09-04-2007 Media Madness

The whole world is apparently watching the news around the massive increases in diagnoses of bipolar disorder in kids, teens, and adults. My earlier post on this is here. Hundreds of references from the mainstream media and news sites such as CNN. I'm glad to see many in the media are layering all of this with appropriate skepticism and that some docs are pointing out that so many kids they see diagnosed with bipolar disorder have been misdiagnosed. One doc puts it at four of five patients. This from the Los Angeles Times/Newsday:

"Dr. Gabrielle A. Carlson, a psychiatrist at Stony Brook University, said only 1 of every 5 children referred to her with a diagnosis of bipolar disorder actually has it. The rest have autism, depression, anxiety or another psychological disorder. All these conditions involve different treatments, either with drugs or behavioral therapy, or both.

"Carlson, who has studied the increase in bipolar diagnoses, said some parents seemed to prefer a diagnosis of the disorder because the illness, thought to be largely genetic, absolves them of blame. "They don't have to deal with their chaos, their psychiatric disorder, their marital troubles or abuse." She said in some cases providers diagnose psychological problems in children as bipolar disorder to obtain insurance reimbursement for hospitalizations, a practice called upcoding."

Now that's skepticism.

Even Slate got into the act a bit, although as usual Bill Saletan is too glib by half. Several blogs have taken this up as well, including Schools Matter and NPR, which is discussing the matter on "Talk of the Nation."

John Grohol at PsychCentral has a good discussion of the diagnosis explosion story. Now that I have read the full paper, I share his concerns that many of these youths appear to be getting diagnosed and medicated by PCPs. If I recall, that's the same pattern we saw with the ADHD explosion of the 1990s and PCPs are diagnosing and treating on the order of 80 percent of all cases of depression. And their patients are doing so well! I have several other concerns upon reading the paper, which I will get to later. The point here is that PCPs just don't have the time or expertise to be doing mental health work in a consistent reliable fashion. That's not a slap at PCPs. It's an acknowledgment of clinical reality.

Danny Carlat has an amazing item on a psych professor who had a paper appear under his name but is now denouncing it as a piece of commercial crap. Read it.

CL Psych's blog has blown up with comments over the Rita Pal affair in the UK. I have never seen nastier comments in the mental health world and I am glad that the Pal haters decided to steer clear of my blog. Probably because I moderate comments. CL has had to turn on his comment moderatin' software and has encouraged people to get a new hobby. Personally, I find the Pal affair discouraging on so many levels, but I am looking forward to its resolution in the British High Court where I guess the name of my little old blog will get mentioned. In addition, CL has another fabulous skewering of Charles "Ghost Authorship" Nemeroff.

Grohol also has an interesting analysis of an article in Reason magazine that defends the status quo of our deeply conflicted pharma-academia industrial complex. Reason is one of my favorite publications, and I am generally an adovcate for free market solutions, but the article's author Ron Bailey might want to consider not being a lap dog for pharma. The conflict-of-interest-o-rama that is the world of mental health treatment, for example, has been an utter disaster for real world patients and, in my opinion, a huge black eye for academia. Mauricio Tohen anyone?

Souful Sepulcher goes ripshit on my earlier item about a Harvard researcher declaring 50 percent of America DSMable.

Meanwhile, my friend Liz Spikol is taking it easy in Paris. Good for her. Smoke a Gitanes for me, please.

And many thanks to the Wall Street Journal's health blog for linking to my post of yesterday on Lilly's experimental schizophrenia drug.