Psychiatric Drug Facts via :

“Most psychiatric drugs can cause withdrawal reactions, sometimes including life-threatening emotional and physical withdrawal problems… Withdrawal from psychiatric drugs should be done carefully under experienced clinical supervision.” Dr. Peter Breggin

Nov 17, 2012

Is the AACAP providing accurate information?

Is the AACAP serious about providing accurate information to patients, parents and child-serving professionals? 
It doesn't appear to be. 

via AACAP: 
A Guide for Public Child Serving Agencies on 
Psychotropic Medications for Children and Adolescents
"When a medication is not FDA approved it is considered “off label”. It is important to note that the absence of FDA approval also does not indicate that a medication is not effective and safe. Pharmaceutical companies may not choose to dedicate the necessary resources to seek FDA approval. Medication used in the treatment of youth with mental illnesses is often used “offlabel”, as is frequently the case in the medication treatment of pediatric physical illness. There are many medications approved for adults that are used off-label for youth. Off-label prescribing is very common, and the parent or guardian should ask the youth’s provider about the supporting evidence and agreement among other doctors that the medication is effective and safe. 3,5 Such uses may include indications, dosages or age ranges which differ from those formally specified by the FDA. It is ethical, appropriate and consistent with general medical practice to prescribe medication off-label when clinically indicated. The prescriber or pharmacist can advise whether a specific medication is FDA-approved. 

Some psychotropic medications have FDA Black Box Warnings. Medicines with black box 
warnings are still FDA approved, but their use requires particular attention and caution regarding potentially dangerous or life threatening side effects. Selective Serotonin Reuptake Inhibitors (SSRI’s) carry a black box warning that they may cause suicidal ideation or behavior, although the most recent review of the evidence is not conclusive that SSRIs increase suicidal behavior. Families should work in consultation with their child's physician or other mental health professional to develop an emergency action plan, called a “safety plan”. This is a planned set of actions for the family, youth and doctor to take if and when the youth has increased suicidal thinking. This should include access to a 24-hour hotline available to deal with crises. AACAP recommends that family members discuss this with the provider if they are uncertain about a black box warning.7 read here

Via American Academy of Child and Adolescent Psychiatry Advocacy:

Community-Based Systems of Care
some excerpts:
Foster Care
A December 2011 report from the Government Accountability Office report discusses the use of psychotropic medications with children in foster care. The report highlights AACAP's Position Statement on Oversight of Psychotropic Medication Use for Children in State Custody: A Best Principles Guideline as the basis to assess states psychotropic drug monitoring programs for children in foster care. As a result, many states are adopting AACAP guidelines as they develop oversight systems.

AACAP Position Statement on Oversight of Psychotropic Medication Use 
for Children in State Custody: A Best Principles Guideline 
Children in state custody (definition of state custody: the state has assumed all parental responsibilities and decision-making for the child) often have biological, psychological, and social risk factors that predispose them to emotional and behavioral disturbances.  These risk factors can include genetic predisposition, in utero exposure to substances of abuse, medical illnesses, cognitive deficits, a history of abuse and neglect, disrupted attachments, and multiple placements.

Many children in state custody benefit from psychotropic medications as part of a comprehensive mental health treatment plan. However, as a result of several highly publicized cases of questionable inappropriate prescribing, treating youth in state custody with psychopharmacological agents has come under increasingly intense scrutiny.  Consequently, many states have implemented consent, authorization, and monitoring procedures for the use of psychotropic medications for children in state custody. These policies often have unintended consequences such as delaying provision of or reducing access to necessary medical care.

Basic Principles 
 The AACAP is the organization representing professionals most skilled in the art and science of child psychopharmacology.  Accordingly, the AACAP has developed the following basic principles regarding the psychiatric and pharmacologic treatment of children in state custody:
1. Every youth in state custody should be screened and monitored for emotional and/or behavioral disorders.  Youth with apparent emotional disturbances should have a comprehensive psychiatric evaluation.  If indicated, a biopsychosocial treatment plan should be developed.
2. Youth in state custody who require mental health services are entitled to continuity of care, effective case management, and longitudinal treatment planning.
3. Youth in state custody should have access to effective psychosocial, psychotherapeutic, and behavioral treatments, and, when indicated, pharmacotherapy.
4. Psychiatric treatment of children and adolescents requires a rational consent procedure. This is a two-staged process involving informed consent provided by a person or agency authorized by the state to act in loco parentis and assent from the youth.
5. Effective medication management requires careful identification of target symptoms at baseline, monitoring response to treatment, and screening for adverse effects.
6. States developing authorization and monitoring procedures for the use of psychotropic medications for youth in state custody should use the principles in this document as a guide and should assure that children and adolescents in state custody get the pharmacological treatment they need in a timely manner.

Best Principles Guideline 
 For states planning to develop programs for monitoring pharmacotherapy for youth in state custody with severe emotional disturbances, the AACAP proposes the following guidelines. Guidelines are categorized into minimal, recommended, and ideal standards.

1. State child welfare agencies, the juvenile court, or other state or county agencies empowered by law to consent for treatment with psychotropic medications, in consultation with child and adolescent psychiatrists, should establish policies and procedures to guide the psychotropic medication management of youth in state custody.
States should:
a) Identify the parties empowered to consent for treatment for youth in state custody in a timely fashion [minimal].
b) Establish a mechanism to obtain assent for psychotropic medication management from minors when possible [minimal].
c) Obtain simply written psychoeducational materials and medication information sheets to facilitate the consent process [recommended].
d) Establish training requirements for child welfare, court personnel and/or foster parents to help them become more effective advocates for children and adolescents in their custody [ideal]. This training should include the names and indications for use of commonly prescribed psychotropic medications, monitoring for medication effectiveness and side effects, and maintaining medication logs.

Materials for this training should include a written “Guide to Psychotropic Medications” that includes many of the basic guidelines reviewed in the psychotropic medication training curriculum.

2. State child welfare agencies, the juvenile court, or other state or county agencies empowered by law to consent for treatment with psychotropic medications, in consultation with child and adolescent psychiatrist, should design and implement effective oversight procedures that:
a) Establish guidelines for the use of psychotropic medications for youth in state custody [minimal].
b) Establish a program, administered by child and adolescent psychiatrists, to oversee the utilization of medications for youth in state custody [ideal].

The consultation program:

4. State child welfare agencies, the juvenile court, or other state or county agencies empowered by law to consent for treatment with psychotropic medications, should create a website to provide ready access for clinicians, foster parents, and other caregivers to pertinent policies and procedures governing psychotropic medication management, psychoeducational materials about psychotropic medications, consent forms, adverse effect rating forms, reports on prescription patterns for psychotropic medications, and links to helpful, accurate, and ethical websites about child and adolescent psychiatric diagnoses and psychotropic medications [ideal]  (emphasis mine) read here

My primary problem with how psychiatry is dealing with the issue of off label drugging of vulnerable children, is that psychiatrists don't seem to believe they have anything to be accountable for. There have been three Senate investigations into the widespread off label use of psychotropic drugs on poor children who are on Medicaid; with a particular focus on children in foster care. Why is there not any acknowledgement of professional responsibility or ethical accountability? The drugs are being used and recommended by child and adolescent psychiatrists who are academic researchers, "Key Opinion Leaders," who are members of the AACAP.  It is members of the Academy that recommend using psychotropic drugs off label, it is members of the Academy who write the practice parameters and treatment algorithms other medical practitioners use as guides when prescribing psychotropic drugs off label; it is the Academy that has codified the clinical standards of care used to treat children with emotional and behavioral issues.  In spite of this, members of the Academy individually and collectively, are unable or unwilling to be accountable for the real world effects of the Standards of Care that have been codified by the Academy. While it is true that the pharmaceutical industry's marketing of the drugs is aggressive; it is psychiatrists who have written the prescriptions and have written the how-to guides encouraging other medical professionals to prescribe the teratogenic drugs off label. It is members of the Academy who have reported in professional journal articles that the drugs are "safe and effective" used off-label to treat children's emotional and behavioral problems...while minimizing the drug's adverse effects...There is a growing awareness that the pharmaceutical industry would not have been able to illegally market psychotropic drugs to children without the willing complicity of Key Opinion Leaders, the experts.  In the case of psychotropic drugs illegally marketed and prescribed off label to children, it is members of the Academy who wrote and then codified by consensus, the standards of care used clinical practice that recommend using the drugs off label. The lack of supportive empirical data that would validate the recommendations the standards contain, belies the term, "evidence-based" and  the distorts the purpose a "standard of care" is supposed to serve.  The standards have been codified by the Academy's members, and have been used virtually universally, in effect, and in fact, these standards of care have performed as an effective, and extremely lucrative pharmaceutical marketing strategy. The standards also serve to provide an affirmative defense for medical malpractice even though they are riddled with errors of attribution; based upon flawed and fraudulent data; rely on using coercion to encourage "treatment compliance;" give metaphorical explanations instead of factual information about the subjective nature of psychiatric diagnoses; all of which is done in an attempt to manipulate and control patients and parents, which is clearly an unethical abuse of authority.

I see no evidence of accountability individually, or collectively among the AACAP membership. The AACAP elevates psychiatrists who lack of ethical integrity into positions of leadership, "Key Opinion Leaders" are spokespersons and marketeers for the drug industry; while the AACAP's professional journal is a  pharmaceutical marketing tool. The AACAP has used biased, incomplete and /or otherwise fraudulent data when formulating treatment recommendations; and in effect, condones misleading patients about the subjective nature of a psychiatric diagnosis, the direct effects and known risks for the drugs recommended. This deceit is "justified" as necessary in order to maintain psychiatric authority, i.e. to gain and maintain a person's "treatment compliance." Obviously, this is fraud; not an ethical way to practice medicine. A fraud that could not have been perpetrated without the willing complicity of psychiatrists who have yet to experience any negative consequences...

Many of the "Key Opinion Leaders" have purposely misinformed patients, parents and the general public are federally funded researchers, who are vehemently defending their "presciption privileges" with or without a valid medical reason for the prescription. Conspicuously absent from the discussion, the fraud committed to pay for off label prescriptions which are not for any recognized and approved purpolse listed in the compendia Medicaid uses. Psychiatrists commiting fraud is a standard practice. Pharmacists submit fraudulent claims to Medicaid for reimbursement to pay for the off label drugs psychiatrists prescribe. Neuroleptic, i.e. antipsychotic, drugs are now the most commonly prescribed drugs in psychiatry, regardless of the diagnosis. The drugs are even prescribed when there is no psychiatric diagnosis! The massive amount of Medicaid and Medicare fraud that has been committed would never have been possible without the willing cooperation and complicity of research psychiatrists, the APA and AACAP as professional membership organizations and without the abject failure to censure members with blatantly unethical conduct. The rank and file membership of these professional guilds are complicit in their silence.  Doctors of psychiatry have deceived other medical professionals, psychiatric patients, their family members and the general public. Worse than this, psychiatrists have betrayed their primary ethical duty to the patient, and have encouraged other medical professionals to use the same unethical standards of care which rely on coercion, and other questionable methods of control.  standards are not so much "evidence based" as they are Consensus Driven.

The psychopharmacologists are marketeers of madness. 

It is a relatively small number of individual psychiatrists who determined that unethical care standards can be "standardized" by a quasi-democratic process through the American Psychiatric Association and the American Academy of Child and Adolescent Psychiatry; these medical associations validated neuro-toxic psychotropic drug treatment algorithms without empirical support in the existent medical research data. Conveniently, or not, this standardization of what are unethical treatment standards, creates an affirmative defense for medical malpractice when a patient is harmed by using teratogenic drugs according to these accepted "care standards." Why do so many professionals fail to censure or repudiate the blatantly unethical conduct of individual APA and AACAP members? What is apparent is that APA and AACAP members are incapable of policing their individual members or as professional organizations or standard bearers. In all reality, fraudulent research used as a part of a marketing strategy; it is entrenched in psychiatric research and standard clinical practices this marketing agenda continues to defraud the Medicaid, Medicare, and Tri-Care programs and harm psychiatric patients. Psychiatrists often fail to recognize, or perhaps actually  believe that Tardive Dyskinesia, diabetes, obesity, high cholesterol, heart disease, akisthesia, and brain damage are "justifiable risks" and refer to them as unpleasant but, "tolerable side effects" of "safe and effective" treatment. The primary beneficiaries of this psychiatric care standard are the pharmaceutical companies and their stockholders. It is criminal, it violates the Human Rights of children and their parents, veterans and their families, and our elderly and their loved ones targeted because of federal medical benefits. Apparently, psychiatrists believe it's ethical to allow pharma to influence and even to direct clinical treatment standards.

Every aspect of off label psychotropic drug use in children is based on biased research and incomplete or fraudulently reported results of clinical research. In spite of this, psychiatrists who are actively and passively involved, believe care standards based on flawed data can be used; that the unethical prescription of dangerous drugs to children, and the Medicaid fraud should be "monitored." the fraud and abuse of authority and unethical treatment of children must continue, but must not be stopped.

Why would any reasonable person believe that a profession that relies on deceit, clearly unethical behavior, is capable of correcting itself? In reality, the AACAP is vehemently defending their corrupt practices, and continuing to misinform other professionals instead of helping the children that are harmed. To date, there has been no good faith effort to stop using corrupted research data, or retract phony 'peer-reviewed' journal articles. It is insulting all things considered, we are expected to believe that monitoring the off label use of teratogenic drugs with fatal risks prescribed to vulnerable children is to "do no harm;" it's not even ethical.

Is it reasonable to believe that doctors with obvious ethical deficits, secretly managed to "straighten up and fly right?" Perhaps by magic, or a hopeful wish...Trust of an individual, and professional groups must be based on their behaviour, and their ability to be open and honest with others.

The final recommendation above which I emphasized states that the AACAP recommends a website be created with links to "helpful, accurate, and ethical websites about child and adolescent psychiatric diagnoses and psychotropic medications" in effect, the AACAP is recommending something the AACAP itself has utterly failed to do. What is preventing the AACAP from disseminating accurate information on it's website? 

I doubt the writers of the "Best Principles" considered the irony in that the American Academy of Child and Adolescent Psychiatry has biased and inaccurate information about psychiatric diagnoses and psychotropic drugs posted on it's website... It would be a meaningful if the AACAP, in a demonstration of good faith were to follow it's own suggestion and remove the biased, inaccurate information and replace it with accurate, unbiased information.  I won't be holding my breath...

A psychiatrist's take on the AACAP via 1 Boring Old Man:

I suggest actually reading all the words. I thought advocacy would be something lofty like the plight of children and adolescents, or maybe the guild [as in the restrictions of Managed Care]. But I honestly didn’t expect Talking Points for "off label" prescribing – just like I didn’t expect Talking Points for ignoring the Black Box warning [talking points?…]. I suppose it’s possible to argue that they’re lobbying for physicians’ rights to prescribe or that the medicines are vital for children, but that would be a rationalization extraordinaire [an adolescent defense mechanism described by Anna Freud in 1936]. I’m afraid they’re lobbying for the pharmaceutical industry. (emphasis mine)

At this point, I’d enjoy a rant eg "Who are these people? The American Academy of Child and Adolescent Psychopharmacologists?" but I’ll try to remain civil. And I’m not going to go on and on with this vetting of their web site. I think I’ve read enough. The AACAP is heavily infected with the pharmaceutical bug as far as I can see, and I find that disappointing [to say the least]. I’ve lived under the delusion that the reason they won’t retract Dr. Keller’s 2001 article about Study 329 is peculiar, maybe not wanting to hurt the feelings of the authors, or the editor. I retract that naive theory. They’re in the game. I didn’t know that, and it makes me feel kind of sad. It’s an organization I’ve looked up to in the past. I guess things change, sometimes for the worse… read here

The Government Accountability Office Report Foster Children: HHS Guidance Could Help States Improve Oversight of Psychotropic Prescriptions

photo credit AACAP

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