Psychiatric Overmedication - September 5th, 2022 Episode

Updated: Oct 17





This is not a new problem


1980 Chemical straight jackets

https://www.nytimes.com/1980/06/03/archives/psychiatric-drugs-widely-misused-critics-charge-neuroleptics.html?searchResultPosition=2


2006 Psychiatric drug cocktails for children not backed up by scientific trials

https://www.nytimes.com/2006/11/23/world/americas/23iht-drugs.3642084.html?searchResultPosition=1


2010 Overmedicated children https://www.nytimes.com/2010/02/23/health/23book.html?searchResultPosition=2


2014 Near death and overmedicated https://archive.nytimes.com/newoldage.blogs.nytimes.com/2014/09/09/near-death-and-overmedicated/?searchResultPosition=1


2015 Overmedicating patients https://www.nytimes.com/2015/10/02/opinion/overmedicating-patients.html?searchResultPosition=4


2022 This teen was prescribed 10 psychiatric drugs and she is not alone https://www.nytimes.com/2022/08/27/health/teens-psychiatric-drugs.html?searchResultPosition=1


Inappropriate medicated children https://publications.aap.org/pediatrics/article/146/1/e20192832/77028/Attention-Deficit-Hyperactivity-Disorder-and?autologincheck=redirected?nfToken=00000000-0000-0000-0000-000000000000

The problem with the DSM-5 and psychiatric diagnoses generally

DSM5 https://psychiatry.org/psychiatrists/practice/dsm

  • lacks true scientific basis but is validated by opinion

  • has cultural bias

  • pathologizes the human experience

  • NIMH does NOT use it for psychiatric research because it is symptom based

  • promotes pharmaceutical approach


Scientific basis:

Falsely perpetuates the hypothesis of the chemical imbalance concept which has been refuted: Is the chemical imbalance an ‘urban legend’? https://www.sciencedirect.com/science/article/pii/S266656032200038X

Serotonin theory refuted: https://www.nature.com/articles/s41380-022-01661-0


Cultural/political bias:

There is little scientific foundation for what behavior is considered normal versus abnormal in the DSM-5, since decisions were based more on cultural and political opinions of the human norms than any concrete scientific evidence. Think about it this way: 1952 a group of older white men decided what was normal and what was not normal. It's obvious that they had a cultural bias at least at that time. The pathologized homosexuality because that was the cultural standard at the time, not because they had any evidence to support the erroneous disease labeling of a relatively common (7.1%) human experience. We see this happening now in increased assaults on LGBTQIA individuals in the aftermath of significant increase in political hate speech. https://www.washingtonpost.com/national-security/2022/06/17/lgbtq-pride-violence/


Pathologizes the shared human experience:

Shared human emotions, including sadness, anxiety, dejection, and cultural ambivalence which are part of being human in many contexts, become medicalized and pathologized as disorders based on symptomatology rather than common experience.

For example grief from loss like death is often called depression and medicated.

REMEMBER: Homosexual behavior was pathologized from 1952 to 1973 per the DSM.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4060802/pdf/fpsyg-05-00602.pdf

OVERDIAGNOSIS https://journals.sagepub.com/doi/pdf/10.1177/070674371305801106


NIMH

Withdrew support for it 2 weeks after publication in 2013 https://www.psychologytoday.com/us/blog/side-effects/201305/the-nimh-withdraws-support-dsm-5

"The weakness” of the manual, he explained in a sharply worded statement, “is its lack of validity.” “Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure.”

Because the DSM-V grounds diagnosis in symptomatology, psychiatrist are prone to treating symptoms the simplest way possible with medication rather than first investigating root causes such as medical issues, nutrition, trauma, social environment, and family dynamics. https://www.pchtreatment.com/dsm-5-issues/


Promotes pharma approach

69% of the DSM5 editors have ties to pharmaceutical industry. It is argued that the reason anxiety disorders and depressive disorders are separated into 2 diagnoses is so that they can be separately medicated. (More $$$ for pharma)

Medical illness presenting as mood or thought disorder https://www.mdlinx.com/article/5-medical-conditions-that-mimic-psychiatric-disorders/2aAIlMRClHbug3SBgSVKp3


Misdiagnosis Medical mimics: Differential diagnostic considerations for psychiatric symptoms https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6007536/pdf/i2168-9709-6-6-289.pdf


Psychiatrists do not do this in my world:


Multiple sources suggest a variety of elements as part of a comprehensive patient workup. The published literature consensus is that these elements should include:

A complete medical and psychiatric history

History of present illness with review of systems to

identify symptoms suggestive of medical causality

Physical exam

Review of current prescription, over-the-counter and

alternative medications, and recent changes

Mental status examination

Laboratory and diagnostic testing (see specific tests

below)

Interpretation of aggregated findings


NIMH Rationale for moving forward:


  • A diagnostic approach based on the biology as well as the symptoms must not be constrained by the current DSM categories;

  • Mental disorders are biological disorders involving brain circuits that implicate specific domains of cognition, emotion, or behavior;

  • Each level of analysis needs to be understood across a dimension of function;

  • Mapping the cognitive, circuit, and genetic aspects of mental disorders will yield new and better targets for treatment.