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Psychiatry

March 31, 2015

One in Five College Students Suffers from Exploding Head Syndrome

The Journal of Sleep Research this month published the results of a limited study of Washington State University students and their sleep habits. Among other things, the study noted that 18% of the 211 undergraduates involved had some form of Exploding Head Syndrome (EHS).

The name Exploding Head Syndrome dates to research conducted by neurologist J.M.S. Pearce in 1988, but the disorder itself, noted in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition), has been recognized for over a century.

EHS is a condition where the sufferer is awakened by a loud noise that apparently originates within their own head. Though the cause(s) of EHS are unknown, EHS usually occurs just after falling asleep or as a person is starting to wake up. Previously EHS was believed to be both rare and limited primarily to people over the age of 50. Though not harmful, EHS can be frightening. There is no known treatment though various medications including antidepressants have been tried, said WSU’s Brian Sharpless who led the study and is co-author of a forthcoming book: Sleep Paralysis: Historical, Psychological and Medical Perspectives.

People who think they have EHS should consult a doctor to rule out any other problems, Sharpless said. For many sufferers, however, it is reassuring to know that this is a real and apparently somewhat common disorder.

December 5, 2014

Happiness Is Love. Full Stop.

In 1938 Harvard University began following 268 male undergraduate students (including future President John Kennedy) and kicked off the longest-running longitudinal study of human development in history, The Grant Study. The study’s goal was to determine as best as possible what factors contribute most strongly to human flourishing.

George Vaillant, who directed the study for more than three decades, published the study’s most recent findings in the his book Triumphs of Experience. Earlier work on the study include Adaptation to Life, 1977, and Aging Well, 2002. Triumphs of Experience has been widely reviewed, and with good reason.The book and the study are fascinating and informative.

Vaillant raises a number of factors such as the powerful correlation between the warmth of relationships and health and happiness in your later years as well as how significant men’s relationships with their mothers are in determining their well-being in life. For example, Vaillant notes that Men who had “warm” childhood relationships with their mothers took home $87,000 more per year than men whose mothers were uncaring. Men who had poor childhood relationships with their mothers were much more likely to develop dementia when old. Late in their professional lives, the men’s boyhood relationships with their mothers — but not their fathers — were associated with effectiveness at work.

Vaillant also notes that what separates those who viewed themselves as truly happy from those who did not was not in the events that made up their lives — it was in how they responded to those events. The key difference between the happy person and the unhappy one was that one viewed themselves as a victim to their circumstances, while the other sought ways to use their circumstances to their advantage. The degree to which happiness was attained was in the adaptations the participants employed to deal with and shape their reality.

In Vallant’s own words, the #1 most important finding from the Grant Study is this: “The seventy-five years and twenty million dollars expended on the Grant Study points to a straightforward five-word conclusion: Happiness is love. Full stop.”

July 25, 2014

Munchausen by Proxy and Social Media

by Laura McFarland, Communications Director

As the mother of two small children, this is the kind of article I’d prefer to skip over and never have to know about. This past January Garnett-Paul Spears, aged 5, died from sodium poisoning. His mother, Lacey Spears, has been charged with committing depraved murder and manslaughter in the case.

Munchausen by Proxy Syndrome, a disorder wherein caretakers purposely harm children and then bask in the attention and sympathy, has not been specifically mentioned by the prosecutors though “Spears fits the pattern” of such caregivers as noted by some experts.

Dr. Marc Feldman, a psychiatrist and forensic consultant in Birmingham, Alabama, who wrote the book Playing Sick, said he believes the Internet has contributed to the number of Munchausen by proxy cases, with its quick and easy access to a potentially huge, sympathetic audience. One study estimates there are more than 600 cases a year in the U.S. alone. For example, doctors at Seattle Children’s Hospital found three cases of mothers who falsely blogged that their children were near death and were rewarded with support. In a 2011 case in Great Britain, a childless 21-year-old woman joined an Internet forum for parents, claiming to have five children and chronicling her nonexistent baby’s battle with celiac disease and bacterial meningitis. Most cases rarely end in death; when a death occurs, it’s because of a miscalculation, Feldman said. “It would defeat the purpose to kill the child.” Read more…

June 2, 2014

Why Can’t Doctors Identify Killers?

by Brian L. Grant MD

As a forensic psychiatrist, I find myself as pained as the rest of society when a mass murder takes place. But like Dr. Friedman notes in this article, I am also aware that efforts to accurately identify and intervene with, in advance of a tragedy, those individuals who are going to commit such acts is impossible. For every person who commits such acts, there are many more with similar personality and mental health issues who would find such acts unthinkable, just as there are those who kill and maim with no obvious mental health impairments. One can’t confine those with a psychiatric diagnosis without casting a net that would include millions of productive individuals who pose no harm. A kinder and gentler society that focuses on empathy and kindness might make a difference in some cases, but by no means all. The most attentive parenting and caring communities may still fall short when it comes to troubled individuals with distorted senses of reality.

In the absence of the ability to meaningfully predict and intervene before troubled individuals act out, whether they have a psychiatric diagnosis or not, we may wish to look to and study those places where violent deaths are far fewer and consider the differences in place. Are these differences those of demographics, politics, economics, values, or perhaps access to firearms? We make many tradeoffs as a society to achieve certain results and goals. Considering and studying these choices in an open and objective manner may be of great value to all.

November 25, 2013

Emotional Support, with Fur

Pocket, the author’s pet, aka emotional support animal.

That a dog provides comfort to owners is a given. That’s why we call them pets. But now, under the guise of subjective criteria of any physician or licensed therapist and the perceived needs of certain individuals, some are claimed as a necessity that others must tolerate in the public sphere.

Some are claiming and demanding that their pets have therapeutic impact and address an emotional disability and must accompany them on planes, at work, in restaurants, and in pet-free housing. Others claim their animals can retrieve dropped items that they can’t stoop down for, or have the uncanny and improbable talent of detecting and stopping seizures.

Please note that highly trained service animals such as seeing eye dogs actually DO something and deserve respect and access to any setting. But a clear line must be drawn when it comes to animals whose sole talent is BEING. By all means, enjoy your pet, dress it up in silly costumes, feed it from the table, and pay for its chemotherapy. But someone else’s pet provides zero social good to society at large. It will never pay taxes, teach our kids, or shovel the snow off your walk out of altruism. They have earned no dispensation or right to privilege or sacrifice from the rest of us. As one commenter queried, she derives comfort from their husband — can he fly free and sit at her feet on a plane? One’s perceived needs and wishes need not be indulged by society, or endorsed with misguided and abused rules.

June 17, 2013

A profound article, and must read for all patients and physicians

By Brian L. Grant MD

This article on doing no-thing is the best medical article I have read in some time. Properly applied, this technique would do more to solve our health care crisis than all the PPO discounts, new drugs, payment reforms or other interventions and improvements to our system. Doing no-thing, properly applied would reduce prescriptions of unnecessary harmful drugs, surgery, diagnostics, and more. So much of health care is not necessary. Sometimes this can only be learned in hindsight, but often it is obvious from the start.

Doing nothing is perhaps a bit of a misnomer. The act of listening, empathizing and caring – when active interventions are not of benefit to the patient.

The comments on this article are well worth a read. Some are highly critical of the author and others are most supportive. Read more…

May 24, 2013

Release of the DSM-V

The American Psychiatric Association unveiled this past week the fifth edition of its handbook of diagnoses, the D.S.M-V (Diagnostic and Statistical Manual of Mental Disorders, Fifth edition), after 14 years in the making.

This article in The New York Times neatly summarizes a major, on-going discussion over the publication. Per the author,

The media will trumpet the release of the new D.S.M., but practicing psychiatrists will largely regard it as a nonevent. Unfortunately, the same cannot be said for other institutions — insurance companies, state and government agencies, and even the courts — which will continue to imbue the D.S.M. with a precision and an authority it does not have.

Psychiatrists tend to treat according to symptoms. However, the manual carries a fair amount of clout with the rest of society: They are the passports to insurance coverage, the keys to special educational and behavioral services in school and the tickets to disability benefits. Sometimes a diagnosis of a condition like autism, A.D.H.D. or conduct disorder is necessary for students to qualify for special therapies. And diagnoses also figure in disability determination.

As noted, the D.S.M. is an imperfect guide to predicting what treatments will benefit patients most — a reality tied to the fact that psychiatric diagnoses are based on clinical appearances that tend to cluster, not on the mechanism behind the illness, as is the case with, say, bacterial pneumonia.

There are definitely changes in the D.S.M.-V over the fourth edition, and as the article notes much of this this will most likely change as researchers learn more about genetics, brain circuitry and cognitive data to fashion better guides to what to prescribe for patients, and in terms of what new compounds to develop. Read more…

March 15, 2013

Should the head of the NRA be restricted from owning guns?

By Brian L. Grant MD
If a sign of mental illness is delusional thinking and being out of touch with reality, Wayne LaPierre may qualify. His ongoing rants suggesting that there exists some sort of mental health database that if consulted, would screen out murderers, is absurd.

Mr. LaPierre, please show us what you refer to. Also, please demonstrate how many — if any— of those thousands of killers who used firearms were in this non-existent database?

I hope you are not suggesting that an individual who seeks counseling or psychotherapy from a psychiatrist or psychologist, or antidepressants from their primary care doctor should be entered in a registry restricting their current firearm rights?

To do so would fly in the face of logic, privacy, and have zero impact on the problem of gun deaths. There is no linkage between seeking mental health care and dangerousness, and any such registration would only serve to deter individuals from addressing issues that might then go untreated.

Any mental health professional possessing appropriate humility knows that their record of predicting dangerousness is little better than the general public.

The public depiction of some of the recent mass killers certainly describe strange individuals, who before their act are not unlike those that one might find in large numbers in any high school class, software, Star Trek, or dare I say, Psychiatry convention. Hindsight bias, where something suddenly becomes obvious after the fact, is simple but misguided.

The proximate cause of gun deaths are guns and bullets. Killers armed with less lethality may be less dangerous toward others and themselves.

Do we collectively as a society have the political will and common sense to at least confine our arguments to reality?

March 5, 2013

Troubles in Psychiatry

By Brian L. Grant MD

Years ago, long before I had decided to become a psychiatrist, I read the work of psychiatrist Thomas Szasz, MD. He was critical of the concept of mental illness and the role that psychiatry plays in society.

His provocative writings continue to challenge, but did not deter me from becoming a psychiatrist. The idea of understanding human motivation and behavior in what may be the most holistic specialty in medicine appealed greatly and I have learned a great deal over the years and hopefully helped a few patients along the way.

In my years in psychiatry, I have witnessed the movement from a specialty with a foundation in the mind and a focus on psychotherapy as a significant treatment modality, to one where medications reign and therapy has been devalued by many.

Most disturbing to me has been a clear distortion of the profession, driven by overdiagnosis and the labeling of psychopathology attributed to many normal conditions of life — including distractibility being labeled as attention deficit disorder (ADD), and sadness upon the death of a loved one being labeled as bereavement disorder. Many more examples can be found in the culture by looking at those diagnoses that have increased many fold, such as autism, post-traumatic stress disorder, and bipolar disorder in children.

My critique is not meant to apply to a particular individual who deserves individual assessment, but rather the significant trends that are taking place that should cause concern for anyone in distress seeking help and those whose job it is to help.

Of course human suffering exists and significant mental disorders including schizophrenia and major depression are real and deserve careful assessment and effective treatment. Likewise other diagnoses should be scrutinized for individual patients as well as being examined in the aggregate.

Marcia Angell, MD, former editor of the New England Journal of Medicine and one of the thought leaders in American medicine has written incisive reviews of several books:

The Emperor’s New Drugs: Exploding the Antidepressant Myth by Irving Kirsch
Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America by Robert Whitaker Crown
Unhinged: The Trouble with Psychiatry—A Doctor’s Revelations About a Profession in Crisis by Daniel Carlat
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) by American Psychiatric Association

Her review, published in two parts in the New York Review of Books in 2011, was followed by an exchange with some notable psychiatrists who responded to her critiques and her response to them.

The Epidemic of Mental Illness: Why? — Marcia Angell

The Illusions of Psychiatry — Marcia Angell

‘The Illusions of Psychiatry’: An Exchange — John Oldham, Daniel Carlat, Richard Friedman, and Andre Nierenberg, reply by Marcia Angell

I was disheartened and disturbed upon reading her reviews. Not because I disagreed, but because at its core, her critiques ring true and should disturb anyone in society who cares about mental health and expects those engaged in research and treatment in the field to approach their work with intellectual rigor and integrity.

The party line in current psychiatry has diverted from one of thoughtful inquiry and reflection to an unwarranted certainty, callous overdiagnosis of a significant double-digit percentage of the population as mentally ill, and a willingness to prescribe very strong drugs in, at times, a glib and excessive manner, based upon bad science, dubious statistics, and a minimization of significant side effects and potential habituation.

Angell’s review, while not short, is worth reading and passing on, especially to those who deserve to have their beliefs challenged on the nature, extent of, and treatment of mental disorders.

October 1, 2012

The Costly Marketing Budget for Antipsychotic Drugs

By Brian L. Grant, MD

At the American Psychological Association Conference, the pharmaceutical industry has a large marketing presence.

The New York Times article, “A Call for Caution in the Use of Antipsychotic Drugs,” was alarming but not surprising to me as a psychiatrist. The numbers are staggering though. The advertising budget alone, at 2.4 billion dollars for the new antipsychotic drugs equates to about $57,000 per US psychiatrist (about 42,000 total)!

This marketing budget total alone just approximates the entire market for non-Federal IME’s and medical reviews. If spread across the U.S. population evenly, each of us would have consumed about 58 dollars worth of antipsychotic drugs in the past year! The use of such medications is clearly concentrated to a small portion of the population and are prescribed in large amounts by a small portion of psychiatrists and other licensed practitioners.

Anyone who has been to a major psychiatric conference would not be surprised at the massive booths from the drug purveyors manned by sharp men and women hawking the wares, with various enticements to visit their booths. The incentives to over-prescribe is clear, given the money involved.

The fact that a number of medical lightweights fail to understand how they are being used as gatekeepers to these drugs is sad and costly, not only for payers, but for patients who are often given these costly drugs with very real side effects, when less costly alternatives with equal or better outcomes exist. To deny the positive impact of these medications in select patients is wrong. But common sense combined with available science should lead to the obvious conclusion that this is not right.

Label creep, where a good drug is advocated for the wrong reasons, is not unique to psychiatry. Articles like this by Dr. Friedman does little to bring pride to my profession. Similar scrutiny is warranted for so-called ADHD (attention deficit hyperactivity disorder) in adults, fibromyalgia and any other malady that is largely associated with profitable, or abused drugs and often direct to consumer advertising to create a wider market.

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MCNTalk
News, Insights & Opinions

Psychiatry

One in Five College Students Suffers from Exploding Head Syndrome

Happiness Is Love. Full Stop.

Munchausen by Proxy and Social Media

Why Can’t Doctors Identify Killers?

Emotional Support, with Fur

A profound article, and must read for all patients and physicians

Release of the DSM-V

Should the head of the NRA be restricted from owning guns?

Troubles in Psychiatry

The Costly Marketing Budget for Antipsychotic Drugs

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