prescriptions were written for ADHD stimulants, up from 5.6 million in 2007.

 

Sadly, although the numbers are startling, in many ways most of this isn’t news, particularly to college administrators. Back in 2008, the Journal of American College Health reported data from a survey conducted at the University of Kentucky in which 34 percent of students admitted using ADHD stimulants illegally. And Just this April, the New York Times reported on efforts by colleges to crack down on ADHD stimulant abuse.

And it’s not just college students, either. This spring, New York Magazine’s Intelligencer column featured a report on the trendiness of modafinil (brand name Provigil) amongst young professionals. And in 2009, Time Magazine reported on the rising use of Ritalin, Adderall, and Provigil (manufacturer: Teva) in a story provocatively titled “The Case for Cognitive Enhancement.”

A stimulant originally developed to treat narcolepsy, modafinil has gained currency through mentions by popular efficiency experts, including Dave Asprey of the Bulletproof Executive website  and Timothy Ferriss of The 4-Hour Work Week fame. (See the YouTube video of Ferriss talking about modafinil here.)

Amongst the therapeutic professionals charged with diagnosing ADHD in young adults, there’s a movement afoot to strengthen diagnostic criteria and prevent fakery among students seeking prescriptions for misuse. The results were unencouraging; a 2010 study (interestingly, also from the University of Kentucky) published in Psychological Assessment found that “malingerers readily produced ADHD-consistent profiles,” while a 2007 report in the Archives of Clinical Neuropsychology found that “symptoms of ADHD are easily fabricated.”

So where does this leave young adults like my own daughter who, when faced with the challenges of college-level study, become concerned that they legitimately have ADHD? Many college health centers now require a waiting period before a prescription is issued, since students who want the drugs purely as stimulants are likely to be in a hurry. Other college health centers are now refusing to diagnose ADHD, referring students to outside professionals who hopefully have the insight and perception to tell the difference.

Of course, such professionals aren’t always honorable, as was highlighted in the tragic case of Richard Fee, who committed suicide while reportedly addicted to Adderall, and the case of Columbia University student Stephan Perez, who was caught selling Adderall in a sting known as “Operation Ivy League.”

Maybe the seriousness of the problems associated with emergency visits and national attention generated by the SAMSA report will inspire more colleges (and perhaps managers?)  to be on the alert for ADHD drug abuse and doctors to be more cautious in writing prescriptions.
Do you have a story to share about prescription stimulant use, misuse, or abuse? Please comment so others can learn from your experience.

For more health news, follow me here on Forbes.com, on Twitter, @MelanieHaiken, and subscribe to my posts on Facebook.

 

http://www.forbes.com/sites/melaniehaiken/2013/08/13/er-visits-from-adhd-drugs-quadrupled-in-past-six-years-report-says/

Hundreds of Soldiers & Vets Dying From AstraZeneca Antipsychotic--Seroquel

Tuesday, November 8, 2011

Fred A. Baughman Jr., MD & Stan White (Father of Deceased Veteran, Andrew White) disclose the following:

EL CAJON, Calif., Nov. 7, 2011 /PRNewswire/ -- As a neurologist who has discovered and described medical diseases, I (FAB) read the May 24, 2008, Charleston (WV) Gazette article "Vets taking Post Traumatic Stress Disorder drugs die in sleep," and opened and financed my own investigation into these unexplained deaths.

Andrew White, Eric Layne, Nicholas Endicott and Derek Johnson, all in their twenties, were four West Virginia veterans who died in their sleep in early 2008. There were no signs of suicide or of a multi-drug "overdose" leading to coma, as claimed by the Inspector General of the VA. All had been diagnosed "PTSD"—a psychological diagnosis, not a disease (physical abnormality) of the brain. All were on the same prescribed drug cocktail, Seroquel (antipsychotic), Paxil (antidepressant) and Klonopin (benzodiazepine) and all appeared "normal" when they went to sleep.

On February 7, 2008, Surgeon General Eric B. Schoomaker, had announced there had been "a series, a sequence of deaths" in the military suggesting this was "often a consequence of the use of multiple prescription and nonprescription medicines and alcohol."

However, the deaths of the 'Charleston Four' were probable sudden cardiac deaths (SCD), a sudden, pulseless condition leading to brain death in 4-5 minutes, a survival rate or 3-4%, and not allowing time for transfer to a hospital. Conversely, drug-overdose coma is protracted, allowing time for discovery, diagnosis, transport, treatment, and frequently--survival.

Antipsychotics and antidepressants alone or in combination, are known to cause SCD. Sicouri and Antzelevitch (2008) concluded: (1) "A number of antipsychotic and antidepressant drugs can increase the risk of ventricular arrhythmias and sudden cardiac death," (2)"Antipsychotics can increase cardiac risk even at low doses whereas antidepressants do it generally at high doses or in the setting of drug combinations."

On April 13, 2009, Baughman wrote the Office of the Surgeon General (OTSGWebPublisher@...): "On February 7, 2008 the Surgeon General said there had been 'a series, a sequence of deaths.' Has the study of these deaths been published?"

On April 17, 2009 the Office of the Surgeon General responded, "The assessment is still pending and has not been released yet." More than a year later and still no explanation, nor further acknowledgement that these deaths even took place.

In a press release, (PRNewswire, May 19, 2009) Baughman wrote: "I call upon the military for an immediate embargo of all antipsychotics and antidepressants until there has been a complete, wholly public, clarification of the extent and causes of this epidemic of probable sudden cardiac deaths."
Googling "dead in bed," "dead in barracks," by April 16, 2009, veteran's wife, Diane Vande Burgt, had Googled 74 probable sudden cardiac deaths.  By May 2010: 128, and, by November 2, 2011: 247.  Two-hundred-forty-seven!

In April 2010 I was in anonymous receipt of an Army National Guard Serious Incident Report for the 5 months 10/03/09 to 3/7/10. In it were 93 "incidents" including 4 "heart attacks," 6 "cardiac arrests" and 3 "found dead"; 13 of 93 (14%) probable SCDs.

Pfc. Ryan Alderman, was on a cocktail of psych drugs when found unresponsive, dying in his barracks at Ft. Carson, Colo. Sudden cardiac death was confirmed by an ECG done at the scene. Inexplicably, military officials de-classified his death and reversed the cause, calling it instead, a "suicide."

Again I challenge the military to produce the evidence.

In June 2011, a DoD Health Advisory Group backed a highly questionable policy of "polypharmacy" asserting: "…multiple psychotropic meds may be appropriate in select individuals." The fact of the matter is that psychotropic drug polypharmacy is never safe, scientific, or medically justifiable. What it is a means of (1) maximizing profit, and (2) making it difficult to impossible to blame adverse effects on any one drug.

From 2001 to the present, US Central Command has given deploying troops 180 day supplies of prescription psychotropic drugs—Seroquel included.  In a May 2010 report of its Pain Management Task Force, the Army endorsed Seroquel in 25- or 50-milligram doses as a 'sleep aid.'

Over the past decade, $717 million was spent for Risperdal and $846 million for Seroquel, for a mind-blowing total of $1.5 billion when neither Risperdal nor Seroquel have been proven safe or effective for PTSD or sleep disorders.

Ironically, yet not surprisingly, pay-to-play in Washington becomes more egregious every day. Heather Bresch, daughter of U.S. Sen. Joe Manchin, (D-WV) was recently named CEO of WV drug-maker Mylan Inc., that recently contracted with the DoD for over 20 million doses of Seroquel.
Defense Department Health Advisory Group chair, Charles Fogelman, warned: "DoD currently lacks a unified pharmacy database that reflects medication use across pre-deployment, deployment and post-deployment settings." In essence, through a premeditated lack of record keeping, mandated by law at any other pharmacy or medical office to track potential fatal reactions to mixing prescription drugs, the military is willfully preempting all investigations into the injuries and deaths due to psychiatric drugs.

I call on the DoD, VA, House and Senate Armed Services and House and Senate Veterans Affairs Committees to tell concerned Americans and the families of fallen heroes what psychiatric drugs each of the deceased, both combat and non-combat, soldiers and veterans were on?

It is time for the military and government to come clean.

SOURCE Fred A. Baughman Jr., MD

http://www.prnewswire.com/news-releases/hundreds-of-soldiers--vets-dying-from-antipsychotic--seroquel-133366423.html