Tuesday, August 30, 2011

Are the chinese really taking over drug companies?

Stephen Stahl, whose Essential psychopharmacology book now has his name in the title, has a post on his NEI (Neuroscience Education Institute) blog about drug company research. He mentions a crisis meeting at the Royal Society of Medicine this month, which he says he will report on when he gets back. I look forward to hearing more.

He regrets that "Nobody likes drug companies these days". I don't think he's helping their press by seeming to support drug company sponsorship of medical education and illegal marketing of their drugs. At least he admits that half of prescribing in psychiatry is "off label".

Nor is his case helped by misrepresentation of those who express concern about these practices as believers in psychiatric illnesses being "pure inventions of Pharma". As I've pointed out in a previous post, there's no need to be defensive if pharmaceutical companies really are pulling out of psychiatric research.

(With thanks to a post on Carlat Psychiatry Blog).

Monday, August 29, 2011

Unthinkable? R.D. Laing in Guardian editorial

Not sure what prompted an editorial in the Guardian about R.D. Laing in its Unthinkable? series. The editorial makes reference to a production of Knots at the King's Head Theatre. It suggests it is time for a reassessment of Laing in "an era of big pharma and proliferating diagnoses". Samantha Bark in her response says she was thrilled to see the editorial and makes reference to her PhD thesis on Laing, which I have added as a link on my articles critical of psychiatry webpage.

Critical psychiatry has never hidden its origins in the work of R.D. Laing (see my book chapter Historical perspectives on anti-psychiatry). There were excesses in 'anti-psychiatry'. Critical psychiatry aims to avoid the marginalisation experienced by R.D. Laing and others like him designated as 'anti-psychiatrists'.

Sunday, August 14, 2011

Mental illness not same as focal brain lesions

Thomas Insel in his NIMH Director's Blog asks whether a neurological approach to mental illness is helpful. He admits it is an "NIMH mantra" to describe mental disorders as brain disorders. I have previously mentioned his view that mental illnesses are disorders of brain circuits.

He suggests mental illnesses are analogous to heart arrhythmias which may not have a demonstable lesion in the heart. He holds out the hope that mapping patterns of cortical function will find abnormal brain circuitry. The example he gives is of apparent delayed cortical maturation in ADHD. Well, let's see - is this conclusion based on one study ie. Shaw et al (2007), which hasn't been replicated? He also speculates that neuroimaging could allow early detection of so-called circuit disorders.

Insel goes on to state that neuroimaging is beginning to yield biomarkers, but then doesn't say what the biomarkers are. He suggests that deep brain stimulation is demonstrating how changing the activity of specific circuits leads to a remission of refractory depression, but doesn't say what circuits are being changed.

Finally, he at least concedes that, "In truth, we still do not know how to define a circuit". He also concludes that "One thing we can say ... is that earlier notions of mental disorders as chemical imbalances or as social constructs are beginning to look antiquated." Not sure why he includes 'social constructs' in this broadbrush remark, as he's not considered this possibility. His faith in the value of neuroscience to help people recover from mental disorders has been the wish-fulfilling phantasy of modern psychiatry since the 19th century.

Saturday, August 13, 2011

NHS treatment of eating disorders

I have already mentioned Bryan Lask in a previous post about eating disorders. He has responded to a Guardian leader about specialist treatment for anorexic children. He believes that eating disorders are "highly complex genetically determined, brain-based disorders". However, he doesn't explain why he thinks this.

He expresses concern about the reduction in the number of young people admitted to specialist inpatient units and suggests that they are being admitted to paediatric units instead. I'm not sure where he gets his figures from. He argues that the motivation for closure of specialist units is financial.

I presume he means that NHS savings mean that the number of referrals to private units has decreased. He is no longer medical advisor to the Huntercombe group which runs three such units. Maybe he's worried they'll be forced to close. Current reforms of the NHS (see my personal blog) may well eventually open up the market for the management of eating disorders, but it's not necessarily always been the best use of money to ship difficult to manage patients out of the NHS (again, see another personal blog entry).