Clinical

August 14, 2008

Seroquel For Bipolar Maintenance




A brief history of the past decade.

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July 22, 2008

Being The Main Character In Your Own TV Show Is Sort Of A Delusion


Two psychiatrists, believe they have discovered a new, YouTube generation, delusion: believing you are in a secret reality TV show.

The article describes cases of people who believe they are secretly being filmed. 

"I realized that I was and am the centre, the focus of attention by millions and millions of people," explained one patient, an army veteran who came from an upper-middle-class upbringing."My family and everyone I knew were and are actors in a script, a charade whose entire purpose is to make me the focus of the world's attention."
The belief that they are being filmed certainly gives the person a sense of importance, or worth independent of and beyond the mundane life he lives in.  In other words, it allows for an inflation of identity without actually having to do anything.   Call it grandiosity

The patient added that he planned to climb to the top of the Statue of Liberty, and if his true love were waiting for him, the puppeteer strings would be cut. If she failed to show up, he would jump to his death.

Grandiosity is one explanation, but I submit that the important part of this delusion isn't the filming, but the "puppeteer."  The delusion isn't about self-importance, but rather an explanation for powerlessness.  I am being manipulated by the outside.  There's nothing I can do.

Consider that a delusion which enhances your importance might not be one you'd want terminated; but these cases have the termination of the delusion built in.

In "reality" (ha!) such cases are cognitive metaphors for maturity.  Only when you gain sufficient self-awareness and autonomy can you break away from the artificial, manipulated reality of adolescence.

"But these guys are 30 years old!"  Exactly.  Real adolescents don't need a delusion to tell them they're powerless.  But a 30 year old should be dealing with intimacy vs. isolation, but instead they're stuck back at identity vs. role confusion.

The delusion is the protection, not the empowerment.  It says, "don't worry, you haven't accomplished anything because the producers haven't put that into the script yet."  Ultimately, this YouTube delusion is the result of a fleeting awareness that you cannot choose your identity unless you back it up with actions-- that actions are identity.

When a narcissist has this awareness, he has two choices.  He can retreat into a protective delusion, such as this one; or he can convince-- read: force-- someone else to accept his identity even in the absence of actions.  "I am a tough cop!  Well, maybe not actually a cop, but if something went down in this mall, I could be like a cop, and that's just as good!"

You do not want to be the person the narcissist tries to convince.

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July 9, 2008

Clinical Experience vs. Clinical Trials



In CNS Spectrums, Dr. Rosenheck takes Dr. Marder to task for his suggestions that CATIE results are limited and flawed, and clinical trials may not be better than clinical experience.

The article must be very important, because it is labeled as a Communique, yes, just like the one that called for the normalization of relations with China and decreasing arms sales to Taiwan, which brought us the Beijing Olympics 2008.   Thanks, Mr. Nixon!

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July 1, 2008

Six Quick Changes That Will Lead To Better or More Cost Effective Hospital Care



It took me longer to write this then it will to implement the changes.

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June 25, 2008

Acadia Gives Up On ADP-104-- Maybe It Shouldn't Have


The headline says almost everything:  Acadia shares plunge more than 50% on study data for schizophrenia drug.  Turns out the drug didn't work at either of the two doses tested.

They should have called me first: their study was flawed.

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May 22, 2008

What's Wrong With Research In Psychiatry?



Apart from the high fives, bravado, and binge alcoholism.

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April 14, 2008

First Anniversary Of The Death Of Antidepressants

 

February 26, 2008

Yet Another Study On Antidepressants, And No One Notices The Timing

 

February 26, 2008

ECT Deserves A Press Release

 

October 7, 2007

This Is What You Wanted, Right?

Remember all those articles about bipolar needing specific treatments, and that you should never use an antidepressant? 

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October 7, 2007

This Is What You Wanted, Right?

Remember all those articles about bipolar needing specific treatments, and that you should never use an antidepressant? 

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October 3, 2007

An Addendum To "Ten Things Wrong With Medical Journals"

 

I added another "thing wrong" with medical journals.  At the bottom.  I think it's worth reading.

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September 30, 2007

Ten Things Wrong With Medical Journals

 

I know, right?  Only ten?

 

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September 7, 2007

Will Lilly's New Glutamate Agonist Antipsychotic Be A Blockbuster?

It really depends on what you're asking. But the answer is yes.  But don't by LLY yet.

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September 5, 2007

Number Needed To Treat

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How a relatively unused metric can help you score chicks at the Limelight.

That's right, I said score chicks. You got a problem with that?

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August 14, 2007

How To Take Ritalin Correctly

This is a post about Ritalin, Adderall, Dexedrine, and others-- it is meant for those for whom it is written. You know who you are.

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August 6, 2007

How Do You Treat Atrial Fibrillation?

It could be important...

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July 17, 2007

No, Not Effexor, Too!? The Most Important Article On Psychiatry You'll Ever Read, Part II

 
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In which Anne Neville agrees to believe pretty much anything anyone ever tells her, ever, and Richard discovers people are gullible idiots.

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July 10, 2007

The Most Important Article On Psychiatry You Will Ever Read

 

April 19, 2007

Schizophrenia and Dry Cleaning?

A reader (who wants me to write an article on autism and paternal age-- I swear I'm getting to it) sent me a reference to a 2007 article finding an increased rate of schizophrenia in those born to parents who were dry cleaners (all Jewish, negating a racial association).  The authors speculate it's tetrachloroethylene exposure.

There were 4 cases of schizophrenia, out of 144 dry cleaning families.  What's interesting is that in 3 of the schizophrenia cases, the father was the dry cleaner. 

How does it happen? There are two possibilities: one is that tetrachloroethylene is neurotoxic in developing fetuses, so the dad must have somehow brought it home with him to the pregnant mom.  Or, it affects male sperm/ germ cells.

As for Cho, I don't know if his parents were dry cleaners in Korea, or if they started when they all came to the U.S.  But something worth investigating.

BTW: not that this would excuse him even if it were true. 

To Leslie, the reader: if you want credit, put in a comment and I'll put your contact info up here.) 

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