Recent quotes:

The concept of schizophrenia is coming to an end – here's why

I expect to see the end of the concept of schizophrenia soon … the syndrome is already beginning to breakdown, for example, into those cases caused by copy number [genetic] variations, drug abuse, social adversity, etc. Presumably this process will accelerate, and the term schizophrenia will be confined to history, like “dropsy”.

Freud's repressed negligence

Anna Freud provided Masson access to more than 75,000 documents to complete his task, but Masson quickly saw that something was awry in the history. “I began to notice what appeared to be a pattern in the omissions made by Anna Freud in the original, abridged edition,” he wrote in The Atlantic in 1984. “In the letters written after September of 1897 … all the case histories dealing with the sexual seduction of children had been excised. Moreover, every mention of Emma Eckstein … had been deleted.” When he asked Anna Freud why she had deleted certain sections, she said, according to Masson, that she “no longer knew why” and that “she could well understand” his interest, but that “the letter should nevertheless not be published.”

Can Big Data Help Psychiatry Unravel the Complexity of Mental Illness? - Scientific American

Psychiatrist Charles DeBattista of Stanford University and colleagues, compared electroencephalograms (EEGs) collected from depressed patients, with a database of EEGs from over 1,800 patients that included information about response to specific treatments. Using EEG measures to guide decisions about treatment alternatives led to significantly better outcomes than clinical treatment selection.

data driven future... or not

As Harvard Psychiatrists John Torous and Justin Baker recently wrote in JAMA Psychiatry, “Data science and technology can provide a nearly limitless set of decision-support and self-monitoring tools. However, without individual psychiatrists and the field at large making a concerted push to drive the technology forward…these advances will likely fail to transform our troubled system of care.”

The Rise of Evidence-Based Psychiatry - Scientific American Blog Network

Psychiatry remains an outlier in the medical profession regarding the use of data; even after the rigorous Osheroff v. Chestnut Lodge debate, the importance of data in practice remains unsettled. In particular, objective data and data science remain underutilized by the psychiatric community. Has your therapist ever used a predictive algorithm to guide your treatment?

Abysmally primitive

as Dr. Sophia Vinogradov, Chief of Psychiatry at the University of Minnesota Medical School, recently wrote in Nature Human Behavior, “There's a secret that we psychiatrists do not like to talk about: the abysmally primitive state of how we assess, understand, and treat mental illness.”

Why Are There No Biological Tests in Psychiatry? - Scientific American Blog Network

we must also not minimize the grave practical problems and limitations associated with not having biological tests to identify psychiatric disorders. Most troubling is the fact that the overwhelming majority of prescriptions for psychotropic medicines are written by primary care physicians who often have little training in psychiatry; little time to perform an adequate diagnostic evaluation; a tendency to depend on tests rather than talking to patients; and too great a susceptibility to quick trigger diagnosis and poorly chosen pill solutions (fostered by aggressive and misleading drug company marketing). The lack of precise and easily available biological tests in psychiatry permits much loose diagnosing and cowboy prescribing.

DSM versus neuroscience

Compared with the psychiatric diagnoses listed in the Diagnostic and Statistical Manual of Mental Disorders (D.S.M.), which can be vague and flawed, brain-based research holds out the promise of a precise and truly scientific understanding of mental illness.

Dr. Nestler is dean for academic and scientific affairs and director of the Friedman Brain Institute at the Icahn School of Medicine at Mount Sinai. Dr. Hyman is a past director of the National Institute of Mental Health.

Virtually all of today’s treatments are based on serendipitous discoveries made six decades ago.

Study bias

Selective publication of clinical trials on antidepressants also could cause a bias about their perceived effectiveness, according to a study led by researchers at the Portland Veterans Affairs Medical Center (New England Journal of Medicine, 2008). The study examined 74 FDA-registered studies for a dozen antidepressants and found that most studies with negative results were not published in scientific literature or were published in a way that conveyed a positive outcome. The FDA studies showed that half of the drug trials had positive results, but 94 percent of the trials cited in published literature were positive.

The Characteristics of Psychiatrists Disciplined by Professional Colleges in Canada

There were 82 (14%) psychiatrists of 606 physicians disciplined in Canada in the ten years from 2000 through 2009, double the national proportion of psychiatrists.

Doctors overestimate their omnipotence

Now a new study in JAMA Internal Medicine authored by two Australians points out that when it comes to unsound medicine, there is another element at play. It turns out that when prescribing a drug or ordering a procedure doctors are actually quite bad at estimating the benefit and harm associated with it. In a systematic review of 48 studies performed in 17 countries and involving more than 13,000 clinicians, they found that doctors rarely had accurate expectations of benefits or harms. The inaccuracies were in both directions but more often, harm was underestimated and benefit overestimated. Advertisement Paid for by omglane com Final Photo: What Happens Next Is Tragic And Heartbreaking People typically forget how lucky they are to be alive after viewing these 26 images See More No group of doctors fared well. As a result, children with acute ear infections may be overprescribed antibiotics and women with troublesome postmenopausal symptoms may be deprived of hormone replacement therapy. Obstetricians and neurologists underestimated the risk of birth defects from antiepileptic drugs and GPs overestimated the benefit of prostate cancer screening and underestimated the benefit of warfarin for atrial fibrillation, a common heart condition. Transplant surgeons were biased towards an inaccurately low estimate of graft failure and all types of doctors were unaware of the risk of radiation exposure from imaging.

Fractal edges shown to be key to imagery seen in Rorschach inkblots -- ScienceDaily

"These optical illusions seen in inkblots and sometimes in art are important for understanding the human visual system," said Taylor, who is director of the UO Materials Science Institute. "You learn important things from when our eyes get fooled. Fractal patterns in the inkblots are confusing the visual system. Why do you detect a bat or a butterfly when they were never there?"

A Test That Finds the Perfect Drug? - The Atlantic

“Psychiatry remains the only discipline of medicine that has no test to predict treatment response,” said Evian Gordon, the founder of one such company, Brain Resource. “This is providing, for the first time, an objective step as to which drug might be responsive.”

To Treat Depression, Drugs or Therapy? - The New York Times

Over all, about 40 percent of the depressed subjects responded to either treatment. But Dr. Mayberg found striking brain differences between patients who did well with Lexapro compared with cognitive behavior therapy, and vice versa. Patients who had low activity in a brain region called the anterior insula measured before treatment responded quite well to C.B.T. but poorly to Lexapro; conversely, those with high activity in this region had an excellent response to Lexapro, but did poorly with C.B.T. What might explain these different responses? We know that the insula is centrally involved in the capacity for emotional self-awareness, cognitive control and decision making, all of which are impaired by depression. Perhaps cognitive behavior therapy has a more powerful effect than an antidepressant in patients with an underactive insula because it teaches patients to control their emotionally disturbing thoughts in a way that an antidepressant cannot

For Depression, Prescribing Exercise Before Medication

But this powerful, non-drug treatment hasn’t yet become a mainstream remedy. In a 2009 study, only 40 percent of patients reported being counseled to try exercise at their last physician visit.

The Serotonin Surprise | DiscoverMagazine.com

Glenmullen has long suspected that drugs that alter serotonin metabolism cause profound changes in the brain. He bases his suspicion on a body of research during the last 20 years by scientists investigating another class of drugs that includes MDMA (Ecstasy) as well as fenfluramine, the diet drug recently removed from the market because of its association with heart valve problems. These drugs do more than just block serotonin reuptake; they primarily stimulate the release of large quantities of serotonin from nerve endings into the brain. The resulting flood is thought to cause the mind-altering effects of MDMA. And that flood, some scientists argue, leaves brain damage in its wake. When monkeys and rats are given high doses of serotonin releasers--up to 40 times the dose that people generally take--the microscopic architecture of their brains looks different from normal brains. The nerve fibers (axons) that carry serotonin to the target cells seem to change their shape and diminish in number--effects some scientists claim are properly understood as brain damage.