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Archive for May, 2011

Insel’s decade…

The STAR∗D Trial: Revealing the Need for Better Treatments by Thomas R. Insel and Philip S. Wang Psychiatric Services 2009. 60(11):1466-1467. For us, STAR∗D demonstrates that treatment for depression may be less effective than advertised. After 14 weeks of citalopram (average dosage of 41.8 mg per day), 28% to 33% of participants experienced remission. A […]

an eye for an eye world…

Redefining the role of psychiatry in medicine. by Lieberman JA and Rush AJ Am J Psychiatry. 1996 Nov;153(11):1388-97. Sometimes, the hardest thing to see is the thing that’s closest to you. I’ve been wondering why the people who were involved in the revolution of 1980 were always talking about what psychiatrists should or should not […]

revolution II…

Redefining the role of psychiatry in medicine. by Lieberman JA and Rush AJ Am J Psychiatry. 1996 Nov;153(11):1388-97. ABSTRACT OBJECTIVE: The authors evaluate the forces that are changing psychiatric practice and propose options for redefining the clinical and educational goals of psychiatry within medicine. METHOD: An overview of current external and internal forces shaping psychiatry […]

algorithmic psychiatry – the algorithms…

So I set out to see if any of the authors had conflicts of interest with the drugs used in these studies. First I found which ones were available as generics in the years of the studies and colored them green. Then I started with Madhukar Trivedi to look up conflicts of interest planning to […]

algorithmic psychiatry – so little, so badly…

Who ever knows how history will be written in the future when it longer holds us in its grip. Will the Age of Corruption start with TMAP, maybe George W. Bush, Reagan’s Deregulation, Nixon’s Watergate, or maybe go back to LBJ’s decision to fabricating the Gulf of Tonkin? I doubt that TMAP and its spawn […]

algorithmic psychiatry – the fall…

In the last post, I reviewed Drs. Rush and Trivedi’s studies on the TMAP patients. They were buoyed up by the fact that the clinics using their algorithms [ALGO] outperformed their clinics where the docs were left to their own devices [TAU], even though their reanalysis of the data when they eliminated the psychotic patients […]

algorithmic psychiatry – the rise…

In 1996, John Rush, Madhukar Trivedi, and others at the University of Texas, Southwestern developed a set of protocols, algorithms for the treatment of Mental Illnesses in the Texas State public medical systems called TMAP [Texas Medical Algorithm Project]. There are two stories about TMAP. One is about selecting expensive drugs from companies [they had […]

plurality must never be posited without necessity

Ockham’s razor often expressed in Latin as the lex parsimoniae, translating to law of parsimony, law of economy or law of succinctness, is a principle that generally recommends selecting the competing hypothesis that makes the fewest new assumptions, when the hypotheses are equal in other respects… Alternative futures for the DSM revision process: iteration v. […]

truths to be self evident…

After the DSM-III was introduced, people facile with its contents began to "talk funny" [I can’t think of another way to say that]. First, there was a high premium on being able to talk in DSM-ese – using diagnostic terms wherever possible. So instead of "he’s very depressed" they would say "my diagnosis is Major […]

the collector…

My apologies for going on and on about the DSM-III. I guess waiting thirty years, you build up a lot of feelings. Robert Spitzer came along at a time when he could’ve solved a lot of problems. The diagnostic criteria needed to be revised. Psychoanalytic theory had no place as an organizing principle. And he […]