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

Letter to the Editor: A Former Judge Rotenberg Center Worker Speaks Out

Greg Miller worked for the Rotenberg Center in Canton for three years and speaks about his experience.

September 13, 2011

Warning: Some of the content in this letter may be disturbing. Reader discretion is advised. 

By Greg Miller
There is so much for me to share about my three years of experience as a staff in Judge Rotenberg Center that I wanted to share them in writing.

Please note that other former JRC teachers and staff and even psychologists have contacted me in the past to tell me that they appreciate my speaking on behalf of the students, and to tell me of legal threats that keep them from speaking out vocally against JRC’s practices.  I can share only my own experiences and opinions.  No doubt JRC has attempted to discredit me and what I have to share.

My Background
I worked for the Judge Rotenberg Center for over three years, between 2003 – 2006.  I worked as a Teacher’s Assistant, and I turned down offers to work at JRC as a classroom teacher because I was too busy with my studies.

I have a Master’s Degree in Elementary Education from Lesley University.  I previously taught as a classroom teacher in Watertown Public Schools, Lincoln Public Schools, and Winchester Public Schools.  I worked too many hours as a classroom teacher to be able to also study alternative medical approaches for the treatment of children with learning difficulties and autism, and JRC offered me an opportunity to continue to work with children and youth while putting myself through school with ideal work hours.

The reason why I remained at JRC for three years instead of leaving on my first day of training was that I liked JRC’s commitment to getting students off of psychiatric drugs. Students were arriving at JRC looking very drugged up and in very rough conditions. I was a very dedicated worker and supporter of JRC at the start of my employment. JRC always treated me fairly as an employee.
Then my opinion of JRC started to change significantly to where I felt I needed to leave JRC and to speak out against its practices. I started to get signs of traumatic stress while working at JRC, and my doctor advised me repeatedly that I should leave JRC for my own health reasons. I became more aware of what was actually happening to individual students at JRC that parents were not permitted to see, and I wondered how many parents would actually be supportive of JRC if they saw what was happening to their children as I did.

My Opinion on the Use of JRC Shock Therapy
I believe that electric shocks are harmful not only to the student receiving a shock, but to all other students in the room witnessing the traumatic shock incidences. Electric shocks are not necessary to help JRC’s population of students. I saw much use of electric shocks that I felt were unwarranted to appear in student plans, and it seemed to me that individualized student plans were designed without proper oversight or adequate safeguards to prevent misuse of the shock devices.

I was having signs of traumatic stress including nightmares, night sweats, and elevated blood pressure, so that my doctor advised me that I needed to leave JRC. So imagine what it is like and what harm is being done to students who are actually on electric shock devices, who are committing no "wrong" behaviors, but who must witness their classmates getting shocked all day long!

I have witnessed the traumatic effects of electric shocks not only on the students receiving shocks, but also on other students in the room witnessing the shock “treatments” even though they have exhibited no behaviors. It was not uncommon to have incidences where I would reach for my pencil in my JRC apron pocket, on which hung the remote controls, to have students crying out and or jumping up, or throwing their task up in the air, and even grabbing me, because they thought I was going to shock them.

These were all behaviors that would cause students to be shocked depending on the individual student’s plan, so groups of students would all get shocked together, all out of their reaction of fear due to myself or another staff reaching for a pencil in our pockets. If any staff chose not to shock students at such times, we would immediately lose our jobs for “refusing to follow student plans.”
I have participated as required in following student plans to shock multiple students, including when they reacted to watching a fellow classmate tied up in a restraint chair getting attacked by a staffer with a plastic knife (being held) to the student’s throat. This was a judge-approved Clockwork-Orange-type “treatment” for a student who swallowed a small X-Acto knife blade.  A staffer, according to the plan, would run up to the student who had all four limbs tied all day long to a restraint chair, and pretend to force a plastic knife down the student’s mouth while another staff pressed the remote control to give a shock to the student. The staff would repeatedly yell in a gruff voice, “Do you want to swallow a knife?”

Sometimes a number of students watching this would act out in fear and receive shocks for jumping out of their seat, crying out, or dumping their task in reaction to the violence. I highly doubt that the judge ordered all 40 plus other students in the same classroom to have to watch this violent “treatment” of their classmate with his arms and legs tied to a chair. This took place day after day for weeks, with their classmate unable to defend himself in any kind of way. I felt nauseated just being in the room during those treatments, and I was not one of the humans with electric shock devices strapped to my body, so I could only imagine what the students were going through.

I have witnessed terrible injuries including bloody scabs all over the torso, arms, and legs caused by the electrodes. While I have heard of Dr. Israel previously claiming that the injuries were due to staff not properly rotating electrodes after shocking a student, the reality was that some students exhibited behaviors resulting in up to 30 shocks in a day. Some students stopped their behaviors after receiving their maximum 30 shocks for the day. Most of the shock devices used two electrodes to pass current through a specific distance of human flesh to maximize the amount of pain from the same amount of current.  Two red skin marks from electrodes per shock, times 30 shocks in a day, quickly adds up so that very soon electrodes will be placed over previous marks resulting in bloody scabs.  In these cases, the multiple patches of bloody scabs have nothing to do with staff failing to rotate electrodes after shocking students. Rather it exemplifies that the electric shocks approach were not appropriate for the student, and that other approaches should have been found.

Dr. Israel has previously compared the electric shock devices to bee stings. I vividly remember nearly getting the wind knocked out of me during training at JRC back in 2003 when (I was) permitted to test out the weakest of JRC’s electric shock devices on my own arm. That was no bee sting!
I have worked with a young lady who was so underweight while on electric shock devices that she had a feeding tube sewn into her stomach to feed her when she would not eat enough. Upstairs there was a photo of her on the wall near Dr. Matthew Israel’s office from when she first entered JRC, looking comparatively plump.

I have witnessed a student with autism getting shocked for sitting at his desk with his eyes closed for more than 15 seconds because his mother didn’t like the fact that he closed his eyes. I wondered what it might feel like for me to try to shut my eyes at night to go to sleep after I had been shocked several times during the day for closing my eyes! Initially in his behavioral plan, the student was shocked for closing his eyes while walking down the hallway with the reason that it was “health dangerous” to close one’s eyes while walking down a short carpeted hallway.

Later, JRC added more and more places where this student would get shocked for closing his eyes. Students with autism characteristically see the world as over-stimulating and overwhelming. I saw a photograph of the student at a young age with his eyes closed while holding up a large fish on a fishing trip. I don’t believe students should be shocked for having autism.

Besides shocking a student for the behavior of “closing eyes” while sitting at one’s desk for more than 15 seconds, or while walking down the hallway, shocking students for reacting to their classmates getting shocked, or shocking a student with all four limbs tied to a restraint chair while a staff violently attacked the student with a plastic knife to teach him a lesson, there were many other behaviors for which students were shocked that felt absolutely wrong to me. Students during my time at JRC were shocked for tearing a paper cup or Kleenex while sitting and watching television during their break, shocked for standing up and raising a hand and asking to go to the bathroom, shocked for pulling apart a loose thread, shocked for going to the bathroom in one’s clothes after signing that they need to use the bathroom for over two hours, shocking a blind, nonverbal girl with cerebral palsy for making a soft moaning sound in an effort to communicate and also shocking her for holding a staff’s hand, to name a few examples of many.

I am still unaware of even one study done that demonstrates that student behaviors remain “changed” after leaving JRC, once off the shock devices.

I was told repeatedly as a staff member at JRC that not only were these student behavior plans permitted by the judge, but some of the plans were ordered by the judge. Looking back, I question what the judge knew. Certainly JRC had a huge lack of oversight and it seemed that there was inadequate protection for the students.

On more than one occasion, I remember arriving to work and being surprised by drastic changes to individual student plans, where many behaviors for which a student would be shocked were eliminated from the student’s plan or else moved to a “minor” category for which the student would not be shocked. I remember being told by a student’s case manager that the behavior plans were changed because the student had an upcoming court date to prepare for. I do not believe that the judges were given the full picture of what they were approving when approving electric shocks on students.

After looking back, and to summarize some of the atrocities I witnessed and participated in while working at JRC, it is difficult for me to understand how I could have done something so cruel to other human beings. No doubt I was operating on misinformation, and misled to believe many of the same arguments that I hear parents arguing today. I truly believed that JRC was the only school that could help this population of students without the use of psychiatric drugs that turned children into zombies and ruined their livers.

Some children, not all, do respond to the threat of pain as long as they are strapped up to electric shock devices. But it is my strong opinion that JRC used electric shocks for many behaviors when other alternatives were available, and to the exclusion of more effective treatments. Psychologists leaving JRC told me that they had other treatments based on real research in established psychological journals that they wanted to use, but they were not allowed to use those other methods because Dr. Israel favored exclusively the use of electric shocks.

Dr. Israel was out to prove the power of his electric shock devices, and in doing so, somewhere along the line the shock devices must have become more important to him than individual students. It is my opinion, as a former JRC teacher who later worked at another school serving a very similar student population as the JRC students with autism, that NO shocks are necessary to control student behaviors at JRC.

If I was given the opportunity, I would sincerely apologize to each and every student I shocked at JRC. I certainly applaud Senator Brian A. Joyce and many others who have worked so diligently to end what I consider to be torture. Torture that is allowed and exists only in Canton, Massachusetts.

http://canton.patch.com/articles/letter-to-the-editor-a-former-judge-rotenberg-center-worker-speaks-out?mid=51

British Report: Controlling Influence of US Big Pharma

http://www.publications.parliament.uk/pa/cm200405/cmselect/cmhealth/42/42.pdf

DRUGGED INTO SUBMISSION

THE COLUMBUS DISPATCH

Monday, April 25, 2005

LISA MARIE MILLER

Chelsey Kennedy, 15, of Gahanna, says she ''slept for four days and was
in a drug-induced fog for a week" after being subdued with three shots
of a powerful drug at a Dayton treatment center. Now she's at a
Columbus center, but her mother worries about the number of medications
she takes daily - 14, compared with two when she went into treatment
two years ago.

Nurses Andy Hooks, Debbie McCoy and Melani Scurlock, from left, prepare
to give children at Pomegranate Health Systems their medications. A
state doctor warned the Byesville, Ohio, center about its use of ''drug
cocktails" last summer, but officials there say many of the troubled
kids Pomegranate treats arrive with multiple prescriptions.

CHRIS RUSSELL
Nick Malcuit, 16, endured drugs that made him sleep 18 hours a day,
gain 50 pounds and become hyper before doctors found the one to treat
his bipolar disorder. Behind him in his family's Strasburg, Ohio, home
are his stepfather, Aaron Brown; brothers, Maxwell and Nathaniel Brown;
and mother, Gwen Malcuit.

They are sent away for help. ¶ But when they act out, some troubled
children are controlled with potentially dangerous mind-numbing drugs.
¶ No one knows how often residential centers for hard-to-control kids
use psychiatric drugs to subdue them. Privacy laws shroud the centers
in secrecy. ¶ But a three-month investigation of thousands of state
inspection records as well as more than 80 interviews with
child-welfare workers, doctors, families, lawyers and industry
officials reveal growing concerns that pills and injections, most of
them untested on youths, have become a quick fix to stifle
troublemakers.

''At its worst, it's like a scene from the movie One Flew Over the
Cuckoo's Nest with Nurse Ratched chasing after kids with syringes of
psychiatric drugs," said Gayle Channing Tenenbaum, legislative director
for the Public Children Services Association of Ohio.

At best, it's a rare problem being addressed through better training,
says the Ohio Department of Mental Health.

But an advocacy group says Mental Health is making it easier for
treatment centers to force powerful drugs on kids without reporting it.


Ohio Legal Rights Service, which is leading the charge for change, says
the opposite should be done. Mental Health needs to impose far stricter
rules to limit the use of medications and hold centers accountable for
abuses, it says.

Both sides agree that psychiatric drugs can help kids suffering with
anxiety, depression or a host of other mental illnesses. The question
in these cases is whether medications are being used to treat children
or as a chemical straitjacket.

Legal Rights, an independent state agency, has examined nearly 500
cases involving chemical restraints during the past five years,
including:

. A 5-year-old boy who was so doped up that he couldn't stop batting
the air, complaining about imaginary bugs and smacking his lips. A
doctor ordered him off all medication.

. A 10-year-old boy who was chemically restrained 69 times over 80
days. Doctors prescribed up to six drugs at a time - and never
conducted trials to determine which pills worked for what symptoms or
disorders.

. A 12-year-old girl who was injected six times over nine months with
high doses of Thorazine, a powerful sedative that can knock kids out
and cause muscle spasms and twitches. She also was physically
restrained 31 times by as many as three men, despite a history of being
physically and sexually abused.

''It's scandalous that medications are used to subdue kids for
overworked and underpaid staff or as punishment for bad behavior," said
Carolyn Knight, the group's executive director.

Children already traumatized by abuse, neglect or mental illness can be
hurt further by being forced to take a medication, especially when held
down by adrenaline-pumped adults, said Dr. Ellen Bassuk, an associate
professor of psychiatry at Harvard Medical School who has reviewed Ohio
cases.

''The mental-health system is a mess," she said. ''Not only are these
places giving chemical restraints, but they're prescribing risky
combinations and dosages of drugs that are as dangerous and inhumane."

State officials say Ohio law prohibits chemical restraints except in
emergencies when a child or worker is in danger. Even then, they're
supposed to be used only after lessforceful options fail.

''It's been outlawed," said Thomas Wood, chief of licensure and
certification for the Department of Mental Health.

Critics say the state's 52 private residential centers often skirt the
law by calling the restraints emergency medications or a PRN order -
short for a Latin term for giving drugs as needed.

''No one wants to call it a chemical restraint because it is too
emotionally charged a term," said Curtis Decker, executive director of
the National Association of Protection & Advocacy Systems in
Washington.

Others say the practice is protected by an unspoken rule: ''Don't ask,
don't tell."

''It happens underground all the time," said Steve Eidelman, executive
director of the ARC of the United States, a national advocacy group for
the developmentally and mentally disabled, based in Silver Spring, Md.

''It's all about what's easiest for the treatment providers, not what's
good for the kids."

In response to that concern, workers at these centers increasingly are
being taught ways to prevent power struggles instead of how to
physically control children.

''It can be as easy as sitting down with a kid and telling them you
hurt my feelings when you called me a name instead of tackling them to
the ground," said Bob Bowen, chief executive officer of David Mandt and
Associates, a Texas-based training company that Bowen runs from his
Canton office.

Injections as threats

Concerns about overmedicated kids are being heard nationwide.

A children's psychiatric hospital in Louisville, Ky., was chastised in
2003 for giving drugs to children before they could cause problems -
sometimes while still asleep. Kids who refused to take pills were told
they would receive a shot of Thorazine.

In May 2000, a nonprofit group filed a class-action lawsuit on behalf
of 9,000 Tennessee children in large institutions who were given
psychiatric drugs and other restraints without proper legal consent.

''There's no reason to think that Tennessee is an aberration," said
Doug Gray, a lawyer for the New Yorkbased, nonprofit Children's Rights.


Defenders say drugs sometimes are needed to control the increasingly
unruly, violent youths being sent to the centers.

''They bite, hit, kick and spit," said Penny Wyman, executive director
of the Ohio Association of Child Caring Agencies, which represents
residential centers. ''They curse, yell and throw furniture. They're
angry and have a lot of issues to work out."

Many of the children need the kind of intensive care they'd get at a
hospital, but there aren't enough beds, Wyman said. The state closed
most of its mental institutions in the late 1980s and early '90s but
sent little money to community health centers to help with increased
caseloads.

She said Ohio Legal Rights' leaders don't understand the challenges
providers face and are on a ''witch hunt," even though treatment
centers use psychiatric drugs only as a last resort.

Others say they don't understand the fuss.

''It's shocking that we focus so much attention on the residential
treatment centers, which have fewer than 1,000 beds," said Michael
Hogan, executive director of the Ohio Department of Mental Health.

The department licenses the centers, four- to 115-bed facilities that
together can house 919 children. Thousands of kids flow through the
centers in a year, and many more are closed out.

Hogan says the biggest danger facing children is depression. There were
168 youth suicides statewide in 2002, the most-recent figures
available.

''No case of abuse or neglect is good," he said. ''But it would be
wrong for us to ignore the bigger issues, especially as our money gets
tighter and tighter."

Most treatment centers are doing their best, he said. They're adding
psychiatrists, reducing overall restraint use, training staff members
and trying new, positive methods for responding when kids blow up.

Hogan's department thoroughly inspects the centers every two years, or
when concerns arise.

The centers typically charge $100 to more than $1,000 a day. But most
still have few hiring standards and are plagued by high turnover,
Knight said. Workers often are fresh out of college and are paid about
$7 an hour.

The department's assistant medical director agrees that treatmentcenter
workers often are too quick to push drugs because they want calm,
obedient children.

''It's human nature. A lot of adults think children should be seen, not
heard," Dr. Patricia Goetz said. ''It doesn't help that we're a culture
where you can manage everything with a pill."

State intervenes

Last April, the state ''strongly recommended" that Belmont Pines
Hospital, in Youngstown, stop using emergency medications after Goetz
uncovered several troubling trends.

She reviewed 11 cases in which a total of 27 shots of the powerful
drugs Haldol and Thorazine were given to calm angry children.

In a letter, Goetz noted that the medications ''have effects that last
far longer than required for a patient to regain self-control."

Sleepiness can persist for hours or days. And unlike the use of other
restraints, such as padded handcuffs or physical holds, there are no
limits on how long kids can be drugged, said Laurel Stine, director of
federal relations for the Bazelon Center for Mental Health Law in
Washington.

''It's just another way to abuse children who have already been
victimized," Stine said.

Two years earlier, the Department of Mental Health placed Belmont Pines
on probation for five months and barred the 45-bed center from
admitting more children.

The agency took action after Ohio Legal Rights and several Belmont
Pines employees complained that the facility gave too many shots of
Haldol, Thorazine and Vistaril, an antihistamine used for sedation.

One man reported that his son was so drugged up during visits that he
couldn't talk or walk. The boy essentially was being treated as a
''pincushion," said Judy Jackson-Winston, a client-rights officer for
the Cuyahoga County Mental Health Board who spoke with the father.

Belmont Pines officials said they have stopped using emergency
medications and had reduced their use by 86 percent before the state
warning.

''We had already made a decision that we were going to reduce, then
eliminate their use," said Dr. Phillip Maiden, the group's medical
director. ''The Ohio Department of Mental Health just made us do it a
little quicker."

Although he regrets that the center was placed on probation, Chief
Executive Officer George Perry said, ''There's no question, we're
better for it."

Multidrug cocktails

Last summer, Goetz warned about the use of ''drug cocktails" at
Pomegranate Health Systems, which runs a center in Byesville in
Guernsey County and plans to open a $5 million, 60-bed facility in
Franklinton next year.

She questioned why five drugs were needed for a 15-year-old with
posttraumatic stress disorder and intermittent explosive disorder,
which leads to sudden outbursts of violence.

''It is very concerning that this child is on three mood stabilizers -
Depakote, Topamax and Trileptal - and two antipsychotic medications -
Haldol and Seroquel," Goetz wrote. ''There is no evidence that Topamax
or Trileptal decreases aggressive behavior."

Few scientific studies have explored the risks associated with using
multiple psychiatric drugs.

However, experts and researchers agree that drug cocktails increase the
likelihood of death or bad side effects. Also, many behaviorial-health
drugs agitate children, so workers respond by giving them more
medication.

Goetz also criticized Pomegranate for using Haldol too often and in
high doses, even though the drug can cause potentially fatal side
effects, including involuntary muscle contractions, low blood pressure
and rapid heartbeat.

Pomegranate officials defend their medication practices, saying they
treat the most difficult, disturbed children, including those who are
victims of violence or attempt suicide.

On average, the kids they see have been through 20 foster, group and
residential homes, administrator Bob Hall said. Some have had as many
as 33 placements.

Most have been to a different physician or psychiatrist with each move,
and each doctor has prescribed multiple drugs. Complicating matters,
the children's medical records often don't keep pace with their moves.

Pomegranate deals with the problem by creating medical and mentalhealth
work-ups within 30 to 45 days of each child's arrival, Hall said.

''We just received a 71-page package on a kid, and there wasn't one
fact about the kid's medications in all that paper," Hall said.

This type of slip-up proves the system is broken, said Yvette McGee
Brown, a former juvenile court judge who is now president of the Center
for Child and Family Advocacy at Columbus Children's Hospital.

But it doesn't take residential centers off the hook.

''They should get those files," she said. ''Anything less is
malpractice."

While on the bench, McGee Brown frequently called the doctors of
children she thought were overmedicated.

''I had a 10-year-old who was so doped up he was walking around like a
zombie," she said. ''Sure, he wasn't creating any problems. But he was
barely conscious."

Problems with staff members

Chelsey Kennedy, 15, of Gahanna, never will forget the effect of being
given three shots of Haldol one afternoon at Kettering Hospital Youth
Services in Dayton.

''I slept for four days and was in a drug-induced fog for a week after
finally waking up," she said. ''That's just wrong!"

Chelsey, who has bipolar disorder, admits being combative and mouthy at
times. But she said residential staff members often egg on patients.

State records reflect that.

For instance, the Mental Health Department reprimanded a southern Ohio
center in January for creating a ''culture of fear and intimidation."
State inspectors said the children at Oak Ridge Treatment Center, near
Ironton, complained about being cursed at, called names and insulted by
staff members.

They also reported being choked, kneed, ''slammed" and put into a
''sleeper" wrestling hold that temporarily cuts off their breathing.

Wendy Kennedy, 40, said teens are ''manhandled" at Residential
Treatment Centers of Ohio, a South Side facility where her daughter has
lived since early March.

''When I went to visit Chelsey recently, one of the girls had a black
eye, bloodied nose, busted lip and she couldn't move her shoulder - all
because of a restraint," Kennedy said. ''Using brute force is so
wrong."

Residential Treatment officials denied using excessive force and said
no children have been hurt. ''Franklin County Children Services has
found nothing to substantiate any abuse," Chief Executive Officer Jeff
Beasley said.

But in March 2003, Children Services pulled 11 teens from the center
after a worker bruised a girl's wrist during a restraint. The state
also placed Residential Treatment Centers on probation for failing to
meet rules.

Beasley said the center doesn't use any emergency medication - ''only
drugs ordered by the doctor."

However, state mental-health officials cited the facility in August for
using a ''medication as a restraint to control behavior."

Kennedy is concerned that Chelsey might be on too many and maybe even
the wrong medications.

Before entering residential care a year ago, Chelsey was on two drugs.
She's now prescribed 14 - 11 psychiatric and three for diabetes.

''The side effects are terrible," said Kennedy, who turned over custody
of her daughter to Franklin County Children Services in 2004 to get her
mental-health help. ''She has joint pain, reflux and no hormone levels,
which have baffled doctors."

Chelsey also hasn't been herself.

''She can be normal one minute and like a small child another," Kennedy
said. ''I just don't understand why they give her so many drugs but no
meaningful counseling. It kills me."

Gwen Malcuit, 33, of Strasburg in Tuscarawas County, understands
Kennedy's pain. Her 16-year-old son, Nick, was misdiagnosed four times
and given more than a dozen medications before doctors concluded he has
bipolar disorder.

One drug made him sleep 18 hours a day. Another caused him to gain 50
pounds. A third made him fidgety and hyper.

''I really believe the medications impaired his learning," Malcuit
said. ''He was angry, out-of-control and thought I had betrayed him."

Today, Nick is on one medication and enjoys life as a 10 th-grader. He
is doing well in school, has a girlfriend and is looking for a
part-time job.

''Look at what happens when you give a child what he really needs:
appropriate services in his own home," Malcuit said.

She lays part of the blame on the confusing system.

For example, four state agencies license residential centers: the
departments of Health; Job and Family Services; Mental Health; and
Mental Retardation and Developmental Disabilities. Each has different
licensing standards. The Ohio Department of Alcohol and Drug Addiction
Services also certifies some programs.

''It's a maze that leaves families feeling left out," Malcuit said.

It doesn't help that families often relinquish custody of their
children to county child-welfare agencies because mental-health care is
so expensive. And when they do, they frequently lose the power to make
decisions about medications. They're also afraid to challenge decisions
out of fear their children won't be returned.

Fewer reports

Finding out how often treatment centers use drugs to restrain children
has become more difficult.

In January 2004, the Department of Mental Health stopped requiring
treatment centers to fill out incident reports for restraints unless
they involved abuse or neglect, or resulted in an attempted suicide,
injury or death, Knight said.

As a result, the number of reported restraints - both emergency
medications and physical holds - dropped from 6,815 in 2003 to 113 last
year. Reports of emergency drugs declined from 118 in 2003 to 10 last
year.

Mental Health officials say providers now have to log the use of
restraints daily. The department regularly reviews them and compiles
totals every six months.

But advocates say the centers aren't required to note the use of
emergency drugs.

Meanwhile, state developmental disability officials have toughened
their reporting requirements, causing their figures to spike from 12
reported restraints in 2001 to 542 last year.

The Department of Mental Retardation and Developmental Disabilities
also considers the use of any unapproved psychiatric drug - whether in
an emergency or not - a chemical restraint.

''They're well ahead of the Department of Mental Health on this issue,"
Knight said.

MRDD officials admit they toughened their requirements after a scathing
audit by what is now the federal Centers for Medicare & Medicaid
Services in Washington.

''It's tough asking the painful questions, but if you don't you'll
never know if a provider is doping a client up with a powerful
psychotropic medication just for convenience," Director Kenneth Ritchey
said.

Since 2000, the department has added 14 people to its investigative
unit, created an online registry of caregivers who have abused people
with disabilities, and developed a Webbased reporting system for
incidents.

Ohio Legal Rights would like the Department of Mental Health to be
equally vigilant, particularly in requiring treatment centers to report
the use of all restraints.

Legal Rights points to an incident at Kettering Hospital in Dayton last
July in which a 14-year-old girl was restrained - with drugs,
handcuffs, other devices and physical force. Eight staff members, a
guard and two police officers were involved in the episode, which
stretched over ''eight horrendous hours," according to Legal Rights.

Details remain sketchy, but the agency's investigation found:

. The teen became agitated and was put in a seclusion room. State
officials say she was spitting and threatening staff members.

. While in the room, she managed to pull a mattress cover off a bed and
zip herself inside. Police were called and put her into handcuffs until
she calmed down. Staff members replaced the cuffs with other restraints
and kept her tied up for more than seven hours, against state rules.

. The girl was given three shots each of Haldol and Cogentin, a
medication used to offset potential side effects from the Haldol,
including stiffness and tremors. The child-welfare agency responsible
for the teen had never consented to the use of Haldol.

In the end, the guard filed charges against the girl because he had
thrown out his back during the restraint, and she was discharged to
another facility.

Executive Director David Drawbaugh said Kettering is now committed to a
zero-tolerance policy for restraints and seclusion.

State mental-health officials said the incident ''raised a lot of
concerns" but was not reportable as a ''major unusual incident" under
the department's standards.

''This is the kind of human-rights abuse that occurred in the back
wards of psychiatric hospitals 25 years ago," said Laura Wissler, a
parent advocate for the Mental Health Association of Summit County.

''If this isn't reportable, what is?"

Copyright © 2005, The Columbus Dispatch

TeenScreen Fraud for Big Pharma

http://www.opednews.com/pringleEvelyn_041405_teenscreen.htm

Evelyn Pringle

The question is what is TeenScreen, an Angel of Mercy for suicidal teens, or
a pill-pushing front group for Pharma? After investigating the program, I'd
have to say the latter.

Columbia University oversees the TeenScreen Program which invented a survey
to identify school children who are mentally ill. It was designed for kids
between 9 and 18 years of age, and consists of a 52-item computerized
interview that includes questions about depression, suicidal ideations or
attempts, anxiety, and alcohol and drug abuse.

Columbia claims the survey can assesses the symptoms of eight mental
disorders that are either associated with the risk of suicide or mental
illness. On March 2, 2004, the program's Executive Director, Laurie Flynn,
testified at a congressional hearing and said in the screening process,
"youth complete a 10-minute self-administered questionnaire that screens for
social phobia, panic disorder, generalized anxiety disorder, major
depression, alcohol and drug abuse, and suicidality."

This survey is already being administered in many schools all over the
country. Suicide prevention is being used to justify it even after an
evaluation of screening programs by the US Preventive Services Task Force
found no evidence that screening reduces suicide attempts or mortality, and
that there is limited evidence on the accuracy of screening tools to
identify suicide risk.

About 2 years ago, TeenScreen hired the PR firm Rabin Strategic Partners.
According to its website, when hired, the big question for Rabin was, "how
to ensure that every teen in the US has access to this free mental health
check-up?"

To accomplish that feat, the Firm said, "We provided our client with a
ten-year strategy including the marketing, public policy and funding steps
needed to go from here to there."

"We hired and managed public relations, lobbying and advertising services to
implement the plan," Rabin wrote, "And now, on a daily basis, we help read
the media and political environment to revise the plan."
In a summary of progress on Jan 24, 2004, the PR Firm contends its strategy
is paying off, "Programs are now established in more than 100 communities in
34 states. 19 national groups have endorsed ... screening for youth. There
is a waiting list of 250 communities interested in screening programs. There
are three relevant bills pending in Congress and six state governments are
working on plans to spread screening programs statewide," it wrote.

Rabin lists 13 clients besides Columbia College on its website and 5 are
from the pharmaceutical industry. It describes its TeenScreen client as "The
Carmel Hill Center for the Early Diagnosis & Treatment of Mental Illness."

Now that's an honest description of TeenScreen, none of those phony comments
about saving poor suicidal teens, just the facts, diagnose and treat. Kind
of like regular pushers do everyday, go out and recruit new customers to
sell more drugs to.

The truth is the survey is a fraud and cannot diagnose mental illness in
kids. "The normally developing child hardly stays the same long enough to
make stable measurements. Adult criteria for illness can be difficult to
apply to children and adolescents, when the signs and symptoms of mental
disorders are often also the characteristics of normal development,"
according to the US Surgeon General in 1999.

As noted by Canadian-American psychologist, educator and author Dr Daniel
Burston, "any number of things that are, or could be, perfectly natural
responses to an environment can be construed as a sign of mental disorder."

TeenScreen also serves no useful purpose because there are no proven safe
and effective drug treatments for children. Clinical trials on the drugs the
program is pushing, failed to show that they were any safer or more
effective than sugar pills.

Who's Behind TeenScreen?

TeenScreen is just another front group set up to widen the prescription drug
market in the US. These groups are bullhorns for the industry. Groups like
TeenScreen issue press releases on the drastic rise in mental illness, the
media repeats the stories, and a widening market follows.

TeenScreen's goal is to infiltrate the nation's school system to reach the
52 million children who attend school, and get as many as possible hooked on
these expensive drugs for life before they ever leave school.


The fact is, legalized drug pushing is big business, and like with any other
business, Pharma hires PR firms, develops media relationships, advertises
its products, and pays big money to researchers and members of the medical
profession to write reports to lend legitimacy to these brain-damaging
drugs.

The industry doles out millions of dollars to front groups each year. It
dreams up official sounding names to mask their true reason for existence.
However most of the time a group's true colors can be detected by checking
out its leadership to determine who controls the operation.
The PR industry refers to front groups as "partners," and TeenScreen's top
PR guy, Steve Rabin, is an expert at forming these partnerships. Over the
years, in addition to Columbia University, his client list has included,
Abbott, AstraZeneca, Bayer, Bristol-Myers Squibb, Eli Lilly, Glaxo
Wellcombe, Hoffman-La Roche, Janssen-Cilag,, Lundbeck, Novartis, Pfizer,
SmithKline Beecham, Wyeth-Ayerst and the National Alliance of the Mentally
Ill. The common thread in the pyramid of industry-supported groups is the
fact that nearly all of the group leaders at the top are longstanding,
honorary members of Pharma's undercover pill-pushing squad.

TeenScreen Leaders Refuse To Give Information On its website, TeenScreen
invites inquiries by saying, "If you are interested in learning more about
starting a TeenScreen Program in your community or working on policy related
issues, please contact the TeenScreen Program by e-mail at for information
and assistance."

When I decided to investigate the program, I emailed questions to 4 people
in top administrative positions and said in part, "I am in the process of
writing an article about the TeenScreen project and was wondering whether
you could provide me with answers to the questions," that included, (1) Does
your program have any information that indicates that the use of
antidepressants has reduced suicide rates in children? (2) Who are the major
funding sources for the TeenScreen project? (6) On your site you mention
that TeenScreen is funded by private family foundations and that the program
does not receive financial support from the government and is not affiliated
with, or funded by, any pharmaceutical companies. Can you provide me with a
list of the private family foundations that have supported your efforts?

I got no response from Executive Director, Laurie Flynn, or Co-Deputy
Director Robert Caruano. But Senior Program Coordinator, Heather Scanlon
said:
"Because of the large volume of inquiries we receive and the small size of
our staff, we are only able to respond personally to requests for help and
information from individuals establishing local screening programs.

There is an extensive set of materials about the TeenScreen Program on our
website, which we hope will be helpful in providing more information about
our program."

After Leslie McGuire, the Director, emailed me the exact same response, I
decided to conduct my own investigation of the project.

Who's Paying For TeenScreen?


Taxpayers and Pharma are mutually funding this pill-pushing scheme, which
over time, will result in a massive diversion of tax dollars to Pharma. The
statement that "The program does not receive financial support from the
government and is not affiliated with, or funded by, any pharmaceutical
companies," is an outright lie.

What do they call this? On June, 2002 the Update Newsletter published by the
Tennessee Department of Mental Health and Developmental Disabilities,
reported that 170 students had completed a TeenScreen survey conducted by
the NAMI and Columbia University.

According to Update, the survey was funded through grants from AdvoCare and
Eli Lilly.


The great news for Pharma was that 96 of the 170 students (over 50%) who
filled out the survey ended up speaking to a therapist which no doubt means
that Pharma was able to recruit 96 new pill-popping customers.


In addition to drug money, plenty of government funding is earmarked for
TeenScreen already, with more on the way. For instance, on Oct 21, 2004 Bush
authorized $82 million for suicide prevention programs like TeenScreen and a
report in Psychiatric Times says the Bush administration "has proposed an
increase in the budget of CMHS [Center for Mental Health Services] from $862
million in 2004 to $912 million in fiscal 2005."

TeenScreen will no doubt get a good cut of that as well.
While testifying Flynn told congress that states should divert money
allocated for alcohol and drug abuse programs into projects like TeenScreen,
and said:


"Our experience shows that the government can support youth mental health
screening by redirecting existing resources. For example, state and local
education agencies can use Safe and Drug Free Schools and Communities
dollars to support school-based mental health services and suicide
prevention activities. Both the federal and state governments must do a
better job of encouraging local school districts to include mental health
check-ups in their grant applications," she said.


Make no doubt about it, tax payers are going to pay a huge price for
allowing this marketing scheme to get students hooked on drugs. A list of
drugs that must be used on the kids is already set up, modeled after a
similar list used in Texas called the TMAP.

Here's how this part of the scheme works. The drug companies donate money to
the states to implement these programs and then in return, state Medicaid
programs fund the cost of the drugs with tax dollars.

For example, in Texas, Pfizer contributed $232,000 to the Texas department
of mental health to "educate" mental health providers about TMAP, and in
return, the Texas Medicaid program spent $233 million tax dollars on Pfizer
drugs like Zoloft.

Johnson & Johnson (Janssen Pharmaceutica) contributed $224,000 to the state
and Texas Medicaid spent $272 million on J & J antipsychotic drug,
Risperdal.

Eli Lilly contributed $109,000 to "educate" state mental health providers
and as a result, Texas Medicad spent $328 million for Lilly's antipsychotic
drug Zyprexa. Federal dollars are already being funneled through the state
governments to fund TeenScreen. On Nov 17, 2004, Officials at the University
of South Florida Department of Child & Family Studies announced receiving
close to $10 million in federal funds and said $98,641 was awarded to expand
the TeenScreen program in the Tampa Bay area.

The Florida pill-pushers are really hell-bent on drugging kids. They claim
it's possible to diagnose mental illness in infants. "Even before their
first birthday, babies can suffer from clinical depression, traumatic stress
disorder, and a variety of other mental health problems," the Florida
Strategic Plan for Infant Mental Health claimed.

The truth is, the only beneficiaries of TeenScreen are the drug makers,
politicians with campaigns funded by the industry, and the
mental-health-provider-complex made up of psychiatrists, psychologists,
mental institutions, and the pyramid of front groups, which all have a
vested interest in broadening the drug customer base.

Robert Whitaker, author of the best-selling book, Mad in America, tracked
the profits from the sale of these so-called wonder drugs, and reviewed
government data that revealed not only an astonishing increase in the use of
the drugs, but a tremendous rise in the cost to taxpayers since 1987, the
year after the new generation of wonder drugs were put on the market.

According to Whitaker, in 1987, psychotropic drug expenditures were
approximately $1 billion, but by 2002, the cost had risen to $23 billion, 23
times the amount spent a mere 15 years earlier.

The rising costs are not going to slow down any time soon if Flynn has her
way. While testifying, she said, "In 2003, we were able to screen
approximately 14,200 teens ...; among those students, we were able to
identify approximately 3,500 youth with mental health problems and link them
with treatment. This year, we believe we will be able to identify close to
10,000 teens in need, a 300 percent increase over last year."

Study Flynn's estimates and then do the math. If the TeenScreen gravy train
isn't stopped, each year more and more tax dollars will be funneled to
Pharma through a steady stream of newly recruited student-customers, and the
PR genius, Steve Rabin's 10-year strategy plan will be100% successful.

Evelyn Pringle epringle05@... is a columnist for Independent Media TV
and an investigative journalist focused on exposing corruption in government