{"id":51932,"date":"2014-12-04T16:33:15","date_gmt":"2014-12-04T21:33:15","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=51932"},"modified":"2014-12-04T20:55:36","modified_gmt":"2014-12-05T01:55:36","slug":"retro-3","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2014\/12\/04\/retro-3\/","title":{"rendered":"retro&#8230;"},"content":{"rendered":"\n<ul><span class=\"small\"><\/p>\n<div align=\"justify\"><strong><font color=\"#200020\"><span class=\"hw\">a&middot;nach&middot;ro&middot;nism<\/span><\/font><\/strong> &nbsp;<span class=\"pron\">(<font color=\"#200020\"><img decoding=\"async\" border=\"0\" align=\"absbottom\" src=\"http:\/\/img.tfd.com\/hm\/GIF\/schwa.gif\" \/>-n<img decoding=\"async\" border=\"0\" align=\"absbottom\" src=\"http:\/\/img.tfd.com\/hm\/GIF\/abreve.gif\" \/>k<img decoding=\"async\" border=\"0\" align=\"absbottom\" src=\"http:\/\/img.tfd.com\/hm\/GIF\/prime.gif\" \/>r<img decoding=\"async\" border=\"0\" align=\"absbottom\" src=\"http:\/\/img.tfd.com\/hm\/GIF\/schwa.gif\" \/>-n<img decoding=\"async\" border=\"0\" align=\"absbottom\" src=\"http:\/\/img.tfd.com\/hm\/GIF\/ibreve.gif\" \/>z<img decoding=\"async\" border=\"0\" align=\"absbottom\" src=\"http:\/\/img.tfd.com\/hm\/GIF\/lprime.gif\" \/><img decoding=\"async\" border=\"0\" align=\"absbottom\" src=\"http:\/\/img.tfd.com\/hm\/GIF\/schwa.gif\" \/>m<\/font>)<\/span> <\/div>\n<div class=\"pseg\"><em><span class=\"hvr\">noun<\/span><\/em><\/div>\n<div align=\"justify\" class=\"ds-list\"><strong><span class=\"hvr\">1.<\/span> <\/strong> <span class=\"hvr\">The<\/span>  <span class=\"hvr\">representation<\/span>  <span class=\"hvr\">of<\/span>  <span class=\"hvr\">someone<\/span>  <span class=\"hvr\">as<\/span>  <span class=\"hvr\">existing<\/span>  <span class=\"hvr\">or<\/span>  <span class=\"hvr\">something<\/span>  <span class=\"hvr\">as<\/span>  <span class=\"hvr\">happening<\/span>  <span class=\"hvr\">in<\/span>  <span class=\"hvr\">other<\/span>  <span class=\"hvr\">than<\/span>  <span class=\"hvr\">chronological,<\/span>  <span class=\"hvr\">proper,<\/span>  <span class=\"hvr\">or<\/span>  <span class=\"hvr\">historical<\/span>  <span class=\"hvr\">order.<\/span><\/div>\n<div align=\"justify\" class=\"ds-list\"><strong><span class=\"hvr\">2.<\/span> <\/strong> <span class=\"hvr\">One<\/span>  <span class=\"hvr\">that<\/span>  <span class=\"hvr\">is<\/span>  <span class=\"hvr\">out<\/span>  <span class=\"hvr\">of<\/span>  <span class=\"hvr\">its<\/span>  <span class=\"hvr\">proper<\/span>  <span class=\"hvr\">or<\/span>  <span class=\"hvr\">chronological<\/span>  <span class=\"hvr\">order,<\/span>  <span class=\"hvr\">especially<\/span>  <span class=\"hvr\">a<\/span>  <span class=\"hvr\">person<\/span>  <span class=\"hvr\">or<\/span>  <span class=\"hvr\">practice<\/span>  <span class=\"hvr\">that<\/span>  <span class=\"hvr\">belongs<\/span>  <span class=\"hvr\">to<\/span>  <span class=\"hvr\">an<\/span>  <span class=\"hvr\">earlier<\/span>  <span class=\"hvr\">time.<\/span><\/div>\n<p>         <\/p>\n<div align=\"justify\" class=\"etyseg\"><span class=\"hvr\">from<\/span> <span class=\"hvr\">Latin<\/span> <em><span class=\"hvr\">anachronismus,<\/span><\/em> <span class=\"hvr\">from<\/span>  <span class=\"hvr\">Greek<\/span> <em><span class=\"hvr\">anakhronismos<\/span><\/em> <span class=\"hvr\">a<\/span>  <span class=\"hvr\">mistake<\/span>  <span class=\"hvr\">in<\/span>  <span class=\"hvr\">chronology,<\/span>  <span class=\"hvr\">from<\/span> <em><span class=\"hvr\">anakhronizein<\/span><\/em> <span class=\"hvr\">to<\/span>  <span class=\"hvr\">err<\/span>  <span class=\"hvr\">in<\/span>  <span class=\"hvr\">a<\/span>  <span class=\"hvr\">time<\/span>  <span class=\"hvr\">reference,<\/span>  <span class=\"hvr\">from<\/span>  <span class=\"hvr\">ana-<\/span>  <span class=\"hvr\">+<\/span> <em><span class=\"hvr\">khronos<\/span><\/em> <span class=\"hvr\">time]<\/span><\/div>\n<p> <\/span> <\/ul>\n<div align=\"justify\">Perhaps I live in a rarified atmosphere out of touch with the pulse of things, but this strikes me as a relic of days hopefully behind us &#8211; something in the range of a double-knit leisure suit with bell-bottoms, or perhaps the Ghost of Christmas Past in a Dickens holiday TV special:<\/div>\n<blockquote>\n<div align=\"center\" class=\"big\"><a target=\"_blank\" href=\"http:\/\/www.prweb.com\/releases\/2014\/12\/prweb12366469.htm\">CME Outfitters Announces Brand New neuroscienceCME Live and On Demand Activity To Launch January 7, 2015<\/a>:<\/div>\n<div align=\"center\" class=\"big\"><strong><font color=\"#200020\">Remission in MDD<\/font><\/strong><\/div>\n<div align=\"center\" class=\"middle\">CME Outfitters, along with faculty  experts <strong><font color=\"#990000\">Charles B. Nemeroff<\/font><\/strong>, MD, PhD, <strong><font color=\"#990000\">Roger S. McIntyre<\/font><\/strong>, MD, FRCPC, and <strong><font color=\"#990000\">Michael E. Thase<\/font><\/strong>, MD welcome registration for the upcoming  neuroscienceCME Live and On Demand Program: Remission in MDD: What Does  the Future Hold for Clinicians and Patients?<\/div>\n<div align=\"center\" class=\"small\">December 04, 2014 <\/div>\n<p align=\"justify\">  CME Outfitters [CMEO], a leading accredited provider in continuing  medical education, announces its upcoming neuroscienceCME Live and On  Demand activity, <a href=\"http:\/\/www.prweb.net\/Redirect.aspx?id=aHR0cDovL2NtZW91dGZpdHRlcnMuY29tL2NtZWEuYXNwP0lEPTk0OA==\" target=\"_blank\">Remission in MDD: What Does the Future Hold for Clinicians and Patients?<\/a>  The live program will launch on Wednesday, January 7, 2015 at 12:00pm  ET. Faculty experts <strong><font color=\"#990000\">Charles B. Nemeroff<\/font><\/strong>, MD, PhD, <strong><font color=\"#990000\">Roger S. McIntyre<\/font><\/strong>, MD,  FRCPC, and <strong><font color=\"#990000\">Michael E. Thase<\/font><\/strong>, MD will lead an interactive one-hour  discussion that will <strong><font color=\"#990000\">challenge clinicians to reinvent the future of  major depressive disorder treatment which includes increased patient  participation in the treatment process, measurement-based care and a  re-definition of treatment to remission as improvement of all symptoms  of MDD with functional recovery.<\/font><\/strong> Psychiatrists, primary care physicians,  nurse practitioners, physician assistants, nurses, pharmacists, social  workers, clinical case managers, and other health care professionals who  share the goal of achieving remission in patients with MDD are  encouraged to register. <\/p>\n<p align=\"justify\">&ldquo;We have a faculty panel that exhibit some of the brightest minds in  mental health care today,&rdquo; said Jan Perez, CCMEP, CME Outfitters  Managing Partner, &ldquo;It has been a pleasure working with these experts,  and I think the viewers are going walk away from this program with many  new clinical tactics that they can immediately implement into practice  to improve the lives of their patients with MDD.&rdquo;<\/p>\n<div align=\"justify\">At the end of this activity, participants should be able to: <\/div>\n<ul>\n<li>\n<div align=\"justify\"><strong><font color=\"#990000\">Evaluate all patients with major depressive disorder [MDD] for residual symptoms with a <u>validated tool<\/u> at each visit.<\/font><\/strong><\/div>\n<\/li>\n<li>\n<div align=\"justify\">Initiate a treatment plan that involves patient participation to address residual symptoms of depression.<\/div>\n<\/li>\n<\/ul>\n<div align=\"justify\">This program will present a lively and interactive one-hour clinical  discussion, following by 30 minutes of Q&amp;A via telephone and\/or web.   <a href=\"http:\/\/www.prweb.net\/Redirect.aspx?id=aHR0cDovL2NtZW91dGZpdHRlcnMuY29tL2NtZWEuYXNwP0lEPTk0OA==\" target=\"_blank\">Click here for more information about the faculty, financial support, credit information, disclosures, and to register<\/a>.<\/div>\n<\/blockquote>\n<div align=\"justify\">Well, this really is a <em>blast from the past<\/em> even if it does say <em>reinvent the future<\/em> in the blurb. It&#8217;s given by three KOLs from the heyday of what we might call <font color=\"#200020\">the Antidepressant Era<\/font> &#8211; a time when we&#8217;d forgotten the distinction between Major Depression like that seen in Manic-Depressive Illness and Melancholia and the much more common depressions once called Neurotic Depression. We&#8217;d forgotten that depression, even the true Majors, was known to be time limited. We&#8217;d forgotten that people get depressed because of their life circumstances and were seeing depression more like an affliction of the physical kind, an entity. It was a time when the notion of <em>treating to remission<\/em> was all the rave and coming to us from TMAP, the STAR*D study, CO-MED, that series of programs and studies arising from Drs. Rush and Trivedi at UT Southwestern. It was a time when depression not responding to medicine gained a moniker of its own &#8211; Treatment Resistant Depression [TRD] and was being attacked with schemes like sequencing, combining, or augmenting to enhance antidepressant effectiveness. It was also a period when these presenters were at the top of their game, with Dr. Nemeroff holding forth at Emory. Our journals were filled with review articles and novel treatments. But those were the days before Senator Grassley had revealed the unreported pharmaceutical income flowing into pockets where it didn&#8217;t belong [and Dr. Nemeroff abruptly changed universities]. So it&#8217;s hard to believe that there&#8217;s anyone who hasn&#8217;t heard all of what&#8217;s advertised here. It&#8217;s been around for such a long time. But that&#8217;s not why I posted it. <font color=\"#200020\">There&#8217;s a new wrinkle in the fabric:<\/font>   <\/div>\n<ul>\n<li>\n<div align=\"justify\"><strong><font color=\"#990000\">Evaluate all patients with major depressive disorder [MDD] for residual symptoms with a <u>validated tool<\/u> at each visit.<\/font><\/strong><\/div>\n<\/li>\n<\/ul>\n<div align=\"justify\">Back in what I&#8217;m calling <font color=\"#200020\">the Antidepressant Era<\/font>, there was a push for automation, short-cuts in following patients. They talked about depression like it was a condition like anemia and that one could follow it with something like the serum hemoglobin. Lacking such a marker, there were any number of tries at inventing a simple surrogate. Dr. Spitzer and colleagues developed a brief scale for measuring depression, the PHQ-9 [Patient Health Questionnaire] based on the then new DSM criteria that was distributed by Pfizer. When the STAR*D came along, there were other of self-rated Depression scales, the IDS [Inventory of Depressive Symptomatology] and the QIDS [Quick Inventory of Depressive Symptomatology]. The QIDS was developed as an automated telephone option. And in the STAR*D reporting, these instruments [clinician administered, self administered, and telephone administered] were mixed in ways I never could quite figure out. Also, that was a time of algorithms for choosing the antidepressants, including computer programs to pick and change the drugs &#8211; though the actual NIMH funded study of computer directed treatment never got off the ground &#8211; the clinicians wouldn&#8217;t use it [<font color=\"#200020\">IMPACT<\/font>]. All of this was called Measurement Based Care. It was as if this entity called MDD could be diagnosed and treated automatically with almost no human contact [see <a href=\"http:\/\/1boringoldman.com\/index.php\/2011\/04\/03\/a-thirty-five-million-dollar-misunderstanding\/\">a thirty-five million dollar misunderstanding&hellip;<\/a>]. <\/div>\n<p align=\"justify\">Recently, there&#8217;s a new kid on the block &#8211; <strong><font color=\"#200020\">CAT-D<\/font><\/strong>. A couple of years ago, Dr. Robert Gibbons, a statistician teamed up with Dr. David Kupfer [in charge of the DSM-5 Revision] and others to introduce a new test &#8211; a computerized scale using artificial intelligence technology to produce a depression index by answering only a few questions on the computer, or a smart phone. It was later revealed that this was a future commercial product, already incorporated, that was in line with the notion of a new &quot;Dimensional&quot; axis for diagnosis planned for the DSM-5 &#8211; raising questions about the involvement of the company&#8217;s principals, all of whom had a place in the DSM-5 Task Force developing such a commercial product without declaring the COI [see <a href=\"http:\/\/1boringoldman.com\/index.php\/2014\/01\/21\/open-letter-to-the-apa\/\" target=\"_blank\">open letter to the APA&hellip;<\/a>]. Since apologizing for not noting that this is a commercial product in their journal articles [<a href=\"http:\/\/archpsyc.jamanetwork.com\/article.aspx?articleID=1780020\" target=\"_blank\">Failure to Report Financial Disclosure Information<\/a>], these authors\/entrepreneurs haven&#8217;t said much about their instrument, obviously targeted towards screening for depression or following treatment.<\/p>\n<div align=\"justify\">So when I read about this retro and anachronistic CME from Dr. Nemeroff et al, I understandably wondered if the &quot;<strong><font color=\"#990000\">validated tool<\/font><\/strong>&quot; mentioned was the <strong><font color=\"#200020\">CAT-D<\/font><\/strong>. about to make its debut on the world stage as a way to &quot;<strong><font color=\"#990000\">Evaluate all patients with major depressive disorder [MDD] for residual symptoms<\/font><\/strong>&quot; &#8211; its time come round at last. It occurred to me because the &quot;<strong><font color=\"#990000\">validated tool<\/font><\/strong>&quot; is so cryptic, and Dr. Gibbons has been at Dr. Nemeroff&#8217;s University of Miami Grand Rounds in the last year or so [<em>and they run in the same circles?<\/em>]. Just a bit of a paranoid fantasy I&#8217;m having. Oh yeah, don&#8217;t miss the anachronistic <a href=\"http:\/\/www.prweb.net\/Redirect.aspx?id=aHR0cDovL2NtZW91dGZpdHRlcnMuY29tL2NtZWEuYXNwP0lEPTk0OA==\" target=\"_blank\">COI statements<\/a>&#8230; <\/div>\n","protected":false},"excerpt":{"rendered":"<p>a&middot;nach&middot;ro&middot;nism &nbsp;(-nkr-nzm) noun 1. The representation of someone as existing or something as happening in other than chronological, proper, or historical order. 2. One that is out of its proper or chronological order, especially a person or practice that belongs to an earlier time. from Latin anachronismus, from Greek anakhronismos a mistake in chronology, from [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[5],"tags":[],"class_list":["post-51932","post","type-post","status-publish","format-standard","hentry","category-opinion"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/51932","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=51932"}],"version-history":[{"count":23,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/51932\/revisions"}],"predecessor-version":[{"id":51959,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/51932\/revisions\/51959"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=51932"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=51932"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=51932"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}