Ricky Wyatt, a 57-year-old Alabama man who was the lead plaintiff in a 1970 federal class-action lawsuit that helped improve conditions in state psychiatric institutions nationwide, died on November 1. Wyatt had been institutionalized at age 14 on the word of his legal guardian, an aunt, because he was a “hell-raiser” (as he later described himself). Despite having no mental health diagnosis, he was routinely dosed with Thorazine and other psychiatric medications, and lived in horrendous conditions in Bryce State Hospital in Tuscaloosa. The lawsuit, Wyatt v. Stickney, resulted in national guidelines called the Wyatt Standards; the standards called for a humane psychological and physical environment, qualified and sufficient staff, individualized treatment plans and minimum restriction of patient freedom.
Source: http://www.nytimes.com/2011/11/04/health/ricky-wyatt-57-dies-plaintiff-in-landmark-mental-care-suit.html
Reposted at http://www.darkestcloset.blogspot/
Tuesday, November 29, 2011
Monday, November 14, 2011
With the Help of a Video Game, Virtual Help for Families of Veterans
Friday, November 11, 2011 By Fred Mogul Click to play
Posted at http://www.darkestcloset.blogspot.com/,
- Christian Campos (Fred Mogul/WNYC)
Christian Campos is playing a different kind of video game.
Campos, 25, has been following the animated story of a U.S. Marine who has returned home to live with his parents after serving on the front lines.
The game, “Family of Heroes,” is an online interactive role-playing program aimed at helping loved ones communicate with veterans dealing with post-deployment problems, and ultimately, get them treatment.
He nodded his head and smiled knowingly at the screen. He said the similarities between the fictional Marine and his brother, Junior, 22, were uncanny.
Junior spent 10 months in Afghanistan and earlier this year returned to Camp Lejeune, N.C., where he is now. He’s come home to his family in Paterson, N.J., a few times since being back.
“Seeing my brother very anxious, seeing my brother with all those feelings of going back to war, because be feels more safe, he feels more normal, he feels he belongs there — is totally sad, is totally devastating to me as well as my parents," Christian said.
There are an estimated 34,000 veterans of the Afghanistan and Iraq wars in the metropolitan area, and with the final withdrawal of troops from Iraq by the end of the year, that number is expected to increase. As many as two-thirds of combat veterans locally have mental health problems, including anxiety, depression, substance abuse and post-traumatic stress disorder, according to the Veterans Administration.
(Photo: Courtesy of Kognito Interactive)
The military services, the V.A. and independent support groups offer a range of services for families, so they can get help for their loved ones, but many people don’t know where to start.
Ann Feder, a supervisor for mental health services for the regional V.A., hopes the new online program that Christian Campos is playing, called Family of Heroes, will find its way to other people like the Campos family.
“We already do face-to-face outreaches,” she said, “but this is the first time we’re doing a program for any family member, loved one, somebody who cares about the veteran online.”
"Family of Heroes" was produced by a New York City firm called Kognito, which has a $200,000 contract with the local V.A. It's too new to have much of a track record, but more rigorous study is in the works.
V.A. officials said they don’t expect an interactive online program to take the place of traditional resources for families, such as help lines and support groups.
Psychologist Barbara Van Dahlen, who runs a volunteer program for veterans called Give an Hour, said the easy-to-access simulation is one more tool among several.
“Obviously, it’s not going to be the right method for every family,” Van Dahlen said. “But the goal is to create a variety of options, of opportunities to get information to families.”
"Family of Heroes" takes about an hour, and features three families with different challenges. Viewers watch a conversation between spouses or parents and returning veterans, and then replay it, taking the role of the loved one, and trying out different replies, until gently persuading the veteran to seek counseling help.
Christian Campos, taking the role of the virtual Marine’s mother, doesn’t quite get him all the way into therapy, but playing around just a little with the simulation, he gets him to accept the idea of possibly seeing someone. It’s a start.
Christian said he feels newly confident about broaching sensitive subjects with his brother, Junior, who’s returning soon for Thanksgiving: “Knowing how to handle a situation...that could save his life,” Christian said.
Christian Campos said his brother, Junior, was in several vehicles that were hit by roadside bombs, and he was shot in the head, but saved by his helmet.
Speaking from North Carolina, Junior said coming back from Afghanistan took some adjustment initially. He had some problems with anger, but not any more.
“I have no issues. I have no problems now,” he said. “I can control my temper now. I’m calm all the time.”
Junior’s looking forward to coming home for Thanksgiving. Christian, is also upbeat about the upcoming visit – but he also plans to spend some time with the “Family of Heroes” program, and go over it with his parents, just in case.
The game, “Family of Heroes,” is an online interactive role-playing program aimed at helping loved ones communicate with veterans dealing with post-deployment problems, and ultimately, get them treatment.
He nodded his head and smiled knowingly at the screen. He said the similarities between the fictional Marine and his brother, Junior, 22, were uncanny.
Junior spent 10 months in Afghanistan and earlier this year returned to Camp Lejeune, N.C., where he is now. He’s come home to his family in Paterson, N.J., a few times since being back.
“Seeing my brother very anxious, seeing my brother with all those feelings of going back to war, because be feels more safe, he feels more normal, he feels he belongs there — is totally sad, is totally devastating to me as well as my parents," Christian said.
There are an estimated 34,000 veterans of the Afghanistan and Iraq wars in the metropolitan area, and with the final withdrawal of troops from Iraq by the end of the year, that number is expected to increase. As many as two-thirds of combat veterans locally have mental health problems, including anxiety, depression, substance abuse and post-traumatic stress disorder, according to the Veterans Administration.
(Photo: Courtesy of Kognito Interactive)
The military services, the V.A. and independent support groups offer a range of services for families, so they can get help for their loved ones, but many people don’t know where to start.
Ann Feder, a supervisor for mental health services for the regional V.A., hopes the new online program that Christian Campos is playing, called Family of Heroes, will find its way to other people like the Campos family.
“We already do face-to-face outreaches,” she said, “but this is the first time we’re doing a program for any family member, loved one, somebody who cares about the veteran online.”
"Family of Heroes" was produced by a New York City firm called Kognito, which has a $200,000 contract with the local V.A. It's too new to have much of a track record, but more rigorous study is in the works.
V.A. officials said they don’t expect an interactive online program to take the place of traditional resources for families, such as help lines and support groups.
Psychologist Barbara Van Dahlen, who runs a volunteer program for veterans called Give an Hour, said the easy-to-access simulation is one more tool among several.
“Obviously, it’s not going to be the right method for every family,” Van Dahlen said. “But the goal is to create a variety of options, of opportunities to get information to families.”
"Family of Heroes" takes about an hour, and features three families with different challenges. Viewers watch a conversation between spouses or parents and returning veterans, and then replay it, taking the role of the loved one, and trying out different replies, until gently persuading the veteran to seek counseling help.
Christian Campos, taking the role of the virtual Marine’s mother, doesn’t quite get him all the way into therapy, but playing around just a little with the simulation, he gets him to accept the idea of possibly seeing someone. It’s a start.
Christian said he feels newly confident about broaching sensitive subjects with his brother, Junior, who’s returning soon for Thanksgiving: “Knowing how to handle a situation...that could save his life,” Christian said.
Christian Campos said his brother, Junior, was in several vehicles that were hit by roadside bombs, and he was shot in the head, but saved by his helmet.
Speaking from North Carolina, Junior said coming back from Afghanistan took some adjustment initially. He had some problems with anger, but not any more.
“I have no issues. I have no problems now,” he said. “I can control my temper now. I’m calm all the time.”
Junior’s looking forward to coming home for Thanksgiving. Christian, is also upbeat about the upcoming visit – but he also plans to spend some time with the “Family of Heroes” program, and go over it with his parents, just in case.
Too little exercise, too much TV tied to depression
Peposted at http://darkestcloset.blogspot.com/ Posted at http://www.reuters.com/article/2011/11/14/us-depression-exercise-idUSTRE7AD04I20111114
Sun Nov 13, 2011 9:26pm EST
(Reuters) - Older women who got more exercise and less television time were the least likely to be diagnosed with depression, according to a U.S. study of thousands of women -- with physical activity having the biggest impact.
According to findings published in the American Journal of Epidemiology, researchers found that women who reported exercising the most in recent years were about 20 percent less likely to get depression than those who rarely exercised.
On the other hand, the more hours they spent watching TV each week, the more their risk of depression crept up.
"Higher levels of physical activity were associated with lower depression risk," wrote study author Michel Lucas, from the Harvard School of Public Health in Boston.
More time spent being active might boost self-esteem and women's sense of control, as well as the endorphins in their blood, although the study could not prove directly that watching too much television and avoiding exercise caused depression, she added.
The report included close to 50,000 women who filled out surveys every couple of years as part of the U.S. Nurses' Health Study, and covered the years 1992 to 2006.
Participants recorded the amount of time they spent watching TV each week in 1992, and also answered questions about how often they walked, biked, ran and swam between 1992 and 2000.
On the same questionnaires, women reported any new diagnosis of clinical depression or medication taken to treat depression.
The analysis only included women who did not have depression in 1996. Over the next decade, there were 6,500 new cases of depression.
After the researchers accounted for aspects of health and lifestyle linked to depression, including weight, smoking and a range of diseases, exercising the most -- 90 minutes or more each day -- meant women were 20 percent less likely to be diagnosed with depression than those who exercised 10 minutes or less a day.
Women who watched three hours or more of television a day were 13 percent more likely to be diagnosed with depression than those who hardly ever tuned in, but Lucas said at least part of that link might be due to women replacing time they could be exercising with TV watching.
One alternative explanation the researchers brought up is that women might have been experiencing some symptoms of depression before they were diagnosed, leading them to exercise less. A formal diagnosis could have come later.
"Previous studies have suggested that physical activity is associated with a lower risk of depressive symptoms," said Gillian Mead, who studies geriatric medicine at Edinburgh's Royal Infirmary but was not involved in the study.
"(The finding) adds to the growing body of evidence that physical activity is important to maintain brain health," she added in an email to Reuters Health. SOURCE: bit.ly/sQbWMU
(Reporting from New York by Genevra Pittman at Reuters Health; editing by Elaine Lies and Ron Popeski)
http://www.reuters.com/article/2011/11/14/us-depression-exercise-idUSTRE7AD04I20111114
Friday, November 11, 2011
Psychiatry manual revisions spark row
US psychiatrists divided by claims of secrecy and scientific overreach.
Reposted at http://wwwdarkestcloset.blogspot.com/
The question of how best to revise the 'bible' of American psychiatry once again has tempers flaring. The manual, the Diagnostic and Statistical Manual of Mental Disorders (DSM), is significant because it is used to determine clinical diagnoses, insurance reimbursements and research agendas throughout the United States, and is often used as a reference in other countries.
Planning for the upcoming fifth edition of the manual (DSM-V) began in 1999, but as work has picked up during the past year, critics have alleged that the process has been too secretive, and that working groups have been pushed to meet an unrealistic 2012 publication date. Some, including the architects behind the last two editions of the DSM, also complain that project leaders are pushing for the premature inclusion of changes meant to incorporate recent genetic and neurobiological advances, before they are ready for the clinic.
Supporters, meanwhile, say that the changes will not be too drastic, and are meant to make the manual more flexible for future revisions.
Even light tweaking of definitions in the DSM can bring about radical changes in psychiatric practice, as Allen Frances, professor emeritus of psychiatry at Duke University in Durham, North Carolina, wrote in a recent commentary in Psychiatric Times. Frances, chairman of the committee that produced the fourth edition of the manual in 1994, acknowledged that changes in the definitions of autistic disorder and attention-deficit/hyperactivity disorder made then may have contributed to the recent surge in diagnoses of these conditions.
In addition, the manual sometimes has an outsized influence on research directions, says Steven Hyman, provost of Harvard University and a member of the DSM-V task force that is overseeing the revision. Hyman became interested in reforming the DSM when he was director of the National Institute of Mental Health in Bethesda, Maryland, and witnessed the control that it exerted over grant review panels. "I was spending taxpayer money on grants that were being forced into categories that might or might not conform to nature," he says.
“There just hasn't been time to do this in an organized way.”
The latest revisions come as financial ties between prominent psychiatrists and pharmaceutical companies are being closely scrutinized. A 2006 analysis of potential conflicts of interest among those who participated in the last revision showed that 56% of panel members had financial links to the pharmaceutical industry (L. Cosgrove et al. Psychother. Psychosom. 75, 154–160; 2006). For the DSM-V, the American Psychiatric Association, which publishes the manual, vetted potential members of working groups under a new conflict-of-interest policy. But the process introduced delays, and working groups were not finalized until 2008.
Then word broke last July that working group members had signed non-disclosure agreements, agreeing to refrain from distributing pre-publication materials or divulging the content of group discussions pertaining to the rewrite. The agreements were intended to prevent members from publishing material to be used in the DSM-V, says Darrel Regier, vice-chair of the DSM-V task force and director of the American Psychiatric Association's research division. But Robert Spitzer, a professor of psychiatry at Columbia University in New York who oversaw the DSM-III, says that his request to look at minutes of a DSM-V meeting was denied because of these confidentiality agreements.Since then, DSM-V working groups have begun posting regular summaries of their activities online. "All of us have been encouraged to be as public as we can be," says William Carpenter of the Baltimore-based University of Maryland School of Medicine and chair of the working group on psychotic disorders. "But just to have [the confidentiality agreements] — that never would have been considered in the previous revisions," says Spitzer.
From the start, Hyman and DSM-V chairman David Kupfer have also planned to change how the DSM-V evaluates mental disorders. Rather than relying strictly on categorical diagnoses — one either has depression or does not, for example — they have pushed to add 'dimensional' criteria to ascertain to what extent a person is depressed. Such criteria could also address similarities among different disorders, reflecting, for example, neuroimaging studies that suggest multiple anxiety disorders can affect the same region of the brain.
For this reason, Carpenter and others have said the DSM-V will represent a "paradigm shift" — an expression that alarmed critics, who say the science behind such dimensional assessments is not yet ready to be incorporated into clinical assessments. In March, Duke University psychologist and epidemiologist Jane Costello resigned from the working group on child and adolescent disorders after receiving a memo from Kupfer and Regier about including the dimensional approach. Adding these assessments would require a great deal of extra research, she says, at a time when working groups were already behind schedule for their 2012 publication deadline. "There just hasn't been time to do this in an organized way," she says. "This is a huge job."
Hyman says that the changes will not necessarily be so drastic, and could take the form of a few additional, and optional, diagnostic criteria without replacing the old methods.
Mental-health guide accused of overreach
Dispute grows over revisions to diagnostic handbook.
Psychologist David Elkins had modest ambitions for his petition. He and his colleagues were worried that proposed changes to an influential handbook of mental disorders could classify normal behaviours as psychological conditions, potentially leading to inappropriate treatments. So they laid out their concerns in an open letter, co-sponsored by five divisions of the American Psychological Association in Washington DC. “I thought, 'Well, maybe we'll get a couple or maybe 30 signatures',” says Elkins, an emeritus professor at Pepperdine University in Malibu, California.
But the letter, posted online on 22 October (http://go.nature.com/uhmvqq), touched a nerve. Within 10 days more than 2,800 people had signed it, many identifying themselves as mental-health professionals.
The petition targets proposed revisions to the Diagnostic and Statistical Manual of Mental Disorders (DSM), a tome used by psychiatrists, psychologists, counsellors and others worldwide to diagnose mental maladies and set research agendas. The American Psychiatric Association, based in Arlington, Virginia, plans to publish a new edition of the manual, DSM-5, in 2013. The association has declined to comment on Elkins's petition.
Elkins's petition is not the first to raise concerns that the DSM-5 proposals could overreach. In June, the British Psychological Society, based in Leicester, issued a critique that highlighted, for example, the proposed addition of 'attenuated psychosis syndrome'. The society argued that this could be used “to stigmatize eccentric people”.
“There should be a black box warning about how child bipolar disorder is being overdiagnosed.”
Efforts to tighten loose definitions of attention deficit and hyperactivity disorder (ADHD) and bipolar disorder in children have also proved controversial. In response to worries that inexact criteria may have contributed to a surge in diagnoses of these conditions since the 1990s, the DSM-5 task force has proposed a syndrome called 'disruptive mood dysregulation disorder', which would provide an alternative to labelling a child as bipolar or having ADHD. But Frances says that is not enough. “There should be a black box warning about how child bipolar disorder is being overdiagnosed,” he says. “Instead, they've created a new disorder.”
Field trials of the proposed DSM-5 criteria have been completed and investigators plan to publish the results. Helena Kraemer, a statistician and emeritus professor at Stanford University School of Medicine in Palo Alto, California, who is on the DSM-5 committee, says that results from trials of some criteria will indicate whether they generate more frequent diagnoses.
But Mojtabai cautions that trial results may not reflect what will happen when DSM-5 is published. “Any trial is artificial,” he says. “The clinicians in these trials have intensive training, but people who will use this manual in clinical practice will not receive that level of instruction.”
- Nature Volume: 479, Pages: 14 ()
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