Psychiatry 101: Misconceptions About Psychiatric Disorders

It seems the media and perhaps the collective unconscious carry many misconceptions about psychiatric disorders. As a psychiatrist, it often is very difficult to explain to people that what they believe is absolutely wrong as I've heard so many times that they'd rather believe what they see on TV than a highly trained professional. Notice that I chose to illustrate this post with a picture of Freud who wasn't, contrary to what most people believe, a psychiatrist: he was a neurologist!

So here are a few facts that everyone should know:

- Antidepressant medicines aren't addictive. 90% of them do not have a sedative effect. Anti-anxiety medicines and sleeping pills are, on the contrary, addictive. Antidepressant treatments are long treatments. In most cases, they have to be taken over at least a six-month period and sometimes up to five years or more. This is to prevent relapse and it is very important. More than half of the population will stop taking their treatment when they feel better. This is a mistake and it will lead to relapse.

- Multiple Personality Disorder (or Dissociative Identity Disorder) and Schizophrenia aren't the same thing. As a matter of fact, it seems everyone believes that patients suffering from schizophrenia have multiple personalities. This is wrong. Multiple Personality Disorder is classified amongst dissociative disorders which are considered a form of neurosis whereas schizophrenia is a psychosis. Dissociative Identity Disorder is mostly found in North America, it is a culture-dependent disorder (meaning it will only appear in some cultures as long as people believe it exists... Hollywood certainly played a role in the advent of this disorder in North America).

- Patients suffering from schizophrenia aren't dangerous. Serial killers aren't schizophrenic. They're usually either psychopaths or perverts.

- "My cousin used to take tons of pills. That is why she was sick". Honestly, do you believe that a physician would prescribe a treatment to make their patients ill? Do you believe that such a treatment would be sold in pharmacies? Do you believe that med schools would train students on how to make people ill? What you usually see is the tip of the iceberg: a relative who is not well and takes psychotropic medicine. Believe me, they would be doing far worse if they did not take any treatment. Sometimes treatments aren't 100% effective and some cases are more complicated than others. We, psychiatrists, as any other physician are not almighty and can't cure everyone. Would you say that a diabetic has high blood sugar because they take insulin?

That's it for today! More to come soon! Stay tuned!

Social Media Gurus Aren't Psychologists

Everyday, I read so-called Social Media Gurus expressing their thoughts and ideas about the psychological impacts of social media on people. Believe me, there is a lot of crap that has been said on this subject. How can these people think they have any kind of knowledge in Psychology? Most of them are Business School graduates. As far as I know, their training has nothing to do with Psychology or Sociology. So how can they make us believe that what they're thinking or saying is relevant? They are certainly good at developing a business and coming up with new ideas but when it comes to figuring out the profound psychological impacts of their inventions on people, they'd better let professionals deal with it.

Would you consider asking a psychologist or psychiatrist for financial advice? I guess not. So how can we ask entrepreneurs their take on psychology?

In the same line of thinking, many financial analysts talk about the psychological factors involved in the recent global financial crisis. I'm surprised that nobody has ever thought about asking a psychologist or psychiatrist about that. Once again, I wouldn't dare proclaim myself an expert in law or finance, so why would anyone think that they have any knowledge whatsoever in Psychology when they have never studied it?

Being rich or successful doesn't grant oneself instant total knowledge about everything. It, however, seems that most journalists think it is the case. Isn't it absurd?

Stuart Hameroff, Consciousness, Quantum Physics & Quantum Computing

I already Stuart Hameroff in my blog. He's an American anesthesiologist whose theories I find most fascinating as they integrate Quantum Physics in an attempt at understanding the underlying mechanisms of consciousness. Both videos are a must-see!

The Rise Of The Placebo Response In CNS Clinical Trials

There has been a lot of controversy recently about the rise of the Placebo response in recent Central Nervous System (CNS) clinical trials. Many of these trials failed to show statistically different responses between new treatments and Placebos. It seems that the Placebo Response in CNS trials has never been as high in the past and it is becoming more and more important.

Many people have tried to figure out why, some almost going to the extent of seeing some kind of mystical explanation to it. The most common and accepted explanation is to say that clinical investigators are becoming less and less experienced and are responsible for this. The theory is that if an investigator is too empathetic during a clinical trial, they might trigger a higher Placebo Response in the subject. In addition, if the investigator is not properly trained they might be responsible for inaccurate assessments.

I believe that the explanation is actually easier to figure out. As a clinical investigator myself, some might say that I am biased but I also believe myself to be more knowledgeable than mot people about this subject since I am writing about something I experience first hand.

It is my strong belief that the rise of the Placebo Response in recent CNS clinical trials is due to the rise of regulatory and legal pressure. Let me explain this. Pharmaceutical companies are responsible for the clinical trials that they conduct (investigators too of course). Regulatory agencies put a lot of pressure on Pharmaceutical Companies to prove the efficacy of their new treatments. Statistically speaking, if you want to prove the efficacy of a new agent, you have to conduct trials v. placebo and v. the most up-to-date treatment used in the same indication. In order to do so, subjects enrolled in clinical trials have to be "perfect" in the sense that the less concomitant medical condition and treatment they have the better. Following this logic, subjects enrolled in antidepressant trials seldom suffer from any other medical condition, they are not allowed to take other medicine for anxiety or sleeping disorder and most importantly they won't enter the trial if they have suicidal ideations.

This is where the explanation lies: the most severely depressed patients all have suicidal ideations, they all suffer from severe insomnia and anxiety that would require concomitant treatment. Therefore, they wouldn't be enrolled in CNS clinical trials. The only consequence to this is that only less severely depressed patients are enrolled in clinical trials and they are the ones that are the most likely to show Placebo response.

I understand that in order to statistically prove the efficacy of a new agent, it has to be taken by patients with no other concomitant medication. However, the reality is that enhancing to statistical "beauty" of a trial by not allowing concomitant medication leads to enrolling patients that are not heterogenous enough to differentiate the new agent from the Placebo.

In addition, pharmaceutical companies don't want investigators to enroll patients that are at suicidal risks because the legal consequences of a suicide would be devastating. Once again, I understand their reasons but the reality is that it leads to enrolling less severely depressed patients in CNS clinical trials, therefore leading to a higher rate of Placebo responders.

Authorities and Pharmaceutical Companies really need to consider this in the future before they start putting the blame on investigators that, on top of everything, are probably better trained than ever before. In essence, when pharmaceutical companies say that investigators are responsible for the rise of the Placebo Response, they are admitting that patients enrolled in their trials are very likely to show Placebo Response and it has been know for a very long time, that depressed patients very likely to react to external circumstances are usually the least severely depressed ones, hence proving my point!

The Internet Addiction Urban Legend

This post aims at addressing the concept of Internet addiction. As a psychiatrist, I'm baffled to read articles written by fellow psychiatrists (usually the ones that have never used a computer in their entire life) emphasizing the dangers of Internet addiction.

To me, they just don't get it. The Internet is a medium. There is no such thing as being addicted to it. You can certainly be addicted to some online games or say, online porn. But, to me, talking about Internet addiction is, simply put, the proof that the person talking don't know what they're talking about. Many psychiatrists have applied the DSM-IV ("Psychiatry Bible") addiction criteria to the Internet to give birth to the concept of "Internet addiction". To me, it is as stupid as writing about breathing addiction (aren't we all addicted to breathing air? We can't spend a single day without doing it) or feeding addiction (we all feel the urge to eat whenever we've been deprived of food for a few hours...). The same could apply to "reading addiction".

Once again, the Internet is a medium. You can do thousands of different things online. Spending hours in front of a computer doesn't mean that you're addicted to doing the same thing as you can do so many different things on the Internet. People, specially mental health professionals, need to understand this paradigm shift.