2014 marks the 100th anniversary of the outbreak of World War 1: a pivotal time for Europe and a key transition point for medical science. The Lancet marks this centenary with a three part series ‘Legacy of the war 1914-1918’. The three papers examine the impact of World War 1 on infectious disease, military psychiatry, and amputation related pain.
According to the American Society of Addiction Medicine, addiction is “a primary, chronic disease of brain reward, motivation, memory and related circuitry.” However, that’s not what the epidemiology of the disorder suggests. By age 35, half of all people who qualified for active alcoholism or addiction diagnoses during their teens and 20s no longer do, according to a study of over 42,000 Americans in a sample designed to represent the adult population.
Only a quarter of people who recover have ever sought assistance in doing so (including via 12-step programs). This actually makes addictions the psychiatric disorder with the highest odds of recovery.Metafilter's own maias on myths surrounding the disease(?) of substance addiction, and their impact on medicine and policy.
Here are some links to online galleries that combine science, medicine, and art in some way. (previously: psychiatry and art)
Insomnia causes depression as much as depression causes insomnia: Three surprising points from a fascinating episode of KQED Forum [audio, no transcript] with guest Dr. Michelle Primeau of the Stanford School of Medicine.
First story: Treating Insomnia to Heal Depression,
Follow up a couple of days later: Double Effectiveness of Depression Treatment by Treating Insomnia,
Two readers (both psychiatrists) respond, and
A NYT editorial. [more inside]
- Insomnia has long been taught to be a symptom of depression, but in many cases is a cause of depression.
- CBT (Cognitive Behavioral Therapy) is an effective treatment for both insomnia and depression.
- CBT can be more effective and longer lasting than sleeping pills
PTSD and Gene Kelly's lost wartime star turn: For the last six decades or so, a copy [of "Combat Fatigue Irritability"] has been filed away, along with thousands of other films, at the National Library of Medicine. The only people it has been lost to are the public and Gene Kelly’s devoted and still numerous fans. But now the National Library of Medicine is featuring Combat Fatigue Irritability in Medical Movies on the Web, and the film will be given a well-deserved, though very belated, New York premiere, on October 5, 2013, at the New York Academy of Medicine. [more inside]
National Institute of Mental Health director Thomas Insell reports that NIMH will phase out its reliance on the Diagnostic and Statistical Manual of Mental Disorders (DSM), in favor of a revamped psychiatric diagnostic system based on "genetics, imaging, cognitive science, and other levels of information to lay the foundation for a new classification system." [more inside]
Falling STAR*D?: It is common practice for psychiatrists to switch depressive patients between different antidepressants if their current drug does not evince a symptomatic response. Despite clinical wisdom supporting this, little empirical, controlled evidence exists to direct “switching” protocols (e.g. if a patient with Z characteristics is on drug X, is it usually better to switch to drug A, B, or C? Will switching help at all?) in the psychopharmacological treatment of depression. The NIMH-funded STAR*D (Sequenced Alternatives to Relieve Depression) study aimed to address these questions of treatment direction in a very large (n>4000), “real-world” sample using a multi-phase treatment plan with different drugs (and cognitive therapy) at every step to maximize chances of eventual remission. Overall, the NIMH reported that about 67% of patients eventually achieved remission, with few differences in effectiveness between different types of treatment at each step. However, researchers and commentators have raised concerns regarding inconsistent reporting of outcomes, after-the-fact changes in study design and analysis, and other issues that may have inflated, partially invalidated, or misrepresented widely reported treatment outcomes. These inequities may also have implications for the secondary moderator analyses (i.e. does trait A predict switching to X or Y is better?) that were a major reason for the study. [more inside]
“The psychoanalytic mystique was overwhelming. It was a little bit like the evangelical movement.” How Aaron Beck and Cognitive Behavioral Therapy helped increase empiricism in psychotherapy.
According to a new report, children in Sweden are becoming increasingly concerned by their parents' internet habits. "This summer she has been sitting up all day and all night and she forgets what's important to me. And when she's not at the computer she's like a lost soul. She just looks straight ahead and says nothing. I'm not doing so well." Dr Jerald Block from Oregon Health and Science University in Portland is pushing for internet addiction (and its three subtypes: excessive gaming, sexual preoccupations and e-mail/text messaging) to be included as a common disorder in the next update of the DSM (DSM-V). "The relationship is with the computer. It becomes a significant other to them. They exhaust emotions that they could experience in the real world on the computer... It's much more acceptable for kids to talk about game use, whereas adults keep it a secret. Rather than having sex, or arguing with their wife or husband, or feeding their children, these adults are playing games..."
Are you batshitinsane? Viruses and/or bacteria may be the cause.
"Researchers found that failing to publish negative findings inflated the reported effectiveness of all 12 of the antidepressants studied." See also: Serotonin and Depression: A Disconnect between the Advertisements and the Scientific Literature. [more inside]
Dictionary of Disorder - shaping the DSM
Psychiatry by Prescription - Do psychotropic drugs blur the boundaries between illness and health?
The Japanese Gallery of Psychiatric Art. Images from Japanese psychiatric medication advertisements: 1956-2003 (via Absent without leave)
The American Gallery of Psychiatric Art. 'Sanity For Sale: 1960-2000'. Magazine advertisements for psychiatric medications in the latter half of the twentieth century.
Utah Leads Nation in Rate of Anti-Depressant Use. It is interesting (to me) in that the people doing the study credit a "Mother of Zion" syndrome of married Mormon women putting on the happy face regardless of how happy they truly are. My state is up at the top also. Could be all the rain I guess. . .*sigh*