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.


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.