psychiatry
ddobbs | April 5, 2009Heads-up dept:
I'll be discussing I discussed "The Post-Traumatic Stress Trap," my Scientific American story on PTSD, at noon, Monday, April 6, on NHPR's "Word of Mouth." You can listen to the 7-minute segment here, following a very brief intro to the program. Link to the station's website here.
ddobbs | April 3, 2009What are the relative strengths and weaknesses of long-form, slow-bake, "mainstream" journalism and the idiom we call the blogosphere? As per Bora, the meaning of these terms are shifting as we speak. Last night, using my recent story and blogging on PTSD as a point of focus, I put in my latest two cents on this subject at my talk -- actually a long conversation with host and audience -- at the NYU Science, Health and Environmental Program's "Inside-Out" lecture series.
This was a crowd of writers, journalism profs, and journalism students, and I think we were all surprised at how many…
j7uy5 | April 3, 2009From time to time, we hear of faux psychotherapy interventions that are
intended to convert persons from homosexuality to
heterosexuality. Mostly, the publicity has centered on
pseudomoralistic interventions that clearly have a religious agenda as
opposed to a health-enhancing agenda. As such these interventions
cannot be classified as therapy.
However, a recent survey has shown that there still is a small minority
of therapists who will, in some circumstances, attempt to have their
clients convert from homosexuality to heterosexuality. The
results were published in the open-access…
ddobbs | March 20, 2009A few weeks ago, Matt Stevens, the National Guard captain and medic who served in Iraq and whom I mentioned in my Scientific American article, "The Post-Traumatic Stress Trap, wrote me an email about the social unease he often encountered when he showed any behavior that might remind people he had served in Iraq -- a greater seriousness, an impatience with petty concerns or inefficiency, or even just talking about the place.
I have begun to think of military PTSD as to some extent a civilian problem rather than a soldier problem. To expand slightly here; civilians/politicians send soldiers…
ddobbs | March 18, 2009It didn't take long for my Scientific American story on PTSD to draw the sort of fire I expected. A doctor blogging as "egalwan" at Follow Me Here writes
[Dobbs] is critical of a culture which "seemed reflexively to view bad memories, nightmares and any other sign of distress as an indicator of PTSD." To critics like this, the overwhelming incidence of PTSD diagnoses in returning Iraqi veterans is not a reflection of the brutal meaningless horror to which many of the combatants were exposed but of a sissy culture that can no longer suck it up.
Doctor or not, he's seeing politics where my…
j7uy5 | March 18, 2009Today's edition of the Journal of the American Medical Association
contains a study that employed PET scans to determine the effect of
modafinil upon dopamine concentration and reuptake in the human central
nervous system. They conclude with a caution that clinicians
should be mindful of the potential for abuse and dependence in persons
taking modafinil.
The problem with the study is that it adds very little, if anything, to
clinical practice.
href="http://jama.ama-assn.org/cgi/content/short/301/11/1148">Effects
of Modafinil on Dopamine and Dopamine Transporters in the Male Human…
ddobbs | March 16, 2009Below are materials supplementing my story "The Post-Traumatic Stress Trap," Scientific American, April 2009. (You can find the story here and my blog post introducing it here.) I'm starting with annotated sources, source materials, and a bit of multimedia. I hope to add a couple sidebars that didn't fit in the main piece -- though those may end up at the main blog, so you may want to keep an eye there or subscribe via RSS or Atom.
Main sources and documents in "The Post-Traumatic Stress Trap."
These are organized by story section, roughly in the order the relevant material appears.…
ddobbs | March 14, 2009
My story in the April 2009 Scientific American story, "The Post-Traumatic Stress Trap", just went online. Here's the opening:
In 2006, soon after returning from military service in Ramadi, Iraq, during the bloodiest
period of the war, Captain Matt Stevens of the Vermont National Guard began to have a problem with PTSD, or post-traumatic stress disorder. Stevens's problem was not that he had PTSD. It was that he began to have doubts about PTSD: the condition was real enough, but as a diagnosis he saw it being wildly, even dangerously, overextended.
[snip]
"Clinicians aren't separating the…
j7uy5 | March 9, 2009
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This post
will discuss some findings about the factors that
are correlated to clinical response to
href="http://en.wikipedia.org/wiki/Clozapine">clozapine
(Clozaril® , FazaClo® ).
Clozapine is a drug used to treat psychosis. It usually is
used for…
ddobbs | March 5, 2009An ongoing topic here -- raised in depth here, and most recently here -- is how psychiatry is going to right itself from being knocked off-course and off-kilter by its overcozyness with pharma and a corresponding picture of mental disorder.
Psychiatrist Danny Carlat -- one of many dismayed by psychiatry's directtion over the last few years -- sees signs in a recent commentary in the American Journal of Psychiatry, signed by 26 highly prominent psychiatrists, that the discipline is starting to get it.
The key point of the commentary is stated in its title, "Conflict of Interest: An Issue…
ddobbs | March 5, 2009Philip Dawdy takes a interesting look at a new study of the safety of placebo arms in clinical trials of antidepressants in teens. My own quick scan of the study [which Dawdy makes available as pdf download] suggests it's full of great nuggets.
Its take-home: Placebo treatments produced remission rates of 48%, while the rate for active treatment was 59%. And, quite interestingly, the study concludes:
Patients who responded to placebo generally retained their response. Those who did not respond to placebo subsequently responded to active treatment at the same rates as those initiallyl…
ddobbs | March 4, 2009I'm having difficulty even reading, much less posting about, the river of stories about pharma and device industries, FDA regs, conflicts of interest, and so on. But I'll take a stab here at spotlighting the main events and making some sense of where this is headed. For I don't think it's just coincidence that brings in a few days an archetypal pharma scandal, an unexpected and emphatic Supreme court reversal, an underwear check administered to the entire faculty of the Harvard Medical School, and the decision to "make an example" of surgeons who took kickbacks for using medical devices.
The…
ddobbs | February 27, 2009I drove up to Montreal yesterday, and amid visits with anthropologist and Somatosphere founder Eugene Raikhel, anthropologist Allan Young, and Suparna Choudhury, talked about (among other things) the emerging new area of study they're calling "critical neuroscience."
What the heck is critical neuroscience? Well, one definition calls it
the attempt to assess and inform neuroscientific practice from a rich interdisciplinary perspective, and to categorize, evaluate and (begin to) manage the various risks resulting from neuroscience and its results and applications
.
Daniel Lende, one of the…
ddobbs | February 10, 2009Marcia Angell makes it plain:
The fact that drug companies pay prescribers to be "educated" underscores the true nature of the transaction. Students generally pay teachers, not the reverse. The real intent is to influence prescribing habits, through selection of the information provided and through the warm feelings induced by bribery. Prescribers join in the pretence that drug companies provide education because it is lucrative to do so. Even free samples are meant to hook doctors and patients on the newest, most expensive drugs, when older drugs -- or no drug at all -- might be better for…
j7uy5 | February 10, 2009The new Congress and new Administration passed a law already. It
was barely notied by the media. It is a reauthorization and
expansion of the State Children's Health Insurance Program
(SCHIP). Given the expected resistance to major changes in
health care, it was astonishingly easy for Congress and the President
to get this done.
Details are in an open-access article in NEJM:
href="http://content.nejm.org/cgi/content/full/NEJMp0900461">Expanding
Coverage for Children -- The Democrats' Power and SCHIP Reauthorization
John K. Iglehart
NEJM February 4, 2009
(doi:10.1056/NEJMp0900461)…
ddobbs | January 22, 2009
In response to my post on himself, the NY Times, Zyprexa, Infinite Mind, etc.
neurophilosophy | January 20, 2009Delusions are pathological beliefs which persist despite clear evidence that they are actually false. They can vary widely in content, but are always characterized by the absolute certainty with which they are held. Such beliefs reflect an abnormality of thought processes; they are often bizarre and completely unrelated to conventional cultural or religious belief systems, or to the level of intelligence of the person suffering from them.
The delusions experienced by psychiatric patients are sometimes categorized according to their theme. For example, schizophrenics often suffer from…
j7uy5 | January 6, 2009When I was in training, the chairperson (John Greden)
of the department never spoke about schizophrenia. Instead, he
always used the phrase, "the schizophrenias." He believed that
there were different disease states that all produced similar clinical
presentations. But because of the rudimentary state of our
knowledge, we were unable to make clear, meaningful distictions between
these different illnesses. As a result, we were improperly
lumping them together. He thought that soon, we would be able to
make meaningful distinctions between these different illnesses.
Perhaps the advances…
grrlscientist | December 13, 2008tags: hypomania, bipolar disorder, manic depression, mood disorders, mental health, psychology
Image: Michael Witte/NYTimes [larger view].
Have you ever met a person who seems to be on a perpetual caffeine high, without all the shaking? You know the type, those few hyperactive extroverts who are always doing things or meeting people, who have an expansive and optimistic mood yet are easily irritated, and who have an overactive libido or who enjoy really risky pastimes, like jumping out of airplanes or climbing buildings. According to some reading I've been doing, these are apparently…
j7uy5 | December 8, 2008
Tapentadol
is a drug for pain. It was approved by the US FDA for the
treatment of moderate to severe pain. The
href="http://www.fda.gov/bbs/topics/NEWS/2008/NEW01916.html">FDA
news release was dated 24 November 2008, although the actual
approval was a few days earlier.
Tapentadol acts on μ-opioid receptors, making it similar to
morphine
and its ilk. Do we need another opioid agonist? And
if so,
why? Suspicions deepen because it was produced by the same
company that makes tramadol. Indeed, it is similar to
tramadol in
many ways. Tramadol is the active ingredient in
Ultram®, now…