Mental Health Association of Portland

By Joe Rojas-Burke, The Oregonian, Friday, March 23, 2012

Published reports on the new drug Fanapt gave it high marks.

One medical journal emphasized its “comparable efficacy” to other drugs used to treat schizophrenia, and prominently noted a lower risk of certain side effects.

There was no mention that competing drugs outperformed it in three of the first clinical trials, or that in one trial a placebo worked just as well. The Journal of Clinical Psychopharmacology‘s summary also made no mention of Fanapt’s tendency to disturb the heart’s electrical activity and increase risk of cardiac arrest.

The one-sided reporting, uncovered by researchers in Oregon, adds to growing evidence that medical journals paint an overly rosy picture of new drugs. The analysis, published this week in PLoS Medicine, found that many unfavorable results on psychiatric drugs never appeared in the articles doctors rely on to learn about trial results.

“It’s unsettling,” says lead author Dr. Erick Turner, a former drug reviewer for the federal Food and Drug Administration and now at the Portland Veteran Affairs Medical Center and Oregon Health & Science University.

The findings do not imply the drugs don’t work. But rather, doctors and consumers don’t get a full, nuanced picture about drugs and can’t make the best decisions without all the facts about safety and effectiveness.

The bias toward publishing positive results is a widespread problem for drug treatments of all kinds.

Trials with favorable outcomes were nearly five times more likely to be published than those without, researchers at the University of California San Francisco found in 2008 when they examined all the new drugs approved by the U.S. Food and Drug Administration in a two-year period. Medical journals frequently reported conclusions more favorable than those in reviews by the FDA.

“And that’s only focusing on half the picture,” says Lisa Bero, the UC professor who led the study. “The other half of that equation is safety. How much information about harm remains unpublished?”

Turner and co-authors obtained 24 clinical trials submitted to the FDA by drug companies seeking approval for eight second-generation anti-psychotic drugs: Abilify, Fanapt, Zyprexa, Invega, Seroquel, Risperdal, Consta, Geodon. The Oregon researchers compared the FDA data – some obtained only after a request under the Freedom of Information Act – with medical journal articles.

Four studies submitted to the FDA were never published. All yielded negative results. In three, the newer anti-psychotic drug worked no better than an inactive placebo. In one, the new drug proved no more effective than an older, cheaper competing drug.

Some journal articles selectively left out unflattering results. Studies showing Fanapt statistically inferior to three competing drugs were not brought up.

The lead author of the Fanapt paper, Dr. Steven Potkin of the University of California at Irvine, was traveling this week, an assistant said, and “unable to respond.”

Study authors who conduct clinical trials with funding from drug companies don’t necessarily have access to all of the data collected or the freedom to independently analyze findings, experts say. Bero, in her 2008 study, did not find any cases in which drug companies prohibited doctors from publishing trial results, but some researchers complained about foot-dragging. “It is clearly important that this should be published,” one clinical trial researcher said. “I have been and continue to be in contact with [the drug company] to see how this can be published.”

Novartis, the maker of Fanapt, in a written statement said it “is committed to transparently disclosing the results of all clinical trials, whatever their outcome, so that healthcare providers can make fully informed treatment decisions for their patients.” The company said safety and efficacy outcomes from all Novartis-sponsored Fanapt trials have been published in peer-reviewed journals or are on the FDA’s website. Novartis said studies finding Fanapt inferior to competing drugs “were not designed as head to head comparisons.”

The extent of bias in anti-psychotic studies was not as severe as Turner and colleagues found for antidepressants in a study they did in 2008. Nearly a third of the clinical trials of antidepressants by drug companies produced questionable or negative results that never appeared publicly in print.

Part of the problem rests with journal editors, who have a long history of favoring studies with positive results and rejecting those showing a treatment doesn’t work. Journals in recent years have tried to correct the bias.

To allow a more complete view of drug trial results, Congress in 2007 mandated a clinical trial database run by the National Institutes of Health. FDA spokeswoman Sandy Walsh said the agency “has initiated a number of transparency programs over the past few years to help inform the public of the agency’s activities while also preserving confidential information.”

Turner, Bero and others who have studied publication bias insist the FDA urgently needs to disclose more information — and make it easier for doctors and consumers to interpret.

“We need access to data that shows all of the outcomes,” Bero says. “Right now, the best place to get that is through regulatory agencies.”

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Also see:

The Skanner: Study: Medical Journals Don’t Give Doctors Full Picture on Psychiatric Drugs

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By Sandra G. Boodman, for Kaiser Health News, March 12, 2012

This story was produced in collaboration with The Washington Post.

Adriane Fugh-Berman was stunned by the question: Two graduate students who had no symptoms of mental illness wondered if she thought they should take a powerful schizophrenia drug each had been prescribed to treat insomnia.

“It’s a total outrage,” said Fugh-Berman, a physician who is an associate professor of pharmacology at Georgetown University. “These kids needed some basic sleep [advice], like reducing their intake of caffeine and alcohol, not a highly sedating drug.”

Those Georgetown students exemplify a trend that alarms medical experts, policymakers and patient advocates: the skyrocketing increase in the off-label use of an expensive class of drugs called atypical antipsychotics. Until the past decade these 11 drugs, most approved in the 1990s, had been reserved for the approximately 3 percent of Americans with the most disabling mental illnesses, chiefly schizophrenia and bipolar disorder; more recently a few have been approved to treat severe depression.

But these days atypical antipsychotics — the most popular are Seroquel, Zyprexa and Abilify — are being prescribed by psychiatrists and primary-care doctors to treat a panoply of conditions for which they have not been approved, including anxiety, attention-deficit disorder, sleep difficulties, behavioral problems in toddlers and dementia. These new drugs account for more than 90 percent of the market and have eclipsed an older generation of antipsychotics. Two recent reports found that children and adolescents in foster care, some less than a year old, are taking more psychotropic drugs than other children, including those with the severest forms of mental illness.

In 2010 antipsychotic drugs racked up more than $16 billion in sales, according to IMS Health, a firm that tracks drug trends for the health-care industry. For the past three years they have ranked near or at the top of the best-selling classes of drugs, outstripping antidepressants and sometimes cholesterol medicines. A study published last year found that off-label antipsychotic prescriptions doubled between 1995 and 2008, from 4.4 million to 9 million. And a recent report by pharmacy benefits manager Medco estimated that the prevalence of the drugs’ use among adults ballooned more than 169 percent between 2001 and 2010.

Critics say the popularity of atypical antipsychotics reflects a combination of hype that the expensive medicines, which can cost $500 per month, are safer than the earlier generation of drugs; hope that they will work for a variety of ailments when other treatments have not; and aggressive marketing by drug companies to doctors and patients.

“Antipsychotics are overused, overpriced and oversold,” said Allen Frances, former chair of psychiatry at Duke University School of Medicine, who headed the task force that wrote the DSM-IV, psychiatry’s diagnostic bible. While judicious off-label use may be appropriate for those who have not responded to other treatments for, say, severe obsessive-compulsive disorder, Frances said the drugs, which are designed to calm patients and to moderate the hallucinations and delusions of psychosis, are being used “promiscuously, recklessly,” often to control behavior and with little regard for their serious side effects. These include major, rapid weight gain — 40 pounds is not uncommon — Type 2 diabetes, breast development in boys, irreversible facial tics and, among the elderly, an increased risk of death.

The Latest Fad?

Doctors are allowed to prescribe drugs for unapproved uses, but companies are forbidden to promote them for such purposes. In the past few years major drugmakers have paid more than $2 billion to settle lawsuits brought by states and the federal government alleging illegal marketing; some cases are still being litigated, as are thousands of claims by patients. In 2009 Eli Lilly and Co. paid the federal government a record $1.4 billion to settle charges that it illegally marketed Zyprexa through, among other things, a “5 at 5 campaign” that urged nursing homes to administer 5 milligrams of the drug at 5 p.m. to induce sleep.

Wayne Blackmon, a psychiatrist and lawyer who teaches at George Washington University Law School, said he commonly sees patients taking more than one antipsychotic, which raises the risk of side effects. Blackmon regards them as the “drugs du jour,” too often prescribed for “problems of living. Somehow doctors have gotten it into their heads that this is an acceptable use.” Physicians, he said, have a financial incentive to prescribe drugs, widely regarded as a much quicker fix than a time-intensive evaluation and nondrug treatments such as behavior therapy, which might not be covered by insurance.

In a series in the New York Review of Books last year, Marcia Angell, former editor in chief of the New England Journal of Medicine, argued that the apparent “raging epidemic of mental illness” partly reflects diagnosis creep: the expansion of the elastic boundaries that define mental illnesses to include more people, which enlarges the market for psychiatric drugs.

“You can’t push a drug if people don’t think they have a disease,” said Fugh-Berman, who directs PharmedOut, a Georgetown program that educates doctors about drug marketing and promotion. “How do you normalize the use of antipsychotics? By using key opinion leaders to emphasize their use and through CMEs (continuing medical education) and ghost-written articles in medical journals,” which, she said “affect the whole information stream.”

James H. Scully Jr., medical director of the American Psychiatric Association, sees the situation differently. He agrees that misuse of the drugs is a problem and says that off-label prescribing should be based on some evidence of effectiveness. But Scully suggests that a key factor driving use of the drugs, in addition to “intense marketing and some effectiveness,” is the growing number of non-psychiatrists prescribing them. Many lack the expertise and experience necessary to properly diagnose and treat mental health problems, he said.

Among psychiatrists, use of antipsychotics is rooted in a desire to heal, according to Scully. “All of the meds we use have their limits. If you’re trying to help somebody, you think, ‘What else might I be able to do for them?’”

Since 2005, antipsychotics have carried a black-box warning, the strongest possible, cautioning against their use in elderly patients with dementia, because the drugs increase the risk of death. In 2008 the Food and Drug Administration reiterated its earlier warning, noting that “antipsychotics are not indicated for the treatment of dementia-related psychosis.” But experts say such use remains widespread.

In one Northern California nursing home in 2006 and 2007, 22 residents, many suffering from dementia, were given antipsychotics for the convenience of the staff or because the residents refused to go to the dining room. In some cases the drugs were forcibly injected, state officials said. Three residents died.

A 2011 report by the Inspector General of the Department of Health and Human Services found that in a six-month period in 2007, 14 percent of nursing home residents were given antipsychotics. In one case a patient with an undetected urinary-tract infection was given the drugs to control agitation.

“The primary reason is that there’s not enough staff,” said Toby S. Edelman, senior policy attorney for the Center for Medicare Advocacy, a Washington-based nonprofit group, who recently testified about the problem before the Senate Special Committee on Aging. “If you can’t tie people up, you give ‘em a drug” she said, referring to restrictions on the use of physical restraints in nursing homes.

Drugs At 18 Months

Nursing home residents aren’t the only ones gobbling antipsychotics.

Mark E. Helm, a Little Rock pediatrician who was a medical director of Arkansas’s Medicaid evidence-based prescription drug program from 2004 to 2010, said he had seen 18-month-olds being given potent antipsychotic drugs for bipolar disorder, an illness he said rarely develops before adolescence. Antipsychotics, which he characterized as the fastest-growing and most expensive class of drugs covered by the state’s Medicaid program, were typically prescribed to children to control disruptive behavior, which often stemmed from their impoverished, chaotic or dysfunctional families, Helm said. “Sedation is the key reason these meds get used,” he observed.

More than any other factor, experts agree, the explosive growth in the diagnosis of pediatric bipolar disorder has fueled antipsychotic use among children. Between 1994 and 2003, reported diagnoses increased 40-fold, from about 20,000 to approximately 800,000, according to Columbia University researchers.

That diagnosis, popularized by several prominent child psychiatrists in Boston who claimed that extreme irritability, inattention and mood swings were actually pediatric bipolar disorder that can occur before age 2, has undergone a reevaluation in recent years. The reasons include the highly publicized death of a 4-year-old girl in Massachusetts, who along with her two young siblings had been taking a cocktail of powerful drugs for several years to treat bipolar disorder; the revelation of more than $1 million in unreported drug company payments to the leading proponent of the diagnosis; and growing doubts about its validity.

Helm said that antipsychotics, which he believes have become more socially acceptable, serve another purpose: as a gateway to mental health services. “To get a child qualified for SSI disability, it is helpful to have a child on a medicine,” he said, referring to the federal program that assists families of children who are disabled by illness.

Ask Your Doctor

Psychiatrist David J. Muzina, a national practice leader at pharmacy benefits manager Medco, said he believes direct-to-consumer advertising has helped fuel rising use of the drugs. As former director of the mood disorders center at the Cleveland Clinic, he encountered patients who asked for antipsychotics by name, citing a TV commercial or print ad.

Some states are attempting to rein in their use and cut escalating costs. Texas has announced it will not allow a child younger than 3 to receive antipsychotics without authorization from the state. Arkansas now requires parents to give informed consent before a child receives an anti-psychotic drug. The federal Centers for Medicare and Medicaid Services announced it is summoning state officials to a meeting this summer to address the use of antipsychotics in foster care. And Sens. Herb Kohl (D-Wis.) and Charles E. Grassley (R-Iowa) introduced legislation that would require doctors who prescribe antipsychotics off-label to nursing home patients to complete forms certifying that they are appropriate.

Medco is asking doctors to document that they have performed diabetes tests in patients taking the drugs. “Our intention here is to get doctors to reexamine prescriptions,” Muzina said.

“In the short term, I don’t see a change in this trend unless external forces intervene.”

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From The New York Times, November 25, 2011

This is the fourth part in the series “Lives Restored – Managing Severe Mental Illness”, by Benedict Carey.

Part One – Rescuing Others – Expert on Mental Illness Reveals Her Own Fight, New York Times, June 23, 2011
Part Two – Living with Voices – Learning to Cope With a Mind’s Taunting Voices, New York Times, August 7, 2011
Part Three – A High-Profile Executive Job as Defense Against Mental Ills, The New York Times, October 23, 2011

ATHENS, Ohio — She was gone for good, and no amount of meditation could resolve the grief, even out here in the deep quiet of the woods.

Milt Greek pushed to his feet. It was Mother’s Day 2006, not long after his mother’s funeral, and he headed back home knowing that he needed help. A change in the medication for his schizophrenia, for sure. A change in focus, too; time with his family, to forget himself.

And, oh yes, he had to act on an urge expressed in his psychotic delusions: to save the world.

So after cleaning the yard around his house — a big job, a gift to his wife — in the coming days he sat down and wrote a letter to the editor of the local newspaper, supporting a noise-pollution ordinance.

Small things, maybe, but Mr. Greek has learned to live with his diagnosis in part by understanding and acting on its underlying messages, and along the way has built something exceptional: a full life, complete with a family and a career.

He is one of a small number of successful people with a severe psychiatric diagnosis who have chosen to tell their story publicly. In doing so, they are contributing to a deeper understanding of mental illness — and setting an example that can help others recover.

“I started feeling better, stronger, the next day,” said Mr. Greek, 49, a computer programmer who for years, before receiving medical treatment, had delusions of meeting God and Jesus.

“I have such anxiety if I’m not organizing or doing some good work. I don’t feel right,” he said. “That’s what the psychosis has given me, and I consider it to be a gift.”

Doctors generally consider the delusional beliefs of schizophrenia to be just that — delusional — and any attempt to indulge them to be an exercise in reckless collusion that could make matters worse. There is no point, they say, in trying to explain the psychological significance of someone’s belief that the C.I.A. is spying through the TV; it has no basis, other than psychosis.

Yet people who have had such experiences often disagree, arguing that delusions have their origin not solely in the illness, but also in fears, longings and psychological wounds that, once understood, can help people sustain recovery after they receive treatment.

Now, these psychiatric veterans are coming together in increasing numbers, at meetings and conferences, and they are writing up their own case histories, developing their own theories of psychosis, with the benefit of far more data than they have ever had before: one another’s stories.

“It’s a thrilling time, because people with lived experience are beginning to collaborate in large numbers,” said Gail A. Hornstein, a psychologist at Mount Holyoke College and author of “Agnes’s Jacket: A Psychologist’s Search for the Meanings of Madness.” “They are developing their own theories, their own language about what their experiences means from the inside.”

Mr. Greek is one of the most exceptional, having built a successful life and career despite having schizophrenia — and, he says, because of it. He manages the disorder with medication, personal routines, and by minding the messages in his own strange delusions.

“Schizophrenia is the best thing that ever happened to me,” he said. “I know a lot of people with the diagnosis don’t feel that way, but the experience changed me, for the better. I was so arrogant, so narcissistic, so self-involved, and it humbled me. It gave me a purpose, and that purpose has been very much a part of my recovery.”

The Village Eccentric

Like many idealistic undergraduates, Mr. Greek arrived at Ohio University in Athens on a mission. Only, like many undergrads, he wasn’t completely sure what it was.

“To discover a psychological code that people should live by, to create world peace,” he said. “Something like that.”

The town was ready to listen, regardless. It was the fall of 1981, and Athens still had one sandal planted in the 1960s; communes thrived in the Appalachian foothills to the north, and big ideas were in the air, at least in the streets and bars near campus, where professors and students gathered.

One stood out. “You can’t imagine how intense he was back then,” said June Holley, a friend and business consultant in Athens. “He had this long, very thick, curly chestnut hair and wild eyes; he looked like a lion. He could be loud, and I think a lot of people just didn’t want to deal with it.”

Local residents gave him the sidewalk, avoided eye contact, and generally accepted him as one variety of village lunatic — in a town with a rich history of them.

He knew the role, at some level. The son of a college math professor and a lawyer, progressives both, Milton Thomas Greek grew up in Roanoke, Ill., and neighboring Benson, about two hours southwest of Chicago. He declared himself an atheist early and often, which in a devout Christian community was one way to stir the air — and the boys who ruled the schoolyard.

“They told me I was damned — damned! — and came after me,” Mr. Greek said. “Now I see that it was just an excuse, like picking on the fat kid for being fat, or the nerd for being a nerd. But at the time I thought it was all about religion.”

He did not discover the secret to world peace and, by senior year, was in a troubled marriage, and began seeing and hearing things others did not. One day he saw a homeless man in the Athens bus station with eyes “like landscapes that went back into the man’s head infinitely far, stretching on for eternity.” God’s eyes; who else?

Later, he was hitchhiking, and a man with long hair and sandals pulled over to offer a ride, his eyes rippling with the same eternal light as the street person’s. Jesus? It had to be (“I’d already met God, so it made sense.”) The man said something about a small town in the woods, and Mr. Greek thought that that town had to be heaven.

His marriage collapsed. His friends stopped calling. He was back at home in Illinois when a doctor finally gave him a diagnosis — schizophrenia — and prescribed medication.

It seemed like a charade, from start to finish. The doctor never asked what he thought his hallucinations meant, or whether the strange thoughts were linked to experiences in his life. He stopped taking the pills.

“I became very suicidal,” he said. “I had no idea what’s happening to me during this entire time. I had been this big atheist, but here I am thinking that the rapture is about to start and that I’m the Antichrist — all this religious imagery.”

Why?

The answer was obvious and ultimately liberating, but he had to spend a long time wandering in the woods — literally — to find it.

It was 1984, he had begged his way back into Ohio University for graduate studies in sociology, still lost in his own mind, his thoughts turning darker by the day. He was alienating classmates, professors, friends.

About the only exception was Ms. Holley, a graduate student some 15 years his senior who enjoyed his company, and one day he decided to visit the commune where she lived, with her family and several other families. It took him two days to find it, the first spent wandering the misty woods until dark in a waking, delusional dream, and the second stumbling into a clearing just off Hooper Ridge Road, where Ms. Holley and her friends took him in.

Over the next several months they sat with him, accepted him as a member of the tribe, and encouraged his mission to improve the world at face value. And save his life they probably did, in part by suggesting that he seek help.

It was Ms. Holley who delivered the message. “I trusted her completely, so when she said I was hallucinating — when she used the word ‘hallucination’ — I knew it was true,” Mr. Greek said. “I would have to give the medication another try.”

He was lucky. It worked, blunting the psychosis enough that he was able to complete a programming course and find work, first in Illinois and later back in Athens at Ohio University’s Information Technology department. In time he found something more: During a snowstorm in 1996, Mr. Greek knocked on the door of a neighbor he had seen around Athens, a single mother with two teenage children, carrying a full-time job plus graduate classes, who was at that very moment (he would learn later) praying for something to get her through the winter.

The man at the door did not exactly look like a savior, in his beat-up jeans and unruly hair, his soft eyes and half-smile. But he offered to cook dinner — stir fry — on a day when the fridge was nearly empty.

The two neighbors became friendly, then close, and finally fell for each other. Neither can say exactly when it happened, but she remembers looking out her window one day to see Mr. Greek pull up to his apartment across the street, his old Honda coughing white smoke. He popped the hood and backed away from the car in slow motion, staring at the engine, then turned abruptly toward his apartment — and vanished, falling face-first into some bushes. “I thought, ‘Well, O.K., he’s got something,” she said. “I’m not sure what. Absentmindedness, maybe?”

They married in 2003 (Mr. Greek’s wife, an artist, asked that her name not appear in this article, for her own privacy), and she helped him fit his religious delusions, now controlled by medication, into a coherent personal story that has guided his day-do-day life.

The frightening voices and ominous signs saying that he was damned were no more than embodiments of his very real childhood terror of being cast out, as the schoolyard boys threatened. His search for heaven on earth was in part an attempt to escape that fate, to find a secure place. But it also dramatized a longing to put the world right, a mission that may have started as vain fantasy, but in time became an emotional imperative, a need to commit small acts of kindness, like cooking dinner for a snowed-in neighbor.

A Regimen for Coping

“He has this long list of causes that he’s extremely passionate about, and he has strong opinions about almost everything, but he’s also very sensitive to his relations with people and open to other philosophies,” said Melissa Van Meter, who has worked with Mr. Greek at the university and holds very different political views. “It has just impressed me that he could handle so much personally and do so well professionally.”

“When I began to see the delusions in the context of things that were happening in my real life, they finally made some sense,” Mr. Greek said. “And understanding the story of my psychosis helped me see what I needed to stay well.”

Mr. Greek’s regimen combines meditation, work and drug treatment with occasional visits to a therapist and a steady diet of charitable acts. Some of these are meant to improve the community; others are for co-workers and friends, especially those dealing with a psychiatric diagnosis.

To help others experiencing psychotic delusions, he relies on his own theory of what delusions may mean. In an analysis of 20 delusional experiences, all described by sufferers in the first person, Mr. Greek identifies four story lines.

Among them are the rescuer (on a mission to save a particular group); the self-loathing person (lost in a sense of extreme worthlessness); the visionary (on a journey to spiritual realms to bring back truth); and the messianic (out to transform the world through miracles, or contact with deities) — the last of which is his own psychosis story.

Each, in Mr. Greek’s reading, grows out of a specific fear or trauma, whether isolation, abuse or family dysfunction, in the same way his own delusional story symbolized a fear of being a social reject. He is preparing the study for publication in a psychiatric journal and has put much of his thinking into a manual for families dealing with psychosis, called “Schizophrenia: A Blueprint for Recovery.”

Mr. Greek’s analysis of the story lines in psychosis is certainly not the first of its kind, nor the most comprehensive. Psychiatrists, psychologists, therapists and brain scientists have spun out hundreds of ideas about what goes on during a delusion.

But until recently patients themselves — that is, nonprofessionals who have lived with hallucinations and delusions — had little more than their own strange story to study, in any detail. Now they have dozens, and Mr. Greek is one of a small number of such “native” theorists who argue that the content of a delusion should not be ignored but engaged, carefully, once a person has his or her hallucinations under control.

Underlying Needs

“By exploring a person’s anomalous beliefs and experiences, we are better able to understand the underlying feeling and needs that give fuel to these experiences,” said Paris Williams, a psychologist who has struggled with psychosis and recently published a doctoral dissertation analyzing the content of six people’s delusions, which has informed Mr. Greek’s work.

For instance, said Dr. Williams, who is working on a book called “Rethinking Madness,” “we can find ways to make them feel safe when they believe they are being persecuted by malevolent forces, or find ways to help them feel empowered when they experience demanding voices.”

One place Mr. Greek feels safe is in a clearing in the woods behind his house, where on a recent afternoon he disappeared wearing a tie-dyed shirt and old jeans with the knees worn completely through. He practices mindfulness meditation here, tuning in to the rhythms of life that usually pass unnoticed.

Back at home, he runs thoughts and perceptions by his wife. “He says things like, ‘Is that a marching band I’m hearing, or am I just hallucinating?’ ” she said. “I’ll say, ‘Uh no, I don’t hear a band, Milt,’ and he’s fine.”

And he visits a therapist when stress levels are running very high. The therapist has given him diagnoses of schizophrenia and “mood disorder, not otherwise specified,” according to his medical records, and she treats him in sessions and with an antipsychotic drug, adjusting the dosage up or down depending on his mood.

Since his mother’s death, Mr. Greek and his wife have taken several more emotional blows, with other close relatives dying. He has been especially stretched, between his work, various community projects, and traveling to speak, often to police groups about how to understand psychotic thinking when dealing with people on the street.

It was too much, and in August he visited his therapist again, and soon after made a deal with his wife. “She and I signed a contract identifying and limiting volunteer work I will do next year,” he said in an e-mail. “I am being coached on how to say no.”

The world is not yet saved from itself, nor for that matter is Athens. But even a messianic rescuer needs a day off, if only to come back stronger the next.

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The idea may seem preposterous. But the authors of a new study weren’t laughing when they announced they had identified signs of schizophrenia in babies only a few weeks old.

A group of researchers led by John H. Gilmore, MD used ultrasound and MRI to look for brain abnormalities in 26 babies born to mothers with a diagnosis of schizophrenia, along with 26 babies in a “healthy” control group.

Gilmore said the high-risk babies had abnormally large brains, with larger ventricles (fluid-filled spaces in the brain). The differences only showed up in male babies, but Gilmore said that was characteristic of schizophrenia as well, explaining that the illness is more frequent and severe in men.

A Twist of Logic

In other words, when the girls in the high-risk group showed no brain differences at all, Gilmore managed to link the non-results to the illness he was looking for.

And the boys? Gilmore’s press releases do not mention how many male babies actually had brain differences, simply saying that enlargement was present “overall.” At this writing, the full article was only available to paid subscribers to the American Journal of Psychiatry, and the abstract omits exact numbers.

Gilmore, however, was confident enough to envision a brave new world of infant psychiatry. The study, he said, “allows us to start thinking about how we can identify kids at risk for schizophrenia very early and whether there are things that we can do very early on to lessen the risk.”

Milk, Cookies, and Prozac

Is Gilmore talking about drugging babies before they’re a month old? Gilmore doesn’t say that – not quite. He edges quite close, however, with his hopeful assertion that this line of research “will help us target interventions.”

In fact, drugging babies is not that far-fetched, considered along with psychiatry’s progression over the last few decades. Investigative journalist Robert Whitaker, in his groundbreaking new book, “Anatomy of an Epidemic,” traces a path that has led to medicating children on a grand scale.

Whitaker notes that drugging children with psychiatric medications is a relatively new phenomenon. “Mental illness” in children and teenagers was almost unheard of until 1980, when attention-deficit disorder appeared in the DSM-III. Psychiatrists acknowledge that diagnosis mostly followed teacher complaints, not medical evaluations, but doctors were happy to offer Ritalin to fidgety kids. Today, says Whitaker, around 3.5 million U.S. children take stimulants for ADHD – at last count, one in every 23 kids aged 4-17 were taking the drugs.

More Diagnoses, More Drugs

As evidence mounted that the drugs did more harm than good, psychiatrists identified more and more childhood mental illnesses requiring more and more medications. When Prozac emerged as the newest “wonder drug,” kids got SSRIs. By 2002, according to Whitaker, one in 40 kids was on an antidepressant. Drug companies spun efficacy gold from studies made of straw, while keeping the risks quiet. Children taking the drugs paid a price in physical and mental side effects.

The march of psychiatric progress did not falter, however, as doctors came up with another diagnosis that was “exploding” among kids: bipolar disorder. For many kids, who were already taking stimulants or SSRIs, symptoms of mania emerged as a result of their previous psychiatric treatment.

This, of course, required more psychiatric treatment. And the treatment, Whitaker says, involved even more powerful medications, with even greater risks and side effects. Soon, kids were taking antipsychotics and anticonvulsants before they entered grade school. Predictably, many of these kids began experiencing the side effects of these powerful drugs, such as sedation, massive weight gain, and permanent movement disorders.

History suggests, then, when Gilmore hints that medicating babies may be in the near future, we may do well not to laugh.

And history gives one of Gilmore’s remarks an ominous note.

“This is just the very beginning,” he said.

See Robert Whitaker live! Join Portland Hearing Voices for a special benefit lecture:

Thursday, August 19, 7:30 p.m.
Powell’s City of Books Downtown
1005 W. Burnside
Portland, Oregon
For more information: Portland Hearing Voices

By Edward Scott, from the Journal of Clinical Psychology; April 1958, Vol. 14 Issue 2, p156-157, 2p

READ – A comparison of Rorschach and Howard ink blot tests on a schizophrenic population from a content point of view, as a PDF

This article presents a study to compare Rorschach and Howard ink blot tests on a schizophrenic population from a content point of view. The present investigation is based on a population of 50 routine, testable schizophrenics of at least normal intelligence admitted to the Eastern Oregon State Hospital. On one half of the population was first administered, and the following day the other half; on the other half of the sample the process was reversed. Following this, a list of responses was constructed and each response was entered into like categories of content. The total expanded list grew to 139 separate content response categories. However, 49 of these categories consisted merely in different kinds of animals, 14 in various anatomical responses, and 10 in various humanlike responses.