Fw: [Avian2005] Fw: Children Need Protection from Child Psychiatrists' Irresponsible Rx

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Thursday, November 08, 2007 4:00 PM

[Avian2005] Fw: Children Need Protection from Child Psychiatrists' Irresponsible Rx

 

 

- "VERACARE" <veracare (AT) ahrp (DOT) org><Infomail1 (AT) ahrp (DOT) org>Thursday, November 08, 2007 3:27 PMChildren Need Protection from Child Psychiatrists' Irresponsible Rx>> ALLIANCE FOR HUMAN RESEARCH PROTECTION> Promoting Openness, Full Disclosure, and Accountability> http://www.ahrp.org and http://ahrp.blogspot.com>> FYI>> A report by Melissa Healy in the Los Angeles Times (below) describes the> conundrum that parents face when they seek help from a child psychiatrist > in> the US.>> A child's irritating behavior--not at school where her performance is> described as "exemplary"--and her feelings of dejection following ejection> for bad behavior from her girl scout group, led her mother to seek the > help> of a child psychiatrist who promptly declared her to be "bipolar.">> The unprecedented--40-fold increase--in the labeling of US children with> this highly controversial diagnosis has been recently documented by Dr. > Mark> Olfson and colleagues reporting in the Archives of General Psychiatry, > 2007.>> Bipolar is a newly manufactured disorder for children. It was not > recognized> prior to the mid 1990 when the new neuroleptics--a.k.a. 'atypical> antipsychotics' came on the market.>> The "bipolar" diagnosis provides psychiatrists with a liability shield for> their irresponsible, off-label prescribing practices. Indeed, the > connection> has been confirmed by Jon McClellan, MD, medical director of the Child > Study> and Treatment Center at Children's Hospital and Regional Medical Center in> Seattle: "The number of children & adolescents being diagnosed with > bipolar> disorder resulted in a significant rate of polypharmacy." [Psychiatric> Times, 2005]>> Underscoring the validity of criticism against the profession, the 11-year> old girl featured in the LAT article, was prescribed 10 powerful> psychotropic drugs on her first visit to a child psychiatrist:> "Some combination of these mood-stabilizing, anticonvulsive and> antipsychotic drugs, Katie was told, would probably control her daughter's> problematic behaviors, referred to by her psychiatrist as symptoms of a> disease.">> John March, MD, chief of child and adolescent psychiatry at Duke > University> Medical Center lends added credibility to the case we have been making> against the predators within psychiatry:> "We're conducting a giant experiment with the lives of America's children > by> providing them not just one drug, but often two or three drugs in> combination, with no data to know whether these drugs are effective or > safe> over the short term, much less the long term." [American College of> Physicians, Observer, 2007]>> Children exhibiting "problematic behaviors"--heretofore recognized as > normal> growing pains--are pathologized as "symptoms of a disease" by > psychiatrists> who should have their licenses revoked.>> The unnamed psychiatrist has succeeded in increasing the mother's feelings> of guilt and anxiety--perhaps with an eye to adding her to the ranks of > pill> poppers: "Now it's Katie who has the racing thoughts and the alternating> bouts of fear, anxiety, relief and anger. As she ponders whether her> daughter's strange behavior really amounts to mental illness -- and > whether> medication is the answer -- she says, "I feel like I'm flying blind.">> The LAT notes, the mother is "not reassured by the suspicion that the> psychiatric profession is as confused about diagnosing and treating mental> illness in children as she is.">> This mother and daughter are being led astray by a Pied Piper--one of the> many charlatans in psychiatry.>> Additional evidence of professional prescription malpractice was provided > by> Dr. Julie Zito who reported her findings at a meeting of the American> Academy of Child and Adolescent Psychiatry. An analysis of a random sample> (472) from a total of 32,135 Medicaid foster-care enrolees in Texas (aged > 4> to 19) in 2004 demonstrated that:> "nearly 73% of subjects were prescribed two or more psychotropic agents > (in> separate classes) concomitantly, while more than 41% received three or > more;> more than 15% received four or more drugs, and more than 2% received five > or> more." Dr. Zito noted that psychiatrists wrote 93% of the prescriptions > for> the children in this study.>> A body of compelling evidence is enough to indict US psychiatrists for > their> maltreatment of children. Their prescribing practices bear no relation to> what's in the best interest of children, but rather by what's in their> financial best interests an the interest of their pharmaceutical company> supporters who pay them cash incentives.> See analyses of documents obtained by the Minnesota Attorney General in> JAMA, The New York Times. See:> http://ahrp.blogspot.com/2007/03/pharma-payments-to-doctors-integrity.html>>> Contact: Vera Hassner Sharav> veracare (AT) ahrp (DOT) org> 212-595-8974>>> http://tinyurl.com/3338v9> The Los Angeles Times> Are we too quick to medicate children?> By Melissa Healy> November 5, 2007>> KATIE'S middle child "has always had a lot going on in her head,"> says her mother. And much of it has been a mystery to Katie, who has coped> with her daughter's escalating tantrums, combative behavior, bouts of> fearfulness and just-plain-oddity since the 11-year-old was a toddler.>> Katie, left, worries whether medication is the right solution for> her temperamental 11-year-old daughter. "No one wants to feel that their> child is a guinea pig," she says.>> A month ago, Katie, a 38-year-old L.A.-area mother of three, brought> the child to a psychiatrist. The child's behavior and performance in > school> were exemplary, but an ill-tempered outburst had gotten the preteen kicked> out of a Girl Scout troop she had joined at age 5. The girl was confused > and> heartbroken over her ejection.>> The daughter came away from the appointment with a diagnosis of> bipolar disorder. Katie, who asked that her full name be withheld to > protect> her daughter's privacy, came away with a list of 10 powerful psychiatric> medicines and a momentous decision to make. Some combination of these> mood-stabilizing, anticonvulsive and antipsychotic drugs, Katie was told,> would probably control her daughter's problematic behaviors, that a> psychiatrist termed, "symptoms of a disease.">> Now it's Katie who has the racing thoughts and the alternating bouts> of fear, anxiety, relief and anger. As she ponders whether her daughter's> strange behavior really amounts to mental illness -- and whether > medication> is the answer -- she says, "I feel like I'm flying blind.">> And she's not reassured by the suspicion that the psychiatric> profession is as confused about diagnosing and treating mental illness in> children as she is. All these psychiatric labels and pills may keep many> kids on track and even save lives, Katie says. But both seem to be > dispensed> with little certainty as to what they mean and how they work -- and even> less debate over their long-term consequences for children.>> In 2005, the latest year for which statistics are available, at> least 2.2 million American children over the age of 4 were being treated > for> serious difficulties with emotion, concentration, behavior or ability to > get> along with others. It's a figure mental-health professionals say has> exploded in the last decade and a half, along with sales of a wide range > of> psychiatric medications for use by children.>> A welter of studies has shown that kids are being diagnosed at> younger ages, with a wider range of disorders and with more severe > disorders> than ever before. And in growing numbers, they are being medicated with> drugs whose safety, effectiveness and long-range effects on children have> not been demonstrated by extensive research.>> A study published in September found that the diagnosis among> children of bipolar disorder, a mental illness long thought not to exist > in> kids, grew 40-fold over the last decade. The prescribing to kids of> antipsychotic drugs typically used to treat the symptoms of bipolar > illness> have soared as well, despite continuing concerns over side effects such as> weight gain, metabolic changes that can lead to diabetes, and tremors.>> Psychiatrists admit they haven't drawn clear lines between problem> behaviors and mental illness, especially in kids, and they are debating> future fixes. But until those fixes are made, parents -- with their kids'> futures on the line -- are left with little to guide them when a child is> tagged with a psychiatric label.>> Protection from what?>> Katie's maternal instincts tell her she must protect her child. But> from what, she asks -- a disease that threatens health, happiness and> future? A bogus label applied to an admittedly challenging kid? Or drugs> with potentially harmful and little-studied side effects?>> And protect her exactly how -- by resisting or by medicating? "I> don't want to face her as an adult and say I didn't do everything I could > to> make her well. I feel like I'm answering to her future self," Katie says.> "But so much of this is a crapshoot. No one wants to feel that their child> is a guinea pig.">> Mental-health professionals have long warned that the stigma of> mental illness and the cost of its treatment have left millions of > Americans> with psychiatric disorders to suffer untreated. But as childhood diagnoses> of mental illness have surged, some in the profession charge the field of> child psychiatry with the opposite problem. A scourge of overdiagnosis, > says> a growing body of critics, has come to child psychiatry.>> The trend, say these critics, threatens to turn kids like Katie's> daughter -- a preteen whose behavior is certainlyodd but whose school life> remains on track -- into potentially lifelong patients. And, they add, it> has changed the way Americans think about children. Critics warn that as> psychiatric diagnosis and medication of children becomes more widespread,> teachers, well-meaning neighbors and relatives, and parents themselves are> becoming less willing to accept youthful misfits for who they are and to> help them adapt without prescribing drugs or attaching labels.>> "We are suffering . . . from a shrinking tolerance for the broad> limits of normality," says. Dr. Stanley Turecki, author of "The Difficult> Child" and a practicing psychiatrist in New York and Massachusetts.>> For such parents as Katie, that shrinking tolerance seems to have> seeped into places like her daughter's Girl Scout troop as well as her own> extended family, where her daughter's belligerent challenges of strangers> and unpredictable episodes of fearfulness have long been a source of> critical commentary. They have even seeped into Katie's heart.>> "I find myself saying, 'Geez, this is not normal,' " she says. But> she's equally unsure that her daughter's perplexing behavior rises to the> level of mental illness. "Are people," she wonders, "just haphazardly> sticking labels on kids?">> There once was a time when a pocketful of well-worn adjectives,> accompanied by a shrug, would have been sufficient to describe American > kids> at the outer reaches of normal: shy, spirited, combative, dreamy, > sensitive,> fretful -- even odd. All were qualities a child might readily grow out of> with guidance or a few years to mature.>> Definition overhaul>> The descriptors for such youthful outliers have undergone a> linguistic overhaul in recent years, says Ross W. Greene of Harvard > Medical> School's department of psychiatry. Increasingly, talk of temperamental> extremes or social skills that need to be taught or strengthened has given> way to the assignment of disorders, deficits and dysfunctions. Nowadays, a> kid whose behavior is problematic has to have something -- a diagnosis --> which energizes school administrators, absolves parents of guilt and too> often, Greene says, dictates medicating the child with powerful drugs.>> In at least four in 10 cases, according to data from the Centers for> Disease Control and Prevention, parents who seek professional help for > their> troubled children come away with at least one prescription medication.> These diagnoses suggest clear evidence that a malfunction of the brain is> the cause of the problematic behavior. But despite dramatic advances in> neuroscience, that presumption still cannot be verified by a blood test or> brain scan. Mental-health professionals instead must base their diagnoses > on> the presence of a certain number of symptoms, and on a judgment -- by> teachers, parents and the professional evaluator -- that the problem> behaviors impair a child's ability to function.>> The boundary between troublesome behavior and mental illness is> indistinct in adults, psychiatrists acknowledge; in children, whose brains> are still a work in progress, it is fuzzier still. "To tell the truth, I> feel bad for parents," says Greene, who directs the Institute for> Collaborative Problem Solving at Massachusetts General Hospital. "I don't> think diagnoses help us understand how to help the kid.">> It's a frustration felt by Katie. At times, she welcomes the> diagnosis that tells her she's not a bad parent or that might solve the> riddle that is her middle child. But rather than a golden ticket to a fix,> she says, it feels like a can of worms.> "What is a diagnosis?" she says. "All it is is permission to> medicate. We could try this drug -- and then what, if it doesn't work? Do> you go to the next drug, up the dose, decide the diagnosis was wrong?">> Profession in transition>> By the mid-1990s, the effort to prevent or mitigate mental illness> began to focus on kids, who had long been considered too young, before> adolescence, to treat with anything but love, time and therapy aimed at> redirecting their behavior. The profession's new focus would require a few> leaps of faith and some significant reinterpretation of its diagnostic> formulas, says Dr. Lawrence Diller, author of "Running on Ritalin" and > "The> Last Normal Child," two books that are critical of the trend.> Conditions such as bipolar disorder and schizophrenia were long> thought so unlikely to appear in children that they were almost never> diagnosed. If psychiatrists were going to start, they needed to fathom how> symptoms of adult psychiatric illness might look in kids, whose brains are> developing and whose social skills are immature.>> For instance, troublesome behaviors stemming from extreme shyness,> inflexibility, impulsiveness -- even stuttering or tics -- might prompt a> diagnosis of anxiety disorder, bipolar disorder or attention-deficit> hyperactivity disorder, even though those problems will recede or > disappear> with age for many children.>> And a psychiatrist might have to reinterpret, in a child, the> classic pattern of "cycling" between manic and depressive episodes that is> the hallmark of bipolar disorder in grown-ups. Instead of taking months to> swing from high to low, a mercurial, expressive child such as Katie's> daughter might be seen as "ultra-rapidly-cycling" between mania and> depression.>> Thomas Insel, director of the National Institute of Mental Health,> acknowledges that these translations may often be imperfect. Responding in> September to the report of a 40-fold increase in bipolar diagnoses among> kids, Insel warned that overdiagnosis and misdiagnosis probably accounted> for some of the surge.>> Indeed, to some in mental health the behavior of Katie's daughter> might be a classic presentation of pediatric bipolar disorder; others > might> see a strong-willed child who needs to learn better to recognize and cope> with powerful emotions. Katie says that when her daughter was a toddler, > the> girl's tantrums were frequent and stormy. As she grew, she picked fights> with strangers and dreamed up projects too big for a little girl to> accomplish. Now, her mother says, the preteen's raging episodes are > briefer> but more intense and that she hates herself afterward. During a recent > trip> to an amusement park, the child stormed away from her mother and> deliberately, it seemed, got herself lost. During the school day, she > seems> able to hold herself in check and works well in class. At home, she can be> unpredictable. She'll fight with her little brother one minute and fawn > over> him the next.>> "I've had this idea that if I can just get her through being a> child, that she'll be fine, that she'll be high-achieving," Katie says. > Her> daughter's ambitious ideas, strong will, assertiveness with authority> figures: Katie had long believed that in adulthood, these exasperating> traits might make her a leader.>> Now that they've been cast as symptoms of early mental illness,> she's not so sure. Perhaps, she thinks, it would be better to curb them > with> medications. "I don't want her to be some kind of crazy loner," Katie > says.>> Medication grows popular>> In spite of the questions about diagnosing mental illness in> children, the medication of children for psychiatric conditions has shot > up.> At three major U.S. medical centers studied in the early 1990s,> antidepressant use among children aged 2 to 19 increased 2.9-fold, > 4.6-fold,> and 3.6-fold, according to a study published in 2002 in Pediatrics.>> Another study found that among low-income children insured by the> state of Tennessee, the use of new antipsychotic medications doubled in a> five-year period in the late 1990s.>> And in the seven years leading up to 2001, researchers at Brandeis> University, reporting in 2006, found that prescriptions for psychiatric> drugs for teenagers (ages 14 to 18) increased 250%. By 2001, one in every > 10> medical office visits by teenage boys resulted in a prescription for a> psychiatric drug, according to the study in the journal Psychiatric> Services.>> There's also evidence that such diagnoses and their medication are> being dispensed at younger and younger ages. The study of Tennessee > children> found hikes in antipsychotic use even in preschoolers.>> After a 4-year-old Massachusetts girl died of a psychiatric drug> overdose in December 2006, the state undertook a first-of-its-kind review > of> medication records for children in its insurance program for low-income> families. It found that nearly 1,000 children under 7 were taking > Clonidine,> a drug used to treat anxiety and hyperactivity that was found in lethal> doses in the body of the Massachusetts 4-year-old. More than 500 kids > under> 7 were taking antipsychotic drugs.>> The state is now investigating 33 cases in which a child under 5 is> taking at least three psychiatric drugs on a regular basis, and more such> cases are expected to surface. That growth is taking place amid a debate> over the safety and effectiveness in children of many widely prescribed> drugs and drug combinations that have not been extensively tested on them.>> All told, only 12 medications have been approved by the Food and> Drug Administration for treatment of psychiatric disorders in children > under> 18. Six -- mostly stimulants -- are used by an estimated 3.5 million kids > to> treat ADHD, a condition estimated by the government to affect 2.2 million > to> 3.7 million American children. Six -- fluoxetine (Prozac), sertraline> (Zoloft), clomipramine (Anafranil), fluvoxamine (Luvox), lithium and> risperidone (Risperdal) -- are used to treat symptoms of "mood disorders,"> including depression, anxiety disorders and bipolar disorder, in kids.>> But psychiatrists have also tapped extensively into the formulary of> psychotropic medications FDA-approved only for adults. They often > prescribe> them in combinations that have been the subject of few trials for safety > and> effectiveness. Such "off-label" prescribing, which is legal, is done > often,> but not exclusively, when drugs approved for kids don't provide > satisfactory> results.>> The dearth of approved drugs for pediatric use has prompted the two> largest groups of mental-health professionals who treat children -- the> American Psychological Assn. and the American Academy of Child and> Adolescent Psychiatry -- to recommend that the FDA establish a new panel > of> independent experts to advise the agency on the safety and effectiveness > of> psychotropic drugs for children and adolescents. The AACAP has established > a> special working group to conduct and track research on preschool> psychopharmacology, and another to focus on childhood bipolar disorder.>> Wary of early intervention>> Northwestern University's Christopher Lane, author of a new book,> "Shyness: How Normal Behavior Became a Sickness," calls psychiatry's > growing> focus on children "the perfect storm" for overdiagnosis.> "You've got a constituency -- children -- who cannot make informed> medical decisions for themselves," Lane says. In a fast-moving culture > that> heaps stress and high expectations on children, "parents are in many cases> under great pressure to ensure their child succeeds and is socially> proficient. A child that doesn't negotiate rapidly those hurdles can look> very quickly as if he or she is falling behind, or displaying behavior > that> warrants medical concern.">> Some mental-health professionals are wary, too, of the implied> promise of early intervention. In fact, whether, how or in how many cases > a> child's problematic behavior leads to full-blown mental illness -- what> health professionals call the "progression" of the disease -- is in many> cases not well understood, especially when the patient is not even a> teenager yet.>> As to the claim that early treatment will lessen symptoms or prevent> mental illness later, there is growing evidence, but it is hardly a> slam-dunk. And it doesn't address which kids will benefit from> pharmacological treatment and which won't.>> As the mental-health profession begins debate over how to update its> diagnostic manual, the Diagnostic and Statistical Manual of Mental> Disorders, or DSM, which is set for reissue in 2012, it is debating > whether> it has gone too far. The recent publication of two books critical of the> expansion of psychiatric diagnoses -- Lane's "Shyness" and "The Loss of> Sadness," by Allan V. Horwitz and Jerome C. Wakefield -- have touched off > a> flurry of discussion.>> In a foreword to "The Loss of Sadness," Dr. Robert L. Spitzer, a> leading figure in psychiatry, acknowledges the imprecision of the DSM,> "especially the question of how to distinguish disorder from normal> suffering." But he also defends the widening of psychiatry's safety net.> "I'm more concerned with people who could benefit from treatment not > getting> diagnosed -- with under-treatment -- than with overdiagnosis," he says. > "If> you need the drug, it's pretty awful if you don't get it.">> If notions of what's normal for kids have changed, he adds, "I don't> know that that's necessarily bad." More is known now, he says, about how> things can go wrong with human functioning.>> Dr. Robert Hendren, president of the American Academy of Child and> Adolescent Psychiatry, says he is acutely aware of the overdiagnosis > debate.> Among the many possible explanations, he says, is that many psychiatric> drugs appear effective in treating kids' problematic behavior. "When you> believe the medications work, you're awfully tempted," he says. "But we > must> not be seen as pill-pushers."> The profession, he adds, will need better research to justify the growth > in> diagnoses.>> That research will come too late to help Katie judge what's best for her> daughter. She fears that the proposed antipsychotic medication will> exacerbate the child's weight problem and "deaden her spirit."> She looks up bipolar disorder on the Internet and sees that while many of> the symptoms described are "spot on," many don't fit her daughter at > all --> or worse, could fit any child with a difficult temperament, a flair for> drama or a challenging family situation. As she wavers at the threshold of > a> decision, Katie leans toward acceptance of her daughter's diagnosis and > the> pills that will probably come with it. "I've struggled to come up with an> answer. This is at least something I can do," she says.>> She is sad but resigned to choosing without full information.> "All I can do, in the end, is love her and make the best decisions I> can at the time," she says. "That's the blessing and curse of being a> parent. It's never going to be perfect.">> melissa.healy (AT) latimes (DOT) com> ~~~~~~~~~~~~~~~~~~>> http://www.docguide.com/news/content.nsf/news/852571020057CCF68525738> Concomitant Psychotropic Medications Overprescribed in Foster-Care Youth:> Presented at AACAP> By Maria Bishop>> BOSTON, MA -- October 31, 2007 -- Nearly 20% of youths in foster care> receiving psychotropic medications received two or more such drugs in the> same drug class, in a study presented here at the 54th Annual Meeting of > the> American Academy of Child & Adolescent Psychiatry (AACAP).>> Professionally developed monitoring guidelines would help to validate any> necessary prescriptions for multiple psychotropic medications, noted lead> author Julie M. Zito, PhD, MS, Associate Professor in Pharmacy and> Psychiatry, Department of Pharmaceutical Health Services Research, School > of> Pharmacy, University of Maryland, Baltimore, Maryland, United States.>> Dr. Zito and colleagues selected a random sample (n = 472) from a total of> 32,135 Medicaid foster-care enrolees in Texas in 2004. All subjects were > 19> years of age or younger (64% over the age of 10; 5% were age 4 years and> under) and all received at least one psychotropic drug in the study year> (2004).>> The psychotropic drugs were classified under 8 drug descriptions:> anticonvulsants; alpha agonists; antianxiolytics; antidepressants > (selective> serotonin reuptake inhibitors, tricyclic antidepressants, other);> antipsychotics (atypical and conventional); ADHD drugs (amphetamines,> methylphenidate, atomoxetine); lithium; and miscellaneous.>> Results demonstrated that nearly 73% of subjects were prescribed two or > more> psychotropic agents (in separate classes) concomitantly, while more than > 41%> received three or more; more than 15% received four or more drugs, and > more> than 2% received five or more.> Psychiatrists wrote 93% of the prescriptions for the children in this > study.>> Clinician-reported diagnoses indicated the following: attention-deficit> hyperactivity disorder (38.8%), depression (35.5%), adjustment/anxiety> (33.7%), bipolar (17.2%), and oppositional defiant disorder/conduct > disorder> (20.6%).>> Concomitant drug use in this study was assessed manually using > patient-level> computerised claims data from the month of July, 2004.>> Previous studies on the prevalence of multiple psychotropic medications in> foster-care children have included medication claims for periods of 7 days> (underestimating coprescribing) and for periods of 3, 6 and 12 months> (overestimating coprescribing), Dr. Zito noted. Further more realistic > data> are needed to validate the use of psychotropic drugs and to ensure their> effective and safe use in this at-risk population, he added.>> Prescriptions for psychotropic medication for youths in foster care in the> United States in general far exceed prescriptions made to similar> Medicaid-insured youth who qualify because of low family income, according> to the researchers.>> FAIR USE NOTICE: This may contain copyrighted (C ) material the use of > which> has not always been specifically authorized by the copyright owner. Such> material is made available for educational purposes, to advance> understanding of human rights, democracy, scientific, moral, ethical, and> social justice issues, etc. It is believed that this constitutes a 'fair> use' of any such copyrighted material as provided for in Title 17 U.S.C.> section 107 of the US Copyright Law. This material is distributed without> profit.>>>>> _____________> Infomail1 mailing list> to send a message to Infomail1-leave (AT) ahrp (DOT) org