Clinical

June 10, 2009

Children With ADHD Drugs Score Higher on Tests

CHICAGO - Children on medicine for attention deficit disorder scored higher on academic tests than their unmedicated peers in the first large, long-term study suggesting this kind of benefit from the widely used drugs.

Wow.  WOW.  I get more actionable information from porn.


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April 20, 2009

The Woman Who Can't Forget Is Awesome Because She Can Forget

Here's a question: when someone with OCD checks the stove twenty times, why wasn't fifteen times sufficient?


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February 23, 2009

Why No Progress Will Ever Be Made In Psychiatry

Do the past 50 years, post psychoanalysis, seem like marking time in psychiatry?  A series of equally efficacious or toxic treatments being substituted for older versions that are ultimately not any different, all the while hearing the heralds proclaim the incredible advancements in "brain" diseases?  Genetics, serotonin, BDNF!

If it seems like countless billions in research money have not changed psychiatry at all over decades, it's because they haven't.

The first question a fertility doctor asks when she can't get pregnant: are you guys having sex?


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February 16, 2009

The Bubble In Academic Research

And history is quite clear on this: once a bubble pops, it never reflates.


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February 13, 2009

MMR Vaccine Finally Cleared Of Assault

Listen carefully, medicos.  It's the sound of your approaching irrelevance.


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February 9, 2009

Autism and The MMR Vaccine

Just as I was writing about the consequences of ideological bias in autism research...

Mea culpa, I will admit that I never read the primary sources either.  If I had, this blog would not exist, I would have quit psychiatry in 1998 and opened a bar called Cougars and made a fortune.


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February 3, 2009

Two Causes Of Autism

Ah, finally, a post about science only, that doesn't offend anyone.

Whoops, sorry, that's my other blog.  In this blog, I write about how the parents cause autism.




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January 14, 2009

Treating Insomnia With Less

A grog of rum and an issue of The Economist should handle any sleep problems you may have.  But, if you're one of those who think drinking alcohol is wrong but drinking psychiatric medications is right, then this is for you.


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January 9, 2009

The Chart Is Dead, Long Live The Chart




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December 17, 2008

Is Internet Addiction Really An Addiction?

Depends on your definition. Wovon man...


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December 15, 2008

Self-Embedding Syndrome: What's Going On In Ohio?


embedded objects.jpg

A poster presented at the Radiological Society Of North America.   Self-embedding syndrome: adolescents embed foreign bodies into their arms, hands, etc.  In this x-ray, she's embedded 8 pieces of metal into her arm.

What caught my eye were two things: first, even though this is an old problem, the authors say this is the first study on this, suggesting that it's on the rise (enough for radiologists to notice.)  Second, that it happened in Ohio-- which was, along with Indiana, was responsible for half of the youth suicide increase in 2007.


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December 4, 2008

The British Model Of Cost Effectiveness Fails On Philosophy

Good idea, sort of, but it misses a key element.


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December 1, 2008

Off Label Prescribing Turns Out To Be On Label

In which I bite down on a leather strap in an effort not to explode like that guy on Heroes.


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November 27, 2008

How To Treat Vertigo

In Neurology, found by way of Women's Health magazine October 2008, and no I'm not ashamed to admit it.


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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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