A German study just published by Moritz and colleagues provides an interesting insight into antipsychotic drugs used in the treatment of schizophrenia and other psychotic illnesses. Data was collected by asking psychiatric patients to complete a questionnaire about their experiences in taking antipsychotic medication for their mental disorder. The conclusion was that such drugs are effective because they dampen emotion rather than treating any specific symptoms. ‘Doubt, numbing and withdrawal were the main subjective antipsychotic effects’. Basically such drugs just keep patients quiet – an effect which many patients find unpleasant. One reviewer says ‘It is clear we need better ways to help people’.
Posts archived in Abnormality
A few months ago there was an item on this blog about the comments on AQA A markschemes that stated that answers using psychoanalysis as a psychological therapy for schizophrenia would be unlikely to gain high marks. We do not believe this is a justifiable position. However, regardless of whether the board is right or wrong in their position, we plan to update our textbook to include a different therapy – family intervention. We also are providing a copy of this insert free, click family intervention to download.
Some of you will be familiar with research that shows that emotional feelings can be triggered by the body, rather than the other way round. We are happy because we smile, rather than smiling because we are happy. For example, if people put a pencil between their teeth and are asked to rate a cartoon or video, they find them funnier than people who place a pencil between their lips (try it and see which is more like a smile). See here for descriptions of such studies.
An American dermatological surgeon, Eric Finzi, has applied this to the treatment of depression. He injects botox into the ‘frowning’ muscle of depressed patients (the corrugator muscle) to prevent it contracting. He suggests that people can cure themselves by just looking happy and has success stories to support this, documented in his book The Face of Emotion: How botox affects our mood and relationships.
An interesting analysis was recently published showing that the Russell group of Universities have a strong tendency to publish research with significant findings only. Actually a ‘strong tendency’ is an understatement. The analysis found, for example, that researchers from the University of Birmingham published 119 pieces of research during the study period of which only 9% had non-significant findings.
What is especially remarkable about this piece of research is that it is by a sixth form student, Chloë Thompson from The Becket Sixth Form in Nottingham. She did work experience with Clive Adams at Nottingham University, who also works with the Schizophrenia Group of the Cochrane Library (a huge free-to-access database of research on medical and health issues).
The value of this research is that it supports the current pressure on medical research institutions to publish all of their results, not just the positive ones, so that doctors have a truer picture of findings. This is a movement spearheaded by Ben Goldacre in his recent book Bad Pharma.
The largest ever genetic study of psychiatric illness, run by the Massachusetts General Hospital in Boston, USA, has discovered that autism, ADHD, bipolar disorder, major depression and schizophrenia may be linked with a common genetic defect.
Although these five psychiatric disorders are considered separate conditions, they have some symptoms in common. For example, mood and thinking problems can occur with schizophrenia, bipolar disorder and depression. Also children with ADHD often have symptoms of other disorders, such as autism.
According to an article by The Independent journalist Jeremy Laurance, ’Two genes which control the flow of calcium in the brain are implicated in several of the disorders and could provide a target for new treatments.’
Dr Jordan Smoller, one of the lead researchers said: ‘Our results provide new evidence that may inform a move away from descriptive syndromes in psychiatry and towards classification based on underlying causes’. The study was published in the journal The Lancet on February 28, 2013.
Here’s a link to another article on the same study appearing on the ‘My Health News Daily’ website,
Might this mean the next edition of DSM will be a more slender offering?!
PSYA4 June 2012 had a question which asked ‘Outline one biological therapy and one psychological therapy for schizophrenia.’
The mark scheme included the following: ‘Therapies such as psychoanalysis and psychosurgery have been used for schizophrenia in the past but are no longer generally considered suitable. A general outline of these techniques which are not made explicitly relevant to schizophrenia cannot achieve higher than rudimentary.’
In our A2 textbook we have included psychoanalysis as a therapy that can be used for schizophrenia. One reader asked us about this. Our reply was:
1. The mark scheme does not say that answers related to psychoanalysis would receive a poor mark. It says that answers that do not relate psychoanalysis to schizophrenia would attract a poor mark.
2. NICE guidelines updated 2010 discuss the use of psychoanalysis and psychodynamic therapies for schizophrenia. See page 310 of the document.
3. We reported recent research that suggests that the value of psychoanalysis/psychodynamic therapies has been undervalued (see here).
4. The real problem is that therapies in the real world rarely follow just one perspective. Specifications force us to discuss them in this way.
So we feel justified in including it in our book – but would welcome comments from readers or indeed, from AQA.
A book published by Ben Goldacre this year has drawn attention to the fact that drug trials producing negative or nil results are simply not published, thereby making the drugs appear to be more successful than they really are. Goldacre is spearheading a movement to force drug companies into publishing all their results and ensuring that there is free access to such data. (Most research on the effectiveness of drug treatments is funded and controlled by the drug companies).
One example of the effects of such non-reporting was mentioned in an article by Irving Kirsch (here). The effectivness of drug treatments is often assessed by making comparisons between a drug-treatment group and a group of patients receiving a placebo. Meta-analyses of antidepressant medications have reported only modest benefits over placebo treatment. However, when unpublished trial data are included, the benefit falls to almost nothing.
To see more about OCD Awareness Week link
Thomas Szasz died on September 8, at the age of 92. He made a major contribution to the way we view psychiatry and mental illness. Along with David Rosenhan (‘Sane in Insane Places’) and psychiatrist Ronald Laing, Szasz was seen as part of the anti-psychiatry movement of the 1960s, However Szasz felt ‘anti-psychiatry’ was just another label – much like the label ‘mental illness’, and labels oversimplify things. He is particularly known for his book The Myth of Mental Illness in which he argued that it is wrong to label ‘problems people have with living’ as ‘mental illnesses’. The label mental illness is similar to calling some people witches. Neither labels are real; they are human inventions and only obscure our true understanding of the problems that some people have.
The American Psychiatric Association are preparing the next edition of the Diagnostic and Statistical Manual of Mental Disorders, due for release May 2013. They are currently testing some of their new criteria in field trials. This involves clinicians using the list of proposed clinical characteristics to diagnose patients. Comparisons are then made between clinicians to see how reliable the diagnoses are i.e. whether clinicians agree on the diagnoses they give.
The field trials use a statistic called kappa where 1 means effect agreement and 0 is agreement may just be due to chance. A few of the current results are kappas of 0.32 for major depressive disorder, 0.2 for generalised anxiety disorder and 0.01 for patients with symptoms of anxiety and depression. A recent article in the New Scientist (‘Diagnosis Uncertain’) reports that leaders of the DSM revision are suggesting that kappas as low as 0.2 should be considered acceptable whereas others dispute this. The end result may be that millions of people end up with erroneous diagnoses.