A MadMother's challenge to the APA

via Psychiatric News | November 18, 2011
Volume 46 Number 22 page 4-4
American Psychiatric Association

From the President (now the former president)
Psychotherapy in a Changing World
John Oldham, M.D.

an excerpt:

"In a recent TIME Healthland blog, Alan Kazdin responded to questions in a posting with the unfortunate title "Q&A: A Yale Psychologist Calls for the End of Individual Psychotherapy." I found the title puzzling and misleading, since Kazdin acknowledged, in a thoughtful article referred to in the blog, that there is strong evidence of the effectiveness of psychotherapy to treat many psychiatric conditions. Kazdin's concern was that the percentage of people who really need this treatment and actually receive it is extremely low. He urged us to develop new and different ways to provide treatment to reach more people, and I agree. The challenge is substantial, however, and he says that "the poor public has no chance. You go to the bookstore or look online, and 99 percent of what you get is someone winging it." It's hard to argue with most of that.

"Psychiatrists and behavioral health clinicians have been studying the effectiveness of psychotherapy for years. Published randomized, controlled trials are piling up demonstrating the effectiveness of many types of therapy, from cognitive to behavioral to psychodynamic and more, for conditions ranging from mood and anxiety disorders to personality disorders. Yet far at the other end of the spectrum, often under the same heading of "therapy," untested strategies are proliferating. While some of these offerings may help some who are suffering, others may be frankly ineffective, unethical, or the psychological equivalent of snake oil." (emphasis mine)

Oldham then asks, "What to do?" I am more than a little disgusted by members of the APA who focus on what others are doing wrong; there's plenty of the APA's own wrong-doing for the APA to focus on.  

For instance, the "diagnosis and medical treatment" provided by psychiatrists...Psychiatric diagnoses are based on subjective observations and perceptions, i.e. personal opinions; without using diagnostic testing. Psychiatric diagnoses have been defintively declared by the APA to be neurobiological conditions, caused by brain diseases and genetic defects. The APA's declaration is "validated" with a vote among  APA members... Declaring diagnoses to be "chemical imbalances," "brain diseases," and "genetic defects" then claiming the diagnoses are incurable, but require life-long "medical treatment" without ever supporting either the declaration, or the claim with any evidence that conforms to any ethical scientific or medical standards is at best, suspect; at worst, it is simply fraudulent. Psychiatrists use teratogenic drugs which are prescribed singularly, and in combinations which are minimally effective. For some people, the drugs are not at all effective; but virtually all the drugs have significant risks for causing chronic impairments, i.e. iatrogenic harm. Some psychiatrists justify using this unethical standard of care with the excuse, "it's ALL we have." examples: Schizophrenia, and PTSD

I'm not a psychiatrist, I'm a MadMother. 

I have a challenge for the American Psychiatric Association.  

First off, the American Psychiatric Association needs to clean up their own side of the psychiatric diagnosis and treatment street. After that, share with the world just how this was done. Tell the public what safeguards the APA has implemented which will hold unethical psychiatrists accountable. Tell the world how the APA will help prosecute psychiatists whose criminal prescription practices harms and kills their patients; including those who submit fraudulent claims and defraud the American people through Medicaid and Medicare. Tell the world the APA will no longer protect the individual psychiatrists whose unethical "care" standards and treatment protocols are without scientific support. Psychiatric care standards are in effect, marketing tools, not ethical medical care standards---which is why the standards harm, disable and kill psychiatric patients; calling them "standard practices" distorts the meaning of "standard practice."

Psychiatry has in effect, redefined what the term "standard practice" signifies. In psychiatry, a standard practice is legal mechanism to protect psychiatrists; traditionally, standards of care were developed in medicine to protect the patients from unethical professionals.  Being "experts" who are practicing a sub-specialty of medicine, psychiatrists have implemented unethical standards of care which the APA and the AACAP have codified by taking a vote, i.e. consensus. The standards are theoretically validated by evidence in clinical research and practice, i.e. the evidence base. Standards of care with little to no foundation in accurately reported research or carefully reported clinical care experience, are not ethical standards of care, consenus based standards are merely an affirmative defense for medical malpratice for the iatrogenic injuries recklessly inflicted as a direct result of using unethical treatment standards.

Psychiatry's standards of care cause a significant percentage of people who become psychiatric patients to be permanently disabled and die preciptiously from numerous iatrogenic diseases and injuries. Many die from drug-induced or iatrogenically induced homicide, the deaths are classified as "natural" which is despicable, criminal really...  With these common real world outcomes, calling what psychiatry does an "ethical medical specialty" is insulting to one's intelligence. In effect, a standard practice, has become a way to hang psychiatric patients in distress out to dry, in order to protect unethical psychiatrists who use unethical standards of care with impunity. Claiming the treatment is in a patient's best interest and iatrogenic injuries are "tolerable side effects" while simultaneously refusing to acknowledge or address the harm done to patients is bullying; not an ethical medical practice. The prolific use of teratogenic drugs is a standard that is supported by consensus, a political process, not a scientific finding of safety and effectiveness of the recommended treatments. Using treatment algorithms and protocols that are not supported by evidence is  shameful and indefensible, consensus is no substitute for relying on sound scientific principles, relevant data, and ethical medical principles. It is human experimentation that psychiatry has codified as the psychiatric "standard of care" used in clinical practice.

It is not ethical. 

It is not "medicine." 

Psychiatry developed standards of  care to legitimize psychiatry as a medical specialty, and prevent psychiatrists from being held legally liable for damage done to iatrogenically injured patients. In effect, psychiatry's standards of care are primarily an affirmative defense to protect professionals. Psychiatrists have only to demonstrate they followed a "standard clinical practice," to refute malpractice claims---that the standard has no evidence-base and is unethical, apparently doesn't "legally"matter ... The original purpose of having (ethical) standards of care is to protect patients; psychiatry's standards--(or lack therof) serve to protect psychiatrists.

The APA needs to tell the world what it will do to prevent unethical researchers from disseminating fraudulent data about psychiatric diagnoses and recommended treatments; and prevent these unethical psychiatrists from  providing "professional advice and training" to others... 

How will the APA will ensure psychiatrists practice as if 

their primary purpose is to serve the patient's best interests?  

Obviously, abusing authority, using manipulation, misinformation and coercion as treatment tools, is unethical.  The nature of the acts involved in the abuse of power and authority and weilding power to control vulnerable people and while depriving them of the means of defending themselves, is not made innocuous, or  transformed into a therapeutic practice just because it is being done by doctors in standard clinical proactice. In reality, the fact that it is doctors doing these things make the crimes praticularly heinous because they are being carried out under the guise of medical beneficence. The fact that these unethical behaviors and standards of care are being vehemently defended instead of focusing on how to improve the validity of the diagnostic and patient care standards and thereby improve the real world outcomes of  psychiatric patients, is the most troubling aspect of the ongoing crisis of conscience in psychiatry.

As long as the APA has "leaders" in it's hierarchy who exhibit or condone the bad behavior of it's members, and fails to censure unethical academians, e.g. the ego-driven professionals who are PHarma's whores; the APA will lack the trust that only comes from exhibiting ethical conduct and using ethical scientific principles in the practice of medicine. The APA consistently refuses to discredit individual psychiatrist who sell their professional opinions to the highest bidder; the APA continues to publish conflict-ridden op-eds and ghost-written research articles in it's "peer-reviewed" professional journals, and uses textbooks based on fraudulent or sub-standard research data. These facts make past and present APA presidents proclamations, editorial opinions and criticisms, nearly if not entirely, worthless.  To realistically be considered a credible requires a consistent record for having exercising ethically sound medical judgement, and a consistent record of using standard ethical scientific research methods and principles. Psychiatry as a profession has not demonstrated that it values either of these ethical principles with any consistency. Without a  record for ethical integrity, attempting to critique other mental health professionals, appear to be nothing more than juvenile attempts to divert the public's attention away from the APA's serious ethical failures, which is where the focus belongs.

 Using a juvenile defense tactic serves only to further tarnish 
the APA's already sullied reputation. 

To summarize, I believe it is apropos to paraphrase Dr. Oldman: 

"While some of psychiatry's offerings may help some who are suffering, others are frankly ineffective, unethical, and the medical equivalent of snake oil." 

Psychotherapy in a Changing World in it's entirety:


Not long ago I received an unsolicited e-mail promoting a new book. The author of this work holds a doctorate in "transpersonal psychology" and the book describes the author's work with "transmundo beings," described as "nonearth entities that arise in regression therapy."

Well, OK, I think most of us would agree that this particular "therapy" is pretty far out and is unlikely to show up in published research on evidence-based psychotherapies. But coincidentally, a few days later, a colleague at the Menninger Clinic gave me a few printouts from Web sites offering online counseling or "chats," and these samples barely skimmed the surface of the pages and pages that a Google search serves up about this fast growing industry.

For example, one company offers "private online chats" (by appointment, through an online appointment system, $95 for one 60-minute chat, $888 for 10 one-hour chats, paid through Paypal), or "therapy sessions" (response guaranteed within two days, $39.95 for one e-mail session, $349 for 10 e-mail sessions, paid through Paypal). Therapists' photos, credentials, and profiles are provided, and all online therapists are billed as "licensed or board certified in their states, have at least 10 years' experience, and are carefully selected. . . ."

Another example: a self-described "premier online therapy service" advertises that one can "get live help for depression, stress, relationship issues, mental health issues" for clients who "live in rural areas, are homebound, will not go to therapy in person, want convenient, discreet access." Therapists are "licensed counselors" and "e-mmediate care" is provided. When I accessed this site, however, the "e-mmediate care" page said, "All therapists are currently with clients. Please try again."

And yet one more example: "Get professional online counseling advice now." Photos of the therapists are shown, along with profiles. Rates are shown as well, usually $3 a minute (except for one pricey guy who charges $3.25 a minute).

You get the picture. Yet while this may sound outlandish, if you think about it, it's not really new. Doctors and clinicians charge for services rendered, or by the hour. It's just that once we're on the Web or using other new media, it feels (and is) unregulated. There are more and more "celebrity" therapists whose faces become familiar on network or cable shows, where the temptation to slide close to or over the ethical edge is very real. Diagnose a famous person based on secondhand information or hearsay. Give a sound-bite opinion that may sound wise but may be misunderstood by or even harmful to those who are desperate. I recently came across the Web site of a well-trained, credentialed psychiatrist who offers "street therapy," with video samples of his curbside consultations to strangers on city streets, cameras rolling.

In a recent TIME Healthland blog, Alan Kazdin responded to questions in a posting with the unfortunate title "Q&A: A Yale Psychologist Calls for the End of Individual Psychotherapy." I found the title puzzling and misleading, since Kazdin acknowledged, in a thoughtful article referred to in the blog, that there is strong evidence of the effectiveness of psychotherapy to treat many psychiatric conditions. Kazdin's concern was that the percentage of people who really need this treatment and actually receive it is extremely low. He urged us to develop new and different ways to provide treatment to reach more people, and I agree. The challenge is substantial, however, and he says that "the poor public has no chance. You go to the bookstore or look online, and 99 percent of what you get is someone winging it." It's hard to argue with most of that.

Psychiatrists and behavioral health clinicians have been studying the effectiveness of psychotherapy for years. Published randomized, controlled trials are piling up demonstrating the effectiveness of many types of therapy, from cognitive to behavioral to psychodynamic and more, for conditions ranging from mood and anxiety disorders to personality disorders. Yet far at the other end of the spectrum, often under the same heading of "therapy," untested strategies are proliferating. While some of these offerings may help some who are suffering, others may be frankly ineffective, unethical, or the psychological equivalent of snake oil.

What to do? The world is changing very fast, and the Internet is a main engine of change. The development of Web-based therapy was inevitable, and new video-link technology makes "face-to-face" treatment available to remote areas where in-person resources are scarce. APA endorses in-person, face-to-face psychotherapy as an evidence-based, effective treatment for many conditions, spelled out in detail in our practice guidelines. But we need to get on board with the technology of tomorrow, taking an active role to harness its potential, so that more people who need help can get valid, legitimate help in new and nontraditional ways.

One organization doing just that is the American Association for Technology in Psychiatry, in which many APA members are part of a team dedicated to promoting "the use of information technology to improve the quality and availability of psychiatry and mental health care." In addition to establishing a new ECP/MIT Work Group on New Technology, which will focus on improving communication within APA, I am putting the topic of "e-therapy" on the agenda for discussion at the Board of Trustees meeting.

Meantime, while we're exploring new horizons, let's keep teaching each other about the psychotherapy of today. One great opportunity to do just that is already confirmed for our annual meeting in Philadelphia in May 2012. At the Opening Session on Sunday, May 6, a special presentation is planned titled "Cognitive Therapy and Psychodynamic Therapy: More Alike Than Different? A Conversation Between Aaron Beck and Glen Gabbard." I'll be moderating this session, and I'm delighted to be able to share the stage with these uncontested leaders in the world of psychotherapy. Mark your calendars! here

photo from http://www.justducks.co.uk/

Is the primary ethical duty of a physician unknown to mainstream psychiatry?

"I am sure that we will recognize that there are some things in our society, 

some things in our world, to which we should never be adjusted." 

Martin Luther King Jr.

"I am sure that to be silent about psychiatric abuse and oppression is to be complicit."
MadMother

Although definitive evidence in support of the hypothesis that schizophrenia is a brain disease remains elusive, psychiatrists who firmly believe in the correctness of it, used their belief in this hypothetical explanation for the etiology of schizophrenia to justify the "Standard Practice" of prescribing neurotoxic teratogenic drugs as a necessary medical treatment. Calling it a "Standard Practice" is misleading; it is not an ethical medical standard, since it is a "standard" only because it was designated as such by consensus; i.e. a quasi-democratic political process, evidence only of an agreement of the meaning to be attached to behaviors. Psychiatry relies upon consensus, a quasi-democratic process in the absence of evidence gathered by using ethical scientific principles.  It is a standard that does not rely upon the use of sound ethical medical judgement; it is contradictory to the ethical standards of medical science. The standard clinical practices used by psychiatry to "medically treat" psychiatric diagnoses are validated by a political process; as a result, they are not ethical medical standards. In other medical specialties, the standards used in clinical practice are derived from and supported by the data collected in research, and includes documented "anecdotal" evidence from experienced clinicians;  i.e. the "evidence base." Theoretically, to be ethical medical care, care is offered with the primary purpose of serving the best interests of the patient; in the Hippocratic tradition to, "First, do no harm..."

In effect, the AACAP and the APA have determined by a quasi-democratic process, that psychiatric diagnoses are biological, neurodevelopmental brain diseases, or chemical imbalances that require "medical treatment." It is a determination that is not based on research, but on a political process; it is based on a vote. This is also how diagnoses and diagnostic criteria is standardized as well. So psychiatry recommends "treating" behaviors as if they are symptoms of disease; and this recommendation is not based upon the scientific method, or the ethical principles of medicine; which begs the question, why is it called, "medical treatment?"

The devotees of psychiatry's disease model have been frantically searching for proof of an elusive  hypothetical disease that causes psychiatric symptoms; and have yet to find definitive evidence despite decades of diligent searching for it. The fact that they have standards of practice that are based on the belief in an unidentified disease is despicable really, when one considers the loss of liberty, and life that has resulted from ego-maniacal hubris masquerading as "professional medical judgement." Belief in a hypothetical explanation for symptoms is not an ethical basis for any medical decision; it is a juvenile justification for bullying. Psychiatry is, in effect bullying psychiatric patients by using coercion, biased information, Police Powers, and Court Orders; none of which can ever magically transform what is being done into a valid or ethical medical treatment. Stating authoritatively, that a disease exists which requires medical treatment in order to compel or coerce "treatment compliance," is nothing but a fraud.

Do NOT misunderstand what I am saying--distress, social difficulties, emotional, behavioral and cognitive symptoms are all very real; but none have been proven to be the result of a neuro-biological disease, chemical imbalance or a genetic defect. This fact is acknowledged; by the APA, and AACAP and the NIMH. Yet all three of these entities disseminate educational materials for the general public that imply and literally state the exact opposite. At the same time, through NAMI, and other so-called patient advocacy groups, and in "peer-reviewed" professional journals the American Psychiatric Association and the American Academy of Child and Adolescent Psychiatry, disseminate information that authoritatively states, in effect, that psychiatric diagnoses are medical illnesses (like diabetes!) that can be treated "safely and effectively." The claim is more of a hopeful exaggeration; and strictly speaking, is not a truthful claim. The new psychiatry, or "psychopharmacology," purports to be "treating diseases" whose etiology and/or pathology have never been defined, validated, much less understood well enough to ethically support the claim made that their symptoms can be effectively treated.

The diagnoses in the Diagnostic and Statistical Manual are based upon the most unreliable scientific data, subjective observation/opinion. The disease hypothesis is supposedly derived from the mechanism of action of the drugs, but the disease hypothesis predates the use of drugs. In the field of medicine, a phenomenon is studied, and a hypothesis is formulated and tested. In medicine, a disease or defect is studied, defined and validated through testing of the hypothesis, once understood, somatic treatments to reverse, prevent or inhibit the progression of the disease can be developed and tested... Psychotropic drugs can cause disease in major organs and alter the function of physiological processes; in effect, the drugs cause iatrogenic illnesses and impairments; and can cause sudden death. Psychopharmacology has a devotion to the bio-disease paradigm; but it is due to a hopeful belief, an illusion, not sucessful use of the drugs. Psychiatry; i.e. psychopharmacology, does not consistently use scientific standards; and worse yet, it is not grounded in, or even seem to value, ethical medical principles.

Psychiatry does not keep track of how many actually die, develop obesity, diabetes, akathisia, tardive dyskinesia, tachycardia, or any iatrogenic illness from the drugs which will shorten their patient's lives. This is indicative of how important the collection of relevant data necessary for an accurate risk vs. benefit assessment in real world practice is to psychiatry. Why would a belief in a particular etiology for psychiatric symptoms become a justification for adopting a clinical standard of practice unsupported by evidence, or for using force to compel the treatment Under Color of Law? How can it be ethically or morally justifiable to compel treatment with significant and fatal risks by Court Order?

Sudden fatality, the development of chronic conditions that are disabling, i..e. the rate of iatrogenesis, is  needed information for a meaningful risk vs. benefit analysis in real world clinical practice; yet this information is purposely not being collected. Those who are disabled, and the fatal outcomes are considered "anecdotal evidence." Ironically, unlike  the anecdotal evidence used to recommend prescribing the drugs to a patient, this outcome data, is "anecdotal evidence" that is ignored---it is not considered relevant when making treatment decisions.  This is in no small measure why children are being drugged in the manner that they are... Rarely, are iatrogenic, drug-induced deaths, recorded in the FDA AER database, as such. Based upon my own casual observation, child fatalities are commonly reported by a parent or an attorney; not a medical professional.

The twisted logic seems to be, if psychiatric diagnoses are "diseases" and psychiatrists are "doctors" who diagnose the diseases; that what they are do is provide necessary "medical treatment."  Whether a person gives consent or not, is not important. Psychiatry does not treat individuals so much as apply a label to the individual; then implement a treatment protocol.  Since Practice Parameters are based upon consensus, outcomes or overall improvement in the patients was not ever considered important enough to be quantified in any meaningful way, nor was the data considered important enough to collect. The patients' perspective,  physical health and general well being, doesn't appear to be given thoughtful consideration. The effect of treatment on the patient is certainly never as important as the patient never questioning the bio-disease model. A patient must always remain treatment compliant regardless of the actual effects of psychiatric treatment.

Without insisting on the absolute utility of the "treatments" of psychotropic drugs, how would psychiatry "practice medicine?" It would have to return to the "treatment" used prior to the drugs: lobotomy and insulin shock. Choosing to stop the using coercion to control, having respect and showing compassion for patients, considering patients to be worthy of kindness, and treating patients as equals would be an indication that the psychiatric profession may be worthy of trust. Choosing to use methods of control to main authority while continuing to deny the the plight of patients who are harmed, is evidence that psychiatry is not a profession that can be  trusted.

Psychiatry continues to defend the use of coercion, while wielding Police Powers; continues to mislead and lie to patients and the general public, continues to lie about patients and lie about the nature of the diagnoses that are applied to people in distress, with impunity. All of psychiatry's standard practices are anathema to ethical medical principles and the scientific understanding of disease. The manner in which psychiatry is practiced makes it impossible to earn the trust and respect of patients who have critical thinking skills; without mutual respect it is impossible to develop a therapeutic relationship.

It becomes obvious why Informed Consent is not really an important part of psychiatry's "standard clinical practices;" whether it is accidental oversight, careless disregard, or lack of appropriate training, doesn't really matter.  In the end, it is the real world outcomes of the patients themselves that matter; doing what is in a patient's best interest is supposed to be the primary focus in providing medical care.

The refusal to collect accurate data and to base treatment decisions upon ethical scientific methods and sound ethical medical principles, in effect, encourages psychiatrists to be wilfully blind to the countless, uncounted and discounted psychiatric patients they treat who are not "effectively treated;" but are instead grievously harmed. Psychiatry is blind to the plight of patients who are experiencing profound iatrogenic impairments and effectively dismisses the patients, and doesn't collect the data quantifying the harm done to them.

Psychiatric survivors are denigrated by mainstream advocates 'for the mentally ill' and by psychiatrists in "professional" journals. Patients who are liberated from psychiatric incarceration who have reclaimed their voices; refuse to be silent. Psychiatric survivors are the ONLY advocates who speak of and remember the lives that are lost forever. The psychiatric patients who are (de)voiced, who can no longer speak about what happened to them, whether they are alive or dead, are people worthy of respect. They are people who matter, and their real world outcomes are not "anecdotal evidence."

It is a choice to abdicate the primary ethical duty of a physician to, "First, do no harm..."

photo credit bipolarbears11 photobucket

Psychiatry: focused on defending unethical research and clinical care standards instead of real world outcomes

"Currently, there are no pharmacological or psychosocial therapies with enough evidence in youth samples to meet the standards for empirically-supported treatments as defined by Chambless & Hollon (1998; Brown et al., 2008; McClellan & Werry, 2001)." here

via NYTimes:
Use of Antipsychotics in Children Is Criticized
By GARDINER HARRIS

Published: November 18, 2008

a few excerpts:

"From 1993 through the first three months of 2008, 1,207 children given Risperdal suffered serious problems, including 31 who died. Among the deaths was a 9-year-old with attention deficit problems who suffered a fatal stroke 12 days after starting therapy with Risperdal."

"At least 11 of the deaths were children whose treatment with Risperdal was unapproved by the F.D.A. Once the agency approves a medicine for a particular condition, doctors are free to prescribe it for other problems."

"Panel members said they had for years been concerned about the effects of Risperdal and similar medicines, but F.D.A. officials said no studies had been done to test the drugs’ long-term safety."

"Dr. Dure said he was concerned that doctors often failed to recognize the movement disorders, including tardive dyskinesia and dystonia, that can result from using these medicines."

“I have a bias that extra-pyramidal side effects are being under-recognized with these agents,” Dr. Dure said.

"Dr. Laughren of the F.D.A. said the agency could do little to fix the problem. Instead, he said, medical specialty societies must do a better job educating doctors about the drugs’ side effects." here

via Archives of General Psychiatry:

Original Article | June 2006

National Trends in the Outpatient Treatment of Children and Adolescents With Antipsychotic Drugs

Mark Olfson, MD, MPH; Carlos Blanco, MD, PhD; Linxu Liu, PhD; Carmen Moreno, MD; Gonzalo Laje, MD

an excerpt:

Child and adolescent mental health visits that include antipsychotic treatment occur disproportionately among publicly rather than privately insured patients. After adjusting for patient diagnosis and other background characteristics, mental health visits by publicly insured children and adolescents were significantly more likely to include prescription of an antipsychotic medication. This finding is in line with higher youth antipsychotic prescription utilization among populations covered by Medicaid^2 - 3 compared with commercially insured populations.⁴ The basis of this is unknown but may relate to differences in public and private payer reimbursement schedules for pharmacologic or psychological interventions, insurance-related variations in parent or child acceptance of antipsychotic treatment, or selection of patients in different insurance plans by physicians for treatment. Because Medicaid covers children and adolescents with Social Security Income and young people who are medically needy or in foster care, illness severity may account for differences in antipsychotic medication use across insurance groups.²⁹ Additional study is needed to understand the factors that contribute to insurance-related differences in child and adolescent antipsychotic treatment.

Approximately one third of the child and adolescent visits with prescription of antipsychotic medications were by young people with mood disorders. In addition, approximately one third of antipsychotic visits included coprescription of an antidepressant medication and one third included coprescription of a mood stabilizer. At present, there is a dearth of empirical evidence to support these prescribing patterns. 

In office-based practice, almost all of the antipsychotic treatment among children and adolescents is provided by psychiatrists. Although the NAMCS data suggest that primary care physicians and other nonpsychiatrist physicians provide care in approximately half of the youth mental health visits, they seldom prescribe antipsychotic medications. (emphasis mine) here

via American Journal of Psychiatry:

November 01, 2008 

Double-Blind Comparison of First- and Second-Generation Antipsychotics in Early-Onset Schizophrenia and Schizo-affective Disorder: Findings From the Treatment of Early-Onset Schizophrenia Spectrum Disorders (TEOSS) Study

Linmarie Sikich; Jean A. Frazier; Jon McClellan; Robert L. Findling; Benedetto Vitiello; Louise Ritz; Denisse Ambler; Madeline Puglia; Ann E. Maloney; Emily Michael; Sandra De Jong; Karen Slifka; Nancy Noyes; Stefanie Hlastala; Leslie Pierson; Nora K. McNamara; Denise Delporto-Bedoya; Robert Anderson; Robert M. Hamer; Jeffrey A. Lieberman

Am J Psychiatry 2008;165:1420-1431. doi: 10.1176/appi.ajp.2008.08050756

a couple of excerpts:
Finally, different choices could have been made with regard to the specific medications studied. At the time the trial was initiated, olanzapine was widely used in the pediatric population, whereas quetiapine had a small market share. Ziprasidone and aripiprazole, both of which may have fewer metabolic side effects, were introduced subsequent to the initiation of the study. Efforts to introduce them partway through the study were not supported by the FDA or NIMH. We also considered utilizing a placebo for comparison, as opposed to a first-generation antipsychotic. We expected that this would increase the demonstrated efficacy of the second-generation antipsychotics, but it would not address the fundamental comparative questions. Distributing the sample among four treatment conditions rather than three would also have reduced statistical power. We also considered requiring a drug-free baseline to minimize the likelihood of finding no apparent benefit of substituting one partially effective treatment for another. However, concerns about the long-term consequences of delaying effective treatment and associated recruitment difficulties argued against including a placebo treatment group or a drug-free baseline. At the time the study was initiated, there were significant ethical concerns about utilizing any first-generation antipsychotic in comparison with second-generation antipsychotics, because second-generation antipsychotic treatment was the standard of care for early-onset schizophrenia and schizoaffective disorder. We felt any traditional medication selected as a comparator would have to provide a strong potential advantage to maintain therapeutic equipoise. Molindone was chosen as the best option among first-generation antipsychotics based on its low propensity for both weight gain and extrapyramidal side effects. Despite this advantage, molindone is not commonly used in clinical practice. A more frequently used medication, such as perphenazine or haloperidol, might have facilitated comparison with adult studies and acceptance in the community. Failure to require a drug-free baseline may have reduced response rates and led to earlier treatment discontinuation.

Another potential limitation of the study is the 8-week duration of treatment. Different patterns of response or risk of side effects might have emerged over a longer trial. Some young people may require more extended therapy to adequately respond, and it is likely that some aspects of the illness, such as negative symptoms, neurocognitive function, and associated anxiety, may require longer periods to recover (44, 45). However, published standards of care for early-onset schizophrenia and schizoaffective disorder recommend the use of 6- to 8-week trials (1). A longer acute phase trial would have increased the risk of exposing subjects to prolonged ineffective treatment. Furthermore, antipsychotic medication trials in adults with schizophrenia suggest that nonresponse as early as 2–4 weeks after initiating treatment predicts nonresponse up to 12 weeks later (46–49).

The results question the nearly exclusive use of second-generation antipsychotics to treat early-onset schizophrenia and schizoaffective disorder. The safety findings related to weight gain and metabolic problems raise important public health concerns, given the widespread use of second-generation antipsychotics in youth for nonpsychotic disorders. here

Let's be real, using neuroleptic drugs for any psychiatric diagnosis is not supported by any definitive evidence; calling the drugs "effective treatment" is more than stretching the truth---Indeed, the evidence clearly demonstrates neuroleptic drugs are minimally effective for a small minority of children and adults experiencing symptoms of psychosis; and have significant disabling and fatal risks particularly for  children and the elderly.  The standards used in clinical practice are not supported by or derived from empirical data from clinical trials, or data collected from the decades long use of neuroleptic drugs off label in clinical practice---begging the question, how did prescribing these drugs to children "off label" become a "standard practice?"  This experimental use is a standard of care only because it was discussed, and adopted as a "standard" by psychiatrists. It is not because the prescription of neuroleptics is supported by, or derived from any empirical data of the safety or efficacy for the symtoms the drugs are being prescribed to children and youth to treat. In psychiatry, there are standards of care that are without support from any ethical scientific psychiatric research.  Since they are not derived from or supported by the evidence base, these so-called "standard practices" are not ethical medical standards. The drugs are used off label as a "standard" treatment due to the hubris of psychiatric professionals who have determined that consensus will suffice in place of the objective evidence that theoretically is required for a particular practice to become a clinical care "standard." 

I have been reading 'peer-reviewed' psychiatric journal articles for over ten years and I am still amazed at the lack of critical thinking exhibited by the psychiatrists who do the research and write the articles.  The utter lack of of ethical integrity of "RESEARCH PSYCHIATRISTS" is truly stunning.  The commonality is that all of them continue to repetitively state more evidence is needed to support psychiatric standards of care that are the standards psychiatrists disseminate to other professionals for clinical use; and teach to students and other medical professionals! When reporting trial results that don't support the standards used, which are the recommended 'first line treatments' that comprise the Standard of Care---does it not occur to any of these geniuses that the standards are not ethical medical standards!?  Apparently, psychiatric research and clinical practice requires no critical thought...

For example, in the TEOSS drug trials, 12% of patients enrolled were "effectively treated."  97 out of the either 116 or 119 enrolled experienced a serious adverse event; the Olanzapine arm was stopped due to the number of adverse events---At the time, Olanzpine was the most widely prescribed neuroleptic drug in the pediatrics population!  BUT there were no warnings for professionals to stop prescribing the drug to children...Exactly how many more children need to be subjected to what are harmful teratogenic neurotoxic drugs which may in fact disable and kill them, before "external forces" put a stop to these dorktors conducting research in their attempt to validate unethical standards of care? 

As a society we need to recognize that Human Experimentation on people given a psychiatric diagnosis is not an ethical standard of care; nor is it a benificent act. 

The BEST INTERESTS of the patient must come first---even if the patient is unpleasant, and even if we have been taught that the some psychiatric diagnoses mean that a patient's Human Rights can be ignored or revoked--in the interests of society... It is immoral, and it is unconstitutional.  It is also the same ignorant reasoning used to implement Eugenics laws in this country that brutalized tens of thousands, and unlike the Germans in WWII, we didn't keep track of those we killed.  America's program wasn't as 'successful' as Germany's, but it has left a stain.  Worse than that, the fundamental social control strategies and bigotry that propelled eugenics as public policy remain embedded in our publicly funded social service and mental health programs.  Sadly, the lessons learned have not remained in the general public's collective conscience...  

I believe the fact that medical care is supposed to be in the best interests of the patient, has been lost in the debate about how to help 'the seriously mentally ill' altogether.  Patients are being used as research fodder and Human Experimentation is standard psychiatric clinical practice.  In Medicine, a "standard practice" is theoretically supposed be derived from and well-supported by empirical evidence that is ethically gathered and reported in an unbiased manner.  In psychiatry, standards are discussed in committees and "validated" by a vote; these are not scientific methods, so the "standards" are unethical.  Without empirical evidence to support a particular "standard practice" or treatment protocol it is not a "standard of care," it is nothing more than an affirmative defense for psychiatric fraud and medical malpractice.  

The academic elite, Key Opinion Leaders who are members of the American Psychiatric Association and the American Academy of Child and Adolescent Psychiatry are unethical psychiatrists who are desperately defending what are obviously gross departures from ethical scientific methods and ethical medical practice, inexcusable errors in judgement, and blatant abuse of power and authority.  Ironically, these medical professionals are doing this while claiming it is not their ethical medical duty to treat the iatrogenic neurological impairments brain damage and physical diseases psychiatrists inflict upon their patients.  It is medical neglect; it is criminal.  Psychiatrists are doctors, doctors should treat the illnesses they cause instead of spending so much time defending their so-called "professional integrity."  Perhaps treating the iatrogenic illnesses and injuries they are causing will remove the scales of prejudice from their eyes...

It is certain that continuing to deny the iatrogenic harm psychiatrists are causing patients while simultaneously medically neglecting the victims and frantically tryiing to validate unethical clinical care standards with federally funded seeding trials, are desperate, dishonest acts that serve only to further undermine the integrity of psychiatry as a profession.  It's sheer hubris to vehemently defend unethical "standards of care" and "professional integrity," (which is sorely lacking) while maligning psychiatric survivors; adding insult to iatrogenic injury.  It's not possible to regain trust  with the same dishonest, unethical behavior that destroyed it. 

via Vitals NBCNews.com:
Docs: Antipsychotics often prescribed for 'problems of living'
by Sandra G. Boodman Kaiser Health News  March 18, 2012

"Adriane Fugh-Berman was stunned by the question: Two graduate students who had no symptoms of mental illness wondered if she thought they should take a powerful schizophrenia drug each had been prescribed to treat insomnia."

"In 2010 antipsychotic drugs racked up more than $16 billion in sales, according to IMS Health, a firm that tracks drug trends for the health-care industry. For the past three years they have ranked near or at the top of the best-selling classes of drugs, outstripping antidepressants and sometimes cholesterol medicines. A study published last year found that off-label antipsychotic prescriptions doubled between 1995 and 2008, from 4.4 million to 9 million. And a recent report by pharmacy benefits manager Medco estimated that the prevalence of the drugs' use among adults ballooned more than 169 percent between 2001 and 2010."

"Wayne Blackmon, a psychiatrist and lawyer who teaches at George Washington University Law School, said he commonly sees patients taking more than one antipsychotic, which raises the risk of side effects. Blackmon regards them as the "drugs du jour," too often prescribed for "problems of living. Somehow doctors have gotten it into their heads that this is an acceptable use." Physicians, he said, have a financial incentive to prescribe drugs, widely regarded as a much quicker fix than a time-intensive evaluation and nondrug treatments such as behavior therapy, which might not be covered by insurance."

"Medco is asking doctors to document that they have performed diabetes tests in patients taking the drugs. "Our intention here is to get doctors to reexamine prescriptions," Muzina said."

"In the short term, I don't see a change in this trend unless external forces intervene." here