AMICOR PSY

unhappiness in a sick world

2007-09-16T08:40:00.000-07:00

http://www.smh.com.au/news/opinion/terms-of-unhappiness-in-a-sick-world/2007/09/14/1189276986726.html?page=fullpage#contentSwap1
From:
Social Determinants of Health [mailto:SDOH@YORKU.CA] Em nome de
Melissa Raven
domingo, 16 de setembro de 2007 11:32
SDOH@YORKU.CA
Ahmed 2007 Terms of unhappiness in a sick world
My initial reaction to this article was that it was great, because I was focusing on its critique of psychiatry. I particularly like this statement:
'While the middle classes debate their happiness and psychiatry acquires a cultural prestige well beyond its powers, the poor inherit the new straitjacket of psychological language'.
Then I noticed some jarring statements about disadvantaged people.
Ahmed wrote [my comments are in square brackets]:
'I become the healer attempting to cure their condition, pretending somehow their malaise is one of biology [good point] and not of meaning [semi good point, provided meaning is interpreted socially as well as individually].
The result is that it can blind them to the possibility their actions may have played a role in their problems [victim-blaming].'
I would have much preferred it if he had written:
'I become the healer attempting to cure their condition, pretending somehow their malaise is one of biology and not of structural factors, including social constructions of what it means to be a person. The result is that it can blind them to the possibility their life circumstances may have played a role in their problems. It can also blind them to their own agency to change some of those circumstances.'
Ahmed also wrote:
'They are hardly poor in a historical sense, for they have enough money to eat and are housed, educated and medically treated by the state [This is relatively true in Australia (unlike many countries), with the glaring exception of remote Aboriginal communities]. In formulating their situation, poverty in this sense is more like a psychological condition than one determined by socioeconomics [victim-blaming and pathologising; poverty is not a psychological condition, although it can be exacerbated and entrenched by despair].'
It is a pity that Ahmed's sound criticism of psychiatry is mixed with semi-compassionate victim-blaming.
Much of what he says also applies to less disadvantaged people, but they have more power to reject psychiatric labelling (and in a few cases they pay lawyers to use it to their advantage to escape conviction and punishment for bad behaviour).
Terms of unhappiness in a sick world
Tanveer Ahmed
September 15, 2007
As a doctor working in mental health and within the public hospital system, I am a regular witness to those living on the bottom rungs of our society.
They are the homeless, the drug addicts and those suffering from severe mental illness. More often than not, they are all three at once.
I am struck by their amazing uptake of mental health language. They skilfully weave technical psychiatric language into their reporting of symptoms. As a result, comments such as "I'm pretty sure I'm coming down with a depressive disorder" or "I think I'm developing a personality defect"
are not uncommon, even from people with minimal education.
This is in part a reflection of wider society and how the language of human distress has been overtaken by psychological terminology. I hear very few people tell me they are unhappy. They are almost always depressed, even if their life choices or circumstances would be perfectly consistent with them being miserable.
Increasingly they no longer suggest they feel depressed, but that they are getting depression, in the same way we may catch a cold. The consultation then moves to the awkward dance modern therapists play. I become the healer attempting to cure their condition, pretending somehow their malaise is one of biology and not of meaning. The result is that it can blind them to the possibility their actions may have played a role in their problems.
Barely a week goes by when we don't hear of the crisis in mental health.
Rising depression, worsening drug and alcohol problems and a strained social sector make us think that despite our stupendous prosperity, we remain in some kind of existential abyss. It is a symptom of the market society and individualism that our grievances must be turned on to the self.
This is in spite of psychiatry remaining a hazy field, an arena where diagnosis and treatment are poorly correlated and where clinical energies focus on symptom relief. It is reflected further in the tremendous amount written about happiness studies. If being dissatisfied with life is pathological and health is a right, the implication is that happiness is also our birthright.
The use of psychiatric terminology is also more and more colloquial. During the Andrew Johns saga and his eventual secular confession, bipolar disorder was used widely in the press as a synonym for erratic behaviour. The former Victorian premier Jeff Kennett, a tireless campaigner in raising awareness for depression, openly admits he uses the term not in its medical context, but as a synonym for emotional distress.
But just like fashion and baby names, language eventually filters down the social ladder. The dominance of mental health language in projecting our distress is of dubious value when applied to the most disadvantaged groups.
Indeed, it may be complicit in helping them to maintain lives of dependence and misery, the sick role curing them only of their autonomy and personal responsibility.
Bureau of Statistics figures from 2005 show about a third of the 700,000 people receiving the disability pension have been diagnosed with a mental illness. This is a critical group because the vast majority are young and otherwise physically able. Many could be in the prime of their lives.
Forty years ago, fewer than in one in 30 working-age adults relied on welfare payments as the main source of income. The figure today is one in six. In particular, the proportion of the population on the disability support pension has doubled since 1981.
An important player in this debate is the doctor, for they determine if someone meets the criteria for disability. Patients who are on the margin of receiving the pension or Newstart will often ask to receive the pension. The disability pension is more generous than the unemployment benefit and there is little mutual obligation.
The sick role, however, comes with an obligation to seek and comply with treatment. The patient's compliance with treatment is the priority for a doctor. There are many times when giving in to a patient's wishes elsewhere can ensure their compliance with medication. The pension is often one such compromise.
The flipside is that 90 per cent of those receiving disability pensions never return to the workforce. This is not a fact well known to professionals determining disability. Colleagues working in mental health were flabbergasted when they heard the figure.
For many on the margins of eligibility, there is an incentive to remain sick. The welfare market operates like any other - a better price will increase demand. This lack of incentive to take a more active role in society can strip them of meaning in their lives and perpetuate what may have started as mild mental illness.
A feedback loop of disability, welfare and worsening mental health is created. This is a hidden factor straining both Australia's mental health and welfare systems. They are operating in a kind of pathological symbiosis.
This cycle describes many people who are said to be in a state of deep poverty. They are hardly poor in a historical sense, for they have enough money to eat and are housed, educated and medically treated by the state. In formulating their situation, poverty in this sense is more like a psychological condition than one determined by socioeconomics.
While the middle classes debate their happiness and psychiatry acquires a cultural prestige well beyond its powers, the poor inherit the new straitjacket of psychological language. It not only costs the taxpayer billions of dollars, but encourages recipients to wallow as victims of passive circumstance, stripping their lives of meaning and purpose.
Dr Tanveer Ahmed is a psychiatry registrar and writer.
http://www.smh.com.au/news/opinion/terms-of-unhappiness-in-a-sick-world/2007/09/14/1189276986726.html
Melissa Raven, Adjunct Lecturer
Department of Public Health, Flinders University GPO Box 2100 ADELAIDE SA 5001 AUSTRALIA

DSM-V expected to explore physical, mental health links

2007-08-06T12:02:00.000-07:00

DSM-V expected to explore physical, mental health links
The manual's planned revision also will look at psychiatric health throughout the lifespan as well as gender and cultural issues.
By Victoria Stagg Elliott, AMNews staff. Aug. 13, 2007.
The Diagnostic and Statistical Manual of Mental Disorders is about to get a makeover -- it will be the focus of a detailed overhaul that experts hope will reflect emerging scientific understanding and expect to take years to finish.
Those involved in the process predict that the completed revision will place a greater emphasis on how psychiatric illnesses change throughout a person's life and how different mental health issues interact. Gender and cultural issues also are expected to play a bigger role, along with a greater examination of the connection between mental and physical health.
With this article Links
Discuss on Sermo See related content
"It's very important to have a better paradigm than what we've been using to look at somatic presentations of mental disorders, and the relationship to disorders in other organ systems," said Darrel Regier, MD, MPH, vice chair of the task force on the revision and the American Psychiatric Assn.'s director of research.
The last full revision, the DSM-IV, came out in 1994, although a text update was issued in 2000. The DSM-V is due out in 2012, but there is a lot of work to be done before then.
Last month the APA announced the members of the revision task force. Working groups addressing specific mental health issues will be appointed later this year.
A draft will be available for public comment in 2009. This step also will allow researchers to undertake clinical trials to determine the usefulness of the diagnostic categories.
The last full revision of DSM was in 1994.
"As the nation's dictionary of mental illnesses, the Diagnostic and Statistical Manual plays a vital role in assuring that patients get proper diagnoses and treatments for their mental health concerns," said David J. Kupfer, MD, task force chair. "The APA has entrusted the revision of the DSM to world-renowned scientists who have vast experience in research, clinical care, biology, genetics, statistics, epidemiology, public health and consumer advocacy."
In light of the increasing attention being paid to conflict-of-interest issues, the organization also announced rules governing this issue for task force members. Participants are required to reveal all potentially conflicting relationships and are restricted to no more than $10,000 in annual income from industry sources except for unrestricted research grants.
"Patients deserve a diagnostic manual based upon the latest science and free of conflicts of interest," said APA President Carolyn Robinowitz, MD.
Input sought
The organization also will be accepting input through its DSM-V Prelude Project, which can be accessed online (http://www.dsm5.org/), and many organizations and individuals already have weighed in on possible changes. For example, the American Medical Association will be forwarding for consideration a report adopted at its June Annual Meeting on the possible emotional and behavioral effects of video games.
But while this book is influential, it is not without controversy, and critics hope diagnostic criteria will be less expansive. Some feel it currently can lead to people being categorized as having a mental health issue such as depression that could be more related to a temporary situation such as the death of a loved one rather than a psychiatric illness. Questions also have been asked about whether some diagnoses are useful.
"The emphasis on symptoms without context probably needs to be rethought," said Leonard Sax, MD, a family physician in Poolesville, Md., who also holds a PhD in psychology. "And I wonder whether conduct disorder is really a meaningful diagnosis. Maybe the child needs a change in parenting or a change in the peer group? This diagnosis makes it easier for parents to believe that medication is appropriate, but it's not." His book, Boys Adrift: The Five Factors Driving the Growing Epidemic of Unmotivated Boys and Underachieving Young Men, is due out this month.
Meanwhile, some of the experts involved in previous revisions are concerned that 2012 may be too tight of a deadline.
"That's five years to review all the issues and review suggestions for changes and collect data in field trials. I don't see how that can be done in five years," said Robert Spitzer, MD, who was involved in previous revisions and is a professor of psychiatry at Columbia University in New York.
Discuss on Sermo Back to top.
ADDITIONAL INFORMATION:
Weblink
DSM-V Prelude Project (http://www.dsm5.org/)
American Psychiatric Assn. (http://www.psych.org/)

Fronteiras do Pensamento » O Blog

2007-05-19T09:06:00.000-07:00

Fronteiras do Pensamento » O Blog:
Valderês e eu estamos acompanhando semanalmente as conferências do "Fronteiras do Pensamento" e gostaríamos de compartilhar com os amigos algo do que temos aprendido. Vai aqui o link para o Blog do curso no qual podem ser lidas resenhas (obviamente com imperfeições) das conferências. Na última 3a. feira (15 de maio) assistimos dois psicanalistas (um Belga, Lebrun, e outro francez, Melmann), acessíveis através deste Blog, conversando sobre o mundo sem limites...

"Fronteiras do Pensamento é um curso de altos estudos, parte integrante do Projeto Copesul Cultural, realizado de março a dezembro de 2007 em Porto Alegre.
Este Blog é um espaço semanal organizado por nossa equipe para levar ao público fotos, vídeos e matérias dos eventos ocorridos nos Salões de Atos da Universidade Federal do Rio Grande do Sul e da Pontifícia Universidade Católica do RS.
A Programação e mais informações sobre o Fronteiras do Pensamento estão disponíveis no site www.fronteirasdopensamento.com.br
Seja bem-vindo!"

Depression, Antidepressants, and the Risk of Suicide

2007-05-09T18:21:00.000-07:00

http://content.nejm.org/cgi/content/full/NEJMp078015?query=TOC
On May 2, 2007, the Food and Drug Administration (FDA) ordered that all antidepressant medications carry an expanded black-box warning incorporating information about an increased risk of suicidal symptoms in young adults 18 to 24 years of age. Since October 2004, antidepressants have been required to have a black-box warning indicating that they are associated with an increased risk of suicidal thinking, feeling, and behavior in children and adolescents.
The new warning also states that there is no evidence of an increased risk for adults older than 24 years of age and that the risk is actually decreased for adults 65 years of age or older. Strikingly, the label states that "depression and other serious psychiatric disorders are themselves associated with increases in the risk of suicide," which makes it the first black-box warning to note that a disease itself carries risk — and implies that there is risk in not using the very medication being warned about.
The new warning was developed in the wake of a December 2006 meeting of the FDA's Psychopharmacologic Drugs Advisory Committee, which focused on the controversial link between antidepressants and suicide risk in adults. During an often contentious public session, the advisory committee heard from psychiatric experts and from aggrieved family members, who sometimes expressed outrage at the FDA when they spoke of the death of loved ones who had taken antidepressants. In the end, the committee voted 6 to 2 in favor of extending the black-box warning to include adults 18 to 24 years of age.
The notion that antidepressants might be associated with an increased risk of suicidality (suicidal ideation, behavior, or both) in some patients is hardly new. Clinicians have known for years that during the first few weeks of treatment with antidepressants, some patients become "activated" — energized and agitated — before their depressed mood lifts, and that combination makes them more likely to act on preexisting suicidal impulses. But because suicidal thinking, feeling, and behavior are core symptoms of depression, there is no way to know whether suicidal symptoms that develop during treatment are due to the underlying illness or the medication. /.../

Dementia UK

2007-05-09T14:10:00.000-07:00

Dementia UK

A report into the prevalence and cost of dementia prepared by the Personal Social Services Research Unit (PSSRU) at the London School of Economics and the Institute of Psychiatry at King’s College London, for the Alzheimer’s Society
Project directors: Professor Martin Knapp and Professor Martin Prince Research team: Dr Emiliano Albanese, Professor Sube Banerjee, Sujith Dhanasiri, Dr Jose-Luis Fernandez, Dr Cleusa Ferri, Professor Martin Knapp, Dr Paul McCrone, Professor Martin Prince, Tom Snell, Dr Robert Stewart
Alzheimer’s Society 2007

Available online as PDF file [103p.] at: http://www.alzheimers.org.uk/News_and_Campaigns/Campaigning/PDF/Dementia_UK_Full_Report.pdf

“….It is now over a century since 1906 when German neurologist Alois Alzheimer diagnosed the disease which bears his name. What progress has been made? How much better do we understand the diseases that cause dementia? As our population ages, Alzheimer’s disease and other causes of dementias are becoming ever more common and important. We urgently need to understand the impact of dementia in the UK now and in the future. This report is an attempt to answer these key questions and to inform a serious debate about how we as a society can respond to the challenges posed by dementia.

There has been significant progress since 1906, both in our scientific understanding of dementia and public awareness about the diseases which cause it.
We know more now than we ever did. We know that dementia is not a natural part of ageing and that it is caused by a variety of diseases which affect people in different ways. We also now have a range of options to treat the symptoms of dementia and to offer practical support to people with dementia and their families. However, we are a long way from fully understanding dementia and being able to offer a comprehensive response…..”

Content:
1 Introduction
2 The Expert Delphi Consensus on the prevalence of dementia in the UK
3 Number of people with dementia in the UK
3.1 Calculation methods
3.2 Number of people with dementia in the United Kingdom
3.3 Projected increases in the number of people with dementia in the United Kingdom
3.4 Regional variation
3.5 Young onset dementia
3.6 Projected increases in the number of people with young onset dementia
3.7 Number of people with young onset dementia, by age and gender
3.8 Late onset dementia
3.9 Projected increases in the number of people with late onset dementia
3.10 Number of people with late onset dementia, by age and gender
3.11 Dementia subtype
3.12 Residential status
3.13 Ethnicity
3.14 Mortality
3.15 Conclusions
4 Service development
5 Mapping social service provision
Residential care provision
Home care provision
Day care provision
Comparisons of indicators across countries
6 The financial cost of dementia in the UK
7 Recommendations
References
Appendices

Drug Disorders Has Affected 10% of Americans -

2007-05-08T04:51:00.000-07:00

A Variety of Drug Disorders Has Affected 10% of Americans - CME Teaching Brief® - MedPage Today
Primary source: Archives of General PsychiatrySource reference: Compton WM et al. "Prevalence, Correlates, Disability, and Comorbidity of DSM-IV Drug Abuse and Dependence in the United States: Results From the National Epidemiologic Survey on Alcohol and Related Conditions." Arch Gen Psychiatry. 2007;64:566-576.
BETHESDA, Md., May 7 -- About one American in 10 has had a problem with legal or illegal drug use according to researchers here.That figure includes about one in 50 who has been frankly dependent on drugs at some point, according to Wilson Compton, M.D., of the National Institute on Drug Abuse here.
Action Points
Explain to interested patients that drug use disorder includes drug abuse and drug dependence, according to the DSM-IV.
Note that this survey suggests that about one American in 10 has either abused drugs or been dependent on drugs over the course of his or her lifetime.
These data come from face-to-face interviews with 43,093 persons in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions, Dr. Compton and colleagues reported in the May issue of Archives of General Psychiatry.
The survey is the first in more than 16 years to try to get a handle on drug use among American adults, the researchers said.
"Although extensive data on drug use in the U.S. population have been available on an ongoing basis for adults and adolescents," they reported, "epidemiologic data on the prevalence, correlates, disability, treatment and comorbidity of drug use disorders among adults are seldom collected."
Using DSM-IV definitions, the survey used a validated questionnaire aimed at discerning details of alcohol and drug use disorders, nicotine dependence, mood and anxiety disorders, and seven of the 10 personality disorders, the researchers said.
The questionnaire asked about the use of sedatives, tranquilizers, opiates (other than heroin), stimulants, hallucinogens, cannabis, cocaine (including crack cocaine), inhalants/solvents, heroin, and other drugs.
The study found:
10.3% of Americans had drug-use disorder at some point in their lives.
That was broken down into drug abuse (7.7%) and drug dependence (2.6%).
Over the year immediately prior to the interview, 2.0% of Americans reported a drug-use disorder.
That broke down into 1.4% reporting drug abuse and 0.6% reporting drug dependence. /.../

2007-05-02T07:28:00.000-07:00

From MEDPAGE TODAY
U.S. Psychiatric & Mental Health Congress
San Francisco, CA • April 21, 2007
New Definitions on Tap for Mixed Manias SAN FRANCISCO -- Dysphoric mania and other mixed mania states of bipolar disorder will become easier to diagnose with better definitions, a researcher said here. http://www.medpagetoday.com/MeetingCoverage/USPsychiatricMentalHealthCongress/mr/5511
Insomnia Treatment Boosts Antidepressant Efficacy SAN FRANCISCO -- A significant number of patients with major depression also suffer from chronic insomnia that hampers recovery, and treating the insomnia may improve both conditions. http://www.medpagetoday.com/MeetingCoverage/USPsychiatricMentalHealthCongress/mr/5510
Atypical Antipsychotic Medication Cuts Behavioral Symptoms in Autism SAN FRANCISCO -- While the behavioral symptoms of autism have been treated with a wide spectrum of medications, atypical antipsychotics may be the most effective drug class.
http://www.medpagetoday.com/MeetingCoverage/USPsychiatricMentalHealthCongress/mr/5509
Depression Remission Rates Remain Low, But There’s Hope SAN FRANCISCO -- Remission rates remain low for major depression even with multiple antidepressant drug classes available, but the recently approved selegiline patch (Emsam) aims to bring the rates up. http://www.medpagetoday.com/MeetingCoverage/USPsychiatricMentalHealthCongress/mr/5508
Vigilance Still Necessary for Atypical Antipsychotics SAN FRANCISCO -- Atypical antipsychotic medications have improved adverse-event profiles compared with the older generation of antipsychotics, but careful attention to major side effects is still required. http://www.medpagetoday.com/MeetingCoverage/USPsychiatricMentalHealthCongress/mr/5507
Concurrent Treatment Works for ComorbidADHD and Substance Abuse SAN FRANCISCO -- Given the high prevalence of substance abuse in patients with attention deficit hyperactivity disorder (ADHD), psychiatrists need to consider comorbidity in assessment of both conditions. http://www.medpagetoday.com/MeetingCoverage/USPsychiatricMentalHealthCongress/mr/5501

Depression cited as the top cause of medical disability

2007-03-26T05:15:00.000-07:00

Depression cited as the top cause of medical disability
The disease takes a toll, not just personally but economically, reports a U.S. mental health expert.
By Susan J. Landers, AMNews staff. April 2, 2007.

Thomas Insel, MD, director of the National Institute of Mental Health, attended the annual meeting of the World Economic Forum in Davos, Switzerland, in late January, where he caused a stir with a presentation on the high cost of depression.
He recently spoke with AMNews about his remarks.
Question: How big a burden is depression?
Answer: It's the leading source of nonfatal medical disability among people ages 15 to 44 in developed countries like the U.S. and Canada. It is the leading cause by far. Nothing else is even close. In the whole world it is the second or third greatest cause of disability. It costs the United States $53 billion annually in direct treatment costs, mortality and lost productivity.
Q: How are those figures arrived at?
A: You can calculate it in one of two ways: either as a source of disability for people in that age bracket, 15 to 44, or, the way the World Health Organization likes to do it, with a DALY, or disability-adjusted life years. That's the years lost to disability.
Q: It seems a surprisingly high figure.
A: Yes. It doesn't comport with what most of us would think about if we thought about the big killers: heart disease, cancer and stroke. Those are the three big killers, but they aren't the ones that cause the most disability. They cause mortality.[...]

No solo Freud leia sueños

2007-03-18T13:02:00.000-07:00

From: Marcelo Gustavo Colominas

To: undisclosed-recipients:

Sent: Sunday, March 18, 2007 10:56 AM

Subject: No sólo Sigmundo...

No solo Freud leia sueños

Salvo los psicoanalistas, no existen desde hace siglos intelectuales interesados en los sueños. Sin embargo, en la antigüedad tardía los filósofos fueron apasionados por la adivinación... y los sueños proféticos. Artemidoro y Elio Arístides escribieron trabajos que dan cuenta de ello.

PABLO MAURETTE

En su ya clásico estudio sobre los griegos y lo irracional, E. R. Dodds señala con astucia que el hombre tiene el raro privilegio, junto con algunos otros mamíferos, de ser por naturaleza ciudadano de dos mundos: la vigilia y el sueño. Hay quienes han dicho que la vida es sueño y quienes han comparado la muerte con el más glorioso despertar, pero resulta difícil dudar de que el estar despierto y el estar soñando son dos estados radicalmente diferentes. Los filósofos se han ocupado siempre del mundo de la vigilia y han relegado el mundo de los sueños a un segundo plano para servirse de él en raras ocasiones, a la hora de ilustrar ejemplos o de lucirse con símiles o analogías floridas. La modernidad y la posmodernidad, hijas de la revolución cartesiana, encerradas en el yo y enfrentadas al mundo, han cimentado una idea que se puede encontrar ya en Aristóteles, una idea que la ciencia moderna corrobora, nadie que se diga ilustrado podría negarla: los sueños surgen de un archivo de percepciones e imágenes, se refieren al pasado. Es cierto que los sentidos no se cierran cuando estamos durmiendo y es por ello que en ocasiones el presente se inmiscuye en el sueño de manera furtiva. Lo que resulta difícil de aceptar para quienquiera que se precie de ser bienpensante es que en sueños estamos abiertos al mundo y que el mundo nos revela el futuro. La interpretación de los sueños en clave oracular o adivinatoria no goza de prestigio entre la intelligentzia, pero esto podría ser no más que otro capricho de los sofisticados tiempos que corren. El reino de la interpretación de los sueños fue hace más de cien años conquistado, no sin mérito, por Sigmund Freud. El descubrimiento del inconsciente, del cual los sueños son el escenario más notorio, llevó al médico vienés a concluir que el mundo onírico nos puede revelar verdades codificadas acerca de nuestra relación con el mundo y con los otros, siempre en base a experiencias ya vividas. Carl Jung, quien profesaba una ardiente pasión por lo sobrenatural, dio un paso más y se animó a hablar de sueños proféticos, aunque con ello se refiriese a pulsiones propias del individuo que se le revelan en sueños de manera alegórica, anticipando un acontecimiento que él mismo provocará inconscientemente. Pero para encontrar intelectuales hablando seriamente de sueños proféticos y del mundo onírico como ventana esmerilada al futuro hay que retroceder bastante en el tiempo. La antigüedad tardía, ese nebuloso paréntesis entre el nacimiento de Cristo y el inicio de la Edad Media, abundó en intelectuales fascinados por la magia y la adivinación, así como en místicos de variadas afiliaciones, paganos desesperadamente revisionistas, cristianos perdidamente helenizados, oradores desencantados y filósofos ritualistas. Tampoco faltaron hombres ilustrados que consideraron de capital importancia la interpretación de los sueños, aunque hiciese ya mucho tiempo que los griegos se ocupaban de esto. Allá en los albores de la civilización helénica, en el canto XIX de la Odisea, Penélope relataba a un forastero andrajoso un extraño sueño que había tenido en el que un águila descendía del cielo y mataba veinte gansos que estaban a su cuidado. El forastero, en realidad su marido Odiseo disfrazado, le decía que el sueño significaba que el legítimo rey de taca —es decir, él mismo— volvería y mataría a los pretendientes que pululaban por palacio con la intención de desposar a la sufrida reina. Penélope concluía inspirada: "Hay dos puertas por las que los sueños proceden, una de cuerno y la otra de marfil. Los sueños que salen por la de marfil son fatuos, pero los que proceden de la de cuerno significan algo para quienes los sueñan". Esta distinción entre sueños falsos y sueños verdaderos distingue sueños banales y sueños proféticos, y atraviesa toda la antigüedad. El gran manual de interpretación de sueños, Oneirokritiká (La interpretación de los sueños), compuesto por Artemidoro en el siglo II, retoma esta distinción y funda sobre ella su propia teoría de los sueños. Artemidoro distingue al comienzo de su obra el sueño (oneiros) del ensueño (enupnion). El sueño es aquel que sale de la puerta de cuerno, aquel que es portador de una verdad. De hecho, dice Artemidoro haciendo malabares etimológicos que recuerdan a Platón o Heidegger, la palabra oneiros se compone de on, "ser", y eiro, "decir": el sueño dice lo que es, dice el ser. Ensueño o enupnion, por el contrario, proviene de otro término griego para decir "sueño" que es upnos, un vocablo que se asocia con la somnolencia, el letargo, un estado de modorra inconsciente al que Artemidoro relaciona con la puerta de marfil por la que atraviesan los sueños infantiles, inconducentes y baladíes. Pero, ¿qué ser dice el sueño? "El sueño es un movimiento del alma que significa un bien o un mal por venir". El sueño es, entonces, por definición profético. La ciencia onírica se funda de este modo, en primer lugar, sobre la capacidad de distinguir sueños de ensueños, y en segundo lugar se ocupa de interpretar apropiadamente los sueños. Según Artemidoro hay dos tipos de sueños, los especulativos y los alegóricos. Los primeros se refieren a la inmediatez y no requieren de interpretación: un hombre se queda dormido durante un vuelo y sueña con que el avión cae al mar; el hombre se despierta sobresaltado por la pesadilla y se da cuenta de que la nave está, en efecto, cayendo en picada sin esperanza. Los sueños alegóricos, en cambio, no dicen lo que parecen decir y requieren de una mente avezada que los sepa develar. La obra de Artemidoro es, precisamente, una guía para la interpretación de los sueños alegóricos, de aquellas visiones proféticas que nos dicen una cosa por otra. Soñar que uno tiene pelo de cerdo, dice por ejemplo Artemidoro, significa estar en grave peligro, o soñar que le entran a uno hormigas en las orejas predice la muerte porque simboliza un hijo de la tierra que vuelve a la tierra. Como estos hay decenas de disparatados y arbitrarios ejemplos de interpretación alegórica de todo tipo de sueños, incluyendo un excursus sobre la significación de los sueños referidos al coito con la propia madre o con el padre (ver recuadro). También en el siglo II vivió otro hombre para quien el reino de los sueños, las aventuras oníricas y la interpretación de los oráculos habrían de convertirse en una obsesión. Orador itinerante y célebre exponente de aquel gris movimiento conocido como la "segunda sofística", Elio Arístides fue un hombre frágil, enfermizo y egocéntrico. En el medio del camino de la vida, viajando a Roma desde Asia Menor se enfermó y descubrió en la enfermedad un poderoso combustible para su creatividad ya agotada por años de plásticos discursos. Elio no se enfermó de algo, se enfermó de todo: males intestinales, respiratorios y musculares, entre otros, lo atormentaban alternativa y simultáneamente, razón por la cual decidió cambiar de rumbo y dirigirse a Pérgamo a pedir ayuda a Asclepio, el dios de la salud. Se instaló entonces en el templo y en las noches, en sueños, se le empezó a aparecer el dios salvador para revelarle tratamientos de lo más diversos contra sus muy diversas dolencias. Pero Asclepio también le ordenó que llevase un registro de sus sueños, un diario de noche, un "noctario", y Elio Arístides cumplió al pie de la letra. Los Discursos Sagrados son el registro de cientos de sus sueños, la mayoría referidos a apariciones de Asclepio y a las recetas que le confiaba el dios. Abundan también los sueños paranoicos en los que Elio se ve perseguido por pandillas de bárbaros que lo quieren apuñalar y los sueños delirantes y egotistas en los que al soñador se le aparece Platón o el dios Hermes, augurándole éxito y venerándolo. Elio se consideraba un elegido, un hombre excepcional que tenía una relación íntima y personal con Asclepio, por lo que no sólo creía que los sueños eran proféticos, sino que consideraba que eran epifanías del dios destinadas a él y a nadie más que él. Un sueño en especial amerita ser reproducido pues en él la divinidad le revela al sofista el misterio inefable del universo. Se alzaba el lucero del alba en el cielo, estaba amaneciendo, cuando Elio soñó que estaba en un campo de su propiedad e iba por un sendero siguiendo el lucero del alba, que se levantaba guiándolo hacia Oriente. Junto con él iba Piraliano, un gran amigo suyo, habitué del templo y muy versado en los diálogos de Platón. Bromeando, para hacer más amena la caminata, Elio dice a su docto amigo: "En nombre de los dioses, me puedes decir —¡estamos completamente solos!— por qué ustedes los platónicos son tan fanfarrones y quieren siempre dejar a todos estupefactos?" Piraliano ordenó a su amigo que lo siguiese hasta que en un momento le indicó un lugar en el cielo con la mano y le dijo: "Aquel que ves ahí es a quien Platón denomina el Alma del Mundo". Elio levantó sus ojos y vio a Asclepio. De más está decir que Elio se despertó estupefacto. A comienzos del siglo V dC. Sinesio de Cirene escribió un magnífico y muy bello tratado acerca de los sueños, conocido por la tradición como el De Insomnis. Sinesio había sido discípulo de la infortunada filósofa platónica Hipatía de Alejandría, lapidada y desmembrada por una caterva de cristianos en 415, y su obra sobre los sueños es decididamente de corte teórico. De acuerdo con la tradición que lo precede, Sinesio no duda de que los sueños puedan ser proféticos y de que deban ser interpretados, la novedad de su obra es que se trata de una exhortación al lector para que no dependa de intérpretes o magos a la hora de dar sentido a los sueños. Todos recibimos el regalo profético de los dioses en sueños, dice Sinesio, todos poseemos la capacidad de desvelar el enigma de las imágenes alegóricas que nos asaltan durante el estado de sueño profundo. Nadie nos puede quitar ese don, ningún tirano nos puede prohibir que soñemos, ninguna ley nos puede impedir que interpretemos nuestros sueños, pues la facultad adivinatoria es innata, es un tesoro invaluable que todos poseemos. Esta facultad, según Sinesio, se funda en la simpatía universal, aquel principio según el cual todos los seres del universo están en conexión los unos con los otros como partes de un mismo cuerpo. Dado que estamos ligados a las cosas por una fina armonía, el arte de dilucidar los secretos del mundo no nos es ajeno, sólo hay que cultivarlo.

Quien se ocupa de purificar el alma de las cosas materiales tiene más posibilidades de recibir oráculos en sueños; quien vive abrumado por los asuntos del mundo soñará nimiedades salidas por la puerta de marfil. Para Sinesio todas las cosas que son, han sido y serán —también el futuro es una fase de la existencia— proyectan imágenes, como un árbol proyecta su sombra. Las imágenes de cosas pasadas —aunque el tiempo las va desdibujando— y presentes son claras y distintas, pero las que proyectan las cosas que serán, dice con gran poesía Sinesio, "son más indefinidas e indistinguibles pues son las ondas anticipatorias de algo que aún no es presente, eflorescencias de una naturaleza prematura, acertijos de semillas rigurosamente almacenadas que vuelan como dardos hacia fuera". Al dormir estamos abiertos al mundo y el mundo nos susurra los secretos del devenir. La oniromancia es el arte de interpretar las imágenes portentosas que proyectan las cosas que aún no han sucedido. El camino al autoconocimiento al que exhortaba la máxima de Delfos —"conócete a ti mismo"— y al que convoca toda la tradición intelectual helénica no puede emprenderse con seriedad si se ignora aquel otro yo dormido y aquel otro mundo que habitamos en sueños. Ni Sinesio ni Freud pondrían esto en duda. Por eso es que Sinesio, acaso siguiendo el ejemplo del excéntrico Elio Arístides, insta a sus lectores a tener un diario de noche. Extrañamente el noctario, a diferencia del diario, no se ha consolidado como género literario.

http://www.clarin.com/suplementos/cultura/2007/03/17/u-01381864.htm

$100 million to decipher the genetics of severe mental illnesses

2007-03-12T04:35:00.000-07:00

By Carey Goldberg, Globe Staff | March 8, 2007

The Broad Institute, the genomics powerhouse in Cambridge, announced yesterday that it will receive what it believes is the biggest gift ever for psychiatric research to a single US institution: $100 million to decipher the genetics of severe mental illnesses.

The money comes from the Stanley Medical Research Institute , a family philanthropy based in Maryland. It will be used largely to gather and analyze thousands of DNA samples from people with schizophrenia and bipolar disorder, in hopes of determining the complex genetics behind the diseases.

Only in the last year or so has gene-scanning technology reached the point that scientists think that aim is realistic, said Dr. Edward Scolnick , who oversees the Broad's psychiatric research. Researchers at the Broad and elsewhere are also using these genomic tools to make inroads on cancer, diabetes, and other diseases.

For mental illness, it could take several years to determine the key genetic risk factors, Scolnick said. But once that is done, "You can start developing new approaches for diagnosis, new targets for treatment, new understanding of which drugs to use in which people, and turn it into a rational science. That's the Holy Grail./.../"

The Line Between Torture and Cruelty - New York Times

2007-03-06T05:40:00.000-08:00

The Line Between Torture and Cruelty - New York Times:
"The Line Between Torture and Cruelty

Article Tools Sponsored By
By NICHOLAS BAKALAR
Published: March 6, 2007

The United Nations and the United States government make a distinction between torture on the one hand and “cruel, degrading and inhumane treatment” on the other. But a study published yesterday uses data obtained from survivors to suggest that the distinction does not exist in practice, and may inadvertently provide justification for torture.

The conclusions appear to contradict a Justice Department memorandum of Dec. 30, 2004. Citing the United Nations Convention Against Torture, the memorandum argued that a broad range of interrogation techniques, among them forced standing, hooding, subjection to loud noises and deprivation of sleep, food and drink, might be inhumane but did not constitute torture unless they resulted in “prolonged mental harm.”

“Until now, both sides of the debate have expressed opinions based on personal impressions,” said Dr. Metin BasogluThe United Nations and the United States government make a distinction between torture on the one hand and “cruel, degrading and inhumane treatment” on the other. But a study published yesterday uses data obtained from survivors to suggest that the distinction does not exist in practice, and may inadvertently provide justification for torture.

The United Nations and the United States government make a distinction between torture on the one hand and “cruel, degrading and inhumane treatment” on the other. But a study published yesterday uses data obtained from survivors to suggest that the distinction does not exist in practice, and may inadvertently provide justification for torture.

The conclusions appear to contradict a Justice Department memorandum of Dec. 30, 2004. Citing the United Nations Convention Against Torture, the memorandum argued that a broad range of interrogation techniques, among them forced standing, hooding, subjection to loud noises and deprivation of sleep, food and drink, might be inhumane but did not constitute torture unless they resulted in “prolonged mental harm.”

“Until now, both sides of the debate have expressed opinions based on personal impressions,” said Dr. Metin Basoglu, the lead author of the study. “But these data clearly suggest that you cannot make a distinction between physical forms of torture and something else called ‘cruel and degrading treatment.’ ”

Dr. Basoglu is a psychiatrist and a specialist in trauma studies at King’s College London.

Using structured interviews and diagnostic questionnaires, including an established scale that seeks to draw out information on 46 forms of torture, the researchers examined 279 survivors from the former Yugoslavia. Most had experienced physical and psychological torture.

The interviews were conducted from March 2000 to July 2002, an average of eight years after the subjects had last been tortured.

The study, published in The Archives of General Psychiatry, found that most participants with little or no experience of physical torture nevertheless developed post-traumatic stress disorder at some point, and that some people survived even severe physical torture without suffering the disorder.

The presence of post-traumatic stress disorder or other long-term psychological suffering would therefore not constitute a usable definition for torture, because it would exclude many people who actually were severely physically tortured.

Dr. Israel Liberzon, a professor of psychiatry at the University of Michigan, said the lack of a control group made the findings less compelling.

Dr. Gregg Bloche, a psychiatrist and a professor of law at Georgetown University, said what the researchers did was “artful, even brilliant,” considering the circumstances.

“You can’t design alternative torture regimens,” Dr. Bloche said, “which is what you would have to do to meet the scientific criteria for a controlled clinical trial. You have to work with real survivors.”

The participants in the study were asked to rate types of stress on two 5-point scales — fairly to extremely distressing and slightly controllable to not controllable at all.

The physical torture categories included beating, burning and electric shocks. The other categories included rope bondage, cold showers, excrement in food and deprivation of basic needs like sleep or toilets.

On a scale of 0 to 4, the mean distress rating for physical torture was 3.2 to 3.8. The mean distress ratings for 16 of the 33 nonphysical stressors were in the same range.

For example, sham executions, the fondling of genitals and threats of rape were rated 3.6 to 3.7. On the scale measuring loss of control, there was no difference between physical torture and psychological manipulation.

A spokesman for the Justice Department, Erik Amblin, declined to specify what treatments would be cruel and degrading but would not qualify as torture.

Mr. Amblin did say, however, that “acting with the specific intent of causing prolonged mental harm” would be illegal under United States and international law.

Even though the United Nations Convention prohibits cruel, inhuman or degrading treatment as well as torture, Dr. Basoglu said, “the distinction makes people able to argue that torture is O.K.

“They distinguish low levels of physical pain and high levels, as if that’s what makes the experience traumatic. But it’s not dependent on the amount of pain. It’s the issue of control and the extent of distress one experiences.”

Yet Another Worry for Those Who Believe the Glass Is Half-Empty -

2007-01-10T15:24:00.000-08:00

Yet Another Worry for Those Who Believe the Glass Is Half-Empty - New York Times: "Now, it seems, pessimists may really have something to worry about: their health.

A study by researchers in the Netherlands has found that people who are temperamentally pessimistic are more likely to die of heart disease and other causes than those who are by nature optimistic.

The study, led by Dr. Erik J. Giltay of the Psychiatric Center GGZ Delfland and published in The Archives of General Psychiatry, followed 941 Dutch subjects, ages 65 to 85, from 1991 to 2001. Subjects were ranked in quartiles as pessimistic or optimistic on the basis of their reactions to statements like, “I still have positive expectations concerning my future” and, “I often feel that life is full of promises.”"

Sabina Spielrein

2007-01-06T03:07:00.000-08:00

Sabina Spielrein - Wikipedia, the free encyclopedia: "Sabina Spielrein was born 1885 into a family of a Jewish merchant in Rostov, and died there in 1942, murdered by Nazi troops. She was one of the first female psychoanalysts. Sabine Spielrein was married to Pavel Scheftel, a physician of Russian Jewish descent. They had two daughters: Renate, born 1912, and Eva, born 1924; both were murdered with their mother in 1942. Scheftel perished in the Great Terror, in 1936. One of her brothers, Isaac Spielrein (also spelt Shpilrein or Shpilreyn) was a Soviet psychologist, a pioneer of labor psychology and perished in 1937 during Stalin's Great Terror.

A student of medicine in Zürich, Spielrein was admitted to Burghölzli Mental Hospital near Zürich, where Carl Gustav Jung worked at time, and remained there from August 17 1904 till June 1 1905. In 1904-1911, she established a deep emotional relationship with C. G. Jung; later Jung was her dissertation advisor, and his own work bore certain influence of Spielrein's. She graduated in 1911, defending a dissertation about a case of schizophrenia; in the same year, she was elected member of Vienna Society of Psychoanalysis."

8º Congreso Virtual de Psiquiatría

2006-12-28T01:09:00.000-08:00

8º Congreso Virtual de Psiquiatría: "Hasta el día 30 de enero de 2007 se encuentra abierta la inscripción en forma gratuita para participar del 8º Congreso Virtual de Psiquiatría, en el cual podrán tener acceso entre otros a los trabajos correspondientes a la mesa de discusión “Mujer y tabaco en Iberomérica: desafíos en el nuevo milenio” y a su foro de discusión.

Si desea realizar la inscripción: http://www.psiquiatria.com/...

Atte.

Gabriela Regueira
Secretaria
Red Internacional de Mujeres Contra el Tabaco – INWAT
www.inwat.org"

UNODC - World Drug Report

2006-12-02T11:10:00.000-08:00

UNODC - World Drug Report: " Evolution of the world drug problem Evidence of long-term containment
Website: http://www.unodc.org/unodc/en/world_drug_report.html
PDF [250p.] Volume 1: Analysis - Full Report (PDF, 4.99 MB)
PDF file [220p.] Volume 2: Statistics - Full Report (PDF, 3.13 MB)
“…..Some 200 million people, or 5 percent of the global population age 15-64, have used illicit drugs at least once in the last 12 months. Among this population are people from almost every country on earth. More people are involved in the production and trafficking of illicit drugs and still more are touched by the devastating social and economic costs of this problem. Partially a consequence of its pervasiveness and partially a consequence of the illicit and hidden nature of the problem, reliable analysis and statistics on the production, trafficking and use of illicit drugs are rare.
The World Drug Report 2006 endeavours to fill this gap. It provides one of the most comprehensive overviews of illicit drug trends at the international level. In addition, it presents a special thematic chapter on cannabis, by far the most widely produced, trafficked and used drug in the world. The analysis of trends, some going back 10 years or more, is presented in Volume 1. Detailed statistics are presented in Volume 2. Taken together, these volumes provide the most up-to-date view of today's illicit drug situation……”

World Drug Report 2006 by Chapters
Volume 1: Analysis
Volume 2: Statistics
Contents
Preface
Explanatory notes
Executive Summary
Chapter 1. Trends in World Drug Markets
1.1. The evolution of the world drug problem
1.2. The outlook for world drug markets
1.3 Opium / Heroin market
1.4 Coca / Cocaine market
1.5 Cannabis market 1.6 Amphetamine-type stimulants
Chapter 2. Cannabis: Why we should care
2.1. Introduction
2.2. The world's biggest drug market is growing and uncharted cannabis is produced in their countries, and their other
2.3. The emergence of 'new cannabis' and the reassessment of health risks
2.4. Conclusion

Annex 1 - The plant and the drug
Annex 2 - Estimating yield
Annex 3 - Estimating individual consumption

Endnotes

Contents
Chapter 3. Production
3.1. Opium / Heroin
3.2. Coca / Cocaine
3.3. Cannabis
3.4. Amphetamine-type stimulants
3.5. Other Drugs
Chapter 4. Seizures
4.1 Opiates: Seizures, 1998-2003 4.2 Cocaine: Seizures, 1998-2003 4.3 Cannabis: Seizures, 1998-2003 4.4 Amphetamine-type stimulants: Seizures, 1998-2003
Chapter 5. Prices
5.1. Opiates: Whole, street prices and purity levels
5.2. Cocaine: Wholesale, street prices and purity levels
5.3. Cannabis: Wholesale, street prices and purity levels
5.4. ATS: Wholesale, street prices and purity levels
Chapter 6. Consumption
6.1. Annual Prevalence of drug abuse
6.2. Treatment demand

Chapter 7. Methodology "

The Mechanistic Classification of Addictive Drugs

2006-12-02T03:01:00.000-08:00

PLoS Medicine - The Mechanistic Classification of Addictive Drugs: "The consumption of a variety of natural and synthetic substances can lead to addiction, which is commonly defined by the loss of control and compulsive consumption despite negative consequences. Although addictive drugs have diverse molecular targets in the brain, they share the common initial effect of increasing the concentration of dopamine released from mesocorticolimbic projections.
In this article, we review recent research that has advanced our understanding of the molecular mechanisms underlying this increase of dopamine. Based on this research, we propose a new classification for addictive drugs that we believe may help in directing research towards more effective treatment of addiction "

Dispute over schizophrenia drugs

2006-11-26T02:36:00.000-08:00

BBC NEWS Health Dispute over schizophrenia drugs: "A Manchester University study shows patients respond just as well, and perhaps better, to the older ones.
The Archives of General Psychiatry findings run contrary to the widely held view that newer and dearer drugs are safer and more effective.
But critics say the newer drugs are better and preferred by patients because they have fewer side effects. "

The Genetics of Schizophrenia | Tracking the Origins of the "Cancer of the Mind"

2006-11-21T15:10:00.000-08:00

The Genetics of Schizophrenia Tracking the Origins of the "Cancer of the Mind": "In 1959, John Nash, a brilliant, but somewhat odd, 30-year-old mathematician at the Massachusetts Institute of Technology, experienced the first of several delusional episodes that would lead to his breakdown and that would cause him to spend many years hospitalized. In 1994, as his disease was waning, he was awarded the Nobel Prize in Economics for work in game theory performed in his 20s. A movie about his life, A Beautiful Mind, and a PBS television program, A Brilliant Madness, introduced the general public to his disease, schizophrenia. In a filmed interview for PBS, Nash provides a glimpse of his experience as a schizophrenic:
I had this feeling of persecution. I had the idea that some of the people, I think Eisenhower was still president then, and the Pope and the powers that be might be unsympathetic to me. I envisioned a hidden world where the Communists and non-Communists were into this thing—they were sort of schemers ... I got the idea that I would receive a message somehow. Later on, I felt that I might get a divine revelation by seeing a certain number that would appear. A great coincidence could be interpreted as a message from heaven."
Though sometimes called "the cancer of the mind," schizophrenia remains much more mysterious than the diseases we know as cancer, according to Daniel Weinberger of the National Institute of Mental Health (NIMH), speaking at the June 7, 2006, session of the Academy's Genomic Medicine Discussion Group. "We know that one way or another, cancer genes disrupt the regulation of the cell cycle," he told the audience. "We don't know what schizophrenia is at a biological level." He predicted that the human genome project may have more impact on our understanding of mental disorders than on any other area of medicine, because the genes scientists discover will provide crucial information about the mechanisms of these diseases./.../"

Violence and Mental Illness -- How Strong is the Link?

2006-11-15T16:23:00.000-08:00

NEJM -- Violence and Mental Illness -- How Strong is the Link?:
"On Sunday afternoon, September 3, 2006, Wayne Fenton, a prominent schizophrenia expert and an associate director at the National Institute of Mental Health (NIMH), was found dead in his office. He had just seen a 19-year-old patient with schizophrenia who later admitted to the police that he had beaten Fenton with his fists.
This tragic incident was widely publicized and raises, once again, the controversial question about the potential danger posed by people with mental illness. The killing also left many in the mental health and medical communities concerned about their own safety in dealing with psychotic patients. After all, if an expert like Fenton, who understood the risks better than most, could not protect himself, who could?
It is not an idle question. According to the National Crime Victimization Survey for 1993 to 1999, conducted by the Department of Justice, the annual rate of nonfatal, job-related, violent crime was 12.6 per 1000 workers in all occupations. Among physicians, the rate was 16.2 per 1000, and among nurses, 21.9 per 1000. But for psychiatrists and mental health professionals, the rate was 68.2 per 1000, and for mental health custodial workers, 69.0 per 1000./.../ "
An audio interview with Dr. Richard Friedman

Psychotherapy, Gene Pioneers Honored - Forbes.com

2006-09-17T05:51:00.000-07:00

Psychotherapy, Gene Pioneers Honored - Forbes.com: "Pioneers in psychotherapy and cell biology and three scientists who discovered a crucial enzyme linked to cancer and aging are being awarded prestigious medical prizes. The $100,000 prizes from the Albert & Mary Lasker Foundation will be presented Friday in New York. The Lasker award for clinical medical research goes to Aaron Beck, 85, emeritus professor of psychiatry at the University of Pennsylvania School of Medicine. He developed cognitive therapy, which has transformed the treatment of such psychiatric conditions as depression, suicidal behavior, panic attacks and eating disorders, the foundation said. Beck proposed that depression resulted from unduly negative beliefs and bias against oneself rather than unconscious drives. He led his patients to examine the accuracy of such beliefs, a process that did indeed lift depression. The approach has since been adapted to other psychiatric conditions. "Beck has made a huge impact on untold numbers of people, relieving immeasurable amounts of suffering," the foundation said. The prize for special achievement in medical science goes to Joseph Gall, 78, of the Carnegie Institution's embryology department in Baltimore. He is being honored as a founder of modern cell biology and of the study of structure and function of chromosomes, and for being an early champion of women in science. Nearly 40 years ago, Gall and a graduate student devised one of the most widely used techniques in cell biology, called in situ hybridization, which lets scientists locate genes or other specific bits of DNA within tissues or cells. Three scientists share the Lasker prize for basic medical research for predicting and discovering an enzyme called telomerase. They are Elizabeth Blackburn, 57, of the University of California, San Francisco; Carol W. Greider, 45, of the Johns Hopkins University School of Medicine in Baltimore, and Jack W. Szostak, 53, of Harvard Medical School. Telomerase adds DNA to the tips of chromosomes to replace genetic material that has eroded away. The prize-winners' work set the stage for research suggesting that cancer cells use telomerase to sustain their uncontrolled growth. Scientists are studying whether drugs that block the enzyme can fight the disease. In addition, scientists believe that the DNA erosion the enzyme repairs might play a role in age-related illnesses. "

Obsessive-compulsive disorder -- Heyman et al. 333 (7565): 424 -- BMJ

2006-08-25T18:07:00.000-07:00

Obsessive-compulsive disorder -- Heyman et al. 333 (7565): 424 -- BMJ: "Obsessive-compulsive disorder is one of the more common serious mental illnesses. The shame and secrecy associated with it, as well as lack of recognition of its characteristic symptoms, can lead to delay in diagnosis and treatment. Effective psychological and drug treatments are available for the distressing, time consuming, repetitive thoughts and rituals and the associated functional impairment. This article reviews the presentation and assessment of obsessive-compulsive disorder and discusses the current best treatment options, as well as directions for the future. "

Pós Graduação Latu-Sensu em Dependência Química - RJ Reconhecido pelo MEC

2006-08-22T07:11:00.000-07:00

(Convite enviado por Analice Gigliotti [analice@iis.com.br])
Escola Paulista de Medicina (UNIFESP) Centro de Estudos do Departamento de Psiquiatria da UNIFESP/EPM UNIAD - Unidade de Pesquisa em Álcool e Drogas
Santa Casa da Misericórdia do Rio de Janeiro
Pós Graduação Latu-Sensu em Dependência Química - RJ Reconhecido pelo MEC

Pré Requisitos:
Disponibilidade para leitura de textos em inglês
Interesse ou atividade profissional relacionada ao atendimento de dependentes químicos
Disponibilidade para apresentação de seminários e de casos

Coordenação:

Geral - Prof. Dr. Ronaldo Laranjeira - Psiquiatra, PhD em Psiquiatria pela Universidade de Londres e Coordenador - UNIAD-UNIFESP/EPM.

Local – Profa. Dra. Analice Gigliotti – Psiquiatra, Especialista em Dependência Química UNIFESP e Mestre em Medicina pelo Depto. Psiquiatria da UNIFESP e Chefe do Setor de Dependência Química do Serviço de Psiquiatria da Santa Casa de Misericórdia do RJ.

Aulas e Carga Horária:

As aulas ocorrem quinzenalmente, aos sábados das 08hs às 18hs – no Serviço de Psiquiatria da SCMRJ - Carga horária de 360hs.Obs.: No primeiro mês as aulas serão semanais passando a partir do segundo mês a ser quinzenais.

Datas:

Inscrições: De 18/07 a 11/09
Aulas: 07/10/2006 a 08/12/2007 - férias de 17/12/2006 a 26/01/2007

Investimento:

Inscrição: R$ 150,00
Matrícula: R$ 70,00
Mensalidade: Quinze parcelas de R$ 400,00

Inscrições:
http://procdados.epm.br/dpd/proex/index.htm Procurar em Psiquiatria > Dependência Química - Fora de Sede. Caso não consiga fazê-lo, ligar para Marta (21)2210 5564

Processo Seletivo:
Entrevista de Seleção em 23/09/2006. Agendar com Marta (21)22105564 ou psiquiatriascmrj@uol.com.br para os que fizeram previamente a inscrição pela internet

Matrícula:
Documentos: 2 fotos 3x4 colorida sem data, curriculum vitae. Cópia: histórico escolar, diploma de graduação, RG, CPF, título de eleitor, comprovante última eleição, certidão de nascimento/casamento, tipagem sanguínea.

Maiores Informações:
Serviço de Psiquiatria da SCMRJ – Rua Santa Luzia 206 – Centro – CEP 20020-020
E-mail: cursos@uniad.org.br ou psiquiatriascmrj@uol.com.br
Tel. (11) 5571-0493 com Alex ou Tatiane e (21) 2210-5564 com Marta

Ketamine: immediate treatment of depression

2006-08-08T04:22:00.000-07:00

http://www.medpagetoday.com/Psychiatry/Depression/dh/3877

BETHESDA, Md., Aug. 7 -- Symptoms of depression can be made to disappear in less than two hours with a common anesthetic, not the weeks or months required for onset of relief with traditional antidepressants, according to results of a pilot study.
"We have broken the sound barrier in depression treatment," said Carlos A. Zarate, Jr., M.D., chief of the mood disorders section the National Institute of Mental Health, who reported on the effects of ketamine, a common anesthetic, in the August 8 issue of the Archives of General Psychiatry.
Dr. Zarate and colleagues said a single injection of ketamine, which targets the N-methlyl-D-aspartate (NMDA) receptor, can eliminate depression symptoms within 110 minutes. /.../

Obesity Linked to Depression, or Vice Versa - CME Teaching Brief - MedPage Today

2006-07-06T04:45:00.000-07:00

Obesity Linked to Depression, or Vice Versa - CME Teaching Brief - MedPage Today: "SEATTLE, July 5 � Depression and obesity are often partners in pathology, according to investigators here.
Obese persons have a 20% elevated risk of depression compared with those of normal weight, reported Gregory E. Simon, M.D., M.P.H., of the Group Health Cooperative here, and colleagues in the July issue of Archives of General Psychiatry.
For white, college-educated obese individuals, the additional depression risk reaches as high 44%, said Gregory E. Simon, M.D., M.P.H., of the Group Health Cooperative here in the July issue of Archives of General Psychiatry. "

The Depression Report

2006-07-03T05:14:00.000-07:00

The depression report

The New Science of Siblings

2006-07-02T14:31:00.000-07:00

The New Science of Siblings
(cover matter from the last Time Magazine)
Your parents raised you. Your spouse lives with you. But it's your brothers and sisters who really shaped you. Surprising research reveals howBy JEFFREY KLUGER
There are a lot of ways to study a painting, and one of the best is to get to know the painter. The splash or splatter of color makes a lot more sense when you understand the rage or whimsy or heart behind it. The songwriter, similarly, can lay bare the song, the poet the poem, the builder the building.
So what explains the complex bit of artistry that is the human personality? We may not be born as tabulae rasae. Any parent can tell you that each child comes from the womb with an individual temperament that seems preloaded at the factory. But from the moment of birth, a lot of things set to work on that temperament--moderating it, challenging it, annealing it, wounding it. What we're left with after 10 or 20 or 50 years is quite different from what we started out with.
For a long time, researchers have tried to nail down just what shapes us--or what, at least, shapes us most. And over the years, they've had a lot of eureka moments. First it was our parents, particularly our mothers. Then it was our genes. Next it was our peers, who show up last but hold great sway. And all those ideas were good ones--but only as far as they went.
The fact is once investigators had strip-mined all the data from those theories, they still came away with as many questions as answers. Somewhere, there was a sort of temperamental dark matter exerting an invisible gravitational pull of its own. More and more, scientists are concluding that this unexplained force is our siblings.
From the time they are born, our brothers and sisters are our collaborators and co-conspirators, our role models and cautionary tales. They are our scolds, protectors, goads, tormentors, playmates, counselors, sources of envy, objects of pride. They teach us how to resolve conflicts and how not to; how to conduct friendships and when to walk away from them. Sisters teach brothers about the mysteries of girls; brothers teach sisters about the puzzle of boys. Our spouses arrive comparatively late in our lives; our parents eventually leave us. Our siblings may be the only people we'll ever know who truly qualify as partners for life. "Siblings,%

BORGES HABLA A LOS PSICOANALISTAS

2006-06-25T16:33:00.000-07:00

Eviado por: Marcelo Gustavo Colominas [mgcolominas@hotmail.com]
BORGES HABLA A LOS PSICOANALISTAS
“Fábula de la noche”
“A todos nosotros, sobre todo a quienes han cometido la imprudencia de cumplir 81 años, nos han sucedido cosas terribles. Pero el sabor de lo terrible no es el sabor de la pesadilla, que es inconfundible, como el sabor del café”, dijo Borges, en 1980, en una conferencia destinada a un público de psicoanalistas.

POR JORGE LUIS BORGES *

Iniciaremos este diálogo con una referencia a Paul Groussac. El libro se llama El viaje intelectual, creo que en la segunda serie hay un artículo titulado “Entre sueños”, y Groussac, al fin de ese artículo, se asombra, creo que con toda razón, de que cada mañana salgamos de ese confuso laberinto, de ese orbe irracional de los sueños, y nos despertemos relativamente cuerdos, relativamente lúcidos. A él le parece muy raro que, después de ese eclipse, recobremos, más o menos, la razón, y creo que Groussac dice la verdad. Creo que los sueños son uno de los hechos más singulares de la vida. Es desde luego el problema: cómo dividir los sueños de la vigilia. Pero ya veremos algo de eso después.

Creo que Lucrecio también habla de los sueños, pero tendríamos citas más cercanas. Hay unos versos de Góngora: “El sueño, autor de representaciones/ en su teatro, sobre el viento armado,/ sombras suele vestir de bulto bello”.
Bulto quiere decir apariencia o rostro. Luego habría un pasaje análogo de Addison, un pasaje posterior, ya que Góngora corresponde al siglo XVII y Addison al siglo XVIII, en uno de los cuatro volúmenes del Spectator, El espectador, famosa revista de Addison, de Steele y otros; ahí, en un artículo referido a los sueños, cita ese autor latino que no recuerdo, y luego dice que cuando dormimos se enciende en nuestro cerebro un pequeño teatro y que, milagrosamente, inexplicablemente, somos los actores, el auditorio, el edificio –incluyendo la escena, naturalmente–, el autor y las palabras que se dicen, es decir, él recalca, lo mismo que Góngora, el carácter histriónico de los sueños.

El psicólogo Spieler, en su libro The mind of man, dice que los sueños corresponden a la forma más baja del pensamiento, a la forma más pobre del pensamiento. Bueno, esto podría tener sentido si interpretamos que los sueños pueden corresponder a la mente primitiva, es decir, en los sueños nosotros no usamos razonamientos pero sí estamos, digamos, urdiendo fábulas, mitos, y el hecho de que sean disparatados no importa. Podríamos decir, creo que no sería una exageración, que los sueños son la forma estética más antigua de todas, parece que los hombres siempre han soñado y, sin duda, en el caso de los salvajes, no se distinguen los sueños de la vigilia. Los chicos tampoco distinguen bien los sueños de la vigilia. Yo recuerdo, vivíamos en Adrogué entonces, yo vivía con mi hermana, con sus hijos, nos contaban sus sueños, todas las mañanas; en casa teníamos esa tradición, recuerdo que le pregunté a mi sobrino, que tendría seis o siete años, le pregunté qué había soñado, y él me dijo: “Yo soñé que me había perdido, que yo me había perdido en un bosque, y vi una casita de madera, entonces fui a la casita, la puerta se abrió y saliste vos”. Luego interrumpió el relato para preguntarme: “¿Qué estabas haciendo en esa casita?”. Es decir, él no hacía ninguna diferencia entre los sueños y la vigilia, y quizás esta anécdota ilustre más lo que Schopenhauer llamó “das traumhafte Wesen des
Lebens”: el ambiente onírico de la vida, pero no sé si la palabra onírico es exacta, parece pedantesca, en cambio si yo digo traumhafte en alemán, o dreamlike en inglés, uso una palabra más parecida al lenguaje oral.

Desde luego, para el idealismo no hay una diferencia esencial entre vivir y soñar. Creo que si eso se dice, digamos, de un modo abstracto, como lo dice Calderón en el título de su drama La vida es sueño, no nos impresiona; en cambio, si se dice de un modo indirecto, como en esa pequeña anécdota que yo me he permitido referir, “Qué estabas haciendo en esa casita”, ahí se siente la afinidad de la vida y el sueño. Y yo tengo una mala costumbre, que ustedes conocen, pero no sé si es una mala costumbre, de citar siempre a Chuang Tzu, uno de los padres del taoísmo, cuya fecha corresponde a cinco siglos antes de la era cristiana, y recuerdo esta frase que me impresionó tanto cuando la leí por primera vez en un libroque fue comentado por Oscar Wilde, una versión de Chuang Tzu hecha por Herbert Allen Giles, después he leído otras hechas por un misionero escocés, Legge, y la de Wilhelm, la más conocida de todas. Bueno, más o menos Chuang Tzu dice: “Chuang Tzu soñó que era una mariposa, y no sabía, al despertar, si era un hombre que había soñado ser una mariposa o si era una mariposa que ahora soñaba ser un hombre”. Yo querría detenerme acá un momento para señalar, digámoslo, el acierto de haber elegido una mariposa, porque si Chuang Tzu hubiera dicho:
Chuang Tzu soñó que era un tigre y no sabía al despertar si era un tigre que había soñado ser un hombre, bueno, esto no habría dicho absolutamente nada; en cambio, parece que la mariposa conviene a lo frágil, a lo evanescente de los sueños, y él ha acertado plenamente.

Hay también un artículo muy lindo de Stevenson, “A Chapter of Dreams”, “Un capítulo sobre sueños”, y ahí él dice que solía soñar, él solía tener pesadillas. Ustedes sin duda conocen bien la literatura, una literatura sobre pesadillas. Yo lo he buscado en vano en el libro de Havelock Ellis, en otros libros hay referencias a los sueños, pero no se insiste en la pesadilla; la pesadilla, esa suerte de tigre en los sueños, me parece especialmente importante. Coleridge dijo que en la vigilia los hechos producen las emociones –por ejemplo, si entrara un león aquí sentiríamos miedo, y, suponiendo que uno esté acostado, si sobre mi pecho se acuesta una esfinge, me quedo horrorizado–, pero que en los sueños ocurre lo contrario, es decir que las imágenes de los sueños no producen emociones, sino que las emociones engendran las imágenes, lo cual estaría de acuerdo con lo que yo dije hace un rato, que los sueños son, bueno, quizá la más antigua de las formas del arte, y los sueños se dan hasta entre los animales; recuerdo esa línea del poeta latino que dice “El perro ladra siguiendo los rastros de la liebre”, el perro que duerme. Bueno, dice Stevenson que él solía tener pesadillas, todos las tenemos, y que había algo que le inspiraba un horror especial, que era cierto matiz del color pardo. Ahora, que ese matiz del color pardo no le inspiraba horror en la vigilia, pero soñando sí, le inspiraba horror, y luego cuenta un sueño de él en el cual hay un altillo, un viejo gato, no, un perro, que está tendido, y luego el perro le guiña inexplicablemente un ojo, y él siente eso como terrible.

Stevenson cuenta también que él estaba durmiendo y gritó, que su mujer lo despertó y que él le dijo: me has despertado de una lindísima pesadilla; y él había soñado la escena central de Jekyll y Hyde. Lo que él soñó fue el momento en el cual Jekyll toma la droga y se transforma en Hyde, es decir, en un ser hecho, no del bien y del mal como todos nosotros, sino de puro mal; él soñó eso, y, dice, lo demás tuve que inventarlo yo a mi pobre manera humana, pero el don nos fue dado por el sueño.

Y ahora vamos al tema de la pesadilla. Es una lástima que en el idioma castellano la palabra sea tan fea, pesadilla, pero qué vamos a hacer, tenemos que sobrellevar el idioma; en cambio, en otros idiomas, por ejemplo en francés, cauchemar; en inglés, curiosamente, nightmare vendría a ser “yegua de la noche”. Sin duda Victor Hugo conocía bien el inglés, a Victor Hugo le llamaba la atención esta hermosa palabra, “yegua de la noche”
–Shakespeare habla de la yegua de la noche y de sus potrillos, que son nueve– y entonces él habla de la pesadilla en las Contemplations y la llama, sin duda pensando en la imagen que le dio el idioma inglés, la llama a la pesadilla le cheval noir de la nuit, el caballo negro de la noche. Creo que, según los etimólogos ingleses, nightmare no significó originariamente yegua de la noche, creo que nightmare puede ser fábula de la noche, ya que la pesadilla es una ficción de las horas de la noche, o demonio de la noche.

En alemán tenemos la palabra Alp, que no tiene nada que ver con los Alpes, esa palabra quiere decir elfo, corresponde a un modo antiguo de decir elfo, es decir, todo esto equivaldría a la idea del demonio, del súcubo. Y en griego la palabra es muy hermosa también, efialtes, que es el demonio que causa la pesadilla. Se entiende que ese demonio se acuesta, oprime el vientre de quien está durmiendo y le da la pesadilla. De modo que tendríamos una idea parecida: nightmare, Alp y efialtes, la idea de un demonio.

Esto me lleva a otra idea –pero es una pequeña aventura teológica, de la cual me voy a arrepentir enseguida–, a la idea de que hay algo en la pesadilla que no se da en la realidad. Por ejemplo, a todos nosotros, sobre todo a quienes han cometido la imprudencia de cumplir 81 años, nos han sucedido cosas terribles. Pero el sabor de lo terrible no es el sabor de la pesadilla, que es un sabor inconfundible, digamos como el sabor del café o el sabor del té, o ese otro sabor que vendría a ser el color amarillo. Hay algo en la pesadilla que no corresponde a la realidad. Entonces esos nombres tendrían razón, ya que, al decir efialtes o al decir Alp, nos referimos a un ser sobrenatural, a un demonio, de modo que la pesadilla, con ese sabor, que, como dijo Coleridge, no procede de las imágenes sino del sentimiento que invocan, ése vendría a ser el sabor del infierno, salvo que yo no creo en el infierno, pero en este momento vamos a aceptar eso. Quiero decir que los sueños están hechos de memorias, la memoria desde luego incluye el olvido, quizá sea imposible sin olvidos o sin modificaciones, bueno, pues habría algo que se da en los sueños que no se da en la realidad, el sabor peculiar de la pesadilla.

Y aquí quiero mencionar un libro que me gusta mencionar, que recuerdo todos los días, La Divina Comedia de Dante. Uno pensaría que el sabor de la pesadilla está sobre todo en los primeros cantos, en los cantos del Infierno; y sin embargo eso no ocurre, ya que el Infierno del Dante es un lugar en el que ocurren cosas atroces, donde ocurren torturas, por ejemplo, pero el sabor de la pesadilla sólo se encuentra en aquel canto, tranquilo, terriblemente tranquilo, donde él describe el nobile castello, el noble castillo donde están las grandes almas de la antigüedad, a quienes les está negada la visión de Dios, y también está el gran guerrero Saladino, y él se encuentra con Homero, con la espada en la mano, ahí está Virgilio, ahí está Lucano, ahí está Ovidio, ahí está Horacio, todos ellos viven en ese noble castillo y están desesperados, bueno, no pueden esperar nada, saben que no llegarán a Dios, y Dante los imagina en ese castillo silencioso, y creo que en ese canto, del nobile castello, ahí está la presencia de la pesadilla, el de un horror que no se da en los otros cantos, donde solamente hay hechos atroces pero no lo que yo llamo el sabor peculiar de la pesadilla, esa sensación que sólo se da en la pesadilla y no, aun cuando nos ocurran cosas atroces, en la vigilia.

* Fragmento de la conferencia “Los sueños y la poesía”, pronunciada el 19 de septiembre de 1980 en la EFBA e incluida en el libro Borges en la Escuela Freudiana de Buenos Aires (ed. Agalma). Próximamente –con el auspicio de la Secretaría de Cultura de la Nación–, la EFBA presentará un CD con el audio de las conferencias.

Ego traps us in costly, losing battles, study finds

2006-06-15T21:03:00.000-07:00

Ego traps us in costly, losing battles, study finds: "A gambler plunges deeper into debt when crushing losses should scream to him to quit. A banker keeps lending to someone who clearly won’t pay back. A leader pours troops and money into a war that has become a quagmire."

Bipolarv1_406.pdf (application/pdf Object)

2006-06-02T04:53:00.000-07:00

v1_406.pdf (application/pdf Object)
Depressive disorders are among the most
frequently encountered mental illnesses in
the primary care setting. Major depressive
disorder (MDD), known colloquially as
“clinical depression,” will be experienced
by 1 in 6 people in the United States at
some point in their lives.1 The personal,
societal, and economic costs of MDD and
other depressive disorders are profound:
• Among the 90% of US suicides attributable
to diagnosable mental disorders, depressive disorders are the most significant contributors 2
• MDD is the leading cause of disability among US people aged 15 to 442
• In the United States, MDD incurs an annual cost of approximately $83 billion: $26.1 billion for medical care, $5.4 billion for suicide-related mortality, and $51.5
billion in workplace costs 3/.../

ADHD Drugs and Cardiovascular Risk

2006-05-24T18:02:00.000-07:00

NEJM -- ADHD Drugs and Cardiovascular Risk: "To the Editor: Nissen (April 6 issue)1 recommends attaching a 'black box' warning regarding serious cardiovascular risks to the labeling of stimulant medications used to treat attention deficit�hyperactivity disorder (ADHD). We agree that patient safety is paramount and that the long-term benefits and risks of stimulant treatment are not known definitively, yet we are concerned that such a warning will discourage patients and their families from using effective treatment. Untreated ADHD is associated with an elevated risk of substance abuse, academic failure, and motor vehicle accidents and an increased rate of psychiatric disorders.2 "

Nearly Half of Women No Strangers to Domestic Violence - CME Teaching Brief - MedPage Today

2006-05-17T07:53:00.000-07:00

Nearly Half of Women No Strangers to Domestic Violence - CME Teaching Brief - MedPage Today: "SEATTLE, May 16 — Domestic violence has struck nearly half of all women, about 44%, at some point during their adult lives, according to a survey.

Considerably fewer women, about 15%, reported domestic violence within the past five years, and that figure fell to about 8% for incidents in the past year, reported Robert S. Thompson, M.D., of the Group Health Center for Health Studies here in the June issue of the American Journal of Preventive Medicine."

Prevalence of deliberate self harm and attempted suicide within contemporary Goth youth subculture: longitudinal cohort study -- Young et al. 332 (754

2006-05-06T11:45:00.000-07:00

Prevalence of deliberate self harm and attempted suicide within contemporary Goth youth subculture: longitudinal cohort study -- Young et al. 332 (7549): 1058 -- BMJ: "Deliberate self harm is relatively common among young people, with rates of 7%-14% in the United Kingdom.1 2 Common acts of self harm include cutting, burning, and punching, usually resulting in relatively minor injury; rarer, more serious, acts include self poisoning.

Self harm is understood to be a maladaptive coping strategy intended to relieve negative emotions such as anger, anxiety, frustration, or guilt. It is usually unrelated to an immediate suicide attempt. Knowledge about risk factors is limited, but previous research has implicated peer modelling and depression.1 2 Self harm is related to later risk of suicide and psychiatric disorder and has a high prevalence among certain subpopulations, notably prisoners and homosexual and bisexual people.1-3 The media have linked contemporary Goth youth subculture with self harm,4 but evidence for this is sparse. 'Goth' could be described as a subgenre of punk with a dark and sinister aesthetic, with aficionados conspicuous by their range of distinctive clothing and makeup and tastes in music.4 5 We investigated whether identification with Goth is associated with self harm."

Sigmund Freud - encyclopedia article about Sigmund Freud.

2006-05-06T11:29:00.000-07:00

Sigmund Freud - encyclopedia article about Sigmund Freud.: "Sigmund Freud (May 6, 1856 – September 23, 1939; [ˈziːgmʊnt ˈfrɔʏ̯t]) was an Austrian neurologist and the founder of the psychoanalytic school of psychology, based on his theory that unconscious motives determine much behavior, that particular kinds of unconscious thoughts and memories, especially sexual and aggressive ones, are the source of neurosis, and that neurosis could be treated through bringing these unconscious thoughts and memories to consciousness in psychoanalytic treatment. He was initially interested in hypnotism and how it could be used to help the mentally ill, but later abandoned hypnotism in favor of free association and dream analysis in developing what is now known as 'the talking cure.' These became the core elements of psychoanalysis. Freud was initially especially interested in what was then called hysteria (now known as conversion syndrome), but expanded his work to other forms of neurosis, especially obsessive-compulsive disorder./.../ "

Insight Into Depression

2006-05-02T04:54:00.000-07:00

Insight Into Depression | About Us: "Mission Statement
Insight Into Depression's mission is to provide non-psychiatry trained health care professionals with high quality, peer-reviewed CME opportunities and comprehensive scientific and clinical information in the specific area of Major Depressive Disorders (MDD) to improve the diagnosis of these disorders commonly overlooked in the primary care setting"

Insight Into Depression

2006-04-24T04:16:00.000-07:00

Insight Into Depression | About Us: "Insight Into Depression's mission is to provide non-psychiatry trained health care professionals with high quality, peer-reviewed CME opportunities and comprehensive scientific and clinical information in the specific area of Major Depressive Disorders (MDD) to improve the diagnosis of these disorders commonly overlooked in the primary care setting.
Initiative Overview
Through multi-curricula and multimedia platforms, Insight Into Depression strives to be the source of MDD education and information for primary care, general practice, and family practice physicians, as well as internal medicine specialists. As components of the Insight Into Depression integrated initiative may be of interest to additional health care providers and clinicians, activities will be open to all practitioners involved in the diagnosis and/or treatment of MDD."

Insight Into Depression

2006-04-24T04:14:00.000-07:00

Insight Into Depression About Us: "Insight Into Depression's mission is to provide non-psychiatry trained health care professionals with high quality, peer-reviewed CME opportunities and comprehensive scientific and clinical information in the specific area of Major Depressive Disorders (MDD) to improve the diagnosis of these disorders commonly overlooked in the primary care setting.
Initiative Overview
Through multi-curricula and multimedia platforms, Insight Into Depression strives to be the source of MDD education and information for primary care, general practice, and family practice physicians, as well as internal medicine specialists. As components of the Insight Into Depression integrated initiative may be of interest to additional health care providers and clinicians, activities will be open to all practitioners involved in the diagnosis and/or treatment of MDD.
The following goals were developed as guiding objectives for health care practitioners participating in Insight Into Depression continuing medical education activities:
Recognize barriers to the diagnosis of depression in the primary care setting
Identify common medical conditions that can confuse the diagnosis of depression
Develop strategies for communicating with patients about the diagnosis, prognosis, and initiation and duration of therapy
Review the critical importance of compliance with treatment regimens with patients and their families or other support members
Adopt a systematic approach to monitoring patient response and develop strategies, including referral, for dealing with an inadequate response to therapy
Use best evidence available in treating the individual patient as a whole/.../ "

Insight Into Depression

2006-04-24T04:08:00.000-07:00

Insight Into Depression
Depression has reached dramatic proportions and represents a national problem that is often ignored, either because it is not recognized, diagnosed properly and/or because of the stigma that is still attached to it. Therefore, Insight Into Depression was founded in 2006 as a joint CME initiative by the University of Pennsylvania School of Medicine and its educational partner, Atlas Medical Communications to address the current need for additional education about the diagnosis and treatment of major depressive disorders for primary care, general practice, and family practice physicians, as well as internal medicine specialists.

Addiction Relapse Associated with Temptation Brain Chemical - CME Teaching Brief - MedPage Today

2006-04-14T05:19:00.000-07:00

Addiction Relapse Associated with Temptation Brain Chemical - CME Teaching Brief - MedPage Today: "Review
ANN ARBOR, Mich., April 13 - A stress-related brain chemical that seems to create a susceptibility to temptation may be related to why alcoholics fall off the wagon or clean drug addicts turn recidivist. The chemical is called corticotropin-releasing factor.
So it appears in rats. Corticotropin-releasing factor has long been known to be involved in aversive behavior, making people or animals shy away from pain or distress. But paradoxically, it also appears to play a role in one of the brain's reward systems, according to Kent Berridge, Ph.D., of the University of Michigan.
'In this one reward-related structure -- the nucleus accumbens -- it seems to be having this paradoxical effect of turning on the desire for a reward,' Dr. Berridge said in an interview from Cambridge, England, where he is a visiting professor.
Corticotropin-releasing factor, which is released during stress, has mostly negative effects, including appetite suppression, Dr. Berridge and colleagues noted in the April 13 online issue of the open access journal BMC Biology. But in the nucleus accumbens of experimental rats, it appears to trigger an increased appetite for a pleasurable reward. /.../"

MRI scans may have antidepressant effect - Mental Health - MSNBC.com

2006-04-04T18:59:00.000-07:00

MRI scans may have antidepressant effect - Mental Health - MSNBC.com
(Recomendado por Ana Robinson Achutti)
MRI scans may have antidepressant effect Study suggests electromagnetic fields can affect brain biology
Reuters
Updated: 6:25 p.m. ET March 10, 2005
WASHINGTON - High-speed magnetic resonance imaging scans produce effects in rats similar to the use of antidepressants, confirming observations made in human patients, U.S. researchers reported Thursday.
The finding suggests that electromagnetic fields can affect brain biology, the team at McLean Hospital and Harvard Medical School reported.
“We found that when we administered the magnetic stimulation to the rats, we saw an antidepressant-like effect, the same effect as seen after administration of standard antidepressant drugs,” said William Carlezon, director of McLean’s Behavioral Genetics Laboratory.
Writing in the journal Biological Psychiatry, Carlezon and colleagues said they tested the rats after another team at the hospital reported a new type of magnetic resonance imaging, called echo planar magnetic resonance spectroscopic imaging (EP-MRSI), had improved the mood of people in the depressed phase of bipolar disorder.
The new study was designed “to see if we could demonstrate in an animal model what the clinicians thought they were seeing in humans,” Carlezon said.
When repeatedly stressed, rats develop helpless behavior, which may be their version of despair, the researchers said. But in the experiment, the rats that had been exposed to EP-MRSI showed less helplessness during the stress tests.
“They behaved as if they had received an antidepressant,” said Dr. Bruce Cohen, psychiatrist in chief at McLean.
“It’s a non-drug way to change the firing of nerve cells,” Cohen said. “That’s why the implications of this work have the potential to be so profound.”
MRIs more invasive than thought?While this may offer a new way to treat depression, it also suggests that at least some forms of MRI are more invasive than previously thought, the researchers said.
“Renewed caution is warranted when high-speed MRI is used to diagnose or study disorders involving the brain,” the researchers wrote.
“People assume when they are getting an MRI that nothing is happening, that you are simply getting a picture of the brain. But in actuality the body is being exposed to magnetic and electrical fields,” Carlezon said.
“They may cause other effects we don’t understand yet,” he added.

Gracias, Sigmund

2006-03-31T06:26:00.000-08:00

De: Marcelo Gustavo Colominas [mailto:mgcolominas@gigared.com]
Enviada em: sexta-feira, 31 de março de 2006 11:09
Para: "Undisclosed-Recipient:;"@n8.gigared.com
Assunto: Gracias, Sigmund (M. Aguinis)

Gracias, Sigmund
WASHINGTON

Este año se conmemora el 150° aniversario del nacimiento de Sigmund Freud. En muchos países se realizan actividades que evocan su vida y su fascinante obra. La bibliografía desenfrenada sobre su pensamiento es inabarcable, y los aspectos ligados con ella comprenden casi todos los rincones del laberinto humano.

En los Estados Unidos, sin embargo, se ha vacilado a partir de la segunda mitad del siglo XX entre una rendida admiración y el rechazo torpe. Freud visitó este país en 1909, por poco tiempo, y saludó a su público con una frase inolvidable: “Vengo a traerles la peste”. Después, su prestigio aumentó en forma sostenida y la Segunda Guerra Mundial determinó la llegada de notables discípulos, que se ocuparon de difundir y ampliar el campo del psicoanálisis.

Pero la aparición de terapias alternativas y de psicofármacos puso en cuestión su calidad y eficacia. En los años 90 parecía registrarse una caída irremediable, lo cual es ahora, de súbito, objeto de una revisión. Pocos años atrás se decía que Freud había muerto. Ahora se empieza a decir que está muy vivo, respaldado por disciplinas que hasta hace poco se consideraban sus sepultureros. La acusación de que fue más poeta que científico se diluyen al recordar que empezó sus trabajos en la ardua investigación histológica y que durante el resto de su existencia lo obsesionó verificar la certeza de sus descubrimientos, al extremo de que a veces mantenía versiones diferentes sobre una misma cuestión a la espera de poder resolverlas con fundamento más adelante, él mismo o sus continuadores.

El laboratorio de sus años iniciales se transformó en el laboratorio de su consultorio psicoanalítico. Al principio estudiaba con microscopio las células del sistema nervioso central y luego, con lupa de entomólogo (o de Sherlock Holmes), los mínimos detalles de las palabras de sus pacientes, para hacer visibles escandalosos secretos.

En una precoz carta a su novia Martha Bernays, le escribió: “Preciosa amada... en este momento estoy tentado por el deseo de descifrar el acertijo de la estructura cerebral. Creo que la anatomía es el único verdadero rival que tienes o tendrás en la vida”. Inventó un método de coloración que le permitía la observación más detallada de las células.

Algunos de sus dibujos, realizados con el arte de Leonardo (que después analizaría en un famoso escrito), serán exhibidos en un homenaje que le brindará la Academia de Medicina de Nueva York dentro de un mes. Prueban su calidad de observador su destreza para captar detalles y su imaginación conceptual. Publicó varios trabajos sobre la histología de los peces y un libro sobre la afasia, antes de empezar el prodigioso develamiento de la mente humana. Fue un profesional de damasquinado rigor que jamás deseó apartarse de la recta científica, pero que estaba bendecido, además, por un excepcional talento literario. Gracias a la seducción de sus textos, pudo vencer las espinosas resistencias que generaron hipótesis revolucionarias, destinadas a sedimentar un procedimiento novedoso de tratamiento, basado, sin embargo, en la herramienta más antigua, valiosa y despreciada del hombre: la palabra.

Hasta hace poco parecía que las neurociencias iban a matar el psicoanálisis. Ahora se multiplican las voces que reconocen el valor de las semillas sembradas por Freud. En la época victoriana, ocuparse de la mente era tarea de filósofos y especuladores. Cinco años antes de lanzar su fundamental Interpretación de los sueños (1900: inauguró el siglo), Freud escribió su arduo Proyecto para una psicología científica. Era un esfuerzo creador impresionante, porque en ese tiempo se carecía de suficiente información histológica y fisiológica y no había escáneres de resonancia magnética, potenciales evocados, ADN ni aportes de la química.

Freud nunca quiso publicar esa obra, que fue impresa después de su muerte. Allí aparecen los brotes de futuras ideas. Se trata de un modelo cohesivo entre la mente y el cerebro, cosa que ahora nos parece obvia, pero que entonces no lo era. Explora las raíces de las abstracciones y describe las células nerviosas que serían responsables de la conciencia, la memoria y la percepción. Eric Kandel, de la Universidad de Columbia, asegura que en ese libro Freud desarrolló el concepto de que la neurona es el elemento esencial del cerebro y de que el contacto entre las neuronas puede ser modificado mediante el aprendizaje.

Lo admirable es que las neurociencias duras admiten que muchos de sus avances se han realizado a partir de los conceptos que Sigmund Freud dejó inconclusos. El escaneo cerebral permite ver lo que Freud sólo pudo intuir con su genio. Las pruebas son numerosas y no asombrarán a los especialistas. Sólo citaré las que alcanzaron mayor difusión. Kandel y sus colaboradores, por ejemplo, han tratado de seguir pistas en los cerebros de estudiantes voluntarios, a los cuales se les mostraron fugaces imágenes de rostros temibles. Tan rápido corrían las imágenes que los voluntarios dijeron que no habían podido ver nada. Pero las imágenes mostraron otra cosa en el escáner: se había encendido la amígdala cerebral, donde se concentra el centro del miedo. Es decir, concluyeron los investigadores, el inconsciente existe.

También se estudió la represión. En la Universidad de Oregon han podido verificarla mediante el “olvido motivado”. Michael Anderson entrenó a personas para memorizar pares de palabras que no tuvieran relación entre sí, como “prueba” y “cucaracha”, por ejemplo. Después las sometió a una resonancia magnética y pidió que se concentraran en la primera palabra, sin prestar atención a la otra. El escáner mostró un complejo circuito: el hipocampo, responsable de recuperar la memoria, exhibía una actividad reducida, mientras que el córtex lateral prefrontal, que ayuda a inhibir las acciones reflejas (como, por ejemplo, retirar la mano de un plato caliente), mostró una actividad multiplicada. Por supuesto que hay mucha distancia entre suprimir una palabra suelta y enterrar en el inconsciente un trauma poderoso, pero, como afirma Anderson, “creo que Freud estaba sobre algo importante”.

Otros estudios utilizaron imágenes cerebrales para descubrir los circuitos que se activan cuando la mente es sometida a un fuerte conflicto; por ejemplo, entre un deseo y un impulso que tiende a inhibir ese deseo. También hay estudios sobre traumas precoces y sus efectos muchos años después. Entre los experimentos con drogas se ha tratado de establecer si es posible corregir un estrés traumático mediante la supresión de determinados recuerdos. En fin: la lista sería larga. Pero debemos saber que sólo se pisó el primer peldaño. En las próximas décadas seguro que tendremos un río de sorpresas adicionales en geométrica progresión.

Ya no es posible dudar de algunos descubrimientos realizados por Sigmund Freud como el mensaje cifrado de los sueños, la significación de los olvidos, la importancia de la sexualidad y su presencia en la infancia, las pulsiones agresivas, el conflicto edípico, la rivalidad fraterna, el poder de los afectos, las transferencias invisibles y otros temas que disecó en forma paciente y brillante. Entre tantas, la humanidad le debe reflexiones profundas sobre la guerra, las ilusiones, el fenómeno de masas, el malestar en la cultura, los orígenes de la religión y el conflicto humano interminable.

De su robusto tronco se han desprendido decenas de escuelas que introdujeron modificaciones, ajustes e inventiva. La psicoterapia se ha convertido en un instrumento imprescindible que puede asociarse con otros recursos, según los pacientes. Jamás olvidarse del antiguo principio que afirma: no existen enfermedades, sino enfermos. Cada individuo necesita y merece una atención específica, al margen de lo que indiquen las teorías o los rituales. En este sentido, debe mantenerse el modelo del sabio Sigmund, que nunca cesaba de prestar atención a sus propios errores, para corregirlos cuanto antes. En la práctica del psicoanálisis he observado que muchos colegas permanecen fijados a los textos como si se tratase de obras sacras y verdades reveladas, con arrogante desdén hacia los cuestionamientos que se realizan desde otras ópticas. Freud no ha creado una religión, sino una disciplina con ambiciones científicas. Como tal, debe ser objeto de estudios incesantes y descarnados y escuchar las críticas de los pacientes y de la sociedad, además de estudiar con interés los progresos de otros campos.

Al siglo y medio del nacimiento de Sigmund Freud, debemos manifestarle nuestra gratitud por haber insuflado al mundo el soplo maravilloso y fértil de su genialidad.
© La Nacion

Por Marcos Aguinis
Para LA NACION

http://www.lanacion.com.ar/opinion/nota.asp?nota_id=793189
LA NACION 31.03.2006 Página 19 Opinión

ADHD Drugs and CV Risk

2006-03-20T15:08:00.000-08:00

ADHD Drugs and Cardiovascular Risk
Steven E. Nissen, M.D.
On February 9, 2006, the Drug Safety and Risk Management Advisory Committee of the Food and Drug Administration (FDA) voted by a narrow
margin — eight to seven — to recommend a “black box" worning describing the cardiovascular risk of stimulant drugs

Psicologia Hospitalar: Compartilhando a Prática

2006-03-19T17:06:00.000-08:00

Psicologia Hospitalar: Compartilhando a Prática
OBJETIVO:
Oferecer um amplo panorama da prática do psicólogo no hospital.
PÚBLICO-ALVO
Psicólogos, profissionais e acadêmicos das diferentes áreas da saúde que atuam em hospitais.
REALIZAÇÃO
Início: 25/04/2006
Término: 22/08/2006
Dias: 25/04, 2, 9, 16, 23, 30/05, 6, 13, 20, 27/06, 4, 11/07, 1°, 8, 15 e 22/08/2006
Horário: terças-feiras, das 19h15 às 22h15
Duração: 48 horas
Local: sala 2D215 - Centro 2 Av. Unisinos, 950 - São Leopoldo – RS
MINISTRANTES
O curso será ministrado por profissionais que atuam em hospitais de referência no RS, os quais compartilharão suas experiências de trabalho nas diversas unidades hospitalares.
David Zimerman – Médico Psicanalista.
Anna Maria Ruschel – Psicóloga. Professora no Curso de Psicologia da Unisinos.
Carmem Esther Rieth – Psicóloga. Profa na Feevale e supervisora Hospital Mun. de N. Hamburgo.
Cláudia dos Santos – Psicóloga e Supervisora em Psic Clínica no Ulbra Saúde - Hospital Independência.
Denise Ruschel Bandeira - Professora na Graduação e no PPG em Psicologia – UFRGS.
Desirée Luzardo Cardozo Bianchessi - Psicóloga no Hospital de Clínicas de Porto Alegre.
Diana Clotilde Peruffo Ducati – Psicóloga no Hospital Fêmina S.A.
Evelyn Soledad Reyes Vigueras - Psicóloga do Serviço de Psicologia Clínica no Instituto de Cardiologia.
Fabiane Menezes Azevedo – Psicóloga no Hospital Ernesto Dornelles.
Juliana Rausch Potter - Psicóloga do Hosp da Criança Sto Antônio - Complexo Hosp. Sta Casa P. Alegre.
Karla Bender Rovatti - Psicóloga do Hospital Mãe de Deus, referência no Instituto do Câncer e nas UTIS.
Luciana Saraiva Schmal - Psicóloga no Hospital Ernesto Dornelles.
Mariza Sanchez – Psicóloga. Professora na Ulbra.
Patrícia Pereira Ruschel - Chefe do Serviço de Psicologia Clínica do Instituto de Cardiologia/FUC.
Roseli Fátima Armiliatto Bortoluzzi – Psicóloga. Desenvolvimento Organiz. Hosp. de Clínicas P. Alegre.
Tânia Rudnicki - Professora na Ulbra. Presidente da Sociedade Brasileira de Psicologia Hospitalar.
COORDENAÇÃO
Anna Maria Ruschel – Psicóloga. Professora no Curso de Psicologia da Unisinos.
Simone Dill Azeredo Bolze - Psicóloga. Responsável pelo Serviço de Saúde Mental da Secretaria Municipal de Saúde de Arroio dos Ratos e coordenadora do projeto de implantação do Hospital-Dia no município
PROMOÇÃO
Universidade do Vale do Rio dos Sinos - Unisinos
Unidade Acadêmica Educação Continuada
INFORMAÇÕES
Linha direta Unisinos
Fone/fax: (51) 591 1122
www.unisinos.br/extensao/saude
e-mail: extensao@unisinos.br Este curso também pode ser realizado in company.
VAGAS LIMITADASInscrições até 19/4/2006

Brain May Be Important Factor In Heart Disease - CME Teaching Brief - MedPage Today

2006-03-07T03:48:00.000-08:00

APS: Brain May Be Important Factor In Heart Disease - CME Teaching Brief - MedPage Today: " * Explain to interested patients that this small preliminary study suggests low serotonin activity may influence behaviors such as smoking or physical inactivity that predispose one to atherosclerosis.

* Inform patients who ask that studies have yet to demonstrate that current anti-depressant treatments can reduce risk for atherosclerosis.

Review
DENVER, March 6 - Brains that make less serotonin appear to have thicker arteries, a preclinical sign of cerebrovascular disease, investigators reported here.

Low serotonin levels explain why some people make lifestyle choices that put them at risk for atherosclerosis, such as smoking and physical inactivity, said Matthew F. Muldoon, M.D., M.P.H., of the University of Pittsburgh at the American Psychosomatic Society meeting.

Or, he added, poor lifestyle choices may drive down serotonin levels in the brain, affecting the neurotransmitter's role in modulating blood pressure, metabolism, and appetite.

But either way, this study is the first to show a connection between serotonin and hardening of the arteries, Dr. Muldoon said.

The study included 244 healthy, non-depressed volunteers between the ages of 30 and 55 with no clinical signs of vascular disease. Half were men, and most were white. The researchers measured participant's/.../"

Folhetos- Cebrid-Unifesp/EPM

2006-02-16T15:49:00.000-08:00

Folhetos- Cebrid-Unifesp/EPM: "O que é o CEBRID?

O CEBRID é o Centro Brasileiro de Informações sobre Drogas Psicotrópicas, que funciona no Departamento de Psicobiologia da UNIFESP (Universidade Federal de São Paulo), antiga Escola Paulista de Medicina. É uma entidade sem fins lucrativos e existe exclusivamente para ser útil à população. Para cumprir esta função o CEBRID ministra cursos, palestras e reuniões científicas sobre o assunto Drogas, publica livros, faz levantamentos sobre o consumo de drogas entre estudantes, meninos de rua, etc., mantém um Banco de trabalhos científicos brasileiros sobre o abuso de drogas (mais de 2.000) e publica um Boletim trimestral.

O CEBRID é constituído por uma equipe técnica composta de especialistas nas áreas de medicina, sociologia, farmácia-bioquímica, psicologia e biologia."

EU: Improving mental health of the population

2006-02-06T13:26:00.000-08:00

Improving the mental health of the population.
Towards a strategy on mental health for the European Union
1. INTRODUCTION
The mental health of the European population is a resource for the attainment of some of the EU’s strategic policy objectives, such as to put Europe back on the path to long-term prosperity, to sustain Europe’s commitment to solidarity and social justice, and to bring tangible practical benefits to the quality of life for European citizens.
However, the mental health of the EU population can be considerably improved:
• Mental ill health affects every fourth citizen and can lead to suicide, a cause of too many deaths;
• Mental ill health causes significant losses and burdens to the economic, social, educational as well as criminal and justice systems;
• Stigmatisation, discrimination and non-respect for the human rights and the dignity of mentally ill and disabled people still exist, challenging core European values.
Improvement is possible. Many initiatives have already been taken. Further development and consolidation of the existing actions is required. The January 2005 WHO European Ministerial Conference on Mental Health established a framework for comprehensive action, and created strong political commitment for mental health. It invited the European Commission, a collaborating partner of the conference, to contribute to implementing this framework for action, in line with its competencies and the Council’s expectations and in partnership with the WHO.
This Green paper is a first answer to this invitation. It proposes to establish an EU-strategy on mental health. This would add value: by constituting a framework for exchange and cooperation between Member States; by helping to increase the coherence of actions in the health and non-health policy sectors in Member States and at Community level; and by allowing involvement of a broad range of relevant stakeholders into building solutions.

A sensible 10-year plan for mental health

2006-01-13T09:40:00.000-08:00

The Lancet: "As Klaus Ebmeier and colleagues describe in their Lancet Seminar today, depression affects around one in six people in the USA at some time in their lives, and may double their chance of death. These figures are similar for other developed countries and are compounded by the fact that over 50% of people with depression will become functionally impaired because of their illness.
Sadly, for many people a diagnosis of depression is made worse by the social stigma that still clings to all mental-health diagnoses, by difficulties in accessing treatment options, and by confusion about which treatments work and which may make their problems worse. The bewildering spectrum of therapeutic alternatives ranges from a conversation with a psychologist, through a confusing array of pharmacological alternatives, to more radical treatments such as deep brain stimulation. Paradoxically, some of the best drugs, serotonin reuptake inhibitors, have been associated with an increased risk of suicide, although research published this month in the American Journal of Psychiatry suggests that this effect might be less common than initially thought.
The release last week of a policy paper, The future of mental health: a vision for 2015, by a multi-agency panel in the UK, is welcome news for patients with depression and those who care for them. Bold in its outlook, the policy envisages a shift in focus from mental illness to mental wellbeing over the next 10 years. Replete with important practical suggestions, the paper also considers broader aspects of mental-health policy, including education for children about mental-health issues and the importance of ensuring that prisoners with mental-health needs receive care comparable to that deemed acceptable outside prison.
The paper's authors rightly point out that, however bold they may/.../"

Alterations in 5-HT1B Receptor Function by p11 in Depression-Like States -- Svenningsson et al. 311 (5757): 77 -- Science

2006-01-06T16:02:00.000-08:00

Alterations in 5-HT1B Receptor Function by p11 in Depression-Like States -- Svenningsson et al. 311 (5757): 77 -- Science: "Alterations in 5-HT1B Receptor Function by p11 in Depression-Like States
Per Svenningsson,1,2 Karima Chergui,2 Ilan Rachleff,1 Marc Flajolet,1 Xiaoqun Zhang,2 Malika El Yacoubi,3 Jean-Marie Vaugeois,3 George G. Nomikos,4 Paul Greengard1*
The pathophysiology of depression remains enigmatic, although abnormalities in serotonin signaling have been implicated. We have found that the serotonin 1B receptor [5-hydroxytryptamine (5-HT1B) receptor] interacts with p11. p11 increases localization of 5-HT1B receptors at the cell surface. p11 is increased in rodent brains by antidepressants or electroconvulsive therapy, but decreased in an animal model of depression and in brain tissue from depressed patients. Overexpression of p11 increases 5-HT1B receptor function in cells and recapitulates certain behaviors seen after antidepressant treatment in mice. p11 knockout mice exhibit a depression-like phenotype and have reduced responsiveness to 5-HT1B receptor agonists and reduced behavioral reactions to an antidepressant.
1 Laboratory of Molecular and Cellular Neuroscience, The Rockefeller University, New York, NY 10021, USA.
2 Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden.
3 Unite de Neuropsychopharmacologie Experimentale�CNRS FRE2735, European Institute for Peptide Research (IFRMP 23), Faculty of Medicine and Pharmacy, Rouen F76183 Cedex, France.
4 Neuroscience Discovery Research, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, USA.
* To whom correspondence should be addressed, E-mail: greengard@rockefeller.edu "

Poverty Limits Efficacy of Treatment for Depression - CME Teaching Brief - MedPage Today

2006-01-04T02:30:00.000-08:00

Poverty Limits Efficacy of Treatment for Depression - CME Teaching Brief - MedPage Today: "Recognize that older depressed patients living in low-income areas may have a poor response rate to pharmacologic and talk therapy for depression and are more likely to report suicidal ideation. "

Serotonin and Depression: A Disconnect between the Advertisements and the Scientific Literature

2005-12-26T11:18:00.000-08:00

PLoS Medicine: Serotonin and Depression: A Disconnect between the Advertisements and the Scientific Literature: "In the United States, selective serotonin reuptake inhibitor (SSRI) antidepressants are advertised directly to consumers [1]. These highly successful direct-to-consumer advertising (DTCA) campaigns have largely revolved around the claim that SSRIs correct a chemical imbalance caused by a lack of serotonin (see Tables 1 and 2). For instance, sertraline (Zoloft) was the sixth best-selling medication in the US in 2004, with over $3 billion in sales [2] likely due, at least in part, to the widely disseminated advertising campaign starring Zoloft's miserably depressed ovoid creature. Research has demonstrated that class-wide SSRI advertising has expanded the size of the antidepressant market [3], and SSRIs are now among the best-selling drugs in medical practice [2]."/.../

Perspectives on the Efficacy of Antidepressants for Child and Adolescent Depression

2005-12-20T02:32:00.000-08:00

PLoS Medicine: Perspectives on the Efficacy of Antidepressants for Child and Adolescent Depression: "Practitioners of pediatric medicine may still be undecided as to whether the newer generation of antidepressant drugs is effective for child and adolescent depression (CAD) [1]. Since 1989, when selective serotonin reuptake inhibitors (SSRIs) were introduced in the United States, they have become the top-selling drug category; as many as one in eight adult Americans having tried at least one SSRI in the past ten years. Despite their popularity in treating adult depression, the efficacy of SSRIs for CAD remains in dispute. In this article, I examine some of the core problems in medical research that have led to this disagreement."

the Mood Disorder Questionnaire (MDQ)

2005-12-06T15:25:00.000-08:00

Download Your Copy of the Mood Disorder Questionnaire (MDQ): "

Hirschfeld, et al, conducted a large-scale community screening for DSM-IV bipolar I and II disorders. The Mood Disorder Questionnaire (MDQ), a validated screening tool for bipolar I and II disorders, was sent to a sample of > 125,000 adults in the United States.
Of the adults identified as screening positive for bipolar I and II disorders, only 20% had previously received a diagnosis of bipolar disorder. 31% had received a diagnosis of unipolar depression.
Almost 50% of respondents reported receiving no diagnosis of either unipolar depression or bipolar disorder"/.../

Two forms of paranoia noted: "Poor Me" and "Bad Me"

2005-11-30T17:01:00.000-08:00

Two forms of paranoia noted: "Poor Me" and "Bad Me"
Traditionally, paranoia is defined as a delusion of persecution. The paranoid person thinks people are “out to get” him or her.

Now, some researchers say mounting evidence suggests paranoia, traditionally considered one condition, really takes two forms.

In the first, the paranoiac believes the persecution is unfair. This is called “Poor Me” paranoia. In the second, the patient thinks he actually deserves to be persecuted. This is dubbed “Bad Me” paranoia.
/.../

Depression in children and young people

2005-11-25T05:40:00.000-08:00

Depression in children and young people: "Depression in children and young people
Full title: Depression in children and young people: identification and management in primary, community and secondary care
NICE and the National Collaborating Centre for Mental Health have published a guideline for the NHS in England and Wales on identifying and managing depression in children and young people.

CG28 Depression in children and young people - Full guideline 25 October 2005
CG28 Depression in children and young people - Implementation advice 26 October 2005
CG28 Depression in children and young people - Presenter slides 26 October 2005
CG28 Depression in children and young people - Analysis of cost impact 26 October 2005
CG28 Depression in children and young people - NICE guideline 28 September 2005
CG28 Depression in children and young people - NICE guideline (Word version) 28 September 2005
CG28 Depression in children and young people - Quick reference guide 28 September 2005
CG28 Depression in children and young people - Information for the public 28 September 2005
Scope: Depression in children 29 September 2003
2005/022 Latest NICE guidance sets new standards for treating depression in children and young people 28 September 20"

New guidelines set to improve identification, diagnosis and treatment of obsessive-compulsive disorder in children and adults

2005-11-25T05:34:00.000-08:00

2005/028 New guidelines set to improve identification, diagnosis and treatment of obsessive-compulsive disorder in children and adults: "2005/028 New guidelines set to improve identification, diagnosis and treatment of obsessive-compulsive disorder in children and adults
The National Institute for Health and Clinical Excellence (NICE) and the National Collaborating Centre for Mental Health have today (23 November) launched a clinical guideline on the identification, treatment and management of obsessive-compulsive disorder and body dysmorphic disorder in children and adults.

2005/028 New guidelines set to improve identification, diagnosis and treatment of obsessive-compulsive disorder in children and adults
(34.0Kb 12sec @ 28.8Kbps)"

Mental Health in the United States: Health Care and Well Being of Children With Chronic Emotional, Behavioral, or Developmental Problems—United States

2005-11-22T15:52:00.000-08:00

Mental Health in the United States: Health Care and Well Being of Children With Chronic Emotional, Behavioral, or Developmental Problems—United States, 2001

JAMA. 2005;294:2567-2569. MMWR. 2005;54:985-989

The needs of children with emotional, behavioral, and developmental (EBD) problems are a national concern. To assess the health care and well being of children who have chronic EBD problems requiring treatment or counseling, researchers from Oregon Health and Science University and CDC analyzed parent-reported data from the 2001 National Survey of Children with Special Health Care Needs. This report summarizes the findings of that analysis, which indicated that, compared with children with special health-care needs (CSHCN) who do not have chronic EBD problems, children with chronic EBD problems were more likely to experience diminished health and quality of life and to have problems accessing and receiving needed care. These children were more likely to have health conditions that affect their daily activities and cause them to miss school. In addition, their health-care needs were more likely to affect their families. The results of this analysis reinforce existing recommendations that encourage expansions in screening and early detection of mental health problems, as well as improvements in access, coordination, and quality of health-care services for children with EBD problems.

National Phobics Society - The Anxiety Disorders Charity

2005-11-07T04:54:00.000-08:00

National Phobics Society - The Anxiety Disorders Charity:
"Welcome to the National Phobics Society
NPS was established in 1970. Over the years we've grown to become the largest charity dealing with anxiety and phobias.
We can provide support and help if you've been diagnosed with, or suspect you may have an anxiety condition as listed on the right. We can also help you deal with specific phobias such as fear of spiders, blushing, vomiting, being alone, public speaking, heights - in fact, any fear that's stopped you from getting on with your life.
With our help you can start to recover your confidence and forget your fear.
We can also offer information and services to professional health care workers (GP's, psychologists, psychiatrists, social workers etc.) working, or interested in the area of anxiety disorders."/.../

WHO European Ministerial Conference on Mental Health

2005-10-28T05:53:00.000-07:00

WHO European Ministerial Conference on Mental HealthFacing the Challenges, Building Solutions
Helsinki, Finland, 12–15 January 2005
Questions and answers, some facts and figures
What is the Helsinki Conference?
It is the first ministerial conference on mental health to be held by the WHO Regional Office for Europe. Ministers and other high-level decision-makers from the 52 Member States of the WHO European Region are invited to meet in Helsinki, Finland, from 12 to 15 January 2005 to make decisions about future policies on mental health across the Region. The delegations will also include medical and technical experts, and some user-group representatives. Some observers may also be invited to attend. Both plenary and parallel sessions will be open to the press.
What will come out of it?
Ministers will agree on an action plan and declaration, which will have been negotiated with all Member States. These are likely to drive policy on mental health in the WHO European Region for at least the next five years.

Schizophrenia Research Forum: Home

2005-10-28T03:32:00.000-07:00

Schizophrenia Research Forum: Home
Research News

SELENBP1 Joins Array of Schizophrenia Gene Candidates
19 October 2005. A new DNA microarray study of schizophrenia patients in the U.S. and Taiwan suggests that the selenium-binding protein, SELENBP1, might...

CATIE Comes To Surprising Conclusions
16 October 2005. The results of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study raise as many questions as they answer...

A New Web Hub for All Things Related to Schizophrenia Research
15 October 2005. Welcome to the Schizophrenia Research Forum website—a virtual community for science about schizophrenia and related disorders...

Misdiagnosing "hysteria" has remained steady since the 1970s -- 331 (7523): 0 -- BMJ

2005-10-28T03:06:00.000-07:00

Misdiagnosing "hysteria" has remained steady since the 1970s -- 331 (7523): 0 -- BMJ: "Misdiagnosing 'hysteria' has remained steady since the 1970s
Misdiagnosing symptoms of non-psychiatric diseases such as stroke as psychiatric illness ('hysteria') happened in about a third of patients diagnosed with 'conversion symptoms' in the 1950s but had fallen to 4% by the 1970s and has remained steady since then. In a systematic review Stone and colleagues (p 989) included almost 1500 adults with motor and sensory symptoms unexplained by disease from 27 studies on diagnostic outcomes with a median follow-up time of five years. Misdiagnosis was most common in patients with gait or movement disorders and a psychiatric history, and the advent of computed tomography did not further improve diagnostic accuracy. "

Being big or growing fast: systematic review of size and growth in infancy and later obesity -- Baird et al. 331 (7522): 929 -- BMJ

2005-10-26T06:54:00.000-07:00

Being big or growing fast: systematic review of size and growth in infancy and later obesity -- Baird et al. 331 (7522): 929 -- BMJ: "Being big or growing fast: systematic review of size and growth in infancy and later obesity
Janis Baird, research fellow1, David Fisher, research assistant1, Patricia Lucas, lecturer2, Jos Kleijnen, director3, Helen Roberts, professor of child health4, Catherine Law, reader in children's health5
1 MRC Epidemiology Resource Centre, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, 2 School for Policy Studies, University of Bristol, Bristol BS8 1TZ, 3 Centre for Reviews and Dissemination, University of York, York YO10 5DD, 4 Child Health Research and Policy Unit, City University, London EC1Y 4TY, 5 Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, University College London, London WC1N 1EH
Correspondence to: J Baird jb@mrc.soton.ac.uk

Abstract
Top
Abstract
Introduction
Methods
Results
Discussion
References

Objectives To assess the association between infant size or growth and subsequent obesity and to determine if any association has been stable over time.
Design Systematic review.
Data sources Medline, Embase, bibliographies of included studies, contact with first authors of included studies and other experts.
Inclusion criteria Studies that assessed the relation between infant size or growth during the first two years of life and subsequent obesity.
Main outcome measure Obesity at any age after infancy.
Results 24 studies met the inclusion criteria (22 cohort and two case-control studies). Of these, 18 assessed the relation between infant size and subsequent obesity, most showing that infants who were defined a"

Heartless Bosses Create Coronary-Prone Workers -

2005-10-25T16:44:00.000-07:00

Heartless Bosses Create Coronary-Prone Workers - CME Teaching Brief - MedPage Today: "Heartless Bosses Create Coronary-Prone Workers

By Neil Osterweil, Senior Associate Editor, MedPage Today
Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine.
October 25, 2005
Also covered by: Forbes, MSNBC
Ask patients about workplace stress, and help them with stress-reduction strategies when they feel beset by unreasonable demands or unfair supervisors.

Review
HELSINKI, Oct. 24 - Harried employees who complain that their work is killing them might just be right.
Or to put it in a more positive light, workers who feel that they are treated justly on the job have a significantly lower risk for coronary artery disease.
Investigators here and in London came to this conclusion after studying the heart health of 6,442 British men who work for Her Majesty's civil service.
'This is the first study, to our knowledge, that demonstrates that justice at work may protect against coronary heart disease,' Mika Kivimaki, Ph.D., of the Finnish Institute of Occupational Health and colleagues at University College London Medical School reported in the Oct. 24 issue of the Archives of Internal Medicine.
'In men who perceived a high level of justice, the risk of incident coronary heart disease was 30% lower than among those who perceived a low or an intermediate level of justice,' they added.
When workers believe that their supervisors listen to them, consider their viewpoints, involve them in decision-making and generally treat them fairly, they tend to have lower levels of stress, negative emotions, and absenteeism, the investigators noted.
'There are plausible mech"

Suicide Prevention Strategies

2005-10-25T16:32:00.000-07:00

Suicide Prevention Strategies
A Systematic Review

J. John Mann, MD;

JAMA. 2005;294:2064-2074.
Context In 2002, an estimated 877 000 lives were lost worldwide through suicide. Some developed nations have implemented national suicide prevention plans. Although these plans generally propose multiple interventions, their effectiveness is rarely evaluated.

Objectives To examine evidence for the effectiveness of specific suicide-preventive interventions and to make recommendations for future prevention programs and research.

Data Sources and Study Selection Relevant publications were identified via electronic searches of MEDLINE, the Cochrane Library, and PsychINFO databases using multiple search terms related to suicide prevention. Studies, published between 1966 and June 2005, included those that evaluated preventative interventions in major domains; education and awareness for the general public and for professionals; screening tools for at-risk individuals; treatment of psychiatric disorders; restricting access to lethal means; and responsible media reporting of suicide.

Data Extraction Data were extracted on primary outcomes of interest: suicidal behavior (completion, attempt, ideation), intermediary or secondary outcomes (treatment seeking, identification of at-risk individuals, antidepressant prescription/use rates, referrals), or both. Experts from 15 countries reviewed all studies. Included articles were those that reported on completed and attempted suicide and suicidal ideation; or, where applicable, intermediate outcomes, including help-seeking behavior, identification of at-risk individuals, entry into treatment, and antidepressant prescription rates. We included 3 major types of studies for which the research question was clearly defined: systematic reviews and meta-analyses (n = 10); quantitative studies, either randomized controlled trials (n = 18) or cohort studies (n = 24); and ecological, or population- based studies (n = 41). Heterogeneity of study populations and methodology did not permit formal meta-analysis; thus, a narrative synthesis is presented.

Promoting the Mental Health of Population

2005-10-25T03:34:00.000-07:00

Promoting the Mental Health of Population

"Promoting the Mental Health of the Population. Towards a Strategy on Mental health for the European Union" There is now an increasing interest in the mental health of the EU-population, and a strong political commitment for action in this field. This is why the European Commission decided to present a Green paper "Promoting the Mental Health of the Population. Towards a Strategy on Mental health for the European Union". The document outlines the relevance of mental health for some of the EU's strategic policy objectives (prosperity, solidarity and social justice, quality of life of citizens), proposes the development of a strategy on mental health at Community-level and identifies its possible priorities.
The European Commission invites European institutions, Governments, health professionals, stakeholders in other sectors, civil society including patient organisations, and the research community to communicate their views on this document and the questions raised in its section 8.
Contributions in the context of this consultation process should be sent to the Commission by 31 May 2006, on the following ways:
a) by email to address "mailto:mental-health@cec.eu.int" mental-health@cec.eu.int, or:
b) by post mail to the following address:European CommissionDirectorate-general for Health and Consumer ProtectionUnit C/2 "Health Information"L-2920 Luxembourg
Contributions received will be published on this website, unless requests not to do so have explicitly been made.
In late 2006, the Commission intends to present its analysis of the responses received together with, if appropriate, its proposal and/or initiatives for a strategy"

Changes in mental health of UK hospital consultants since the mid-1990s

2005-08-26T10:11:00.000-07:00

The Lancet: "Changes in mental health of UK hospital consultants since the mid-1990s

Cath Taylor, Jill Graham, Henry WW Potts, Michael A Richards and Amanda J Ramirez
Summary

We assessed changes in the mental health of UK hospital consultants from five specialties, on the basis of surveys done in 1994 (880 participants) and 2002 (1308 participants). The proportion of consultants with psychiatric morbidity rose from 27% (235) in 1994 to 32% (414) in 2002. The prevalence of emotional exhaustion increased from 32% (284) in 1994 to 41% (526) in 2002. Multivariate analyses showed that increased job stress without a comparable increase in job satisfaction accounted for the decline in mental health, which was especially marked in clinical and surgical oncologists. Action is needed to improve the working lives of consultants."

Humanitarian Assistance & Development Co-operation - Bibliography

2005-08-18T21:11:00.000-07:00

I am doing some research to assess the priority for mental health and psychological assistance (of any sort) in policy relating to peace-building
or reconstruction efforts after violent conflict.

I am currently looking over a few WHO, UN, DFID and USAID documents (i.e. 'Conflict Reduction and Humanitarian Assistance'), as found here:
http://www.acdi-cida.gc.ca/cida_ind.nsf/0/d8f4782dbad2af8985256aed004dd5df?OpenDocument

If you know of any more guideline documents worth looking at, I would be grateful if you could let me know by emailing me at this address.

Thank you!

Ruwan Ratnayake MHS
rratnaya@jhsph.edu

Efficacy of antidepressants in adults -- Moncrieff and Kirsch 331 (7509): 155 -- BMJ

2005-07-15T10:26:00.000-07:00

Efficacy of antidepressants in adults -- Moncrieff and Kirsch 331 (7509): 155 -- BMJ

(Recommended by Marcelo Gustavo Colominas [mgcolominas@gigared.com])
Most people with depression are initially treated with antidepressants. But how well do the data support their use, and should we reconsider our strategy?

Evidence-Based Mental Health Treatments and Services

2005-07-09T06:45:00.000-07:00

Evidence-Based Mental Health Treatments and Services:
Anthony F. Lehman, Howard H. Goldman, Lisa B. Dixon, and Rachel Churchill
"The purpose of this report is to inform policymakers about the significance of recent advances in evaluating evidence for allocating resources to and within public mental health programs. These advances are of particular importance because the public sector is the largest payer for services to persons with chronic mental illness.
The authors' central point is that the best evidence yields both good and bad news. The good news is that 'many potentially available treatments and services' have been shown to produce 'improved symptoms and functioning' in patients with severe, persistent mental illness. The bad is that 'there are substantial gaps between what science tells us to do and what we do in actual practice, despite the significant investment of public resources.'
The research about which the authors report is increasingly useful to policymakers and clinicians. Many scientists are working collaboratively, often across national boundaries, to collect, analyze, and synthesize evidence about interventions to prevent and treat illness. A recent Milbank Report describes this international scientific advance (Ray Moynihan, Evaluating Health Services: A Reporter Covers the Science of Research Synthesis). "

Risk for schizophrenia and schizophrenia-like psychosis among patients with epilepsy: population based cohort study -- Qin et al. 331 (7507): 23 -- BMJ

2005-07-03T05:17:00.000-07:00

Risk for schizophrenia and schizophrenia-like psychosis among patients with epilepsy: population based cohort study -- Qin et al. 331 (7507): 23 -- BMJ: "Risk for schizophrenia and schizophrenia-like psychosis among patients with epilepsy: population based cohort study
Ping Qin"
The association between epilepsy and psychosis has been researched since the nineteenth century. Several studies1-4 but not all5 6 have found a higher prevalence of schizophrenia-like psychosis in patients with epilepsy compared with the general population. Yet many questions remain unanswered and large scale studies using empirical data are scant.7 The causal mechanism underlying the association is unclear. Seizures may damage the brain, which may in turn increase the risk of schizophrenia-like psychosis, or the two conditions may share common aetiological factors. These hypotheses may be disentangled by evaluating the risk of schizophrenia-like psychosis in people with a family history of epilepsy.8 Genetic vulnerability to psychosis may facilitate the development of psychosis in the patients with epilepsy.9 10 However, there have been no published family history studies with appropriate methods.8 In addition, differences in risk of developing psychosis—for example, by type of epilepsy, age at onset, and number of admission to hospital—remain poorly understood.

In this population based cohort study we examined the risk of schizophrenia or schizophrenia-like psychosis associated with a history of epilepsy using data from Danish longitudinal registers. We also investigated how and to what extent this risk is influenced by family histories of psychosis and of epilepsy.

WHO | Mental health

2005-06-30T07:47:00.000-07:00

WHO | Mental health: "Mental health

This page provides links to descriptions of activities, reports, news and events, as well as contacts and cooperating partners in the various WHO programmes and offices working on this topic. Also shown are links to related web sites and topics.

MeSH scope note: The state wherein the person is well adjusted."

Postnatal Paternal Depression Triggers Behavioral Problems for Sons

2005-06-27T04:59:00.000-07:00

Postnatal Paternal Depression Triggers Behavioral Problems for Sons - CME Teaching Brief - MedPage Today:
"Postnatal Paternal Depression Triggers Behavioral Problems for Sons

By Rabiya Tuma, Ph.D., MedPage Today Staff Writer
Reviewed by Rubeen K. Israni, M.D., Fellow, Renal-Electrolyte and Hypertension Division, University of Pennsylvania School of Medicine
June 24, 2005
Also covered by: CNN, Fox News, MSNBC
MedPage Today Action Points

* Be aware that paternal depression, as well as maternal depression, can have a long-term impact on a child's behavior. Know that boys are particularly vulnerable to their father's and mother's moods.

* Consider asking about both parent's emotional states during postnatal visits. If a parent shows depressive symptoms, consider referring them to a mental health practitioner.

* Be aware that this is the first large study to consider the effects of paternal mood on a child's development and the results need to be replicated elsewhere."

Psychiatry and Human Rights

2005-06-22T17:28:00.000-07:00

The Dominion: Psychiatry and Human Rights:
Bush's Drug Plan for America by Pierre Loiselle
"On May 2nd, dissident mental health professionals joined forces with people who have been psychiatrized to protest human rights abuses in mental health treatments and what they call the collusion between the pharmaceutical industry and the psychiatric profession. Targeting the pharmaceutical industry's lobby group PhRMA (Pharmaceutical Research and Manufacturer's Association) in Washington D.C., they sounded the alarm on a Bush Administration plan to screen all United States citizens for mental illness."

Snake Phobias, Moodiness and a Battle in Psychiatry

2005-06-15T13:52:00.000-07:00

June 14, 2005
Snake Phobias, Moodiness and a Battle in Psychiatry
By BENEDICT CAREY
(recommended by Dennis Raphael)

A college student becomes so compulsive about cleaning his dorm room that his grades begin to slip. An executive living in New York has a mortal fear of snakes but lives in Manhattan and rarely goes outside the city where he might encounter one. A computer technician, deeply anxious around strangers, avoids social and company gatherings and is passed over for promotion.

Are these people mentally ill?

In a report released last week, researchers estimated that more than half of Americans would develop mental disorders in their lives, raising questions about where mental health ends and illness begins.

In fact, psychiatrists have no good answer, and the boundary between mental illness and normal mental struggle has become a battle line dividing the profession into two viscerally opposed camps.

On one side are doctors who say that the definition of mental illness should be broad enough to include mild conditions, which can make people miserable and often lead to more severe problems later.

On the other are experts who say that the current definitions should be tightened to ensure that limited resources go to those who need them the most and to preserve the profession's credibility with a public that often scoffs at claims that large numbers of Americans have mental disorders.

The question is not just philosophical: where psychiatrists draw the line may determine not only the willingness of insurers to pay for services, but the future of research on moderate and mild mental disorders. Directly and indirectly, it will also shape the decisions of millions of people who agonize over whether they or their loved ones are in need of help, merely eccentric or dealing with ordinary life struggles.

"This argument is heating up right now," said Dr. Darrel Regier, director of research at the American Psychiatric Association, "because we're in the process of revising the diagnostic manual," the catalog of mental disorders on which research, treatment and the profession itself are based.

The next edition of the manual is expected to appear in 2010 or 2011, "and there's going continued debate in the scientific community about what the cut-points of clinical disease are," Dr. Regier said.

Psychiatrists have been searching for more than a century for some biological marker for mental disease, to little avail. Although there is promising work in genetics and brain imaging, researchers are not likely to have anything resembling a blood test for a mental illness soon, leaving them with what they have always had: observations of behavior, and patients' answers to questions about how they feel and how severe their condition is.

Severity is at the core of the debate. Are slumps in mood bad enough to make someone miss work? Does anxiety over social situations disrupt friendships and play havoc with romantic relationships?

Insurers have long incorporated severity measures in decisions about what to cover. Dr. Alex Rodriguez, chief medical officer for behavioral health at Magellan Health Services, the country's largest managed mental health insurer, said that Magellan used several standardized tests to rate how much a problem is interfering with someone's life. The company is developing its own scale to track how well people function. "This is a tool that would allow the therapist to monitor a patient's progress from session to session," he said.

Although the current edition of the American Psychiatric Association's catalog of mental disorders includes severity as a part of diagnosis, some experts say these measures are not tough or specific enough.

Dr. Stuart Kirk, a professor of social welfare at the University of California, Los Angeles, who has been critical of the manual, gives examples of what could, under the current diagnostic guidelines, qualify as a substance abuse disorder: a college student who every month or so drinks too much beer on Sunday night and misses his chemistry class at 8 a.m. Monday, lowering his grade; or a middle-aged professional who smokes a joint now and then drives to a restaurant, risking arrest.

"Although perhaps representing bad judgment," Dr. Kirk wrote in an e-mail message, these cases "would not be seen by most people as valid examples of mental illness, and they shouldn't be because they represent no underlying, internal, pathological mental state."

Separating the heavies from the lightweights - by asking, say, "Did you ever go to a doctor for your problem, or talk to anyone about it?" - has a significant effect on who counts as mentally impaired.

After researchers reported in a large national survey in 1994 that 30 percent of Americans adults had a mental illness in the past year, Dr. Regier and others reanalyzed the data, taking into account whether people had reported their mental troubles to a therapist or friend, had received treatment or had taken other actions.

They found that the number of people who qualified for a diagnosis of mental illness in the previous year plunged to 20 percent over all; rates of some disorders dropped by a third to half.

But limiting the count to those who have taken action does not give an accurate picture of the extent of illness, argue other researchers, who have been sharply critical of efforts to drive down prevalence estimates.

Dr. Robert Spitzer, a professor of psychiatry at Columbia University and the principal architect of the third edition of the diagnostic manual, wrote in a letter to The Archives of Psychiatry, "Many physical disorders are often transient and mild and may not require treatment (e.g. acute viral infections or low back syndrome). It would be absurd to recognize such conditions only when treatment was indicated."

He added, "Let us not revise diagnostic criteria that help us make clinically valid standard diagnoses in order to make community prevalence data easier to justify to a skeptical public."

Dr. Ronald Kessler, a professor of health care policy at Harvard and the lead author of the 1994 survey and the nationwide survey released last week, said squeezing diagnoses so that many mild cases drop out could blind the profession to a group of people it should be paying more attention to, not less.

"We know that there are prodromes, states that put people at higher risk, like hypertension for heart disease, which doctors treat," he said. "You can call these milder mental conditions what you want, and you may decide to treat them or not, but if you don't identify them they fall off the radar, and you don't know much of anything about them."

In the survey released last week, Dr. Kessler and his colleagues found that half of disorders started by age 14, and three-quarters by age 24. "These are people who may show up at age 25 or later as depressed alcoholics, maybe they're in trouble with the law, they've lost relationships, and from my perspective we need to go upstream and find out what's happening before they become so desperate," Dr. Kessler said.

One condition whose estimated prevalence has bounced around like a Ping-Pong ball in this debate is social phobia, extreme anxiety over social situations. In a 1984 survey, investigators identified social phobia primarily by asking about excessive fear of speaking in public. They found a one-year prevalence rate of 1.7 percent.

But psychiatrists soon concluded that other kinds of fears, including a fear of eating in public or using public restrooms, were variations of social phobia. When, in 1994, these and others questions were included, the prevalence rate rose to 7.4 percent.

Dr. Regier re-evaluated the data using a different criterion for severity and found a much lower rate: 3.2 percent. Last week, Dr. Kessler reported a rate of 6.8 percent.

"You can see why people have a hard time believing these numbers because they change so much depending on how you look at the data," said Dr. David Mechanic, director of the Institute for Health, Health Care Policy and Aging Research at Rutgers University.

Yet the cutoff points for disease severity have real effects on the lives of people like Paul Pusateri, 48, a Baltimore business analyst.

Mr. Pusateri said he was outgoing through college but then had a panic attack in his mid-20's, as he was preparing to give a speech. He managed to build a career and family despite surges of anxiety before speeches and meetings. But finally, more than two decades after the first symptoms, he reached a point where he dreaded even small or one-on-one meetings with familiar co-workers.

"It's very bizarre; the only way I can describe the feeling is, Imagine walking down the street at dusk having someone put a gun in your face and threaten to kill you - having that absolute terror before a routine work meeting," he said.

Mr. Pusateri said that, perhaps unconsciously, he applied severity criteria to his own growing mental struggles. He may have set the bar too high: only when he began badly mangling presentations at work, and then dreaded going in at all, did he tell his wife that he felt he was in trouble. His wife had watched a therapist talk about social phobia on television, and soon he was getting help.

He considers himself lucky to have found a diagnosis at all, not to mention a therapist. "I was desperate by the time I did anything about it, I saw that my livelihood was at stake," he said.

Yet by all outside appearances, and by some strict definitions, he might not have qualified as having a disorder until he took some action.

In the coming years, Dr. Regier's office will be responsible for clarifying the thresholds of disease for the next diagnostic manual, to somehow identify difficult cases like this one, while remaining credible to insurers and to the public at large.

After a prolonged controversy last year over the use of antidepressants in children, most experts say the last thing psychiatry needs now is for this process to turn into a public fight over who is sick and who is not.

But this fight may be hard to avoid. The two sides are far apart, debates over the diagnostic manual are traditionally contentious and despite increasing openness about mental illness the public tends to be skeptical of any prevalence numbers over a few percent.

"That's the problem," said Dr. Regier, "people hear these higher prevalence rates and they immediately start thinking about severe, disabling schizophrenia. But we know these surveys include a lot of mild cases, and we need to ask, How significant are these?"

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Social capital and mental health: An interdisciplinary review of primary evidence

2005-06-13T05:52:00.000-07:00

ScienceDirect - Social Science & Medicine : Social capital and mental health: An interdisciplinary review of primary evidence:
Astier M. Almedom
"An interdisciplinary interrogation of primary evidence linking social capital and mental health sought to establish: (1) ‘quality of evidence’ (assessed in terms of study design, methods used to address stated questions, rigor of data analysis, and logic and clarity of interpretation of results), and (2) applicability of the evidence to public health policy and practice with respect to mental health. It is found that social capital, a complex and compound construct, can be both an asset and a liability with respect to mental health of those in receipt of and those providing services and other interventions. The most meaningful assessment of social capital or components thereof may examine individual access to rather than possession of social capital, a property of groups, and therefore an ecological variable. Theoretical advances in research on social capital serve to identify mainly two types of social capital: bonding (between individuals in a group) and bridging (between groups). Each type of social capital has cognitive and/or structural component(s) and may operate at micro and/or macro level(s). Effective mental health policy and service provision may build or strengthen bridging social capital and benefit from both bonding and bridging social capital where either or both exist. Established indicators of social capital are amenable to quantitative and qualitative assessment, preferably in tandem. However studies that employ combined research design are rare or non-existent. Interdisciplinary multi-method investigations and analyses are called for in order to unravel mechanisms whereby social capital and mental health might be meaningfully associated."

Narcisim Revisited

2005-06-12T17:28:00.000-07:00

Narcisim Revisited
Amor Próprio Maligno
Sam Vaknin, Ph.D.

Mental illness said to affect one-quarter of Americans

2005-06-07T17:49:00.000-07:00

Mental illness said to affect one-quarter of Americans
By Leila Abboud, The Wall Street Journal

More Americans are seeking treatment for mental illnesses than ever before, but most of them fail to get adequate care, according to a major new government study.

In the once-a-decade report funded by the National Institutes of Health, researchers found that one-quarter of Americans had a psychiatric disorder in the year prior to the survey, down slightly from 28 percent in the report a decade ago. But 40 percent of affected people sought treatment, up from just 25 percent who sought treatment in the previous report. The study, which is intended to provide a national snapshot of the most commonly occurring mental illnesses, covered conditions ranging from obsessive compulsive disorder, attention deficit disorder to depression and bipolar disorder. (Rarer conditions such as schizophrenia, which is believed to affect just 1 percent of the population, weren't included.)

The National Network for Mental Health

2005-06-04T12:48:00.000-07:00

The National Network for Mental Health: "Welcome to the National Network for Mental Health website. It is my sincerest hope that you will find the information you see here to be both informative, and inspirational.

The National Network for Mental Health is a unique national organization that has a 'grassroots' history and approach."

Take a whiff of this stuff, trust us

2005-06-02T03:16:00.000-07:00

Kansas City Star | 06/02/2005 | Take a whiff of this stuff, trust us: "Take a whiff of this stuff, trust us

PHILADELPHIA — A hormone known to make fools fall in love may also part fools from their money, according to a recent experiment from Switzerland.

There, a team of psychologists and economists set up a game simulating financial investment and found that a whiff of the hormone oxytocin — previously linked to mating in other mammals — induced human subjects to more readily trust others with money. The findings were published in today’s issue of the journal Nature."

Americans as Survivors

2005-06-01T22:54:00.000-07:00

http://content.nejm.org/cgi/content/full/352/22/2263/DC1
Interview with Dr. Robert Jay Lifton on the psychological responses of Americans to the collective trauma of war and terrorist attack.
Supplement to Lifton R.J. Americans as Survivors. N Engl J Med 2005;352(22):2263-5.
Dr. Lifton is a member of the Department of Psychiatry at Harvard Medical School, Boston, and at the Cambridge Health Alliance, Cambridge, Mass.
Rachel Gotbaum, the interviewer, is an independent producer based in Boston

Physicians have always been concerned with how people survivetrauma. There has been much interest in the psychology of thesurvivors of such massive trauma as that inflicted by the Nazisin their death camps, by the atomic bombing of Hiroshima andNagasaki, and more recently, by the extraordinary earthquakeand tsunami in South Asia. Less noted has been the experience of Americans as survivorsof violent collective trauma. We owe this lack of attentionto the relative rarity of large-scale killing and dying on Americansoil and to the fact that in wars fought abroad, suffering hasusually been countered by a sense of victorious achievement.

The Global Prevalence of Schizophrenia

2005-05-30T18:22:00.000-07:00

PLoS Medicine: The Global Prevalence of Schizophrenia

Policies of Exclusion, Poverty & Health -

2005-05-01T10:28:00.000-07:00

Policies of Exclusion, Poverty & Health - ABOUT THE BOOK:
"'How many times in the past while has someone looked right through you'? This is one question asked in the new book Policies of Exclusion, Poverty & Health: Stories from the Front, which is the outcome of an intense study of 21 women living in poverty in one Canadian community.

The book includes the 21 stories, written in the women’s own words, plus two reports – also written in the first-person and so from the storytellers' perspective. The first report draws out the dominant themes found in the stories. The second details the storytellers' recommendations for positive change, and offers encouragement and advice to other women in poverty to 'mobilize, galvanize, and politicize.' Together, the stories and reports contain surprises that challenge long-held assumptions about Canada’s poor.

An 'amazing odyssey [of] courage, grit, and determination.'
--Stephen Hume, The Vancouver Sun. (See his editorial)"

Demoralization - A Syndrome Which Should Not Be Confused With Depression

2005-04-22T07:49:00.000-07:00

Demoralization - A Syndrome Which Should Not Be Confused With Depression: "A group of Italian researchers headed by Prof. Giovanni Fava (University of Bologna) has published a multicenter investigation on demoralization in the setting of medical disease. Demoralization was defined according to diagnostic criteria encompassing unpleasant, distressing feelings of personal failure and inadequacies, with a loss of continuity in the sense of sequence between past and future. "

Happy People Are Healthier, Study Suggests

2005-04-19T07:01:00.000-07:00

Science & Technology at Scientific American.com: Happy People Are Healthier, Study Suggests
The song "Don't worry, be happy," could double as sound medical advice, the results of a new study suggest. Whereas previous research had linked depression with an increased incidence of health problems, the new findings reveal that people who report more everyday happiness are healthier overall than their less joyous counterparts in a number of key ways. In particular, happy men experienced lower heart rates throughout the day, indicating good cardiovascular health.

Managing common mental health disorders in primary care: conceptual models and evidence base

2005-04-08T17:38:00.000-07:00

Managing common mental health disorders in primary care: conceptual models and evidence base -- Bower and Gilbody 330 (7495): 839 -- BMJ
Peter Bower, senior research fellow, Simon Gilbody, senior lecturer in mental health services research

The use of conceptual models can help to bridge the gap between research findings and policy development, illustrated here by the complex area of primary care mental health services

Reuters AlertNet - Therapy said good as drugs for some depression

2005-04-06T07:25:00.000-07:00

Reuters AlertNet - Therapy said good as drugs for some depression: "Therapy said good as drugs for some depression
04 Apr 2005 20:00:13 GMT
Source: Reuters
CHICAGO, April 4 (Reuters) - Psychological therapy and counseling can be just as effective as drugs in the early stages of treating moderate to severe depression, a study released on Monday found, contrary to current practice."

Depression an obstacle in treating older patients ...

2005-03-28T04:08:00.000-08:00

AMNews: April 4, 2005. Depression an obstacle in treating older patients ... American Medical News
Scenario: How can you best treat an aging patient with quality-of-life issues?
Millions of aging men and women with chronic medical conditions complicated by social and psychological problems resist elective treatments, even those that could significantly improve their quality of life. What can, and should, primary care physicians do?

Mental Health is our Collective Wealth:

2005-03-25T13:55:00.000-08:00

A Discussion Paper (2 April 2003)
M. McCubbin, R. Labonte, R.B. Sullivan, & B. Dallaire. Submitted by R. Labonte to the Federal/Provincial/Territorial Advisory Network
on Mental Health, and Health Canada
EXECUTIVE SUMMARY
This paper introduces readers to population mental health issues. First, we present a simple framework for Population Mental Health, showing improving mental health status as a function of individual capacities, environmental supports, and equity in the distribution of environmental supports. Also, we explain how the mental health of individuals depends not only on themselves, but also on their environments: ecological, social, political, economic.
Next follows key “pathways to population mental health”, with suggested actions ¾ often implicating decision-makers outside the mental health or health systems ¾ to improve the mental health of our society. Here is a selection of such actions

FDA panel findings intensify struggles with prescribing of antidepressants ...

2005-03-14T05:40:00.000-08:00

AMNews: Oct. 4, 2004. FDA panel findings intensify struggles with prescribing of antidepressants ... American Medical News
By Susan J. Landers, AMNews staff. Oct. 4, 2004.

Washington -- Physicians who treat depressed children and teens are even more carefully weighing the risks and benefits of prescribing antidepressant medications after the Sept. 14 recommendation of two Food and Drug Administration advisory panels that the agency place "black box" warnings on the medications' labels.

After considering evidence from 24 clinical trials, and testimony of numerous physicians and anguished parents whose children committed suicide after treatment with selective serotonin reuptake inhibitors, the Psychopharmacologic Drugs Advisory Committee and the Pediatric Advisory Committee jointly voted 15-8 to recommend that the strongest possible warning be placed on the drugs' labels to alert physicians to their dangers.