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Sunday, May 20, 2012

Not Unrelated

Two separate, independent presentations at the Psychiatry Grand Rounds seem as if one almost answers the other.

The 1st was a review of the literature, by Robert Whitaker, Journalist and author of Anatomy of an Epidemic.  He looked at "the effect of psychiatric medications on long-term outcomes".  He challenged the notion that we've made great progress in treating mental illness with psychotropic medication since the introduction of Thorazine in 1955He noted that this belief has led to, for example, an expenditure of 40 billion dollars in this country alone in one year, 2007.  From 1957 to 2007 he noticed a soaring increase in disability in country after country.  He questioned this manner of care and concluded that the current standard of care of immediate and long-term use of anti-psychotics cannot be supported.
The disorders he was looking at were the psychotic disorders, such as schizophrenia, and affective disorders such as bi-polar disorder, anxiety and depression.  He found no compelling evidence that there was improvement long-term.  And, yet, a study done from 1945 to 1955 found that of all diagnosed, 2/3 were discharged and achieved 50% employment and lived independently, 1/3 had some symptoms but were functioning reasonably well, and only 1/3 were chronically ill.  A paradox found in a study done in 1967 found that those treated with medication were more likely to be hospitalized.  Recovery from these illnesses, without medication, does take a long time---4 to 5 years.  But for those who achieved this without drugs, there was extraordinary stability (Martin, Harrow, 2012).  What works is intensive psycho-social care.
Some of the questions he posed were:  Do anti-psychotics make people more biologically vulnerable to psychosis (is the cure worse than the disease?); do the drugs exacerbate some of the metabolic problems, the atrophy of the pre-frontal cortex and the poor outcome of some of these illnesses?
He called for more tolerance in society of people who may have some eccentric behaviors; it might in the end, lead to less disability.
(Just gotta say, this guy has a lotta guts, presenting this material to a group of mostly psychiatrists who primarily prescribe these medicines.  It  was a stunned audience.)

The other presentation was on a brand new approach to quieting the mind, Neurofeedback, an outcome of biofeedback, being used and studied by Peter E. Newsom, MD. psychiatrist in Menlo Park, California.  So far, he has found that this method helps with bi-polar disorder, generalized anxiety disorder, and attention deficit hyperactivity disorder.  It is a matter of measuring the amount of electrical energy being produced by the body, showing that on a screen and teaching the patient to keep their brain waves primarily in the Alpha  level which is, calm but alert.  This is the state most of us enjoy.
It is learning the ability to focus, concentrate, and calm.  It is learning how to navigate (within yourself), how to get to certain states of mind, how to cut down on distracting thoughts.  (it is mindfulness centered healing).

In addition, since it has also been found to help immensely with problems resulting from brain injuries, the department of defense is going to be conducting a huge study on this form of treatment which will be the first big money going into this idea.  He told the story of one of his patients, a 16 year old boy who had suffered a head trauma which left him with migraines, insomnia, some amnesia, a loss of his ability to read and, of course, mood problems.  These problems were successfully treated with neurofeedback.  Neurofeedback can be seen as a good alternative to other forms of treatment for mental health problems.

Please feel free to comment.

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