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Suicidal behaviour is a disease, psychiatrists argue

“As suicide rates climb steeply in the US a growing number of psychiatrists are arguing that suicidal behaviour should be considered as a disease in its own right, rather than as a behaviour resulting from a mood disorder.

They base their argument on mounting evidence showing that the brains of people who have committed suicide have striking similarities, quite distinct from what is seen in the brains of people who have similar mood disorders but who died of natural causes.

Suicide also tends to be more common in some families, suggesting there may be genetic and other biological factors in play. What’s more, most people with mood disorders never attempt to kill themselves, and about 10 per cent of suicides have no history of mental disease.

The idea of classifying suicidal tendencies as a disease is being taken seriously. The team behind the fifth edition of the Diagnostic Standards Manual (DSM-5) – the newest version of psychiatry’s “bible”, released at the American Psychiatric Association’s meeting in San Francisco this week – considered a proposal to have “suicide behaviour disorder” listed as a distinct diagnosis. It was ultimately put on probation: put into a list of topics deemed to require further research for possible inclusion in future DSM revisions.” (New Scientist).

New Scientist has by far the best coverage of the core issues around diagnostic revision in psychiatry, as an aside. This issue is yet another challenge to diagnostic categorization. I have long felt that suicidal behavior cuts across labels, that suicidal patients with different diagnoses have more similarities than differences, and there is a dissociation between treatment of the underlying disorder and treatment fo the suicidal behavior. Suicide may have a distinct biocmistry and neurophysiology, or it may be an epiphenomenon of another phenomenon which cuts across diagnoses, namely impulsivity and dyscontrol.

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When disaster strikes, it’s survival of the sociable

Vipiteno

With the promise of more and more extreme weather, officials rush to make infrastructure improvements. But they may be ignoring the greatest factor in survivability, a robust social infrastructure among the affected. What can we do, in the face of the ongoing breakdown of community in modern life? (New Scientist)

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New Efforts to Overhaul Psychiatric Diagnoses Spurred by DSM Turmoil

‘With the new manual on the eve of its official debut, many experts are already looking beyond it. Some envision a future in which psychiatric diagnoses are based on the underlying biological causes instead of a description of a patient’s symptoms. Others caution that such a single-minded focus on biology ignores important social factors that contribute to mental illness. If there’s any area of agreement it’s this: There has to be a better way.

The DSM is used by doctors to diagnose patients, by insurance companies to decide what treatments to pay for, and by pharmaceutical companies and government funding agencies to set research priorities. The new edition, DSM-5, defines hundreds of mental disorders.

The fundamental problem, according to many of DSM’s critics, is that these definitions don’t carve nature at its joints.

“An obvious, easy example is schizophrenia,” said Peter Kinderman, a clinical psychologist at the University of Liverpool. “If you’re a 52-year-old man who hears voices, you’ll receive a diagnosis of schizophrenia. If you’re a 27-year-old woman with delusional beliefs, you’ll also receive a diagnosis of schizophrenia,” Kinderman said. “Two people can receive the same diagnosis and not have a single thing in common. That’s ludicrous scientifically.”

In most areas of medicine, diagnoses are based on the cause of illness. Heartburn and heart attacks both cause chest pain, but they’re different diagnoses because they have different underlying causes.

‘Two people can receive the same diagnosis and not have a single thing in common. That’s ludicrous scientifically.’

In psychiatry, however, the underlying causes are poorly understood. What doctors now diagnose as schizophrenia may in fact be several disorders with different causes that happen to produce an overlapping set of symptoms. Conversely, two people with the same underlying biology could conceivably end up with two different DSM diagnoses — one with schizophrenia, say, and the other with bipolar disorder…’ (Wired.com)

Although I certainly know how and when to ‘label’ (e.g. to help my patients secure coverage from their insurance companies) I have long been a critic of the DSM, not merely as the 5th edition is released. Diagnostic nihilism is the only way to treat individual patients, given the modern state of psychiatry.

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Let’s Fight Big Pharma’s Crusade to Turn Eccentricity Into Illness

My wife reading in bed. And it wasn't because ...

As both a psychiatrist and a confirmed eccentric, this is dear to my heart:

“With an assist from an overly ambitious psychiatry, all human difference is being transmuted into chemical imbalance meant to be treated with a handy pill. Turning difference into illness was among the great strokes of marketing genius accomplished in our time.

All the great characters in myths, novels, and plays have endured the test of time precisely because they drift so colorfully away from the mean. Do we really want to put Oedipus on the couch, give Hamlet a quick course of behavior therapy, start Lear on antipsychotics?

I think not. Human diversity has its purposes or it would not have survived the evolutionary rat race. Our ancestors made it because the tribe combined a wide variety of talents and inclinations. There were leaders high on their own narcissism and followers content enough to be dependent on them; people who were paranoid enough to sniff out hidden threats, compulsive enough to get the job done, and exhibitionistic enough to attract mates. Perhaps the healthiest individuals were those who best balanced all these traits somewhere near the golden mean, but the best bet for the group was to have outliers always ready to step up to the plate as the particular occasion demanded.

I like eccentricity and eccentrics. The word eccentric comes from Greek geometry meaning “out of center.” It entered English as an astronomical description of the rotational paths of the heavenly bodies. Now it is used to describe people who are different — mostly with pejorative connotations, not often enough with admiration for their particular genius.

Nature abhors homogeneity and simply adores eccentric diversity. We should celebrate the fact that most humans are at least somewhat eccentric and accept ourselves as we are, warts and all. Human difference was never meant to be reducible to an exhaustive list of diagnoses drawn carelessly from a psychiatric manual.” (Wired.com)

This is by Allen Frances MD, professor emeritus and former chair of the Department of Psychiatry and Behavioral Science at Duke University School of Medicine. The Chairman of the DSM-IV Task Force and part of the leadership group for previous editions, Frances’ book Saving Normal: An Insider’s Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life was released this week.

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New Approach Raises Hope for Development of Heroin Vaccine

Finding vaccines to combat drugs of abuse is an ongoing and challenging quest. The goal is to find compounds that produce antibodies that bind to drugs in the bloodstream, stopping them from entering the brain, and thus eliminating their effects. A heroin vaccine is even more difficult to develop because the drug quickly metabolizes into other active compounds. However, researchers from the Scripps Research Institute in La Jolla, Calif., have tested a new approach that that takes heroin metabolism into account.” (Psychiatric News)