Biomarkers: Can Blood & Brain Scans Help with Future Depression Treatment?

Are predictive biomarkers the wave of the future of depression treatment?

Recent research has demonstrated -- in small pilot studies -- that brain PET scans and, in a separate study, blood proteins, may act as important biomarkers for determining whether an antidepressant or cognitive behavioral therapy might be the best treatment for a person's clinical depression.

Such an indicator would be a potential boon for those seeking treatment for depression. Currently, depression treatment is characterized by a trial-and-error approach, with most professionals recommending most people get both medications and psychotherapy.

These studies point to the possibility that, in the future, we may have a more reliable way of directing people to the treatment that's going to be the most effective for them.

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Eating Disorders

With Obesity, A New Disease is Born: Its Profound Implications for Psychiatry

A new disease was discovered the other day -- or rather, one was created.

There is no “lab test” for this disease, nor is there an X-ray, MRI, or CT scan that can detect it. It is diagnosed on the basis of a mathematical formula that many believe is simplistic and poorly-validated.

Sometimes this “disease” results in metabolic abnormalities, sometimes not.

Many clinicians view the decision to recognize this disease as another example of “medicalizing” a problem stemming from the person’s “life-style” -- not from a specific pathological process. In fact, the declaration that this condition is a “disease” was the result of a vote among a group of doctors at a medical meeting in Chicago.

In effect, this condition became a disease through a show of hands.

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Project ECHO: Can We Teach Physicians to Better Diagnose Mental Disorders?

I'm conflicted about the announcement of Project ECHO's expansion last week. The ECHO Institute was founded by the Robert Wood Johnson Foundation, the GE Foundation and the University of New Mexico Health Sciences Center to help primary care physicians do a better job with common, chronic condition diagnosis and treatment via Project ECHO.

On Friday, they announced a new initiative focusing on mental health treatment. The new effort will involve having academics train primary-care physicians to strengthen and better coordinate their mental health care.

It's the right focus, because family doctors and general practitioners prescribe the majority of antidepressants in this country, and are often the first-line professional to see a patient who may have a mental health concern.

But then the director of Project ECHO, Sanjeev Arora, spoke.

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Not in the DSM-5: Internet Addiction & Parental Alienation Disorder

Disappointing to some professionals, I'm sure, is the fact that two disorders didn't make it into the DSM-5 at all -- not even in the chapter "Conditions for Further Study."

Those two lonely disorders? "Internet addiction" and parental alienation disorder.

This is a nice respite from the hype surrounding both these concerns and reaffirms what we've been saying here for years -- these are not mental disorders. Do some people have a usually-temporary and almost-always transitory problem with figuring out how much time to spend on the Internet? Sure they do -- it's just not a disorder-level concern.

And the evidence is simply too sparse for "parental alienation disorder," which I believe has propagated more for legal than clinical reasons.

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How Dr. Joyce Brothers Helped Shape Me as a Therapist

This guest article from YourTango was written by Jamie (Simkins) Rogers.

I've been feeling nostalgic since the recent death of Dr. Joyce Brothers the other week. I grew up watching Brothers on shows like Donahue and The Tonight Show Starring Johnny Carson while my grandmother crocheted afghans beside me.

I knew I wanted to be a therapist from a very young age, having analyzed my own familial relationships ad nauseum (I was a weird kid). Back then, I loved Dr. Brothers' wit, grace, class and charm.

Today, I respect her as the rarity she was during her prime: an accomplished female in the field of psychology.

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DSM-5 Released: The Big Changes

The DSM-5 was officially released today. We will be covering it in the weeks to come here on the blog and over at Psych Central Professional in a series of upcoming articles detailing the major changes.

In the meantime, here is an overview of the big changes. We sat in on a conference call that the American Psychiatric Association (APA) had in order to introduce the new version of the diagnostic reference manual used primarily by clinicians in the U.S. to diagnose mental disorders. It is called the Diagnostic and Statistical Manual of Mental Disorders and is now in its fifth major revision (DSM-5).

James Scully, Jr., MD, CEO of the APA, kicked off the call by remarking that the DSM-5 will be a "critical guidebook for clinicians" -- a theme echoed by the other speakers on the call.

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Did the NIMH Withdraw Support for the DSM-5? No

In the past week, I've seen some incredibly sensationalistic articles published about the upcoming DSM-5 and a letter recently released by the National Institute of Mental Health (NIMH). In the letter by Dr. Thomas Insel, director of the NIMH, wrote in part, "That is why NIMH will be re-orienting its research away from DSM categories."

Some writers read a lot more into that statement than was actually there. Science 2.0 -- a website that claims it houses "The world's best scientists, the Internet's smartest readers" -- had this headline, "NIMH Delivers A Kill Shot To DSM-5." Psychology Today made the claim, "The NIMH Withdraws Support for DSM-5." (The DSM-5 is the new edition of the reference manual used to treatment mental disorders in the U.S.)

So is any of this true? In a word, no. This is science "journalism" at its worse.

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APA Sued Over Misleading Membership Fees — Again

Nearly three years ago, we reported on the kerfuffle over psychologists who were upset to find that the "mandatory assessment" fee they thought was, well, mandatory turned out to be entirely optional. The fee was being paid to the American Psychological Association (APA), the professional guild association for psychologists, to fund a legally separate organization, the APAPO, tasked with lobbying (mostly at the state level -- not the federal level).

A class-action lawsuit against the APA was thrown out earlier last year on technical grounds (but with prejudice, suggesting a new lawsuit has a harder road to climb).

Despite that, a new lawsuit was recently filed in federal court in California "accusing the group of misleading its members into paying a fee used to fund its lobbying arm as part of their annual dues."

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NAMI Illinois Rejects Psychologists’ Attempts to Gain Prescription Privileges

"Insanity is doing the same thing over and over again but expecting different results."
~ Rita Mae Brown

Ya have to admire psychologists who endlessly lobby state legislatures for the right to extend prescription privileges to their profession (with a little additional training). They won't take repeated defeat as a sign that perhaps their efforts are... insane?

Illinois is the latest state to hand psychologists seeking prescription privileges a defeat, with NAMI Illinois siding on the side of not supporting the bills in front of the Illinois legislature. After intense lobbying by both sides of this issue, they concluded, "NAMI Illinois opposes SB 2187 and HB 3074 in its current form to expand prescriptions privileges to psychologists."

When will psychologists learn?

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Kaiser Permanente’s Sad Mental Health Care in California

California has some patient-friendly regulations on its books, meant to help patients get the care they need in a reasonable amount of time. One of those regulations is that patients shouldn't have to wait more than 10 business days for a regular appointment with their health or mental health care provider.

Yet, Kaiser Permanente's health maintenance organization in the state -- rather than abide by the regulation -- regularly made patients wanting mental health care wait longer than the 10 business days. In fact, in one case from 2010, the California Department of Managed Health Care (DMHC) fined Kaiser $75,000 for unreasonably delaying a child’s autism diagnosis for almost 11 months! The new report found that anywhere from 17 to 40 percent of patients waited longer than 14 days for an appointment.

Last week, the DMHC was again at Kaiser's doorstep, finding that Kaiser kept two sets of appointment records to try and circumvent this regulation -- a paper appointment calendar and an electronic health record calendar. The DMHC cited Kaiser for "serious" deficiencies in how it manages and provides mental health care services to its patients.

Kaiser Permanente is one of those enormous health care providers that seems to have lost the plot -- providing reasonable and timely health care for its customers.

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3 Reasons Why I Am a DSM Agnostic

My first introduction to the Diagnostic Statistical Manual (DSM), published by the American Psychiatric Association (APA), was standing in the kitchen of my parents' home and witnessing my father in full rant.

My dad was a psychiatrist/ psychoanalyst of the old school. Which is to say he was brilliant, but also a man of his particular age. Which is to further say his fury was directed at the APA for taking homosexuality as a diagnosable mental illness out of the manual. It was 1973.

Hardly aware of what he was so upset about, I did hear him dramatically declare that he was withdrawing his membership in the APA. My dad loved being a psychoanalyst and he loved being a physician but he wasn't that crazy (you should forgive the word) about being a psychiatrist. His prescription pad gathered dust as he focused on talk therapy. So his threat to quit the APA wasn't idle. But it wasn't like he was giving up his beloved couch.

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Final DSM 5 Approved by American Psychiatric Association

Yesterday, the board of trustees of the American Psychiatric Association (APA) approved a set of updates, revisions and changes to the reference manual used to diagnose mental disorders. The revision of the manual, called the Diagnostic and Statistical Manual of Mental Disorders and abbreviated as the DSM, is the first significant update in nearly two decades.

Disorders that will be in the new DSM-5 -- but only in Section 3, a category of disorders needing further research -- include: Attenuated psychosis syndrome, Internet use gaming disorder, Non-suicidal self-injury, and Suicidal behavioral disorder. Section 3 disorders generally won't be reimbursed by insurance companies for treatment, since they are still undergoing research and revision to their criteria.

So here's a list of the major updates...

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