Psychiatry's Turbid Solution

Psychiatry?s generic concept of disorder has long served an important legitimizing function for the broad array of conditions for which individuals seek mental health treatment, regardless of their presumed causes. Wakefield?s proposal to restrict the mental disorder concept to only a subset of these conditions has given rise to concerns about the uncertain consequences of classifying others as non-disorders. In Bergner?s recent counterproposal, this concern is masked in the form of a conspicuously overinclusive definition of mental disorder. Bergner?s resistance to Wakefield?s classification objective underscores an important, unmet, and often unacknowledged need within the clinical treatment community. The challenge ahead lies in finding ways to address this need without compromising the integrity of efforts to develop a more coherent concept of mental disorder

The Abduction of Disorder in Psychiatry

The evolutionary cornerstone of J. C. Wakefield's (1999) harmful dysfunction thesis is a faulty assumption of comparability between mental and biological processes that overlooks the unique plasticity and openness of the brain?s functioning design. This omission leads Wakefield to an idealized concept of natural mental functions, illusory interpretations of mental disorders as harmful dysfunctions, and exaggerated claims for the validity of his explanatory and stipulative proposals. The authors argue that there are numerous ways in which evolutionarily intact mental and psychological processes, combined with striking discontinuities within and between evolutionary and contemporary social/cultural environments, may cause non-dysfunction variants of many widely accepted major mental disorders. These examples undermine many of Wakefield's arguments for adopting a harmful dysfunction concept of mental disorder

Issues in the Diagnosis of Attention Deficit Disorder: A Cautionary Note on the Gordon Diagnostic System

In a recent paper Gordon (1986) has compared the strengths and weaknesses of traditional microcomputer-based assessment of attention deficit disorder (ADD) with those offered by the Gordon Diagnostic System (GDS; Gordon & McClure 1983; 1984). Not surprisingly, although careful not to overstate the case, he finds GDS to be an improvement over the use of standard microcomputers. Nevertheless, several of his criticisms of microcomputers seem forced, and he tends to downplay some of the more serious concerns associated with the GDS. Given that the GDS is receiving widespread attention, with nationwide marketing procedures underway, it seems fitting to examine its strengths and weaknesses independently as compared to more traditional methods of assessment of attention deficit disorder. To facilitate this goal the history of the GDS will be reviewed since in its relatively brief life several important events have already occurred

Prenatal Smoke Exposure Predicts Hyperactive/Impulsive but Not Inattentive ADHD Symptoms in Adolescent and Young Adult Girls

We examined the longitudinal associations between prenatal tobacco smoke exposure (PSE) and attention‐deficit hyperactivity disorder (ADHD) symptom domains in adolescence and young adulthood. A sample of girls with ADHD combined presentation (N = 93), ADHD predominantly inattentive presentation (N = 47), and matched comparisons (N = 88) was assessed prospectively. Symptoms of hyperactivity/impulsivity (HI), inattention (IA), and oppositionality (oppositional defiant disorder) were measured via multiple informants 5 (M age = 14 years; retention rate = 92%) and 10 years (M age = 20 years; retention rate = 95%) following childhood ascertainment. PSE was captured via maternal self‐report. We used linear regressions to examine the prediction from PSE to both HI and IA in adolescence and early adulthood after stringent control of relevant confounding variables. PSE significantly predicted HI during adolescence and young adulthood across multiple informants but did not predict IA at either wave. Symptoms of HI may have partial etiological independence from IA symptoms. Copyright © 2015 John Wiley & Sons, Ltd.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/133536/1/icd1943_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/133536/2/icd1943.pd

Peer Rejection and Friendships in Children with Attention-Deficit/Hyperactivity Disorder: Contributions to Long-Term Outcomes

Even after evidence-based treatment, Attention- Deficit/Hyperactivity Disorder (ADHD) is associated with poor long-term outcomes. These outcomes may be partly explained by difficulties in peer functioning, which are common among children with ADHD and which do not respond optimally to standard ADHD treatments. We examined whether peer rejection and lack of dyadic friendships experienced by children with ADHD after treatment contribute to long-term emotional and behavioral problems and global impairment, and whether having a reciprocal friend buffers the negative effects of peer rejection. Children with Combined type ADHD (N0300) enrolled in the Multimodal Treatment Study of Children with ADHD (MTA) were followed for 8 years. Peer rejection and dyadic friendships were measured with sociometric assessments after the active treatment period (14 or 24 months after baseline; M ages 9.7 and 10.5 years, respectively). Outcomes included delinquency, depression, anxiety, substance use, and general impairment at 6 and 8 years after baseline (Mean ages 14.9 and 16.8 years, respectively). With inclusion of key covariates, including demographics, symptoms ofADHD, ODD, and CD, and level of the outcome variable at 24 months, peer rejection predicted cigarette smoking, delinquency, anxiety, and global impairment at 6 years and global impairment at 8 years after baseline. Having a reciprocal friend was not, however, uniquely predictive of any outcomes and did not reduce the negative effects of peer rejection. Evaluating and addressing peer rejection in treatment planning may be necessary to improve long-term outcomes in children with ADHD

Cutaneous Adenoid Cystic Carcinoma with Perineural Invasion Treated by Mohs Micrographic Surgery—A Case Report with Literature Review

We report a 58-year-old woman with cutaneous adenoid cystic carcinoma arising on the chest treated with Mohs micrographic surgery. The patient remained tumor-free at 24-month follow-up. To date, only six other cases of cutaneous adenoid cystic carcinoma were reportedly managed by Mohs surgery. Cutaneous adenoid cystic carcinoma has low potential for distant metastasis but is notorious for its aggressive infiltrative growth pattern, frequent perineural invasion, and high risk of local recurrence after excision. We propose that Mohs surgery is an ideal method to achieve margin-free removal of cutaneous adenoid cystic carcinoma. A brief literature review is provided

Parent Rated Symptoms of Inattention in Childhood Predict High School Academic Achievement Across Two Culturally and Diagnostically Diverse Samples

Objective: To investigate parent reports of childhood symptoms of inattention as a predictor of adolescent academic achievement, taking into account the impact of the child’s intellectual functioning, in two diagnostically and culturally diverse samples.Method: Samples: (a) an all-female sample in the U.S. predominated by youth with ADHD (Berkeley Girls with ADHD Longitudinal Study [BGALS], N = 202), and (b) a mixed-sex sample recruited from a Norwegian population-based sample (the Bergen Child Study [BCS], N = 93). Inattention and intellectual function were assessed via the same measures in the two samples; academic achievement scores during and beyond high school and demographic covariates were country-specific.Results: Childhood inattention predicted subsequent academic achievement in both samples, with a somewhat stronger effect in the BGALS sample, which included a large subgroup of children with ADHD. Intellectual function was another strong predictor, but the effect of early inattention remained statistically significant in both samples when intellectual function was covaried.Conclusion: The effect of early indicators of inattention on future academic success was robust across the two samples. These results support the use of remediation procedures broadly applied. Future longitudinal multicenter studies with pre-planned common inclusion criteria should be performed to increase our understanding of the importance of inattention in primary school children for concurrent and prospective functioning

Filling in the Gaps in the 4.85 GHz Sky

We describe a 4.85 GHz survey of bright, flat-spectrum radio sources conducted with the Effelsberg 100 m telescope in an attempt to improve the completeness of existing surveys, such as CRATES. We report the results of these observations and of follow-up 8.4 GHz observations with the VLA of a subset of the sample. We comment on the connection to the WMAP point source catalog and on the survey's effectiveness at supplementing the CRATES sky coverage.Comment: 13 pages, 3 figures, 2 tables. Accepted for publication in the Astronomical Journal. Tables available in electronic form: http://astro.stanford.edu/gaps

Discriminating Between Children With ADHD and Classmates Using Peer Variables

Objective: Impaired peer relationships have long been recognized as one of the major functional problems of children with ADHD, but no specific guidelines on clinical levels of impairment in this domain exist. Method: This study used Receiver Operating Characteristics methodology to determine what aspects of peer functioning best discriminate between children with ADHD and their classmates. Optimal cutoffs indicative of clinical levels of impairment associated with ADHD diagnosis were determined for all variables. The participants were 165 children with AD/HD who were part of the Multimodal Treatment Study of Children With ADHD and their 1,298 classmates. Results: Variables that best discriminated between children with ADHD and their classmates included peer rejection and negative imbalance between given and received liking ratings (i.e., children with ADHD liked others more than they were liked). Conclusion: Peer rejection and negative imbalance show most promise for identifying clinically significant levels of peer relationship impairment in children with ADHD. (J. of Att. Dis. 2009; 12(4) 372-380)