tag:blogger.com,1999:blog-7772182113499451603.post6503412675455762338..comments2024-03-27T10:50:53.692-05:00Comments on Real Psychiatry: An Effort To Distance Critical Psychiatry From Antipsychiatry George Dawson, MD, DFAPAhttp://www.blogger.com/profile/03474899831557543486noreply@blogger.comBlogger12125tag:blogger.com,1999:blog-7772182113499451603.post-74665381953526233712019-03-06T19:43:34.028-06:002019-03-06T19:43:34.028-06:00I think that most of the early use is going to be ...I think that most of the early use is going to be in large clinics and medical centers where there are areas (post op, recovery rooms, infusion rooms, etc) where people can be observed en masse by trained staff and discharged. Smaller clinics might be able to replicate that to come extent by hiring ICU nurses or nurse anesthetists and coordinating the treatments for the same day of the week. <br /><br />Time will tell - this is all fueled by the promise of results for treatment resistant depression. That will give it an advantage over Relprevv - sustained release olanzapine that never really caught on. George Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-45855852542718269982019-03-06T18:55:17.688-06:002019-03-06T18:55:17.688-06:00Articles like this cause me to pause and reconside...Articles like this cause me to pause and reconsider:<br /><br />https://www.npr.org/sections/health-shots/2018/08/29/642700616/ketamine-a-promising-depression-treatment-seems-to-act-like-an-opioid?utm_campaign=storyshare&utm_source=twitter.com&utm_medium=social<br /><br />I think the purpose of the article was pro but my thoughts ended up being con.James O'Brien, M.D.https://www.blogger.com/profile/14994350319492582321noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-74980209288681917962019-03-06T16:50:22.343-06:002019-03-06T16:50:22.343-06:00I was wondering about ACLS myself, it's not a ...I was wondering about ACLS myself, it's not a bad idea anyway (probably will save more lives than robotic board recertification). Or maybe do you need a bed instead of a couch? You're not going to wait two hours and not see other patients, so there would have to be at least some kind of trained observer.<br /><br />One odd elephant in the room about the reputation of psychiatry...it's completely dependent on the reputation of psychology since most people don't know the difference and psychology is much bigger. I feel comfortable criticizing it because I have criticized psychiatry much like the late Mickey Nardo on the scientific and statistical problems in the field.<br /><br />Psychology (and related fields) training has slowly abandoned scientific approaches since the Boulder model went out of fashion...with disastrous results. It's abundantly clear when you read most of the on-line articles at psychological websites than only a few, such as Scott Lillenfeld, have a solid background in science and research. Much of it is just cathartic BS and personal agendas, as well as downright dangerous and stupid fake science, such as fat acceptance and "healthy at any weight". They don't realize how completely out of touch they look to the average reader.<br /><br />James O'Brien, M.D.https://www.blogger.com/profile/14994350319492582321noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-80492731450321242982019-03-06T16:36:35.587-06:002019-03-06T16:36:35.587-06:00I think there needs to be a standardized approach....I think there needs to be a standardized approach. If you have a crash cart - do you also need to be ACLS certified? I am assuming the office based approach approved by the FDA means it can be managed less intensively than that - but I need to read the package insert and look at the ADEs in the trials.George Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-52094662844555792602019-03-06T15:59:11.631-06:002019-03-06T15:59:11.631-06:00I'm interested but there are some logistical i...I'm interested but there are some logistical issues. I think you need a third room with a couch and a crash cart, and a nurse.<br />James O'Brien, M.D.https://www.blogger.com/profile/14994350319492582321noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-87805360234669108632019-03-06T10:49:44.916-06:002019-03-06T10:49:44.916-06:00It will be interesting to see what will happen wit...It will be interesting to see what will happen with the FDA approach. They are using a REMS approach so that it will be administered in MD offices only and it is not a take home drug.<br /><br />https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm632761.htm<br /><br />When I explained that to my wife after she heard the news story - her response was: "Who is going to go into a doctor's office every week to take a drug?" I did explain to her that it was less invasive than the current infusion - but not much. There is still an observation period and the patient needs to be driven home.<br /><br />There is also the issue that the infusion clinics seemed to be waning in the Twin Cities for some reason and I wonder if attrition due to the weekly procedure was part of that.<br /><br />I have seen people abusing very high doses of ketamine that the got from some of these clinics that were run by non-psychiatrists by using both tablets and compounded gels. As most psychiatrists know ketamine (along with PCP) is an abusable drug. I have seen it abused for at least 30 years and why people wanted to get dissociation and psychosis was always a mystery - but with Schatzberg's recent paper we now have a mechanism.<br /><br />Hope to put something on the blog here about it soon. A psychiatrist on Twitter who had early access described positive results. A friend of mine who specializes in treatment refractory mood disorders told me that 2/3 of his patients respond to the infusion.George Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-91715487754404266372019-03-06T10:16:43.494-06:002019-03-06T10:16:43.494-06:00That I do have a problem with. But there are ple...That I do have a problem with. But there are plenty of highly qualified people criticizing psychiatry and psychology. One can disagree with Healy but he is not stupid. Look at the pablum that comes out of Psychology Today's website and the throwaway psych journals. Most of it is virtue signaling ideology and not science. Many of us on this site have negative feelings about drugs like Paxil and the lack of measurement and biomarkers in psychiatric practice and have not been shy about saying so. <br /><br />In the interest of epistemic humility, I'm open to the idea that the newly approved esketamine will be a breakthrough but I am very skeptical. What's your current take on it?James O'Brien, M.D.https://www.blogger.com/profile/14994350319492582321noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-48173959580883295902019-03-05T23:04:32.639-06:002019-03-05T23:04:32.639-06:00I will always have a problem with somebody presumi...I will always have a problem with somebody presuming that they know more about my job than I do and then telling me that I am an idiot based on their superior knowledge.<br /><br />It's as simple as that. George Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-29116307253321448802019-03-05T22:41:14.699-06:002019-03-05T22:41:14.699-06:00I'm not all that bothered by critical psychiat...I'm not all that bothered by critical psychiatry. Look at clinical nutrition and the standard practice of internists and FPs. Most of them have bought into 70 years of institutionally backed misinformation on sugar and cholesterol. Statins are more controversial than SSRIs. I remember when ulcers were caused by stress not helicobacter. It happens in other fields too. It's how fields evolve. But we are in a rut and I think that's what a lot of us are responding too.James O'Brien, M.D.https://www.blogger.com/profile/14994350319492582321noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-77138401605833606902019-03-05T21:53:33.537-06:002019-03-05T21:53:33.537-06:00Thanks, the link to my critique of the NYTimes art...Thanks, the link to my critique of the NYTimes article on Prof. Gutting critique of the DSM-5 is particularly useful. Although he criticizes Foucault, it is telling that he make the same mistake, some of his defenders try to jump on me rhetorically, and in the end nobody can tell me how they would ever determine the difference between an explicit and implicit agenda. I was really interested in that answer and nobody was able to provide it.<br /><br />If you are going to philosophize about something and you don't know anything about it - your logical should be airtight. And in that scenario - how could it be?<br /><br />Psychoanalysis should be a technical field like the rest of psychiatry. I think it is a useful endeavor both at the clinical and theoretical level. I don't think being affiliated with a philosopher adds much. Antipsychiatry seems to depend on it along with rhetoric. <br /><br />George Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-21713180759479113302019-03-05T17:44:00.979-06:002019-03-05T17:44:00.979-06:00BTW, I did enjoy your takedown of Foucault. But ...BTW, I did enjoy your takedown of Foucault. But the postmodernist scourge has infiltrated modern psychiatry and psychology and has become mainstream. Lacan and Marceuse dominate a lot of analytical institutions today.James O'Brien, M.D.https://www.blogger.com/profile/14994350319492582321noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-43376207741131494292019-03-03T19:30:46.683-06:002019-03-03T19:30:46.683-06:00Szasz and Jeffrey Liebermann can both be wrong and...Szasz and Jeffrey Liebermann can both be wrong and they are.<br /><br />There certainly are psychiatric diagnoses that are nonessentialist statistical constructs but there certainly are not 300 of them, "precisely defined".<br /><br />Psychiatry and DSM undermine the case for treating the seriously mentally ill involuntarily by calling everything bad that happens a mental disorder. <br /><br />Feighner had it right in 1970 or whatever...let's focus on the 15 or so big ones and treat the rest as situational problems and areas of research.<br /><br />We have a goddam murine typhus outbreak in LA right now because we can't take care of the basic legal and management issues of serious cases.<br /><br />But psychiatry and psychology organizations want to have serious discussions about whether traditional masculinity and voting for Trump are mental disorders and whether or not unpleasant tweets can be the basis of PTSD.<br /><br />This is what happens when you don't prioritize and take nosology seriously with the attention of a statistician. This was all covered by Meehl forty years ago but no one paid attention other than a few quantitative psychologists.James O'Brien, M.D.https://www.blogger.com/profile/14994350319492582321noreply@blogger.com