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https://www.facebook.com/douglas.berger.3954 https://twitter.com/Douglas_Berger1 https://www.linkedin.com/in/douglasbergerpsychiatristtokyo/ Blogs: https://www.youtube.com/channel/UCDj351WhGaBdU22UeV1NCCw https://douglasbergerpsychiatristtokyo.tumblr.com/ https://douglasbergerpsychiatristtokyoblog.wordpress.com/ http://douglasbergerpsychiatristtokyo.weebly.com/ Websites: DouglasBergerPsychiatristTokyo.com http://douglas-berger-psychiatrist-tokyo-reviews.com/ http://about-douglas-berger-psychiatrist-tokyo.com/ http://douglas-berger-psychiatrist-tokyo-info.com/ http://douglas-berger-psychiatrist-tokyo.com/ Original article published, October 07, 2016 in The Psychiatric Times:
http://www.psychiatrictimes.com/blogs/couch-crisis/deconstructing-and-reconstructing-goldwater-rule#comment-509 Thank you, Ron, for your thorough reply that I largely agree with. First though, let’s be clear, your article was on psychiatric diagnosis in INDIVIDUALS not on the validity of the existence of psychiatric diagnoses in the population. You stated, “On occasion psychiatrists are asked for an opinion about an individual who is in the light of public attention or who has disclosed information about himself/herself through public media.” You are also falling into a logic trap by noting that a SOME medical or neurological problems have no specific marker, i.e., migraine. This is because there are also many like stroke or brain tumor that DO have an objectively measurable parameter such as seeing infarction, hemorrhage, or mass on a brain scan. Unfortunately there is NO psychiatric condition that has an objectively measurable parameter in an INDIVIDUAL in spite of some persons in a POPULATION who fit diagnostic criteria showing various DIFFERENT and subtle brain abnormalities. Brain scans can be said to have near 100% validity in physically proving that the condition specified because scan results match physical findings on direct examination of the brain seen in surgery or autopsy. This is what is meant by “clearly definable and objectively measurable”. The first link you provide below by Aboraya states: “The authors encourage clinicians to use as many validity criteria as possible to improve the validity of their diagnosis.” They do not state or prove anywhere that a psychiatric diagnosis in an INDIVIDUAL is the same as having objective proof as in neurology (I would place Alzheimer’s in neurology not psychiatry for this discussion). The paper by Levy only discusses that pursuit eye movement findings are commonly found in POPLULATIONS of persons who fit criteria for schizophrenia (and in the CLINICALLY UNAFFECTED relatives of these persons). As they show in Fig 5 and in other places in the article, findings are trends in these groups with a standard error but they nowhere state that these tests can be used clinically as proof of diagnosis in an individual. It’s not the same as seeing a mass in one’s head CT which is clearly a mass: there is no trend or standard error, nearly all INDIVIDUAL cases are either yes or no. Coincidentally, I was also the lead author on a published study of eye-movements in schizophrenia: Berger D, Nezu S, Iga T, Hosaka T, Nakamura S: INFORMATION PROCESSING EFFECT ON SACCADIC REACTION TIME IN SCHIZOPHRENIA, Neuropsychiatry, Neuropsychology & Behavioral Neurology, (Journal Name Changed to: Cognitive and Behavioral Neurology) 3:2, 80-97;1990. Full paper here: https://www.japanpsychiatrist.com/Abstracts/Information_processing_effect_on_saccadic_reaction_time_in_schizophrenia.pdf We found a strong trend for differences between normals and those diagnosed with schizophrenia in the small group we studied, but there was overlap and there were outliers. Thus, it is just interesting research data, it is not useful clinically for individual diagnosis, nor does it prove the validity of schizophrenia. Now, evaluating public figures who are more likely to have personality issues, ADHD, mild forms of mood disorder etc. and not schizophrenia is even more problematic because there is less robust evidence of a consistent biologic finding in populations of these persons compared to schizophrenia, especially in personality disorders. So while we would agree on Goldwater, I think you need to take it to the next level of uncertainty when it comes to labeling individuals, examined or not. Psychiatric diagnoses are helpful in clinical treatment, but are unproven constructs and never more than concepts that guide us in what to do, and for mental health workers and institutions to bill medical insurance companies. For more information about Douglas Berger Psychiatrist Tokyo visit the following websites: http://douglasbergerpsychiatristtokyo.com/ http://douglas-berger-psychiatrist-tokyo-reviews.com/ http://about-douglas-berger-psychiatrist-tokyo.com/ http://douglas-berger-psychiatrist-tokyo-info.com/ ‘Why the “You” in an Afterlife Wouldn’t Really Be You’
https://www.scientificamerican.com/article/why-the-ldquo-you-rdquo-in-an-afterlife-wouldnt-really-be-you/ Shermer states that a copy of your memories is no different than your twin but twins never had the same memories to begin with. If one’s genes and connectomes could be exactly copied and functional then there would be two of “you”, both exactly the same at the moment of copy, the next instant on diverging biological life courses. While the engineering hurdle is enormous, it is not physically impossible. For more information about Douglas Berger Psychiatrist Tokyo visit the following websites: http://douglasbergerpsychiatristtokyo.com/ http://douglas-berger-psychiatrist-tokyo-reviews.com/ http://about-douglas-berger-psychiatrist-tokyo.com/ http://douglas-berger-psychiatrist-tokyo-info.com/ http://douglas-berger-psychiatrist-tokyo.com/ http://www.psychiatrictimes.com/bipolar-disorder/lithium-alzheimer-prevention-what-are-we-waiting#comment-49925
The answer to Dr. Phelps’ “what are we waiting for” is a large prospective study of Alzheimer’s patients with a long-term follow up (the studies linked in his comment below are not this kind of study). The study Dr. Phelps is excited about only had 55 persons in each arm with only a 1.5 year follow up (a short follow up for Alzheimer’s), the treatment effect maintained but did not improve further in the final 3 month evaluation term: https://www.researchgate.net/publication/228098677_Microdose_Lithium_Treatment_Stabilized_Cognitive_Impairment_in_Patients_with_Alzheimer's_Disease Looking at the graph of MMSE score changes, assuming these results in this small sample would be valid in a large group, MMSE differences of about 5 points began to seem come out by 12 months and held up to 18 months, but there was no further improvement from month 15 to month 18 in the treatment group, and no deterioration in the control group. Will this modest level of improvement persist in large samples for many months, and how does 5 points on the MMSE translate into meaningful clinical differences over the following few years is a crucial piece of information before we start thumping our prescription pads with lithium prescriptions. I encourage Dr. Phelps to look more carefully at the design and results of this study and change his call from prescribing lithium to promoting a bigger and longer trial. We don’t want people running to lithium if it doesn’t work very much or for too long, perhaps taking larger doses in a fever to treat dementia knowing larger doses are routinely used for mood disorders (no matter what people are told some will still try to take more), and avoiding other treatments, i.e., memantine for which lithium would need a head-to-head comparison. For more information about Douglas Berger Psychiatrist Tokyo visit the following websites: http://douglasbergerpsychiatristtokyo.com/ http://douglas-berger-psychiatrist-tokyo-reviews.com/ http://about-douglas-berger-psychiatrist-tokyo.com/ http://douglas-berger-psychiatrist-tokyo-info.com/ http://douglas-berger-psychiatrist-tokyo.com/ |
Author - Douglas BurgerBilingual Psychiatrist located in Tokyo. Archives
June 2018
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