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Psychiatric Diagnoses in Children

Autism and anti-depressant study

Researchers at the Autism Research Program at the Kaiser Permanente Division in Oakland, California released a study in July 2011 showing that mothers of children with autism were twice as likely to have been prescribed common anti-depressants (serotonin reuptake inhibitors, or SSRIs) during the year before their pregnancy than mothers of healthy children. The team studied nearly 300 children with autism and 1,500 randomly selected healthy children and then checked their mothers’ medical records. They found mothers of the children with autism were twice as likely to have taken an antidepressant in the year before delivery than children in the control group. The effect was strongest — three times higher — when the drugs were taken in the first trimester of pregnancy. However, "there are real risks to not being treated for a serious illness like depression. You have to weigh the options," said Dr. Thomas Insel, director of the National Institute of Mental Health." go to msnbc

This article illustrates how tricky the mental health situation in the US is at the moment. We may read it and say, 'oh no' to the idea of psychiatric drugs in pregnancy possibly causing autism, yet must also realize a serious mental illness of depression naturally needs treatment so that the mother can rise to even the most basic responsibilities of mothering in the first place, something she could not due if seriously depressed. The trick is to unpack the emotional knot here. The US medical system in 2013, whether by collusion or by imprudence, legitimates an over-reliance on pharmaceutical solutions to unpleasant emotion states.

This means that mothers may be diagnosed incorrectly as so depressed that they need to be on medication (such depression does occur). For those who are less seriously depressed, their emotional state could be treated by therapy - which would both help the mother and not harm the baby. But, therapy takes more time than a pill, and at first glance appears more expensive (an hour's therapy fee vs. a few pills) for health insurance companies. But, when one then expands the picture to include, to stay with this article, the treatments and special education necessary for an autistic child its entire life, well, the fees of even high-level non-pharmaceutical solutions such as long-term psychodynamic therapy are made relative.


American pill-poppers

by Jennifer Planeta

"... One observation: Americans are a bunch of pill poppers. Because Artur was the maintenance manager at this resort, he was often called into the guests' units to fix or adjust various things. As a result, he often saw the luggage contents that the travelers unpacked during their stay. Without fail, the Americans always had numerous pill bottles.

Regardless if these bottles contained meditations, vitamins, supplements or a motley of all three, the Americans seemed to be the only ones who consistently traveled with so many pills. No other culture appeared to travel with or need as many pills as the Americans. (Pretty interesting considering the power and wealth of the pharmaceutical companies in the United States. Not to mention their grip on the American medical system.)" see multilingual living

 

Bipolar disagnoses

The number of American children and adolescents diagnosed with Bipolar Disorder in in-patient community hospitals increased 4-fold since the year 2000, reaching rates of up to 40 percent. In outpatient clinics, it doubled, reaching the 6 percent. Outpatient office visits for children and adolescents with bipolar disorder in the United States increased from 20,000 in 1994-95 to 800,000 in 2002-03. The data suggest that doctors had been more aggressively applying the diagnosis to children, rather than that the incidence of the disorder has increased.

The reasons for this increase in diagnosis are unclear. On the one hand, bombardment of information from the scientific community will have made clinicians aware of the nature of the disorder and the methods for diagnosis and treatment in children. That, in turn, would increase the rate of diagnosis. On the other hand, assumptions regarding behavior, particularly in regard to the differential diagnosis of bipolar disorder, ADHD, and conduct disorder in children and adolescents, may also play a role.

In addition, some argue that the rise in diagnosis of pediatric bipolar disorder is the result of the influence of the pharmaceutical industry on psychiatry, especially with regard to big pharma's recent push to expand the market of atypical antipsychotics to children and the elderly.

 

The "consensus" regarding the diagnosis in the pediatric age group seems to apply only to the USA. The British National Institute on Health and Clinical Excellence (NICE) guidelines on bipolar disorder in 2006 specifically described the broadened criteria used in the USA to diagnose bipolar disorder in children as suitable "only for research" and "were not convinced that evidence currently exists to support the everyday clinical use of (pediatric bipolar phenotype) diagnoses which increase the "risk that medicines may be used to inappropriately treat a bipolar diathesis that does not exist." A 2002 German survey of 251 child and adolescent psychiatrists (average 15 years clinical experience) found only 8 percent had ever diagnosed a pre-pubertal case of bipolar disorder in their careers. A similar survey of 199 child & adolescent psychiatrists (av 15 years clinical experience) in Australia and New Zealand also found much lower rates of diagnosis than in the USA and a consensus that bipolar disorder was overdiagnosed in children and youth in the USA. Concerns about overdiagnosis in the USA have also been expressed by American child & adolescent psychiatrists and a series of essays in the book "Bipolar children: Cutting-edge controversy, insights and research" highlight several controversies and suggest the science still lacks consensus with regard to bipolar disorder diagnosis in the pediatric age group. [View source]

text excerpted from "Bipolar Disorder in Children," Wikipedia, but for purposes of ease of reading, footnotes were removed. See Wikipedia for full description.

 

What is crying 'too much'?

by Meredith Small

"We now have drugs that offset hyperactivity, therapy to dampen behavioral disorders, and special tutors to help the learning-disabled. But who decides when these interventions are necessary? … When a parent brings in a baby and says she is crying 'too much,' what, [Pediatrician Ronald Barr] asks himself, does 'too much' mean? If this mother was a !Kung San, crying for ten minutes might be 'too much,' but for a Canadian the 'too much' line might be crossed after an hour. Also, different parents have different tolerance levels." There is a Wessel definition of colic, but parents and doctors differ in their understanding of how that relates to their baby and their parenting capacities. [View source]

Small, Meredith, 1998, "Our Babies, Ourselves: How Biology and Culture Shape the Way we Parent," Anchor Books (Doubleday)

Lack of attachment and public disease no.1

by Ann Kathrin Scheerer

We, as psychoanalysts, treat patients that often had insufficient experience in relating when they were small, which then laid the foundation for future suffering. There is much talk about depression as the "public disease no. 1", but there seems to be a lack of reflection on how much the early loss of relating and attachment is behind this symptom. Even though we do not state a monocausal connection here, we cannot deny our knowledge about autobiographical context. full text in German

Mommy,am I Really Bipolar?

"I have been a child psychiatrist for nearly five decades and have seen diagnostic fads come and go. But I have never witnessed anything like the tidal wave of unwarranted enthusiasm for the diagnosis of bipolar disorder in children that now engulfs the public and the profession. Before 1995, bipolar disorder, once known as manic-depressive illness, was rarely diagnosed in children; today nearly one third of all children and adolescents discharged from child psychiatric hospitals are diagnosed with the disorder and medicated accordingly. The rise of outpatient office visits for children and adolescents with bipolar disorder increased 40-fold from 20,000 in 1994–95 to 800,000 in 2002–03. A Harvard child-psychiatry group led by Dr. Joseph Biederman, a prominent supporter of the diagnosis, recently insisted, “Juvenile bipolar disorder is a serious illness that is estimated to affect approximately 1 percent to 4 percent of children.

"I believe, to the contrary, that there is no scientific evidence to support the belief that bipolar disorder surfaces in childhood. In fact, the opposite seems to be the case: the evidence against the existence of pediatric bipolar disorder is so strong that it’s difficult to imagine how it has gained the endorsement of anyone in the scientific community. And the effect of this trendy thinking can have devastating consequences. Such children are regularly prescribed medications that are not effective in kids and have unwelcome side effects." read more in Newsweek

 

A very interesting article on the changing development of the scientific method

by Jonah Lehrer

"On September 18, 2007, a few dozen neuroscientists, psychiatrists, and drug-company executives gathered in a hotel conference room in Brussels to hear some startling news. It had to do with a class of drugs known as atypical or second-generation antipsychotics, which came on the market in the early nineties. The drugs, sold under brand names such as Abilify, Seroquel, and Zyprexa, had been tested on schizophrenics in several large clinical trials, all of which had demonstrated a dramatic decrease in the subjects’ psychiatric symptoms. As a result, second-generation antipsychotics had become one of the fastest-growing and most profitable pharmaceutical classes. By 2001, Eli Lilly’s Zyprexa was generating more revenue than Prozac. It remains the company’s top-selling drug. But the data presented at the Brussels meeting made it clear that something strange was happening: the therapeutic power of the drugs appeared to be steadily waning." go to the New Yorker

ADHD medication in 4-year-olds

by Peggy O'Mara

"Things to do before resorting to medication: 1) Environment: A child with an active mind and body needs a calming environment with plenty of time and space to run off steam, to explore and to wear himself or herself out. I once asked a friend whose son had just been diagnosed with ADHD if he would be a problem if he lived on a farm. She said, “No.” … Have meals and bedtimes at the same times every day. Create routines to help children focus on regular tasks. 2) Diet: Start with food. ... Keep food simple. 3)Non-drug solutions: Integrative therapies like herbal medicine, homeopathy, and acupuncture can be explored before drugs are considered or can be used as complements to drug therapy. ... The Pfeiffer Medical Center, a nonprofit medical research and treatment facility specializing in research and treatment of biochemical imbalance, is one place that helps with these kinds of tests." go to Mothering.com


 


Interested in more? Here are other articles:
research psychology
psychoanalysis happiness
emotional literacy depression
Chinese medicine bipolar
autism anxiety
ADHD

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