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/ http://www.psychiatrictimes.com/cultural-psychiatry/google-or-not-google-question#comment-49924
This article has conflated a discussion about the legal, ethical, and alliance-building aspects of whether a clinician may or may not search up and then share information about a patient. Questions 1,2,3 are limiting because they ask about ethics only. Legal: The internet is a public data base and anyone can legally look up anyone else on it. Regardless of the veracity of the information on the internet (which should be highly suspect), or whether “free-speech”, and private information should or should not be so easily available for the perusal of anyone else, it is legal for a psychiatrist to look up anything that is publicly available on a search engine (except some parts of the “deep net”. See: https://www.quora.com/Is-it-illegal-to-surf-browse-the-deep-web). Ethics: Any psychiatrist can make it completely ethical to search public data about any patient as long as they openly state they may do so on their terms of service, i.e., on the clinician’s web site or informed consents patients may sign when they register as a patient. It may sometimes be prudent to search the criminal history of a patient that you are sharing a small private room with a closed door. Any patient who does not wish to be searched up can freely decide not to engage with this doctor. It may still not be unethical to search up about a patient even if it is not specifically stipulated in their terms of service or informed consent, it depends on how broadly we would like to define a clinician’s freedom to use the internet or other public data bases. It could be said to be “common knowledge” that anyone may ethically search up about anyone else, although having a terms of service and informed consent before therapy makes the ethics clear. Alliance Building: Alliance building concerns are only an issue if the clinician decides to hint at or tell the patient they have done a search about the patient. It is not far-fetched, however, to conclude that the alliance may likely suffer when it becomes known to a patient that the clinician did a search. The veracity of much of the information on the internet is a big question, patients may feel their privacy has been breached, and helping a patient gain insight should not depend on a clinician’s search results, patients will likely just get defensive. If doing a search in a session together with a patient, or sharing a search result that the clinician has found would help a patient gain insight, they wouldn’t need to be receiving psychiatric care to begin with. The conclusion of all of this is that: 1. Clinicians should have a terms of service and informed consent procedures that include the possibility of looking up public information on patients regardless of whether they would actually do a search. 2. There are probably very few instances where a clinician would want to share the results of a search about a patient with that patient. 3. The questions as posed in the article are not answerable under the suppositions of the case that do not specify the clinicians terms of service or informed consent except to say the clinician should have them, search results are not the same as facts, and clinicians should not bring up search results unless they wish to have a tearful or angry patient who may likely quit the therapy, write bad reviews about the doctor, or even self or other harm. I’m sure there are anecdotes of a “happy ending” to a clinician sharing a search result about a patient with that patient, there are always rules and exceptions to rules in psychiatry. 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/ www.psychiatrictimes.com/anxiety/deconstructing-and-reconstructing-goldwater-rule
Ron, I like your logic here and I agree with your conclusions. However, you penned this article on the assumption that psychiatric nosology is a validated classification, and that a diagnosis would be known to a psychiatrist if they could directly examine a patient. I think you well aware that the DSM classifications are motivated by a mix of attempting to avoid under or over diagnosing a condition, receiving reimbursement, compromising with special interest groups within psychiatry, and that the names of conditions change, merge, or split over the generations of new DSMs depending on a multitude of factors that have little to do with the validity of a condition. Most crucially, there are no biologically measurable anchor points to objectify the labels we give as diagnoses, there is considerable overlap between many criteria sets, and even the DSMs are clear that they do not purport to classify conditions based on etiology much less objective measures. The conclusion of all this mess is that, even if a psychiatrist did evaluate a person directly, and even if it was ethical to discuss those findings, any discussion would need the disclaimer that diagnostic labels in psychiatry are for the working purpose of formulating treatment directionality, they are not proven entities that are tied to a clearly definable and objectively measurable parameter as for example leukemia, stroke, MI, etc. are, and thus it is probably unethical to even mention a differential diagnosis much less the name of a condition to anyone not involved in treatment planning, implementation, or support. In psychiatry, all labels should be given with this caveat and cautions to patients. The results of treatment challenge and dechallenge and longitudinal course follow-up can help with some level of treatment confidence, but these are by no means validating our classification. It is probably prudent to leave any and all professional opinions out of the public realm on scientific if not ethical grounds. This conclusion has nothing to do with the fact that psychiatrists are also members of society allowed to give like/dislike or agree/disagree opinions about public figures, but not a diagnostic or other psychiatric label, both because of lack of validity as well as on ethical grounds. Thank you for again writing on a timely topic. 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/ Dr. Kelly,
You state that Amber lens therapy “works” for [bipolar spectrum] disorder. Can you provide the readers with a confirmatory double-blind placebo-controlled study to back this claim? The only article I could find was this preliminary case series http://www.medical-hypotheses.com/article/S0306-9877(07)00372-6/fulltext If there is only a preliminary case series, and if amber lens therapy can not be blinded nor have blind placebo control-which it seems to me that it can not, then it is not yet valid to say Amber lens therapy works for bipolar disorder. 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/psychotherapy/doctor-am-i-gay-primer-sexual-identities
Dr. Drescher’s model of complex feelings regarding sexual orientation is mainly based on psychological and social factors. His discussion is not wrong, but it seems hard to me to write an article about this topic without noting the basic genetic concepts of genotype vs phenotype and rare type vs wild type. More and more evidence is pointing to considerable genetic influence on the determinism of sexual orientation. The National Health Interview Survey reported in July 2014 that 1.6 percent of Americans identify as gay or lesbian, and 0.7 percent identify as bisexual, that would be a total of 2.3% of the population. It is hard to imagine this huge number of persons having a psychosocial determinant or just “wishing” to have this strong proclivity to same-sex sexual interest. It seems prudent to assume this is built into them to large degree. Science is getting closer in this regard. For example this study, www.natureworldnews.com/articles/10443/20141118/homosexuality-genetic-strongest-evidence.htm details how a study of more than 800 gay participants shared notable patterns in two regions of the human genome - one on the X chromosome and one on chromosome 8. Because same-sex sexual desire does not lead to reproduction as frequently as opposite-sex desire would, mathematically it must be a smaller percent of the population making it the “rare type” vs the heterosexual “wild type” (reproductive technology may begin to level that difference). Even so, genotype is not everything, and there can be some movement along a phenotypic behavioral spectrum depending on a mix of biological, and psychosocial influences. A genotype will likely set some phenotypic anchor-point from which one can move along to some degree in fantasy or in behavior while they confirm their “set-point” in a biological sense. For example, some persons are better at concepts and thinking and some are better at making things with their hands-and this is probably genetically determined-but most people can do both to some degree. We do not necessarily need to invoke complex psychological theory to describe how persons find their set-point and proclivity in the phenotype that fits them best. I’m not saying Dr. Drescher’s ideas are incorrect, but I do think they need to be better integrated to the hardwired background that determines who we are. 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 In “One’s True Nature”, Stickleback fish were said to “tamp down individual personalities” and “conform” when they were placed under the same cover as opposed to individual cover in pursuit food located at the other end of the tank. Regardless of behavior when separated, it seems to be conjecture that these fish tamped-down their personalities when covered together when they may just as well have been exhibiting imitative behavior.
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://douglas-berger-psychiatrist-tokyo.com/ Social Media
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/ (Unpublished)
By Douglas Berger, Tokyo Psychiatrist Schermer states that accused witches who provide false and unverifiable information are an example of why torture is not effective. Comparing the value and verifiability of various forms of interrogation may give data on the value of torture in a population of interrogees, but doesn’t say whether a specific individual will or will not break and divulge valuable and verifiable information. 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/ Douglas Berger, Tokyo Psychiatrist
“Brain Trust” in the March issue left me with 2 questions. 1. there is no proof that less cortical surface are resulted from poverty vs. that poverty is the result of smaller cortical surface area in parents that then genetically pass this problem along to their offspring (genetic factors are common most psychiatric disorders); and 2. There is no evidence that food and/or educational/ tutoring vouchers would perform worse than the giving these families cash. Clearly some cash subsidies will be diverted. 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/ May 31, 2017 | By Christopher G. Fichtner, MD and Howard B. Moss, MD.
Comment by Doug Berger, Psychiatirst in Tokyo, Japan This article seems quite reasonable, and is in severe contradistinction to other recent articles in the PT on marijuana: 1. Marijuana and the Psychiatric Patient, Psychiatric Times April 10, 2017, By Burns Woodward, MD: http://www.psychiatrictimes.com/blogs/couch-crisis/marijuana-and-psychiatric-patient#comment-53335 2. Cannabis Use in Young Adults: Challenges During the Transition to Adulthood, Psychiatric Times December 30, 2015, By Jodi Gilman, PhD: http://www.psychiatrictimes.com/special-reports/cannabis-use-young-adults-challenges-during-transition-achdulthood Both of which were horrifically anti-marijuana, probably written by NIDA and signed-off by the authors (see the links to the comments). However, Fichtner and Moss could probably have added more caveats to using marijuana, clearly not all is actually positive: 1. While the authors did discuss using marijuana ingredients by routes other than inhalation, it is probably not a good idea for one’s lungs to smoke burnt plant substances. 2. They should be clearer that using marijuana based medicinal products is very different from smoking it lest they suggest that pot use may be good for psychiatric disorders (molecular CBD may have quite different effects than marijuana), and the authors were not as clear on that as they should be. Dr. Moss has $2,900 stock in GW Pharma makers of marijuana derivative drugs, probably more connection to the topic at hand than we would like to see in an academic writer. 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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