Child Bipolar Research and Drug Company Payola

Clinical Psychology and Psychiatry alerted me to an article in yesterday’s New York Times. Here’s the lead from the Times story:

A world-renowned Harvard child psychiatrist whose work has helped fuel an explosion in the use of powerful antipsychotic medicines in children earned at least $1.6 million in consulting fees from drug makers from 2000 to 2007 but for years did not report much of this income to university officials, according to information given Congressional investigators.

And another excerpt:

Dr. Biederman is one of the most influential researchers in child psychiatry and is widely admired for focusing the field’s attention on its most troubled young patients. Although many of his studies are small and often financed by drug makers, his work helped to fuel a controversial 40-fold increase from 1994 to 2003 in the diagnosis of pediatric bipolar disorder, which is characterized by severe mood swings, and a rapid rise in the use of antipsychotic medicines in children. The Grassley investigation did not address research quality.

And here are some comments from Clinical Psych:

I’m still awaiting any impressive outcome dataon the “bipolar” kids being treated with antipsychotics. Especially the young kids. 4 year olds on Seroquel — I’m glad I’m not on Joe’s level. Are we better off now that the diagnosis of bipolar has run rampant in kids?

Dr. Carlat has a little more perspective on the issue, and some familiarity with the researchers involved:

A little sleazy? Maybe. Malevolent? I don’t think so.

The big lesson here is that Congress must pass the Physician Payment Sunshine Act, because we will never be able to grasp the extent of the complex financial relationships between companies and thought leaders without this legislation….

I have been reading the pertinent documents in the Congressional Record in order to figure out whether these three psychiatrists, all of whom I know from my training days at MGH, behaved very badly or just a little badly. All three are highly intelligent and committed researchers. During my residency days, I received a few lectures from Dr. Wilens, and he is a good, solid person. I didn’t have as much contact with Dr. Biederman or Dr. Spencer.

And Furious Seasons picked up on these details from the article:

“The group published the results of a string of drug trials from 2001 to 2006, but the studies were so small and loosely designed that they were largely inconclusive, experts say. In some studies testing antipsychotic drugs, the group defined improvement as a decline of 30 percent or more on a scale called the Young Mania Rating Scale — well below the 50 percent change that most researchers now use as the standard.”

And the money:

What’s stunning to me is just how much money these researchers were pulling in.

Biederman: $1.6 million from 2000 to 2007

Wilens: $1.6 million from 2000 to 2007

Thomas Spencer: $1 million from 2000 to 2007.


Biological Bases of Behavior

A very broad domain.
Psychologists are expected to have knowledge of biological and neural bases of behavior, and psychopharmacology. This includes areas like neuroanatomy, neurophysiology, and neuroendocrinology. It pertains to specific brain functions such as “perception, action, attention, memory, temperament, and mood in normal and chronic disordered states… and/or chronic disease (e.g. insulin shock, diabetes, mood disorders, dementia, schizophrenia, and Alzheimer’s)”(quote from the Association of State and Provincial Psychology Boards).

Current trends.
The current trend is to explain things in terms of chemistry rather than psychological events. But the two are inseparable. Everything we do is, on some level, the result of chemical reactions within our brains and bodies. And the things we do result in chemical changes in our brains and bodies. There is a chicken and egg problem with locating the causes of depression or anxiety in the deficits of a particular neurotransmitter, such as serotonin. This is not to say that neurotransmitters are not connected with depression — there clearly is a relationship. What effects do chronic negative thoughts have on the production of neurotransmitters? Or chronic negative emotional states? We do not have simple, clear answers to these questions.

One case: Schizophrenia.
Consider briefly, your own beliefs about schizophrenia. The current thinking is that this is a brain disorder. There are observable differences in the brains of schizophrenics. From this point of view, there is no cure, only management. Now read this.

Prescription privileges.
Psychologists, as a group, are pushing strongly for the right to prescribe psychotropic medications. While there are some compelling arguments for doing this (lack of access to psychiatrists in rural areas, for one), prescribing medications potentially lures the practice away from human problems and dilemmas. Think for a moment — what is your view of the role of drug companies in medicine? Does that role help or hinder medical practice?

Kalea Chapman, Psy.D.

Eight Domains in Psychology

Eight domains of competence.
Psychologists must pass the national licensing exam before they are licensed. The exam is divided into eight domains. As I’ve said, psychologists do a number of different things. A quick look at these gives you an idea about areas that psychologists are expected to be knowledgeable in. I’ll be writing more about each of the domains.

  1. Biological Bases of behavior
  2. Cognitive-Affective Bases of Behavior
  3. Social and Multicultural Bases of Behavior
  4. Growth and Lifespan Development
  5. Assessment and Diagnosis
  6. Treatment, Intervention, and Prevention
  7. Research Methods and Statistics
  8. Ethical/Legal/Professional Issues

Kalea Chapman, Psy.D.

Two Aspects of Psychology

Psychologists do a lot of different things.
One division within the field is between scientists and practitioners. The scientific group tends to be more research oriented. The practitioners tend to be more clinically oriented. The links provide some insight into what each group does.

Kalea Chapman, Psy.D.

Rose City Counseling Center

Rose City is on 595 E. Colorado Blvd., suite 303. It is on the corner of Madison. If you’re looking at the website, it’s in the historical building in the photo. The office has more the feel of a private practice than a clinic.

The center has been established to provide high quality, psychoanalytically oriented, individual psychotherapy services to those who traditionally are not able to afford them and who do not have insurance coverage for mental health treatment. Treatment will be provided by post-doctoral level, registered psychological assistants under the supervision of our staff psychologist.

Rose City Counseling Center (RCCC) provides individual, couple, family, and group psychotherapy. Psychotherapy seeks to treat a variety of emotional and interpersonal problems. It intends to reduce or eliminate certain psychological symptoms, and to improve social and occupational functioning. Unlike medical consultations, it proceeds by having all parties work actively to gain insight into and alter certain maladaptive emotional states and behaviors.

Fees. Our sliding scale fees range from $25 to $80. We do not accept private insurances or Medi-Cal or Medi-Care. Our intention is to provide psychological services to people who cannot afford to come to us in private practice, and who cannot get individual psychotherapy in other settings such as community mental health centers.

Contact. The telephone number is: (626) 793-8609.

Kalea Chapman, Psy.D.


Why People Seek Help: Five Common Reasons

Here are some common reasons people come in for therapy:

  1. Trouble in relationships. marriage, friendships, coworkers.
  2. Life transitions. Adolescence, marriage, change of career, divorce, empty nest, retirement — each of these phases poses unique challenges.
  3. Anxiety. Many life transitions are tough on the nerves.
  4. Depression. Sometimes we don’t even realize we are depressed. If you are suffering from apathy, difficulty with sleep or sleeping too much, feeling blue, irritable, or lack of motivation that lasts for more than a few days you may be suffering from depression.
  5. Lack of direction. Sometimes people find that they are unhappy about where they are in their lives, confused how they got where they are. Psychotherapy is excellent at addressing such questions in a thoughtful, respectful manner that offers an opportunity for growth.