Fwd: Bipolar Diagnosis in Children to be delegitimized in DSM-V / Long-Term Care_ NY Times

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ALLIANCE FOR HUMAN RESEARCH PROTECTIONA Catalyst for Public Debate: Promoting Openness, Full Disclosure, andAccountabilityhttp://www.ahrp.org <http://www.ahrp.org/> FYITwo front page articles in today's New York Times are of particularsignificance to those seeking to reform US healthcare--addressing bothquality of care and expenditure.1. "Revising Book on Disorders of the Mind" by Benedict Carey, reveals thatthe bipolar diagnosis for children and the prescribing of toxicantipsychotics for children will be delegitimized in the revised diagnosticmanual in psychiatry, the DSM-5.http://www.nytimes.com/2010/02/10/health/10psych.htmlThe foremost revision to psychiatry's diagnostic manual (in the forthcomingDSM-V) overturns current American psychiatric practice of loosely"diagnosing" children with bipolar and then misprescribing toxicantipsychotics for children. These practices have been aggressively promotedby leading child psychiatrists, most notably by Dr. Joseph Biederman ofHarvard / Massachusetts General Hospital. Under the revised DSM-V diagnostic criteria, "Far fewer children would get adiagnosis of bipolar disorder."This revision is clearly the result of documented evidence brought to publicattention. The evidence shows that children have become casualties ofpsychiatry's commercially driven, drug-centered, clinical practices. Addingfuel were the revelations about those psychiatrists' financial ties topsychotropic drug manufacturers. "'The treatment of bipolar disorder is meds first, meds second and medsthird," said Dr. Jack McClellan, a psychiatrist at the University ofWashington who is not working on the manual. 'Whereas if these kids have abehavior disorder, then behavioral treatment should be considered theprimary treatment'."Children have been misdiagnosed, then targeted for abusive prescribing oftoxic drugs, endorsed by American child psychiatrists at leading academicinstitutions and the American Psychiatric Association. "The misdiagnosisled many children to be given powerful antipsychotic drugs, which haveserious side effects, including metabolic changes."Leading psychiatrists now admit that most of unruly children weremisdiagnosed as bipolar:"One significant change would be adding a childhood disorder called temperdysregulation disorder with dysphoria, a recommendation that grew out ofrecent findings that many wildly aggressive, irritable children who havebeen given a diagnosis of bipolar disorder do not have it.Some diagnoses of bipolar disorder have been in children as young as 2, andthere have been widespread reports that doctors promoting the diagnosisreceived consulting and speaking fees from the makers of the drugs." Of note, psychiatry's leadership--those who are largely responsible for themeteoric rise in the labeling of normal children as "bipolar" --who led theway by lending the appearance of legitimacy to the illegitimate prescribingantipsychotics for young children--which rank among industry's mostdamage-producing drugs---are retreating from their stance.Even Dr. David Shaffer, a child psychiatrist at Columbia, a strong proponentof using psychoactive drugs for children; the psychiatrist responsible forthe design and promotion of TeenScreen--a mental screening dragnet designedto increase the number of school children labeled with mental disordersrequiring immediate intervention; has now conceded that the current practiceof labeling misbehaving children as bipolar has been wrong. Dr. Shaffer isquoted by the Times stating that he and his colleagues on the APA panelworking on the manual "hope the people contemplating a diagnosis of bipolarfor these patients would think again'." A second important revision would retreat from the practice of presumingthat children's misbehavior signaled "risk syndromes" for severeincapacitating mental illness which justified interventions with toxicpharmaceuticals:"One of the most controversial proposals was to identify "risk syndromes,"that is, a risk of developing a disorder like schizophrenia or dementia.Studies of teenagers identified as at high risk of developing psychosis, forinstance, find that 70 percent or more in fact do not come down with thedisorder.""I completely understand the idea of trying to catch something early," Dr.First said, "but there's a huge potential that many unusual, semi-deviant,creative kids could fall under this umbrella and carry this label for therest of their lives."Imagine the human tragedies that follow the mislabeling of 70% of childrenas severely mentally ill, who are then exposed to extremely toxic drugs thatinduce diabetes, cardiovascular disease, and a host of other severe adverseeffects. Adding insult to injury, US taxpayers have been saddled with thecost of drugs that undermine the health of children who then requirelife-long care for drug-induced (iatrogenic) chronic diseases.2. The second front page article in today's Times, "The World of Long-TermCare Hospitals" by Alex Berenson is an investigative piece which blows thelid on unregulated, for-profit, long-term care hospitals, such as thefacilities run by Sect Medical Corp, which Medicare's reimbursement rulesfavor--no matter that the quality of care provided at some (most ?) of thesefacilities is sub-standard. The Times reports: "Unlike traditional hospitals, Medicare does not penalizethem financially if they fail to submit quality data.""Under Medicare payment rules, traditional hospitals often lose money onpatients who stay for long periods. So they have a financial incentive todischarge patients to long-term hospitals, which then receive new Medicarepayments for admitting the patients. Both hospitals benefit financially."Long-term care hospitals are projected to cost taxpayers $4.8 billion thisyear compared to $398 million in 1993. http://www.nytimes.com/2010/02/10/health/policy/10care.html?ref=todayspaperContact: Vera Hassner Sharavveracare212-595-8974<http://www.nytimes.com/2010/02/10/health/10psych.html> Revising Book on Disorders of the Mind By BENEDICT CAREY Published: February 10, 2010 Far fewer children would get a diagnosis of bipolar disorder. " Binge eatingdisorder " and "hypersexuality" might become part of the everyday language.And the way many mental disorders are diagnosed and treated would be sharplyrevised. These are a few of the changes proposed on Tuesday by doctors charged withrevising psychiatry's encyclopedia of mental disorders, the guidebook thatlargely determines where society draws the line between normal and notnormal, between eccentricity and illness, between self-indulgence andself-destruction - and, by extension, when and how patients should betreated. The eagerly awaited revisions - to be published, if adopted, in the fifthedition of the Diagnostic and Statistical Manual of Mental Disorders, due in2013 - would be the first in a decade. For months they have been the subject of intense speculation and lobbying byadvocacy groups, and some proposed changes have already been widelydiscussed - including folding the diagnosis of Asperger's syndrome into abroader category, autism spectrum disorder. But others, including a proposed alternative for bipolar disorder in manychildren, were unveiled on Tuesday. Experts said the recommendations, postedonline at DSM5.org <http://dsm5.org/> for public comment, could bring rapidchange in several areas."Anything you put in that book, any little change you make, has hugeimplications not only for psychiatry but for pharmaceutical marketing,research, for the legal system, for who's considered to be normal or not,for who's considered disabled," said Dr. Michael First, a professor ofpsychiatry at Columbia University who edited the fourth edition of themanual but is not involved in the fifth. "And it has huge implications for stigma," Dr. First continued, "because themore disorders you put in, the more people get labels, and the higher therisk that some get inappropriate treatment."One significant change would be adding a childhood disorder called temperdysregulation disorder with dysphoria, a recommendation that grew out ofrecent findings that many wildly aggressive, irritable children who havebeen given a diagnosis of bipolar disorder do not have it. The misdiagnosis led many children to be given powerful antipsychotic drugs,which have serious side effects, including metabolic changes."The treatment of bipolar disorder is meds first, meds second and medsthird," said Dr. Jack McClellan, a psychiatrist at the University ofWashington who is not working on the manual. "Whereas if these kids have abehavior disorder, then behavioral treatment should be considered theprimary treatment."Some diagnoses of bipolar disorder have been in children as young as 2, andthere have been widespread reports that doctors promoting the diagnosisreceived consulting and speaking fees from the makers of the drugs.In a conference call on Tuesday, Dr. David Shaffer, a child psychiatrist atColumbia, said he and his colleagues on the panel working on the manual"wanted to come up with a diagnosis that captures the behavioral disturbanceand mood upset, and hope the people contemplating a diagnosis of bipolar forthese patients would think again."Experts gave the American Psychiatric Association, which publishes themanual, predictably mixed reviews. Some were relieved that the task forceworking on the manual - which includes neurologists and psychologists aswell as psychiatrists had revised the previous version rather than trying torewrite it. Others criticized the authors, saying many diagnoses in the manual wouldstill lack a rigorous scientific basis. The good news, said Edward Shorter, a historian of psychiatry who has beencritical of the manual, is that most patients will be spared the confusionof a changed diagnosis. But "the bad news," he added, "is that thescientific status of the main diseases in previous editions of the D.S.M. -the keystones of the vault of psychiatry - is fragile."To more completely characterize all patients, the authors propose usingmeasures of severity, from mild to severe, and ratings of symptoms, likeanxiety, that are found as often with personality disorders as withdepression. "In the current version of the manual, people either meet the threshold byhaving a certain number of symptoms, or they don't," said Dr. Darrel A.Regier, the psychiatric association's research director and, with Dr. DavidJ. Kupfer of the University of Pittsburgh , the co-chairman of the taskforce. "But often that doesn't fit reality. Someone with schizophreniamight have symptoms of insomnia , of anxiety; these aren't the diagnosticcriteria for schizophrenia, but they affect the patient's life, and we'dlike to have a standard way of measuring them."In a conference call on Tuesday, Dr. Regier, Dr. Kupfer and several othermembers of the task force outlined their favored revisions. The task forcefavored making semantic changes that some psychiatrists have long arguedfor, trading the term " mental retardation " for "intellectual disability,"for instance, and " substance abuse " for "addiction." One of the most controversial proposals was to identify "risk syndromes,"that is, a risk of developing a disorder like schizophrenia or dementia.Studies of teenagers identified as at high risk of developing psychosis, forinstance, find that 70 percent or more in fact do not come down with thedisorder. "I completely understand the idea of trying to catch something early," Dr.First said, "but there's a huge potential that many unusual, semi-deviant,creative kids could fall under this umbrella and carry this label for therest of their lives."Dr. William T. Carpenter, a psychiatrist at the University of Maryland andpart of the group proposing the idea, said it needed more testing. "Concernsabout stigma and excessive treatment must be there," he said. "But keep inmind that these are individuals seeking help, who have distress, and thequestion is, What's wrong with them?" The panel proposed adding several disorders with a high likelihood ofentering the pop vernacular. One, a new description of sex addiction, is"hypersexuality," which, in part, is when "a great deal of time is consumedby sexual fantasies and urges; and in planning for and engaging in sexualbehavior." Another is "binge eating disorder," defined as at least one binge a week forthree months - eating platefuls of food, fast, and to the point ofdiscomfort - accompanied by severe guilt and plunges in mood. "This is not the normative overeating that we all do, by any means," saidDr. B. Timothy Walsh, a psychiatrist at Columbia and the New York StatePsychiatric Institute who is working on the manual. "It involves much moreloss of control, more distress, deeper feelings of guilt and unhappiness."FAIR USE NOTICE: This may contain copyrighted (C ) material the use of whichhas not always been specifically authorized by the copyright owner. Suchmaterial is made available for educational purposes, to advanceunderstanding of human rights, democracy, scientific, moral, ethical, andsocial justice issues, etc. It is believed that this constitutes a 'fairuse' of any such copyrighted material as provided for in Title 17 U.S.C.section 107 of the US Copyright Law. 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