FDA and Child Bipolar

Philip over at Furious Seasons is on a rant about the FDA legitimizing the childhood bipolar diagnosis, one which does not yet occur in the DSM. Essentially, it sounds like the rationale is that since they’ve approved studies about medicating the disorder and approved dosages of Abilify and Risperdal with children — then the disorder exists. Today Furious Seasons posts all about the adverse effects of those two drugs. The excerpt from yesterday’s post:

Earlier today, I asked the FDA to respond to a statement made by Harvard child psychiatrist Janet Wozniak, wherein the doctor claimed that the FDA accepted the validity of the hotly-debated child bipolar disorder. That was news to me, since the diagnosis does not exist in the DSM and many child psychiatrists such as Jack McClellan and Larry Diller, both affiliated with major medical schools, even claim that the child bipolar diagnosis is not real.

Addendum: Clinical Psychology and Psychiatry also posts on this topic, and points to a John Grohol post at Psych Central, also on child bipolar. Dr. Grohol rightly points out that the FDA logic for sanctioning this diagnosis is circular…


Oliver Sacks on Autism

First, a quote from today’s New York Times on nationally syndicated radio host Michael Savage:

Mr. Savage, above, referred to autism as “a fraud, a racket,” and asserted that what “99 percent” of children with autism most needed was a parent willing to tell them things like, “Don’t act like a moron.”

On a more enlightened note, here’s a fascinating video on autism hosted by noted author Oliver Sacks. Much of the focus is on a gifted autistic painter. She goes to museums and becomes fascinated by the security systems. This is really an interesting video, “Rage for Order” worth checking out.

Pharmaceutical Sales 2007: Antipsychotics For Sale

Out of the $663 billion sales of pharmaceuticals in 2007, the sale of psychotropic medications was not that high: 3 percent for antipsychotics, 3 percent for antidepressants. Yet if you look at the top ten best-selling drugs, three of them are antipsychotics. The source is IMS health, who describe themselves:

IMS is the one global source for pharmaceutical market intelligence, providing critical information, analysis and services that drive decisions and shape strategies.

Clinical Psychology and Psychiatry: A Closer Look quotes the IMS statistics and adds these observations:

Antipsychotics were the sixth best selling class of medications globally in 2007, according to IMS Health. They raked in a cool $20.7 billion, an increase of 10.7% from 2006. Thank God we are doing a better job of overrecognizing, er, appropriately treating bipolar disorder. Antidepressants were #7, at $19.7 billion, down nearly seven percent. This does not appear to be due to declining prescriptions. Blame generics, not decreased prescriptions for the lower numbers. With Cymbalta, Lilly has shown that new antidepressants don’t have to be anything special, so it would behoove other companies to release other run of the mill antidepressants, attach a comical, er, highly educational marketing campaign such as Depression Hurts, then watch the money roll in. Just some free advice.

It was the author of that website (Clinical Psych) that proposed a National Bipolar Unawareness Week. An humorous take on the overdiagnosis of manic depression.

Magnetic Therapy for Treatment Resistant Depression

When treatment for depression doesn’t seem to be working, it’s time to suggest alternatives. Dr. Deb has an interesting post on the use of Repetitive Transcranial Magnetic Stimulation, known as rTMS.

rTMS, as it is called, is a non-invasive brain stimulation technique that increases neural blood flow in the brain. The procedure is not a surgical one, and should not be confused with Electroconvulsive Therapy

In rTMS, a doctor holds a device over a specified area of the brain. Magnetic currents pass through the scalp, sending bursts of electrical fields deep into the brain to alter neural activity.

rTMS has been used for Treatment Resistant Depression for Obsessive Compulsive Disorder and to reduce Schizophrenic Hallucinations – as well as to treat medical conditions like stroke, migraine, Parkinson’s and Epilepsy, just to name a few.

Psychotherapy: A Series of Thoughts

Many books have been written in hope of defining psychotherapy. Here’s a very short attempt (has appeared as part 1, part 2, on the ‘psychotherapy?’ page):

Psychotherapy is a conversation between two people — where one person predominantly talks and the other predominantly listens. The goal of the conversation that develops is to foster insight into the nature of the person doing most of the talking, as well as insight into that person’s problems. But insight is not enough. The important work is somehow getting that insight to stick. To incorporate it into that person’s life in meaningful ways that in turn helps that person better adjust to her or his life.

Even such a simple definition leaves so much that is important out, and there are so many questions it raises, and statements that beg qualification.

Not a blame game.
Psychotherapy is not about complaining endlessly about past injuries. It is not about painting family members as the cause of all our problems. It can be about understanding one’s perceptions of past and present events and how those perceptions color our views of our daily life. Some misunderstand psychotherapy as playing a blame game, not accepting responsibility. Quite the reverse, psychotherapy encourages us to examine and challenge our own perceptions (which may or may not resemble historical truth) of the past. It is important to examine perceptions, because it is our perceptions which shape how we perceive our current world, and inform our decision making and actions.

Making meaning.
Human beings are meaning-making creatures. Faced with confusion, we will attempt to find meaning, even where there is none. Psychotherapy is about uncovering and addressing those meanings. Meanings may generated within one’s self, within one’s family, within one’s community, within one’s culture. Those meanings that may even be obscure to ourselves. A good therapist will gently challenge us to examine inconsistencies in our perceptions and beliefs about ourselves and our interactions with others — and to examine what they might mean. Psychotherapy does not generally come upon “Eureka, that’s it!” sorts of answers, although such insights may suggest further avenues of inquiry. It is a very process-focused endeavor that studies our questions about ourselves in a sustained, methodical, and patient manner.

Recognizing patterns.
Before we can begin to understand our patterns, we have to become aware of them. Part of what psychotherapy does is help to make people more aware of patterns and behaviors that they themselves might not have noticed. It is a process of teasing out the many possible sources that contribute to those behaviors. Many patients express a sense of relief when they are able to bring new meaning to a past situation they had viewed simply from one perspective.

When solutions become problems.
Often the problems we bring to therapy represent our best solutions to our problems — but they are solutions that have stopped working, and in some cases have become new problems. Psychotherapy is an intervention to help us not repeat endlessly the same unproductive solutions.

An authentic emotional connection.
Purely intellectual understanding is very limited. There has to be an authentic emotional connection in connection to our understanding of past events in order to effect meaningful change. A therapist will help you to hone in on, rather than gloss over aspects of your life which seem to be potentially loaded with emotional meaning. A good therapist will convey understanding and empathy for what you are going through. To a great degree, the connection you have with your therapist is what determines the success of your therapy.

Change takes time and collaboration.
Meaningful change does not happen overnight. Many of these patterns of behavior have been honed over years and years, and take time to examine, untangle, and reintegrate into our current lives. Since this type of therapy is more likely to focus on meaning rather than symptoms, it takes time.

It has been written that psychotherapy could conceivably occur between two people without one of them being a therapist. Yet this is quite unlikely. The way that therapists listen, without generally offering advice or solutions, is not the usual mode of casual conversation. A conversation dedicated, on a weekly basis, solely to the concerns of one person is not likely to occur outside of psychotherapy.

Listening in an informed, sustained way.
A therapist will listen knowing what types of life events are likely to have an impact on one’s style of relating to self and others. A therapist will listen knowing that each stage of life (e.g., adolescence, young adulthood, parenthood, middle age, retirement) brings its own unique set of problems, and what are the usual hurdles during these stages. Finally, a therapist will listen with an understanding of the pathologies that can develop in responses to certain problems and have experience in working with those pathologies (e.g., depression, anxiety, obsessive behavior).

Kalea Chapman, Psy.D.

Body Position Affects Memory of Events

Fascinating piece at Cognitive Daily on headlined topic, from a 2007 study. One idea that occurs immediately, is that this idea lends credence to treatments for PTSD that involve physical movements, even re-dramatizing the event. Here’s an excerpt:

A new study adds an unexpected method to the list of ways to spur memories about our past: body position. That’s right: just holding your body in the right position means you’ll have faster, more accurate access to certain memories. If you stand as if holding a golf club, you’re quicker to remember an event that happened while you were golfing than if you position your body in a non-golfing pose.