Wednesday, July 30, 2008

Woo in Psychiatry II

In response to my "Woo in Psychiatry" post, an anonymous poster advised:
read work by Steven Sevush MD

A quick google search reveals that Dr. Sevush is a geriatric psychiatrist, that he's done some work on Alzheimer's, and that he is written on consciousness. I am not sure if this essay is by him, but it came up when I googled "Steven Sevush MD and quantum".

Now quantum mechanics has some interesting philosophical implications, though it takes several years of advanced college mathematics (which I lack) to have even a basic understanding of quantum mechanics. Quantum mechanics has some interesting implications for the concept of consciousness. There has been some research looking at the speed of neural transmission, and whether an action can begin before the person makes the decision to carry out the action (I am probably butchering the concept, see Roger Penrose for more details).

I maintain my assertion that quantum mechanics has nothing to do with psychiatric treatment. I have no problem if a psychiatrist is interested in quantum mechanics and its philosophical implications. However, if a psychiatrist starts talking about "energy fields" to his patients, that psychiatrist is a quack.

At the last Psychiatric Congress (an annual CME seminar), I suffered through an hour session on psychotherapy in which a psychiatrist who thought he knew much more than he actually did about quantum mechanics erroneously said that quantum mechanics is about energy fields and that we are all connected by energy fields (quantum field theory has nothing to do with us all being connected). I had to restrain myself from telling him that he was a fool.
The only "energy" or "energy field" relevant to psychiatric treatment is the energy generated by an electroconvulsive therapy machine.

Autism is not a mental illness (according to Dear Abby)

DEAR ABBY: I just finished reading your June 9 column and am shocked at what I read. Your response regarding autism was way off base. You said, "Autism is a mental health disorder ... some people consider ... to be shameful."
Autism is a neurological disorder, NOT a mental health disorder......

DEAR MELISSA: My thanks to you -- and the many other readers -- who wrote to correct me..... autism is often considered a mental health disorder because it affects behavior, cognitive ability and social skills. However, it is genetically predetermined -- biologically based.
Experts clearly agree that autism is a neurologically based condition. The current criteria used to diagnose autism are contained in the Diagnostic and Statistical Manual of Mental Disorders, a publication of the American Psychiatric Association. However, this does not mean that autism is a "mental illness." Autism is most accurately described as a "neurodevelopmental disorder."

Most psychiatric conditions have at least some biological basis. Schizophrenia can also be considered a "neurodevelopmental disorder," though it has a later onset than autism. There is no clear dividing line between what is considered a neurological brain disease and what is considered a mental illness.

Wednesday, July 23, 2008

Psychiatrists in the News

A famous psychiatrist has been featured prominently in the news headlines this week:
(CNN) -- Radovan Karadzic, whose Interpol charges listed "flamboyant behavior" as a distinguishing characteristic, was a practicing psychiatrist who came to be nicknamed the "Butcher of Bosnia."
Twice indicted in 1995 by the U.N. International Criminal Tribunal for the former Yugoslavia, Karadzic faces charges of genocide, complicity in genocide, extermination, murder, willful killing, persecutions, deportation, inhumane acts, terror against civilians and hostage-taking.
While president of the so-called Serbian Republic of Bosnia-Herzegovina, Karadzic's troops were reported to have massacred over hundreds of thousands of Muslims and Croats during a campaign of "ethnic cleansing." Early estimates of the death toll from the 3-year war ranged up to 300,000, but recent research reduced that to about 100,000.

Karadzic was born on June 19, 1945, in Petnjica, Montenegro. He studied psychiatry and medicine at the University of Sarajevo during the 1960s and took courses in psychiatry and poetry at Columbia University from 1974 to 1975.

Monday, July 21, 2008

Poker in Mississippi

Those living in Jackson MS no longer have to drive to the coastal region to play No Limit Texas Hold'em. Vicksburg (45 minutes from Jackson) now has 2 poker rooms. The room at the Horizon casino, though, is of low quality and sometimes only has Limit games. I recommend the Ameristar casino- not as good as the Imperial Palace in Biloxi, but Ameristar does usually have several No Limit tables going.

Woo in Psychiatry

Alternative medicine quackery is spreading throughout medicine, but is especially common in psychiatry:

Complexity theory, quantum mechanics, and quantum field theory are conceptual frameworks that have been largely overlooked by Western medicine as potentially useful explanatory models of illness and healing. These nonclassical paradigms may eventually lead to models or research methods that will clarify the nature of putative informational or energetic phenomena related to health, illness, and healing. Phenomena regarded as legitimate subjects of inquiry in nonorthodox paradigms that have been largely overlooked by Western biomedical research include the role of intention in healing and the putative beneficial effects of “subtle energy” on health.

Quantum brain dynamics is a nonclassical model that uses quantum field theory to explain subtle dynamic characteristics of brain functioning, including postulated influences of nonclassical forms of energy and information on the brain. It has been suggested that healing intention operates through nonlocal energetic interactions between the consciousness of the medical practitioner and the physical body or consciousness of the patient. Conventionally trained physicians generally regard reports of beneficial outcomes following “energy” treatments as examples of the placebo effect because contemporary Western science is not able to substantiate the role of postulated forms of nonclassical energy when these modalities are employed.

If you hear a psychiatrist using the word "quantum" or if you hear him talking about "energy fields", that psychiatrist is a quack and you should run out of his office as fast as possible. Quantum mechanics has nothing to do with psychiatric treatment.

suicide nation

USA Today reports on the Japanese suicide epidemic, which is being fueled by economic hard-times as well as Japanese cultural traditions promoting suicide:

"Suicide is not considered a sin," says sociologist Masahiro Yamada of Chuo University in Tokyo. "We've made it a bit of a virtue."
A decade of weak economic growth and the unraveling of Japan's system of lifetime employment have left many middle-age and elderly men unemployed and in financial ruin. Among Japanese suicides, nearly 71% are men, more than 73% are 40 or older, and more than 57% are jobless.
For an unemployed, former "salaryman," suicide can be "a rational decision," Yamada says. When a man commits suicide in Japan, his beneficiaries can still collect his life insurance. And insurers pay off Japanese home mortgages when a family's breadwinner dies — even if the death is a suicide. "If he dies, the rest of the family gets money," Yamada says. "If he continues to live without a job, they will lose the house."

Thursday, July 17, 2008

Should Pre-meds have to take Organic Chemistry??

The Wall Street Journal Health Blog discusses this issue. Here is the comment I posted:

I am all for weeding out people, but I think that the 2nd semester of O chem is a waste of time. Instead of a 2nd sem of O chem, I would require a semester of med-school level Biochemistry (and use this as a weed out course, in addition to the 1 semester of Ochem). I disagree with the previous comment of getting rid of physics. A basic knowledge of physics is helpful for many areas of medicine - neurophysiology (EEG/sleep studies), radiation oncology, nuclear radiology, and ophthalmology.

Sunday, July 13, 2008

Psychiatry and the Pharmaceutical Industry

Congress is accusing the profession of Psychiatry and its leading organization, the American Psychiatric Association, of prostituting themselves to the pharmaceutical industry:

But now the profession itself is under attack in Congress, accused of allowing this relationship to become too cozy. After a series of stinging investigations of individual doctors’ arrangements with drug makers, Senator Charles E. Grassley, Republican of Iowa, is demanding that the American Psychiatric Association, the field’s premier professional organization, give an accounting of its financing.

“I have come to understand that money from the pharmaceutical industry can shape the practices of nonprofit organizations that purport to be independent in their viewpoints and actions,” Mr. Grassley said Thursday in a letter to the association.

In 2006, the latest year for which numbers are available, the drug industry accounted for about 30 percent of the association’s $62.5 million in financing. About half of that money went to drug advertisements in psychiatric journals and exhibits at the annual meeting, and the other half to sponsor fellowships, conferences and industry symposiums at the annual meeting.

Here is the Consumerist's take on the issue:

Psychiatry is nothing more than a well-funded front for big pharma, according to lawmakers investigating the field's premier organization, the American Psychiatric Association. Unlike psychologists, psychiatrists can write prescriptions, giving pharmaceutical companies a powerful incentive to lavishly subsidize both their lifestyle and profession.
A psychiatrist's office is a "safe space," where it's ok to ask any question, including: "have you received any compensation from any drug company?"

My practice is mainly sleep medicine- largely osa and cpap. Unless you count hypnotics like Ambien and Lunesta (I typically start off with generic Ambien before trying Lunesta or Ambien CR), I prescribe less psychotropics than the typical internist and much less than the typical psychiatrist. I resigned my membership in the APA over a year ago. I am not in the pay of the pharmaceutical companies.

Monday, July 07, 2008

The Disadvantages of having a doctor for a mother

I haven't had much time to blog recently, and I don't really have anything original to say today. I did come across an interesting post, via Kevin MD, on the Mothers in Medicine blog. In the post "Second generation", a mother/resident discusses her current situation and how it was like for her to grow up as a child of a doctor:

"I really adored my nanny (who coincidentally had the same first name as my mother), and that was a good thing since she was the adult I spent the most time with."

Every day when I leave in the morning, she reaches out for me and cries. And I think to myself, "What kind of mother am I to leave her like this?" But when I go to work, I’m earning the money that pays the rent and building a career that hopefully someday she’ll be proud of.