In a new study published in JAMA Psychiatry, the use of antipsychotics (in this case, olanzapine) was associated with damage to the brain in multiple areas. The researchers used a randomized, controlled trial (RCT) design, which allows them to suggest that the drugs cause the observed effect on the brain. The researchers found “widespread” cortical thinning in those who took the drug versus those who took a placebo.
“Unlike uncontrolled studies, our randomized, double-blind placebo-controlled clinical trial design provides potential evidence for causation: olanzapine administration may cause a decrease in cortical thickness in humans,” the researchers write.
Exposure to olanzapine for just 36 weeks resulted in a loss of cortical thickness equal to up to four times the loss, on average, over the entire lifespan of someone who did not take the drug.Read More
In a new article in the Journal of Bioethical Inquiry, researchers reveal how grassroots patient advocacy groups began to fail consumers after taking money from pharmaceutical companies. The authors, led by Sharon Batt, a bioethicist from Dalhousie University in Canada, argue that pharmaceutical industry funding of consumer advocacy groups altered the goals and research priorities of these organizations. Batt and her co-authors, Judy Butler, Olivia Shannon, and Adriane Fugh-Berman, write:
“Accepting industry money would result in vulnerable patients being susceptible to the parroting of certain marketing messages that distorted scientific evidence, with the potential to cause needless suffering, misplaces hope, premature deaths, and misspent funds.”
“People who say it cannot be done, should not interrupt those who are doing it.” This quote by George Bernard Shaw was used as the title of an article about a severely disabled boy in Rwanda with cerebral palsy who made remarkable developmental gains after being deinstitutionalised and placed in a foster family by Hope for Homes for Children,1 an organisation at the forefront of a growing global movement to eliminate institutional care. The first part of the Lancet Group Commission on institutionalisation and deinstitutionalisation of children in The Lancet Psychiatry by Marinus van IJzendoorn and colleagues2 highlights the necessity of deinstitutionalising children, and the second part in The Lancet Child and Adolescent Health by Philip Goldman and colleagues3 provides a blueprint for achieving this goal.
As detailed in the first part of the Commission,2 research overwhelmingly shows that institutional care is detrimental to children’s development, especially with regard to physical growth, cognition, attention, and brain development (assessed head circumference). Significant but smaller negative effects are also found on children’s socioemotional development and physical health. Data also show that deinstitutionalisation, during which children leave institutions for foster or family care, is associated with significant recovery in some domains (eg, physical growth, including head circumference, and cognition), but not others (eg, attention), with greater length of time in institutions associated with increased risk of adverse outcomes and diminished chance of recovery.2
In both parts of the Commission,2,3 institutions are defined as any publicly or privately managed and staffed collective living arrangement for children that is not family based, and includes small-scale group homes. Many of these small-scale group homes have similar problems to their larger predecessors, including high child-to-caregiver ratios, multiple rotating shifts for staff to cover constant care, and large turnover rates of underpaid and insufficiently trained staff.2Read More
Awais Aftab is a psychiatrist in Cleveland, Ohio, and Clinical Assistant Professor of Psychiatry at Case Western Reserve University.
He is a member of the executive council of the Association for the Advancement of Philosophy and Psychiatry. He has been actively involved in initiatives to educate psychiatrists and trainees on the intersection of philosophy and psychiatry.
He leads the interview series Conversations in Critical Psychiatry for Psychiatric Times, which explores critical and philosophical perspectives in psychiatry and engages with prominent commentators within and outside the profession who have made meaningful criticisms of the status quo. He is also a member of the Psychiatric Times Advisory Board.
In this interview, he explores his journey into both philosophy and psychiatry and how he understands the relationship between these two disciplines. Aftab goes on to discuss how he began the critical psychiatry interview series and what he has learned from this experience and the pushback he has received. He then elaborates on how studying the philosophical issues in psychiatry, through a “conceptual competence” curriculum, could transform the doctor-patient relationship and improve mental health care.
The transcript below has been edited for length and clarity. Listen to the audio of the interview here.Read More
First, my ongoing, unremitting struggle for sanity…
I wrote this article during the fourth and fifth week of the Coronavirus lockdown in England. I wrote it whist living in an Air B&B in London, in a room with an en–suite bathroom – no living room, no garden, just a small kitchen that I have been sharing with the other two Air B&B residents.
Since the beginning of lockdown I have been ‘self-shielding’ (to use the UK government terminology), being one of the 1.5 million people in the UK deemed ‘extremely vulnerable’ to Coronavirus. What makes me part of this very high-risk group is that I have an ‘underlying health condition’ (Crohn’s Disease) and I am immunosuppressed due to the Crohn’s Disease medication I am on. As a result of ‘self-shielding’, I have only briefly left my room four times in the five weeks of the lockdown – for food shopping and collecting medication. But I am luckier than many in that I am able to buy fresh food on-line, and I have a good friend who has offered to collect my medication.
‘Stay home, save lives’ – says the Coronavirus lockdown motto. I am nowhere I can call home (we are not all in this together after all). My ‘self-shielding’ has brought about acute feelings of isolation, as well as a strong sense of lack of control, a sense of existing in enforced captivity and solitary confinement in one fairly small room (I live alone). I have been reminded of that other (profoundly traumatising) place and time – the acute psychiatric ward in Manchester where I was sectioned for three months back in 2009 – where I experienced a similar sense of imprisonment, lack of freedom of movement, and deprivation of liberty. That other place and time is both similar and very different. During the Coronavirus lockdown I have not been severely depressed, psychotic and suicidal as I was back in 2009, and I would not need Section 17 leave from a psychiatrist to leave my Air B&B.Read More
In 2004, the US Food and Drug Administration (FDA) controversially issued a black box warning that antidepressants were associated with an increased risk of suicidal thoughts and behaviours in people aged under 18 years. In 2007, the warning was expanded to include young adults aged under 25 years. In 2005, the Australian Therapeutic Goods Administration responded to the FDA warning by requiring Product and Consumer Information leaflets to be updated to reflect the risk. However, there was considerable debate, and at times emotive backlash, in academic journals and the international media. Prominent US and Australian mental health organisations and psychiatrists challenged the FDA warning. They argued that, on balance, antidepressant use was likely to reduce the risk of suicide. Several ecological studies were cited misleadingly as evidence that decreasing antidepressant use increases suicide risk. From 2008 to 2018, Australian per-capita child, adolescent and young adult antidepressant dispensing (0–27 years of age) and suicide (0–24 years) rates have increased approximately 66% and 49%, respectively. In addition, there was a 98% increase in intentional poisonings among 5 to 19 year-olds in New South Wales and Victoria between 2006 and 2016, with substantial overlap between the most commonly dispensed psychotropics and the drugs most commonly used in self-poisoning. These results do not support claims that increased antidepressant use reduces youth suicide risk. They are more consistent with the FDA warning and the hypothesis that antidepressant use increases the risk of suicide and self-harm by young people. Causal relationships cannot be established with certainty until there is a vast improvement in post-marketing surveillance. However, there is clear evidence that more young Australians are taking antidepressants, and more young Australians are killing themselves and self-harming, often by intentionally overdosing on the very substances that are supposed to help them.
We also asked Peter Groot who helped develop the first Tapering Strips for Antidepressant withdrawal – who with colleagues has demonstrated that this can help many people – not all – unfortunately not all he would say.
Before answering the questions, all were asked, Peter offered some more general views that have been paraphrased here.Read More
The killings of George Floyd, Ahmaud Arbery, Breonna Taylor, and so many others are leading many Americans to reflect on structural racism in society and resolve to do things differently. They have led me to make the difficult decision to end my membership with organized psychiatry, specifically the American Psychiatric Association.
After years of committing myself to the APA and believing that organized psychiatry was an effective vehicle by which progress could be made, racism is driving me and other Black physician leaders out of organized psychiatry, just as it has pushed Black physician leaders out of academic medicine.
As a physician, I grew up in the APA. During my residency, I was selected to receive the APA/GlaxoSmithKline Fellowship (now known as the APA/American Psychiatric Association Foundation Leadership Fellowship). Its goal is “to prepare future leaders in the field of psychiatry.” I was delighted, and proud, until I read the press release bearing the headline that 10 residents had been awarded the fellowship. Yet only nine names were listed in the release. The name of the only Black person in the fellowship class, mine, was left off. I was hurt but didn’t at the time feel the need to correct this “oversight,” and remained silent.Read More
More than 100 UK psychiatrists have written to their representative body urging it to root out institutional racism and a colonial mentality in the profession.
In an open letter to the new president of the Royal College of Psychiatrists, Dr Adrian James, who starts in the role on Wednesday, the members say there is a “once-in-a-generation opportunity to put psychiatry at the forefront in tackling systemic racism”.
They write: “We share a history with psychology and psychotherapy of not just ignoring the effects of discrimination, but painting other cultures as psychologically primitive and casting their approaches to understanding distress as backward superstitions.Read More
Dr. Danielle Hairston grew up in a family that included many role models of what she refers to as Black excellence.
“I had the example of a Black woman pediatrician, so it never occurred to me I couldn’t become a doctor,” says Hairston, who is now the psychiatry residency director at Howard University, where she herself now trains and mentors young Black doctors.
Yet, she says, she and her Black colleagues are routinely questioned in the hospitals and clinics where they work about their rightful place in the halls of medicine. They’re questioned entering the physicians’ lounge; in the elevator, one woman accosted Hairston: “Oh, my God, you’re a doctor? You? You?”
One of her white colleagues mistook her for a patient’s caregiver. “I don’t even necessarily think that he’s racist,” Hairston says. “It’s just that that’s the bias.”
Black Americans make up more than 13% of the U.S. population, yet only 5% of physicians are black. That lack of representation isn’t just a problem within medicine, Hairston notes, but it perpetuates a sense that medical and mental health care is not of — or for — the Black community.Read More