Tuesday, April 22, 2008

Effect of Foster Care vs. Institutional Care

Here. Foster kids did better than institutionalized kids in this study of random assignment (in Bucharest). Control kids did better than both of those groups.

Saturday, April 19, 2008

Abilify Gets a Child FDA Approved Indication

Here. Other neuroleptic uses in children get covered.

1) Abilify is already number one for aggressiveness in young people.

2) Almost none have a mood disorder. Most have ADHD complicated by Oppositional Defiant Disorder or Conduct Disorder (ODD plus criminality).

3) Abilify is the greatest anti-anger medication in the history of mankind. It works like an amphetamine. It is not an amphetamine, and does not improve ADHD symptoms. It reduces impulsivity, and over-reactivity to trivial slights. It wears off like amphetamines. It is short acting like amphetamines. Parents speak of all symptoms recurring after forgetting it for one day, and their resolution upon receiving it late. It has an activiating property in most kids after initial sedation side effects.

4) The advice for its use in bipolar disorder is quite inappropriate. A doctor will only follow the directions once. Kids experience far more nausea, akathesia (restless legs), and rigidity. All patients receive prescriptions for benztropine 0.5 mg or 1 mg if over 120 lbs. Few will use it. However, parents must be warned about distressing Parkinsonian side effects. All patients, even big ones, get 5 mg for at least a week. The prudent clinician may wish to start 2 mg. About 70% of patients respond. Every 6 months or so, the dose has to get split into halves, then it has to get increased. Upon reaching 30 mg a day, the recommended maximum, one may increase the dose. However, one should get an Abilify blood level. In children, doses up to 80 mg may be needed to achieve the blood levels of others on 30 mg. If the blood level is that of average patients on 30 mg, and the response remains poor, Abilify does not work. The blood level may be run at a lab in Willow Grove, PA, for around $110.

5) These effects were discovered by clinicians across the nation. They did not communicate, nor influence each other. The patients and their long suffering, emotional, tearfully grateful parents taught it to the doctors.

6) Abilify is safer than all now available over the counter medications, both in use, and in overdose, accidental and intentional. The 2 mg dose should be available over the counter. Anger is a major public health problem. Most people with bad tempers will never submit to treatment. They may treat themselves at the urgings of their families or employers.

Pharmacotherapy of Aggression in Children and Adolescents

Here, and a case report ( JAACAP, 46:653-658.)

1) The doses are low. Kids have high rates of metabolism. If high doses do not work, check the blood levels of the neuroleptics before moving to a new one.

2) The use of medications for behavior management that lower blood pressure should preclude the use of restraints, except in a serious emergency. One has to choose, blood pressure lowering medication or restraints, not both. With the adoption of such a policy, the incidence of deaths in restraints without explanation drops.

3) Abilify would be the number one neuroleptic for aggression in people under 30 in the US. People with aggression, aged over 30, do not respond as well to it.

How About a Dollar a Day

The need to generate jobs blinded the researchers to a simple and cheap method of making anyone comply with any requirement.

Here.

They have tried a dollar a day to stay.

Wednesday, April 16, 2008

Tamoxifen Reduces Mania

Here. Tamoxifen is a selective estrogen receptor inhibitor used in breast cancer. It also centrally inhibits protein kinase C. It reduced mania ratings by a half in three weeks.

ADHD and Aggressiveness in Girls Result in More Problems in Adulthood

Here. These included smoking, abuse of spouse, early pregnancy, being on welfare, all symptoms of impulsivity.

Masculinization of Prenatal Brain Contributes to Eating Disorder

Here. The comparison took place in identical and fraternal twins, providing some control for environmental differences.

Tuesday, April 8, 2008

TV and DVD Watching by Infants

Here. At 3 months of age? 40% are watching. At 24 months? 90%. Median age of starting to watch? 9 months. Given the sedative power of the screen, I wonder the median age for the onset of internet addiction in infancy.

Manual for Psychiatric Diagnosis in MR

Here. There is no evidence that MR reduces the rate of any psychiatric diagnosis. It may increase it, except for bipolar disorder. An ordinary attempt should be made to diagnose such patients, and to provide standard treatment. One of the problems that arises is the obstructionism and the pretextual advocacy on their behalf. If a guardian refuses standard treatment for a psychiatric diagnosis, a report of medical neglect is mandatory for statutorily mandated professionals. If the risk of physical harm arises, and child welfare authorities refuse to act, it costs $3500 to remove the health guardianship of a resistant parent.

Thursday, April 3, 2008

Evidence Based Practices in Child Psychiatry

Here. Here. Here. Here.

1) Research follows clinical practice. Evidence based practices are the medicine of seven years ago, and medical malpractice. They get written by academic doctors. These have half the clinical experience of clinicians, and no competence to boss the clinician.

2) Government does nothing well. Any government initiative has a presumption of incompetence and of evil intent.

3) Evidence based practices have no scientific support, and are ghoulish human experiments themselves.

4) The Supreme Court has held that government must defer to clinical decision making. The most famous such decision is Roe v Wade.


5) Any government official proposal to impose these practices should be greeted with loud protest, total resistance, and Federal court injunctions, to protect our patients, our care, and to deter these petty tyrants.

Sunday, February 17, 2008

Why Kids Lie

Nice review here. Naturally, the answer is, they learn to do so from their parents.

Friday, February 1, 2008

Child Psychiatrist Shortage Is a Self-Serving Myth

1) When a benefit gets rare, its price increases. Child psychiatry remains among the lowest paid medical specialties. Either, the supply is too big, or the public places a low value on it, and does not want more.

2) Child psychiatrists have a low productivity. They see too few patients. They enumerate elaborate, bogus guidelines, devoid of scientific validity. These seek make wok, worthless extended assessments.

3) Until a rule change, December 19, 2007, none could write multiple scripts for controlled stimulants for their ADHD patients. A third or more of the appointments were time wasting repeat visits, with no change, nothing to discuss because the current regimen served the patient well, had done so for months or years. Lawyer mandated over control of the child psychiatrist added to the perception of a shortage.

4) The lawyer has imposed political correctness. No one may criticize, let alone substantively punish misconduct. The lawyer loves crime because it generates lawyer jobs. Any discouragement of misconduct is strictly forbidden, and deterred by false, over-reaching allegations of abuse, ruinous litigation, and inappropriate removal of children from normal parents. The family represents a rival authority to central government, run the lawyer syndicate. They are out to eradicate the family. Their progress toward that goal is excellent. These self-defeating attacks on behavior control has emboldened all knucklehead behavior, and the sense of invulnerability of vicious, single mother raised, amoral predators. This lawyer scheme markedly increases the demand for psychopharmacological approaches to behavior better remedied by severe punishment.

5) As mentioned above, bastardy markedly increases psychopathological behavior. The lawyer is on the hunt for the productive male. The father has assets to be plundered, and is a rival source of authority to central government. Lawyer orchestrated bastardy destroyed the black
family in the 1960's. A new law will do the same to the white family, this next decade.

Monday, January 14, 2008

Summary of Recent Child Psychiatry Research

Here.

Another Attack on Masculinity by Horrid Boston PC Feminist

What a nightmare on wheels. This is a ridiculous and discriminatory experiment. Any boy forced into such a program may have standing to sue all involved parties for sex harassment and discrimination.

Saturday, January 12, 2008

New Physician-Investigators Less Likely to Get Funding

Proposals for clinical research less successful than for non-clinical research. Money is the sincerest form of valuation. Talk is cheap.

Academic funding serves to increase the expertise of medical school professors. Each of these, by imparting methods, reaches out to the 50,000 families that will get care from the medical students and residents. This is one of the most responsible positions, and requires the top notch clinicians. Instead, pay is half what it is in clinical care. Institutional review boards stymie all creativity. The medical school requires that half the salary come from grants. Only a genius with something specific to achieve will suffer these adverse conditions.

What we get instead are repetitious, uninformative, confirmational research, by a bunch of burnouts.