Thursday, June 30, 2005

Why did Drudge Link This?

The Drudge Report links to the following news report about a 10 year-old girl being raped and impregnated by her step-father. Maybe I've been in psychiatry too long, but this story does not seem surprising or unusual to me. I've heard many stories from young and middle-aged adults of being sexually abused when they were children. I guess 10 is a little young to go through puberty and be biologically capable of being pregnant, but it' not unheard of. This story does not seem unusual enought to be newsworthy to me. Sexual abuse and rape happens to children all the time.

Wednesday, June 29, 2005

Congress attacks Tom Cruise

Tom Cruise’s erratic behavior on his recent worldwide publicity tour has been fodder for gossip columnists and late-night talk-show hosts for weeks, but now the movie star’s comments on mental-health issues last week are attracting serious criticism from members of Congress.Appearing on NBC’s “Today” show to promote his upcoming movie “War of the Worlds,” Cruise called psychiatry “a pseudoscience” and dismissed the effectiveness of antidepressants.The Congressional Mental Health Caucus this week criticized his remarks, saying that the celebrity has reinforced negative perceptions.“It is unfortunate that Tom Cruise has sought to use his celebrity to once again negatively reinforce the unfortunate stigma associated with mental illness,” said Rep. Grace Napolitano (D-Calif.), co-chair of the caucus. “Mr. Cruise is correct in saying that some of the drugs used to treat psychiatric disorders can be abused, but these same drugs have been beneficial to countless numbers of people who can now focus on their work in school or on the job.”Rep. Tim Murphy (R-Pa.), a psychologist and the other co-chair of the caucus, took issue with Cruise’s apparent belief that attitude adjustment alone can overcome mental illness.“If this was the case, mental illnesses would have been cured during the time of the Salem witch trials,” Murphy remarked.“Throughout history, various forms of attitude adjustment including torture, incarceration, relaxation techniques, bloodletting, ice water immersion, and hypnosis have been used to try to cure mental diseases and none have worked,” he continued. “By promoting such a theory, Cruise is providing a false hope that deters people from getting the help they need.”Rep. Patrick Kennedy (D-R.I.), who has long pushed for legislation to enhance mental-health services, labeled Cruise’s comments “irresponsible and counterproductive.” Kennedy said it was wrong to denigrate effective treatments at a time when “10 kids die every day from suicide as a result of untreated mental illnesses” and “when our businesses lose $31 billion per year in productivity as a result of depression alone.”Mental-health groups also have admonished Cruise. The American Psychiatric Association, the National Alliance for the Mentally Ill and the National Mental Health Association (NMHA) issued a joint statement last week: “Mental illnesses are real medical conditions that affect millions of Americans. … It is irresponsible for Mr. Cruise to use his movie publicity tour to promote his own ideological views and deter people with mental illness from getting the care they need.”Mental-health experts said that the statements by Cruise, because of his immense popularity, could lead some people to stop taking their prescribed antidepressants. Michael Faenza, president and CEO of the NMHA, said Cruise’s comments could even prevent some people from seeking help in the first place.The pharmaceutical industry is criticizing Cruise as well. Ken Johnson, senior vice president of Pharmaceutical Research and Manufacturers of America, said, “Actors should act, and highly skilled psychiatrists should treat patients. Cruise’s pronouncements fly in the face of science and effective treatment of a growing number of Americans who depend on medicines to lead normal, productive lives.”Cruise’s agent, Creative Artists Agency, referred a request for a response to the actor’s publicist, who did not comment by press time.Several members of Congress have dealt directly with tragedies related to mental illnesses. Senate Minority Leader Harry Reid (D-Nev.), Sen. Gordon Smith (R-Ore.) and Reps. Bart Stupak (D-Mich.) and Todd Tiahrt (R-Kan.) have lost family members to suicide, the ninth leading cause of death in the United States.Cruise has been active in politics, contributing thousands of dollars over the past decade to Democrats, including Sens. Barbara Boxer (Calif.), Hillary Rodham Clinton (N.Y.) and John Kerry (Mass.).Cruise’s remarks on the “Today” show, which were made in a testy exchange with host Matt Lauer, was the latest in a series of unusual publicity appearances.In contrast to his interview with Lauer, Cruise was jovial while appearing on “The Late Show with David Letterman” last week — even when Letterman indirectly asked Cruise about his earlier interview with Oprah Winfrey, where Cruise jumped up and down to describe his feelings for his fiancĂ©e, Katie Holmes.
From The Hill

Saturday, June 18, 2005

Heading for conference

Heading off for a conference (see sleepdoctor for details). Will be back on the 24th. Some parting thoughts...
Psychiatry is a unique specialty. At a major university hospital, every other specialty admits its own patients to the hospital. A psychiatry resident frequently has to make arrangements for a psych pt to be hospitalized somewhere else. No other type of resident does this.
Gotta run, running late for the airplane, will write more about the strangeness of psychiatry later.

Tuesday, June 14, 2005

In the Future, All Americans will be Fat

According to University of Missouri-Columbia biomedical researchers Frank Booth and Simon Lees, every U.S. child and adult will be obese by 2044 and 2058, respectively, if the current progressive rise continues.In a recent lecture, Booth cited statistics that demonstrated a three- to fourfold increase in the percentage of overweight U.S. children and adolescents since the mid-1980s. Booth believes the increase in obesity is because of an incompatibility between human genes and societal pressures. Human genes evolved to support a great deal of physical activity, yet in the last 20 years, physical activity has decreased dramatically in the United States, Booth said.
From the Clarion-Ledger

Monday, June 13, 2005

Vintage Ads

Received this email (you will have to cut and paste the links into your browser window):

thought you and your blog readers might be interested in this bit of medical humor (unintentionally so) from the past. Pete Vintage pharmaceutical ads This is a gallery of actual ads for pharmaceutical products from the 40’s to the 70s. Not a parody site but some of these drug ads are pretty funny. i.e., injectable whole opium from the juice of the poppy. Via Boing Boing
Pete Quily Adult ADD Coach

Friday, June 10, 2005

The Matrix and Teen Killers

Few films have achieved cult status as quickly as “The Matrix.” The lead character—a passive, unassuming young man—discovers that a malevolent system controls him and almost everyone else. He learns martial arts, then attacks and destroys the system and its allies.
Not surprisingly, “The Matrix” has a particular grip on adolescent and young adult males. For most, the film’s themes and special effects are simply entertainment. Others are drawn—and their concerns perhaps affirmed—by questions the film raises about reality and control over destiny. For a few, the film speaks to overpowering psychic pain.

19-year-old Josh Cooke of Oakton, VA, who murdered his parents with a 12-gauge shot gun, wore out his first copy of ‘The Matrix’ and got a second one.
Like “The Matrix” protagonist, destroying the system—and themselves—begins to seem like their only option. Add access to weapons, and you have a recipe for disaster.
The full article is available at Current Psychiatry

Wednesday, June 08, 2005

My Grandfather is my Father

Medpundit writes "Two Mothers/Two Aunts: If a woman conceives a baby thanks to her sister's ovary, is she the baby's mother or aunt? (Not to mention the question of the sister.) If this becomes popular, as the surgeon hopes it will, we'll need a new word for the mother/aunt combo. (Maunt?)"
If you have no difficulties conceptualizing this complicated family relationship, then you have what it takes to be a psychiatrist. Recently when I asked a new patient why she was coming to see me, she told me "My Grandfather is my Father" (The mother of the patient was sexually abused by her (the mother's) father). Psychiatrists are used to hearing complicated stories about incest and about step and half siblings molesting each other, as well as sexual abuse by step-parents and boyfriends. Sadly, it doesn't take me long anymore to understand how everyone is related.

Tuesday, June 07, 2005

Diagnosis of Darth Vader

Realspace writes (6/6/05) "Watching Star Wars 3 (much better than the first two), I couldn’t help the train of thoughts running through my mind: Paranoid delusions. Grandiosity. Impulsivity. Inflexibility in thinking. Black and white thinking. Anger management issues. Issues with authority figures. Tendency to aggression and violence. Ambivalence. Labile. Poor coping style. Difficulty with trust. Psychomotor agitation. Lack of insight. Query psychosis. Query antisocial personality disorder, possibly psychopathic. Query borderline personality disorder. At very high risk of PTSD, depression. Management? Likelihood of medication compliance? Need for involuntary treatment order? We’d need a lot of backup.."
I think Realspace is on the right track when he mentions the cluster B personality disorder diagnoses of antisocial personality disorder and borderline personality disorder, though I would vote for a diagnosis of narcissistic personality disorder (he has a grandiose sense of self-importance, is preoccupied with fantasies of unlimited power, believes that he is special and should only associate with other high-status people, requires excessive admiration, has a sense of entitlement, shows arrogance, and is often envious of others or believes that others are envious of him. He also lacks empathy, at least at the end of the movie). Anakin is very grandiose and believes that the jedi masters are envious of his power; at the same time he envies their postion on the jedi council. He wants the admiration of others and does not feel that he is getting due respect from the other Jedi. Anakin is preoccupied with power; near the end of the movie he talks about taking over the Galactic Empire from Palpatine.
I agree that he would have been at risk for developing depression and PTSD after he killed his wife and got burned, but there was no direct evidence for either of these diagnoses in the movie. I did not detect any true psychosis in Anakin/Vader.
Managment: he might have been a candidate for intensive psychodynamic therapy before he went to the dark side; after that he was essentially untreatable. Don't think any mediction would have helped. I don't think anyone is powerful enough to enforce an involuntary treatment order on Vader, and it can be hard to get an involuntary treatment order for an axis 2 diagnosis in many jurisdictions. He could have been imprisoned for killing the jedi younglings, but soon after he did this most of the police (jedi) were killed by order 66.

Shifting Costs from the states to the Federal Government

Academic medicine is one big shell game. Initially academic physicians are supported by the state, but as their career develops they are expected to get federal grants. We are expected to shift our support from the state taxpayer to the taxpayers of the USA as a whole.
Medicaid is a similar situation. For every $1 the state of Mississippi spends for Medicaid, it gets $3 from the US government. All the local Mississippi politicians treat this $3 as if it is free money, and don't consider the cost to this country and our sky-rocketing national debt.

Friday, June 03, 2005

Demoralization and Psychiatric Diagnosis

This week's issue of Psychiatric News has several articles on treating demoralization in medical patients dealing with significant illness.
One suggestion given in the article is:
Normalize the patient's distress. State to the patient, "I do not believe that you have a psychiatric disorder. You are someone coping normally with a hard situation. Almost anyone would feel as badly as you are feeling in this situation."
It makes it kind of hard for a consultant psychiatrist (or any psychiatrist) to bill for his services if he doesn't give the patient a psychiatric diagnosis. This leads to overdiagnosis and pathologization of normal human conditions.