Treating acute psychosis with drugs can prolong the anguish

https://aeon.co/essays/treating-acute-psychosis-with-drugs-can-prolong-the-anguish

You Can Have Any Kind Of Treatment You want Providing It’s Our Kind – by Alec Grant PHD

You Can Have Any Kind of Treatment You Want, Providing it’s Our Kind

More Harm Than Good: Confronting the Psychiatric Medication Epidemic – a one-day international conference at the University of Roehampton

More Harm Than Good: Confronting the Psychiatric Medication Epidemic

a one-day international conference at the University of Roehampton

The Council for Evidence-based Psychiatry invites you to join global leaders in the critical psychiatry movement for a one-day conference which will address an urgent public health issue: the iatrogenic harm caused by the over-prescription of psychiatric medications.

There is clear evidence that these drugs cause more harm than good over the long term, and can damage patients and even shorten their lives.  Yet why are these medications so popular?  What harms are they causing?  What can be done to address the problem?

This event brings together key experts from both sides of the Atlantic to debate these issues, and we invite you to join the discussion (see the programme below).

TO BOOK YOUR PLACE PLEASE FOLLOW THIS LINK: http://estore.roehampton.ac.uk/browse/extra_info.asp?compid=1&modid=2&catid=172&prodid=217

Places are limited – early booking is advised!

When:18 September 2015Where: Whitelands College, University of Roehampton, London SW15 5PU (how to find us)

Cost: £85 for delegates, £28 for students, patients / service users and their families (includes lunch)

*** £70 early bird rate for delegates until 30 June! ***

This conference counts for 7 hours of CPD and we can provide CPD certificates on the day.

Speakers and panellists include:

Robert Whitaker

Robert Whitaker is an award-winning science journalist & author, a former fellow of the Safra Center for Ethics at Harvard University in Boston and founder of the influential e-zine madinamerica.com. He is is the author of five books: Mad in America, The Mapmaker’s Wife, On the Laps of Gods, Anatomy of an Epidemic and most recently Psychiatry Under the Influence (with Lisa Cosgrove). His newspaper and magazine articles on the mentally ill and the pharmaceutical industry have garnered several national awards, including a George Polk Award for medical writing and a National Association of Science Writers Award for best magazine article. A series he co-wrote for the Boston Globe on the abuse of mental patients in research settings was named a finalist for the Pulitzer Prize in 1998.

Prof Peter Gøtzsche

Peter C. Gøtzsche is Director of the Nordic Cochrane Centre.  He graduated as a master of science in biology and chemistry in 1974 and as a physician 1984. He is a specialist in internal medicine; worked with clinical trials and regulatory affairs in the drug industry 1975-1983, and at hospitals in Copenhagen 1984-95. He co-founded The Cochrane Collaboration in 1993 and established The Nordic Cochrane Centre the same year. He became professor of Clinical Research Design and Analysis in 2010 at the University of Copenhagen. Peter has published more than 70 papers in “the big five” (BMJ, Lancet, JAMA, Ann Intern Med and N Engl J Med) and his scientific works have been cited over 15,000 times. He is the author of four books, most recently Deadly Psychiatry and Organised Denial (to be published Sep 2015).

Dr Peter Breggin

Peter R. Breggin, MD, has been called “The Conscience of Psychiatry” for his many decades of successful efforts to reform the mental health field. His scientific and educational work has provided the foundation for modern criticism of psychiatric drugs and ECT, and leads the way in promoting more caring and effective therapies. He has authored dozens of scientific articles and more than twenty books including the bestsellerTalking Back to Prozac (1994, with Ginger Breggin), Medication Madness: The Role of Psychiatric Drugs in Cases of Violence, Suicide and Crime (2008), and Psychiatric Drug Withdrawal: A Guide for Prescribers, Therapists, Patients and Their Families (2013). Dr. Breggin acts as a medical expert in criminal, malpractice and product liability suits, often involving adverse drug effects such as suicide, violence, brain injury, death, and tardive dyskinesia. Dr. Breggin is a Harvard-trained psychiatrist and former full-time consultant at NIMH. His private practice is in Ithaca, New York where he treats adults, couples, and families with children.

Prof John Abraham

John Abraham is Professor of Sociology in the Department of Social Science, Health & Medicine at King’s College, London. Initially trained as a mathematician, he worked with the Radical Statistics arm of the British Society for Social Responsibility in Science and then earned three postgraduate degrees: MSc in Science Policy Studies, MA in Sociology and DPhil in Politics. He has published widely in sociology and politics, including four books on sociology of education (e.g. Divide and School: Gender and Class Dynamics in Comprehensive Education) and the politics of food (e.g. Food and Development: The Political Economy of Hunger and the Modern Diet). However, most recently his research has focused entirely on the sociology and politics of pharmaceuticals innovation, safety, efficacy, regulation and cost-effectiveness, especially in the UK, EU and US from the late nineteenth century to the present day.

Dr Joanna Moncrieff

Joanna Moncrieff is a Senior Lecturer in psychiatry at University College London and a practising consultant psychiatrist. She has written articles critical of various psychiatric drug treatments, including lithium, antidepressants and neuroleptics. Joanna has also written about the adverse influence of the pharmaceutical industry on psychiatry. She is also one of the founders and the co-chair of the Critical Psychiatry Network.  Joanna’s research consists of an analysis of all aspects of psychiatric drug treatment. She is interested in the nature and function of diagnosis in modern psychiatric practice, and in the history, politics and philosophy of psychiatry more generally. She has also written three books: The Bitterest Pills, published by Palgrave Macmillan, The Myth of the Chemical Cure, published by Palgrave Macmillan, and A Straight Talking Introduction to Psychiatric Drugs, published by PCCs books.

Prof Peter Kinderman

Peter Kinderman is  Professor of Clinical Psychology and Head of the Institute of Psychology, Health and Society at the University of Liverpool, with over 200 academic staff (32 of them professors) comprising psychiatrists, general practitioners, clinical and other applied psychologists, sociologists, public health physicians, nurses, sociologists and academics. Peter Kinderman’s research activity and clinical work has involved studying serious and enduring mental health problems such as paranoid beliefs and hallucinations, psychological models of mental health and the effectiveness of psychosocial interventions, alternatives to traditional psychiatric and diagnostic approaches and how psychological science can assist public policy in health and social care.  Peter Kinderman has an honorary position as Consultant Clinical Psychologist with Mersey Care NHS Trust. He is currently a member of the UK Office for National Statistics’ Technical Advisory Group for the Measuring National Well-being Programme, and served twice as Chair of the British Psychological Society’s Division of Clinical Psychology.  Peter is also President elect of the British Psychological Society.

Dr James Davies

James Davies is a co-founder of CEP. He graduated from the University of Oxford in 2006 with a PhD in social and medical anthropology. He is a senior lecturer in social anthropology and psychotherapy at the University of Roehampton and is a practicing psychotherapist, having worked for MIND and the NHS.

James has written widely in academe and has delivered lectures at many universities including Harvard, Oxford, Brown, UCL, Columbia (New York), and The New School (New York). James has also written for The Times, The New Scientist, The Guardian, The Daily Mail, Harvard Divinity Bulletin and Salon. He is author of three books including Cracked: why psychiatry is doing more harm than good (2013).

Programme:
8.45am                                Registration9am – 9:45am                     Introduction followed by James Davies: The origins of the DSM

9:45am – 10:30am             Robert Whitaker: Our psychiatric drug epidemic, a historical overview

10:30am                             Questions

10.45am                             Coffee

11am                                   Peter C Gøtzsche: Why few patients benefit from the drugs and many are harmed

11.45am – 12.30pm            Peter Breggin: How to practice psychiatry without drugs

12.30pm                              Questions

12.45pm – 1.45pm             Lunch

1.45pm – 2.15pm                Peter Breggin: Chronic brain impairment and psychiatric drug withdrawal

2.15pm – 2.45pm               Robert Whitaker: ADHD, changing the child instead of the environment

2.45pm – 3.15pm               Prof John Abraham: The misadventures of pharmaceutical regulation

3.15pm – 3.30pm               Questions

3.30pm – 4pm                    Coffee

4pm – 5.30pm                    Panel discussion: “Prescriptions for change”  Chair: Peter Kinderman  Discussants: Prof John Abraham, Prof Peter Breggin, Prof Peter Gøtzsche, Dr Joanna Moncrieff, Prof Lord Patel of Bradford, Robert Whitaker

TO BOOK YOUR PLACE PLEASE FOLLOW THIS LINK: http://estore.roehampton.ac.uk/browse/extra_info.asp?compid=1&modid=2&catid=172&prodid=217

Places are limited – early booking is advised!

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She’s Got A Ticket To Ride (But She Don’t Care)

It comes to something when a patient is asked to pay a General Practitioner to write a letter to the Department of Work and Pensions. A General Practitioner is surely there to oversee the mental wellbeing of a patient? Shouldn’t a standard letter, sent on behalf of a patient, to the DWP, or indeed any part of HMG, be sent by electronic mail, or by Royal Mail, for the cost of second class stamp? I’ve reluctantly agreed to pay £16.50 so that my GP can convey some information on my behalf. Once again, I shall think very carefully about approaching a General Practitioner for any help in relation to any aspect of my mental well being.

From BBC Health – Avatars Help Schizophrenia Patients Talk Back To Voices

http://www.bbc.co.uk/news/health-22720248

Professorial Lecture – Professor Gail A Hornstein -First Person Accounts of Psychosis: Challenges for Mental Health Professionals

Professorial Lecture – Professor Gail A Hornstein
First-person accounts of psychosis: challenges for mental health professionals
Friday 31 May 2013
5 for 5.30pm
Room 9130, Cantor Building, Sheffield Hallam University City Campus

Lecture supported by Sheffield Hallam University’s Department of Nursing and Sheffield Arts and Wellbeing Network

A vast gulf exists between the way medicine explains psychiatric illness and the experiences of those who suffer. Professor Hornstein’s lecture helps us to bridge that gulf, guiding us through the inner lives of those diagnosed with mental illness and emerging with nothing less than a new model for understanding mental distress, one another and ourselves. She will address the importance of listening to the accounts of those who have experienced psychosis as a central component of any mental health practice.

Gail A Hornstein is Professor of Psychology at Mount Holyoke College in South Hadley, Massachusetts (USA). Her research spans the history of 20th century psychology, psychiatry and psychoanalysis and has been supported by the National Library of medicine, the National Science Foundation and the National Endowment for the Humanities. She has compiled a bibliography of first-person narratives of madness which now lists more than 1,000 titles. Her new book, Agnes’s Jacket: A Psychologist’s Search for the Meanings of Madness (PCCS Books, UK edition), shows us how the insights of those diagnosed with mental illness can help us radically reconceive fundamental assumptions about madness and mental life. For more information on her work see http://www.gailhornstein.com/

The lecture will be introduced by Peter Bullimore, one of the Chairs of the Hearing Voices Network, and the Chair of the Paranoia Network. Peter heard his first voice aged seven, after suffering sexual abuse at the hands of a child minder. Through the help of the Hearing Voices Network he was able to reclaim his life from the system. The Hearing Voices Network is a voluntary organization that is made up of people who hear voices and professionals who all share the same ethos that hearing voices is a common human experience. Peter has worked collaboratively with Manchester University for 12 years on the COPE course collaboration in psychosocial education. He also teaches at many other Universities and runs workshops internationally on voices and paranoia working in countries such as Australia, New Zealand and Greece.  He is currently undertaking a research project at Manchester University, examining the 10-year collaborative work between the University and the Network.

Places are free and include pre-event refreshments, but must be booked in advance. Email events@shu.ac.uk

This One Is For The Mental Health Community – By Richard Bentall

From Richard Bentall:

Last week, Dr Frank Hirth of King’s College London was on Radio 4 saying that his research into the neural circuitry of the fruit fly might help us understand neurodevelopmental disorders such as schizophrenia. To cut a long story short, I got copied into some correspondence about this between Dr Hirth and a colleague and was moved to join in as follows:

Dear Frank,

My friend and colleague Dave Pilgrim forwarded me your email to him, which I feel moved to reply to. I am copying in various colleagues who are as concerned as I am about the naive biological reductionism that seems to be dominating media discussions of mental health these days. Briefly, the problems with this view when applied to ‘schizophrenia’ are:

(i) Schizophrenia is a meaningless construct

There is no syndrome of schizophrenia and nobody can agree on who is schizophrenic. To my knowledge, no statistical study has ever identified a cluster of symptoms that correspond to the Kraepelinian concept or its subsequent revisions. Most recent studies have converged on a multidimensional model that incorporates all psychosis diagnoses (schizophrenia, schizoaffective disorder, bipolar disorder, delusional disorder, depression with psychotic features etc) within five dimensions of positive symptoms, negative symptoms, cognitive dysfunction, depression and mania/excitability, or even more complex structural models (see Demjaha, A., et al. (2009). Combining dimensional and categorical representation of psychosis: the way forward for DSM-V and ICD-11? Psychological Medicine, 39, 1943-1955 and, one of my own papers, Reininghaus, U., Priebe, S., & Bentall, R. P. (in press). Testing the psychopathology of psychosis: Evidence for a general psychosis dimension. Schizophrenia Bulletin, available online). In recent field trials, the proposed DSM-V criteria for schizophrenia generated a derisory kappa of 0.46, showing that clinicians working with a precise definition of the disorder and following a diagnostic interview often could not agree on who was schizophrenic and who was not (Regier, D. A., et al. (2013). DSM-5 field trials in the United States and Canada, Part II: Test-retest reliability of selected categorical diagnoses. American Journal of Psychiatry, 170, 59-70)!

(ii) Heritability coefficients are misleading

It is often forgotten that heritability coefficients are, actually, just fancy correlation coefficients. We all know, or should know, that correlation does not necessarily prove causality. Heritability coefficients are statements about populations and not individuals so that it is wildly misleading to suggest that high heritability = mostly genetically caused (for a detailed discussion of this, see Bentall, R. P. (2009). Doctoring the mind: Why psychiatric treatments fail. London: Penguin.).

In fact, precisely because heritability coefficients are correlations which attempt to parse up the variance in a trait to genetic and environmental causes, low variance in the environment leads to inflation of the apparent effects of genes. This is why, for example, IQ is highly heritable in middle class families (where environmental variation is low) but very low in working class families (where environmental variation is high) (Turkheimer, E., et al. (2003). Socioeconomic status modifies heritability of IQ in young children. Psychological Science, 14, 623-628). Also, heritability coefficients assume an additive model of genes and environment, which is wildly implausible given what we know know about how genes work. Again, assuming an additive model when there are G x E interactions leads to massive inflation of heritability and an underestimate of environmental effects (Dickins, W. T., & Flynn, J. R. (2001). Heritability estimates versus large environmental effects: The IQ paradox resolved. Psychological Review, 108, 346-369). This is probably why, as you know, molecular estimates of heritability are generally much lower than those based on the methods of classical genetics. The ‘missing’ heritability in these studies is probably phantom heritability.

Incidentally, you will also know from the genetic studies that you cite, that the consensus amongst geneticists is now that many common alleles (perhaps many hundreds) probably each confer a tiny risk of all kinds of severe mental illness. Although some CNVs have much higher association with psychosis, they account for only a small proportion of patients and are also associated with intellectual disabilities and autism (Owen, M. J. (2012). Implications of genetic findings for understanding schizophrenia. Schizophrenia Bulletin, 38, 904-907. doi: 10.1093/schbul/sbs103). This is further evidence, if ever it was needed, that schizophrenia is a meaningless construct and confirms the impossibility of devising a genetic test for the disorder.

(iii) There is massive evidence that environmental factors are causal in severe mental illness

The implications of ii above are that you can’t estimate environmental influences from heritability estimates – you have to look for them and measure them in their own right. Recent studies have pointed to a wide range of environmental factors associated with psychosis. These include social disadvantage, migration, living in cities and various forms of victimisation. I attach a recent meta-analysis I conducted on the evidence linking childhood adversity to psychosis (Varese, F., et al. (2012). Childhood adversities increase the risk of psychosis: A meta-analysis of patient-control, prospective and cross-sectional cohort studies. Schizophrenia Bulletin, 38, 661–671. doi: 10.1093/schbul/sbs050.) The bare odds ratio between childhood trauma was stable across methodologies (retrospective/prospective) and came in at about 3, much higher than any association with common alleles. More importantly, there is evidence of a dose response effect, with ORs climbing to around 50 for children who have been multiply traumatised. Reaction in the psychiatric community has sometimes been bizarre, with convoluted attempts to explain away the data (see a recent editorial I wrote about this, also attached).

(iv) Brain studies do not provide clear evidence of neurodevelopmental disorder in psychosis

The evidence linking the basal ganglia to psychosis is far from clear cut. The best evidence is from response to antipsychotics, but recent studies suggest that only about 20% of patients show a genuine clinical response (Marques, T. R., et al. (2011). The different trajectories of antipsychotic response: antipsychotics versus placebo. Psychological Medicine, 41, 1481-1488). In any case, abnormal basal ganglia activity could just as likely be attributed to environmental factors – animal studies show that chronic victimisation leads to sensitisation of dopamine pathways in this part of the brain (Selten, J.-P., & Cantor-Graae, E. (2005). Social defeat: Risk factor for psychosis? British Journal of Psychiatry, 187, 101-102).

Current structural and functional neuroimaging studies of psychosis are probably not to be trusted for a variety of complex methodological reasons (Ioannidis, J. P. A. (2011). Excess significance bias in the literature on brain volume abnormalities. Archives of General Psychiatry, 68, 773-780; Button et al. (2013), Power failure: Why small sample size undermines the reliability of neuroscience, Nature Reviews Neuroscience, published online 10 April 2013; doi:10.1038/nrn3475 – this study estimated that the median statistical power of 461 individual fMRI studies contributing to 41 separate meta-analyses was 8%!), not least the emerging evidence that drugs affect brain structure (Ho, B.-C.,et al. (2011). Long-term antipsychotic treatment and brain volumes. Archives of General Psychiatry, 68, 128-137).

In any case, the observed abnormalities could well be the consequence of social and environmental factors (Hoy, K., et al. (2011). Childhood trauma and hippocampal and amygdalar volumes in first–episode psychosis. Schizophrenia Bulletin. doi: 10.1093/schbul/sbr085).

(v) A narrow neurodevelopmental approach is damaging to patients

There is little evidence that the biological approach to psychiatry is benefiting patients. Outcomes for patients suffering from ‘schizophrenia’ have not improved since the Victorian age and an increasing number of people are disabled by psychiatric conditions. This is precisely the opposite to what has happened in physical medicine, where genuine advances have led to improved outcomes and reduced disability (see my Doctoring the Mind, and also Whitaker, R. (2005). Anatomy of an epidemic: Psychiatric drugs and the astonishing rise of mental illness in America. Ethical Human Psychology and Psychiatry, 7, 23-35). Just as importantly, although it is often assumed by doctors that promoting a biological understanding of psychosis will reduce stigma, empirical research provides strong evidence that the opposite is the case, and that biological models actually promote stigma (Read, J., et al.(2006) Acta Psychiatrica Scandinavica, 114, 303-318; Angermeyer, M. C., et al. (2011). Biogenetic explanations and public acceptance of mental illness: systematic review of population studies. British Journal of Psychiatry, 199, 367-372.)

The claim that biological research (on flies or whatever) will one day lead to a cure for schizophrenia is a common rhetorical trick designed to gain publicity and guarantee grant funding. I have no problem with research on the CNS of flies, which seems valuable in its own right. But linking flies to schizophrenia (whatever that is) is really about self-promotion and is damaging to the interests of patients.

Sincerely etc.

Richard Bentall

Your Voice in Sheffield Mental Health Magazine – Article on EMDR Therapy

Check out the Spring edition of Your Voice in Sheffield Mental Health magazine http://www.yourvoicesheffield.org/

My article on EMDR therapy is on page 11

What Is Mental Illness Today?

Five hard questions.
4.30pm, Wednesday 15 May 2013
B63, Law & Social Sciences Building
University Park, University of Nottingham

Professor Nikolas Rose
King’s College London
Mental illnesses are one of the largest burdens upon the economy
and upon the NHS, but we still have very little agreement upon
what they represent or how best to provide for them. This seminar
will consider that knotty problem through questions which consider
some of the empirical, conceptual and ethical dilemmas they raise.
Admission free, all welcome.
Email michelle.fusco@nottingham.ac.uk
to confirm attendance.

Personality Disorder Workshop – Suffolk

Suffolk personality disorder workshop

On Thursday, 21st March 2013, from 10.30 am -1.00 pm at the Friends Meeting House, St John’s Street, Bury St Edmunds, Suffolk IP33 1SJ this workshop aims to explore the experience of this diagnosis, the things people would like help with, looking at what that help might be.

Please contact Suffolk User Forum for any further information
The Hollies, St Clements Hospital. Foxhall Road, Ipswich. IP3 8LS

Telephone 01473 329316