madinamerica
By Peter Simons September 4, 2018
Hallucinations and other psychotic symptoms have been reported after methylphenidate (Ritalin) treatment for ADHD, according to a new study published in the Scandinavian Journal of Child and Adolescent Psychiatry and Psychology. Erica Ramstad led the research at the Psychiatric Research Unit, Region Zealand, Slagelse, Denmark.
A previous FDA report exclusively focused on published, pharmaceutical-industry-sponsored trials of stimulants, which the authors note were at high risk of bias (including under-reporting of adverse effects). Even this report noted the prevalence of psychotic symptoms among children taking methylphenidate and the complete absence of these symptoms in the placebo group.
The current study consisted of two Cochrane systematic meta-analyses—one focused on randomized clinical trials (RCTs), and the other including observational studies and reports from non-placebo-controlled trials. Cochrane systematic meta-analyses are designed to include all available data, not just industry-supported trials, and add a method for rating the risk of bias.
The current analysis synthesized the data from 10 RCTs, 17 non-randomized studies, and 12 patient reports, for a total of 77,358 included patients. Most of the patients were in the non-randomized studies. Very few of the published studies on methylphenidate assessed for psychotic symptoms, so this research is based on those studies that did include this data.
Because the non-randomized studies only involve children taking the drug, there is no way to judge whether the drug caused the effect. Nonetheless, these studies can be used to estimate the prevalence of a symptom, and from these studies, the researchers found that approximately 1-2% of children who began taking methylphenidate then experienced psychotic symptoms as a reported adverse effect of the drug.
The RCTs, on the other hand, can be used to compare children taking the drug to children who were randomly assigned to a placebo. An analysis of these studies found that children on methylphenidate were more than twice as likely (risk ratio 2.07) to develop psychotic symptoms than children on placebo. Although this finding did not reach statistical significance, due to the small sample size in the RCTs (statistically, it could have been due to chance), it supports the idea that the children in the non-randomized studies were more likely to experience psychotic symptoms because of the drug.
The case studies provide information about how psychotic symptoms appear for children taking methylphenidate. Hallucinations (audio, visual, and tactile) were the most common psychotic symptom. The hallucinations happened between 1 hour and 1 day after the children received methylphenidate. In all 16 cases, stopping the drug also stopped the psychotic symptoms. In four cases, children were then put back on the drug—in half of those cases, the psychotic symptoms immediately came back as well. One patient, at 3-year follow-up, was still taking methylphenidate and had received an additional diagnosis of schizophrenia due to continuing psychotic symptoms.
Although stimulant medications (including methylphenidate and amphetamines) are considered first-line interventions for ADHD in children, researchers have raised numerous concerns about the effectiveness of these drugs and of the long-term dangers of children taking these drugs. In fact, long-term research has found that children who took stimulant medications either have the same results or worse results than children with ADHD who did not take stimulants.
A previous Cochrane review of the effectiveness of methylphenidate, led by some of the researchers from the current study, described the evidence of effectiveness as “very low quality” and stated that most of the studies were at “high risk of bias, imprecision, indirectness, heterogeneity and publication bias.” It appears, from these reports, that stimulants may slightly improve children’s behavior in the classroom, according to their teachers’ reports, but that any such finding should be taken with a grain of salt considering the high risk of bias in the included studies.
Because of the high risk of bias and methodological problems plaguing all the RCTs that studied methylphenidate, the authors of the current study reported that they could not say for certain that psychotic symptoms are an adverse effect of methylphenidate treatment. They suggest that future research needs to better assess for psychotic symptoms and include more rigorous, less-biased study design.
****
Ramstad, E., Storebø, O. J., Gerner, T., Krogh, H. B., Holmskov, M., Magnusson, F. L. . . . Simonsen, E. (2018). Hallucinations and other psychotic symptoms in response to methylphenidate in children and adolescents with attention-deficit/hyperactivity disorder: A Cochrane systematic review with meta-analysis and trial sequential analysis. Scandinavian Journal of Child and Adolescent Psychiatry and Psychology, 6(1). doi: 10.21307/sjcapp-2018-003 (Link)
Thank You Mr Simonds and MIA.
Showing posts with label Adderall. Show all posts
Showing posts with label Adderall. Show all posts
Tuesday, September 4, 2018
Friday, September 1, 2017
ADHD Diagnosis Based On "Illogical Rhetoric," Anaylysis Claims
madinamerica
Peter Simons August 29, 2017
In a philosophically rigorous article published in Frontiers in Psychology, Spanish researcher Marino Pérez-Álvarez examines the logic of attention-deficit hyperactivity disorder (ADHD). The two-part analysis first deconstructs the rhetoric composing the diagnosis—including the symptoms and presumed causes of the “disorder.” Pérez-Álvarez then goes on to examine the philosophical bases of the diagnosis as it exists in society.
The researcher, from the University of Oviedo, Spain, has a background in logical theory, and provides specific examples of how the ADHD diagnosis violates the requirements for logically sound argument. His main point is that the reasoning is circular. As an example: If a child exhibits the behaviors that are agreed to constitute ADHD, then the child can be said to “have” ADHD, and by circular reasoning, therefore, the ADHD “causes” those behaviors. Pérez-Álvarez calls out this type of reasoning as illogical rhetoric.
However, he also asks: even if the reasoning is flawed, is there scientific evidence that the neurodevelopmental model is accurate?
His research finds that there is not. In fact, he writes that the general assumptions of genetic research on psychological health are flawed. The assumption that genetics can “cause” behaviors is not consistent with genetic theory. He writes, “The genome mediates adaptation and response to the environment; it does not cause response and adaptive action.” That is, behaviors are not “caused” by genetics. Behaviors are responses to the environment.
Pérez-Álvarez writes that this may help explain why psychiatric researchers include such caveats in their “conclusive” ADHD literature as:
“ADHD-associated genomic variants are non-specific”
“Genomic-wide searches have yet to identify a single candidate gene”
“Specific genes or sets of genes causally linked to the disorder have yet to be discovered”
“Genome-wide associations between ADHD and individual genetic variants have yet to be found”
“The genetic risks implicated in ADHD generally tend to have small effect sizes or be rare and often increase risk of many other types of psychopathology. Thus, they cannot be used for prediction, genetic testing or diagnostic purposes beyond what is predicted by a family history”
“Findings from neurobiological research do not have a direct application in daily clinical practice”
Nonetheless, the same researchers who wrote these statements advocate the neurobiological model of ADHD, stating, for example, that there is “substantial evidence for a genetic origin of ADHD”—which Pérez-Álvarez argues is an illogical way of interpreting the conclusions above. In fact, that article is even titled “Moving toward causality in attention-deficit hyperactivity disorder” which is particularly misleading since the article reviews correlational evidence, not causal conclusions.
According to Pérez-Álvarez, the current direction in ADHD research—and in psychiatric research in general—is to use larger and larger samples in order to find smaller and smaller correlations. But he remarks that a tiny correlation that only shows up when you sample hundreds of thousands of people is not of any value to individual diagnosis.
He writes that researchers in psychiatry often work around the lack of evidence for their standpoint by arguing that “ADHD is a ‘heterogeneous,’ ‘multifactorial,’ or ‘complex’ disorder”—which may be true, but does not excuse researchers from the burden of showing data that can back up their claims.
Pérez-Álvarez also takes aim at the rhetoric of referring to brain-based findings as “bases” and “causes” rather than simple correlates. After all, “As studies show, the brains of taxi drivers and musicians show alterations in specific areas and connections associated with their activities compared to those who are not…” but those neural correlates are certainly not presumed to be the cause of driving taxis or playing the violin. Quite the opposite, in fact—those brain changes are understood to be results of those professions. So why do researchers assume that any brain differences detected when studying people that have been diagnosed are “causing” ADHD?
A key point made by Pérez-Álvarez is that although psychiatric diagnoses may be reliable—psychiatrists may agree on the criteria—there is no evidence that they are valid. Pérez-Álvarez quotes Thomas Insel (then Director of the National Institute of Mental Health) to make this point:
“The strength of each of the editions of DSM has been ‘reliability’—each edition has ensured that clinicians use the same terms in the same ways. The weakness 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.”
To further clarify the difference between reliability and validity, Pérez-Álvarez cites A. Marcia Angell, ex-director of the New England Journal of Medicine, who writes:
“If nearly all physicians agreed that freckles were a sign of cancer, the diagnosis would be ‘reliable,’ but not valid. The problem with the DSM is that in all of its editions, it has simply reflected the opinions of its writers.”
It is important to note that Pérez-Álvarez also argues that ADHD is “real” inasmuch as “the diagnosis already functions as a “cultural idiom.” The construct of ADHD serves to explain a way of being in relation to others that is culturally unacceptable—namely, being more active, more distractible, and more impulsive than other children.
He writes that the diagnosis of ADHD fits perfectly in a long tradition of psychiatry selecting ways of being that are considered culturally invalid, selecting and exaggerating behaviors as “symptoms,” and creating a category or label that can serve as a self-reinforcing a priori concept.
According to Pérez-Álvarez, “Any problems related to “attention,” “activity,” and “impulsivity” are not outside learning as aspects of the development of self-control. Some children may require additional “training” (not treatment).” That is, diagnosing these traits as a “brain disorder” and medicating children only serves to prevent children from learning skills of self-regulation and maintaining attention. Pérez-Álvarez advocates methods of teaching children these skills as part of the developmental process, rather than pathologizing children for acting impulsively and inattentively.
Pérez-Álvarez writes, “Attention-Deficit/Hyperactivity Disorder harmonizes a variety of scientific, medical, educational and family interests besides pharmaceutical industry profits (the most openly shameless and rightly denounced). The only party harmed seems to be the children.”
****
Pérez-Álvarez, M. (2017). The four causes of ADHD: Aristotle in the classroom. Front. Psychol. 8(928). doi: 10.3389/fpsyg.2017.00928 (Link)
Previous articleGreed Disguised as Science: How a Multitude of Factors Led to the Opioid Crisis
Next articleThe Disturbing Link Between Frequent Nightmares and Suicide
https://psychroaches.blogspot.com/search/label/Nightmare
Peter Simons
MIA-UMB News Team: Peter Simons comes from a background in the humanities where he studied English, philosophy, and art. Now working on his PhD in Counseling Psychology, his recent research has focused on conflicts of interest in the psychopharmaceutical research literature, the use of antipsychotic medications in the treatment of depression, and the general philosophical and sociopolitical implications of psychiatric taxonomy in diagnosis and treatment.
Thank You Mr Simons and MIA.
Peter Simons August 29, 2017
In a philosophically rigorous article published in Frontiers in Psychology, Spanish researcher Marino Pérez-Álvarez examines the logic of attention-deficit hyperactivity disorder (ADHD). The two-part analysis first deconstructs the rhetoric composing the diagnosis—including the symptoms and presumed causes of the “disorder.” Pérez-Álvarez then goes on to examine the philosophical bases of the diagnosis as it exists in society.
The researcher, from the University of Oviedo, Spain, has a background in logical theory, and provides specific examples of how the ADHD diagnosis violates the requirements for logically sound argument. His main point is that the reasoning is circular. As an example: If a child exhibits the behaviors that are agreed to constitute ADHD, then the child can be said to “have” ADHD, and by circular reasoning, therefore, the ADHD “causes” those behaviors. Pérez-Álvarez calls out this type of reasoning as illogical rhetoric.
However, he also asks: even if the reasoning is flawed, is there scientific evidence that the neurodevelopmental model is accurate?
His research finds that there is not. In fact, he writes that the general assumptions of genetic research on psychological health are flawed. The assumption that genetics can “cause” behaviors is not consistent with genetic theory. He writes, “The genome mediates adaptation and response to the environment; it does not cause response and adaptive action.” That is, behaviors are not “caused” by genetics. Behaviors are responses to the environment.
Pérez-Álvarez writes that this may help explain why psychiatric researchers include such caveats in their “conclusive” ADHD literature as:
“ADHD-associated genomic variants are non-specific”
“Genomic-wide searches have yet to identify a single candidate gene”
“Specific genes or sets of genes causally linked to the disorder have yet to be discovered”
“Genome-wide associations between ADHD and individual genetic variants have yet to be found”
“The genetic risks implicated in ADHD generally tend to have small effect sizes or be rare and often increase risk of many other types of psychopathology. Thus, they cannot be used for prediction, genetic testing or diagnostic purposes beyond what is predicted by a family history”
“Findings from neurobiological research do not have a direct application in daily clinical practice”
Nonetheless, the same researchers who wrote these statements advocate the neurobiological model of ADHD, stating, for example, that there is “substantial evidence for a genetic origin of ADHD”—which Pérez-Álvarez argues is an illogical way of interpreting the conclusions above. In fact, that article is even titled “Moving toward causality in attention-deficit hyperactivity disorder” which is particularly misleading since the article reviews correlational evidence, not causal conclusions.
According to Pérez-Álvarez, the current direction in ADHD research—and in psychiatric research in general—is to use larger and larger samples in order to find smaller and smaller correlations. But he remarks that a tiny correlation that only shows up when you sample hundreds of thousands of people is not of any value to individual diagnosis.
He writes that researchers in psychiatry often work around the lack of evidence for their standpoint by arguing that “ADHD is a ‘heterogeneous,’ ‘multifactorial,’ or ‘complex’ disorder”—which may be true, but does not excuse researchers from the burden of showing data that can back up their claims.
Pérez-Álvarez also takes aim at the rhetoric of referring to brain-based findings as “bases” and “causes” rather than simple correlates. After all, “As studies show, the brains of taxi drivers and musicians show alterations in specific areas and connections associated with their activities compared to those who are not…” but those neural correlates are certainly not presumed to be the cause of driving taxis or playing the violin. Quite the opposite, in fact—those brain changes are understood to be results of those professions. So why do researchers assume that any brain differences detected when studying people that have been diagnosed are “causing” ADHD?
A key point made by Pérez-Álvarez is that although psychiatric diagnoses may be reliable—psychiatrists may agree on the criteria—there is no evidence that they are valid. Pérez-Álvarez quotes Thomas Insel (then Director of the National Institute of Mental Health) to make this point:
“The strength of each of the editions of DSM has been ‘reliability’—each edition has ensured that clinicians use the same terms in the same ways. The weakness 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.”
To further clarify the difference between reliability and validity, Pérez-Álvarez cites A. Marcia Angell, ex-director of the New England Journal of Medicine, who writes:
“If nearly all physicians agreed that freckles were a sign of cancer, the diagnosis would be ‘reliable,’ but not valid. The problem with the DSM is that in all of its editions, it has simply reflected the opinions of its writers.”
It is important to note that Pérez-Álvarez also argues that ADHD is “real” inasmuch as “the diagnosis already functions as a “cultural idiom.” The construct of ADHD serves to explain a way of being in relation to others that is culturally unacceptable—namely, being more active, more distractible, and more impulsive than other children.
He writes that the diagnosis of ADHD fits perfectly in a long tradition of psychiatry selecting ways of being that are considered culturally invalid, selecting and exaggerating behaviors as “symptoms,” and creating a category or label that can serve as a self-reinforcing a priori concept.
According to Pérez-Álvarez, “Any problems related to “attention,” “activity,” and “impulsivity” are not outside learning as aspects of the development of self-control. Some children may require additional “training” (not treatment).” That is, diagnosing these traits as a “brain disorder” and medicating children only serves to prevent children from learning skills of self-regulation and maintaining attention. Pérez-Álvarez advocates methods of teaching children these skills as part of the developmental process, rather than pathologizing children for acting impulsively and inattentively.
Pérez-Álvarez writes, “Attention-Deficit/Hyperactivity Disorder harmonizes a variety of scientific, medical, educational and family interests besides pharmaceutical industry profits (the most openly shameless and rightly denounced). The only party harmed seems to be the children.”
****
Pérez-Álvarez, M. (2017). The four causes of ADHD: Aristotle in the classroom. Front. Psychol. 8(928). doi: 10.3389/fpsyg.2017.00928 (Link)
Previous articleGreed Disguised as Science: How a Multitude of Factors Led to the Opioid Crisis
Next articleThe Disturbing Link Between Frequent Nightmares and Suicide
https://psychroaches.blogspot.com/search/label/Nightmare
Peter Simons
MIA-UMB News Team: Peter Simons comes from a background in the humanities where he studied English, philosophy, and art. Now working on his PhD in Counseling Psychology, his recent research has focused on conflicts of interest in the psychopharmaceutical research literature, the use of antipsychotic medications in the treatment of depression, and the general philosophical and sociopolitical implications of psychiatric taxonomy in diagnosis and treatment.
Thank You Mr Simons and MIA.
Saturday, November 8, 2014
90% of Doctors Do Not Appropriately Monitor Children's Progress On ADHD Meds
madinamerica;
Thank You Mr Wipond and MIA.
see also:
State Med Boards Not Punishing Dangerous Docs
Medical Boards Lack Resources ??? To Punish Dangerous Docs
Are State Medical Boards Doing Enough To Protect Patients?
HHS: Doctor Malpractice, Disciplinary Data No Longer Public
State Rarely Investigates Hospital Complaints
November 8, 2014
Nearly one-third of pediatricians who treat children for ADHD do not follow the Diagnostic and Statistical Manual of Mental Disorders when diagnosing them, and 90% don’t do appropriate follow-up monitoring, according to research in Pediatrics. “A large number of pediatricians also do not gather parent and teacher ratings of a child’s day-to-day behavior, information that is crucial in diagnosing ADHD and tracking whether prescribed therapies are working,” reported Medical Xpress.
The research involved about 1,600 patient charts selected at random from 188 pediatric health care providers at 50 practices in central and northern Ohio.
Nine out of 10 children diagnosed with ADHD were taking psychiatric medication, while only one in 10 of those were receiving andjunct behavioral therapy or psychotherapy. Nearly half of the children taking medications had not even seen their treating pediatrician within the first month after being put on the drugs. And within the first year after prescribing ADHD medications, about 90% of physicians did not consult parents or teachers about the child’s progress.
“The quality of care seems to be very low and not in accord with American Academy of Pediatrics guidelines,” lead author Jeffery Epstein, director of the Center for ADHD, Behavioral Medicine and Clinical Psychology at Cincinnati Children’s Hospital, told Medical Xpress. Epstein called the findings “disturbing.”
Typical ADHD care leaves room for improvement, study finds (Medical Press, November 3, 2014)
(Abstract) Variability in ADHD Care in Community-Based Pediatrics (Epstein, Jeffery N. Pediatrics. Published online November 3, 2014. doi: 10.1542/peds.2014-1500)
Thank You Mr Wipond and MIA.
see also:
State Med Boards Not Punishing Dangerous Docs
Medical Boards Lack Resources ??? To Punish Dangerous Docs
Are State Medical Boards Doing Enough To Protect Patients?
HHS: Doctor Malpractice, Disciplinary Data No Longer Public
State Rarely Investigates Hospital Complaints
Monday, October 21, 2013
Adderall Implicated In Michigan Murder Trial
Remember in the midst of this ObamaCare/Govt. Knows Best Implosion that 'Mental Health' is a creature of Govt. Without Govt. Funding it, it simply starves to death. And With ObamaCare we're only going to get More of it.
madinamerica;
Adderall Implicated In Michigan Murder Trial
madinamerica;
Adderall Implicated In Michigan Murder Trial
October 9, 2013
“This case does not make sense in the normal sense,” Assistant Prosecutor Doug Newton told jurors in the trial of Michael Hamilton for murder. There were no drugs, women, money, jealousy, or a physical fight before the shooting. “He was smiling at me as he pulled the trigger,” the surviving brother of twins said. The defense argues that Hamilton was involuntarily intoxicated by Adderall, which includes hallucinations and unusual behavior in its list of side-effects, and thus temporarily insane.
Of further interest:Girlfriend testifies Michael Hamilton bought gun ‘for protection’ one month before shooting(Mlive)
From the article:
When with Hamilton, her boyfriend since December 2010, she said she never felt she was in any danger. He was “warm-hearted” and kind, she said.
It did not occur to her to have him “committed” when he started acting suspicious in the spring of 2012, she said, but she suggested he see his doctor. She thought he might have schizophrenia.
She had helped him find a doctor and he had begun seeing a psychiatrist in November 2011. The doctor then prescribed him Adderall.
From the article:
“Chief Assistant Prosecutor Kati Rezmierski, in her questioning of (psychiatrist) Jajo, pointed out multiple instances when Hamilton went to the doctor in need of a new prescription because his had been lost, stolen or damaged.
“The drug is highly addictive and people do overuse it, the doctor said, answering Rezmierski’s questions.”
Saturday, July 13, 2013
ADHD Drugs Don't Boost Kids Grades, Studies Find
Mad In America has;
ADHD Drug Studies Find Little Change In Academic Performance
from the WSJ article:
"A June study looked at medication usage and educational outcomes of nearly 4,000 students in Quebec over an average of 11 years and found that boys who took ADHD drugs actually performed worse in school than those with a similar number of symptoms who didn't. Girls taking the medicine reported more emotional problems, according to a working paper published on the website of the National Bureau of Economic Research, a nonprofit economics research firm."
ADHD Drug Studies Find Little Change In Academic Performance
July 11, 2013
According to the Wall Street Journal’s, story on a June study of 4000 Qubequois students, “a growing body of research finds that in the long run, achievement scores, grade-point averages or the likelihood of repeating a grade generally aren’t any different in kids with ADHD who take medication compared with those who don’t.” Though studies show improvements in such tasks as short-term memory, but the effects don’t seem to translate into the classroom in the long run.
This entry was posted in ADHD, Children and Adolescents, Disorders, Featured News, In the News,Psychiatric Drugs, Stimulants by Kermit Cole. Bookmark the permalink.
Related Posts:
from the WSJ article:
"A June study looked at medication usage and educational outcomes of nearly 4,000 students in Quebec over an average of 11 years and found that boys who took ADHD drugs actually performed worse in school than those with a similar number of symptoms who didn't. Girls taking the medicine reported more emotional problems, according to a working paper published on the website of the National Bureau of Economic Research, a nonprofit economics research firm."
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