Controversies in Psychiatry and DSM-5: The Relevance for Social Work (Occasional Essay)

This essay addresses recent controversies surrounding the forthcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5—the first major revision of the DSM since 1994), as well as questions regarding the safety and efficacy of psychotropic medications discussed in the public domain. Mental health professionals across a wide range of professions have signed a petition to the DSM-5 Task Force protesting changes in the new edition, and critiques of psychiatric medications are increasingly disseminated in the media. These issues have particular relevance for children in foster care, who receive diagnoses and medication at high rates. The general public is increasingly exposed to information on these topics through the media; as advocates and clinicians, it is important that social work practitioners be informed regarding these issues

Clinical Social Work and the Biomedical Industrial Complex

This article examines how the biomedical industrial complex has ensnared social work within a foreign conceptual and practice model that distracts clinical social workers from the special assistance that they can provide for people with mental distress and misbehavior. We discuss: (1) social work\u27s assimilation of psychiatric perspectives and practices during its pursuit of professional status; (2) the persistence of psychiatric hospitalization despite its coercive methods, high cost, and doubtful efficacy; (3) the increasing reliance on the Diagnostic and Statistical Manual of Mental Disorders, despite its widely acknowledged scientific frailty; and (4) the questionable contributions of psychoactive drugs to clinical mental health outcomes and their vast profits for the pharmaceutical industry, using antipsychotic drugs as a case example. We review a number of promising social work interventions overshadowed by the biomedical approach. We urge social work and other helping professions to exercise intellectual independence from the reigning paternalistic drug-centered biomedical ideology in mental health and to rededicate themselves to the supportive, educative, and problem-solving methods unique to their disciplines

Serotonin and Depression: A Disconnect between the Advertisements and the Scientific Literature

Many ads for SSRI antidepressants claim that the drugs boost brain serotonin levels. Lacasse and Leo argue there is little scientific evidence to support this claim

Knowledge of ghostwriting and financial conflicts-of-interest reduces the perceived credibility of biomedical research

<p>Abstract</p> <p>Background</p> <p>While the impact of conflicts-of-interest (COI) is of increasing concern in academic medicine, there is little research on the reaction of practicing clinicians to the disclosure of such conflicts. We developed two research vignettes presenting a fictional antidepressant medication study, one in which the principal investigator had no COI and another in which there were multiple COI disclosed. We confirmed the face validity of the COI vignette through consultation with experts. Hospital-based clinicians were randomly assigned to read one of these two vignettes and then administered a credibility scale.</p> <p>Findings</p> <p>Perceived credibility ratings were much lower in the COI group, with a difference of 11.00 points (31.42%) on the credibility scale total as calculated through the Mann-Whitney U test (95% CI = 6.99 - 15.00, <it>p </it>< .001). Clinicians in the COI group were also less likely to recommend the antidepressant medication discussed in the vignette (Odds Ratio = 0.163, 95% CI = .03 = 0.875).</p> <p>Conclusions</p> <p>In this study, increased disclosure of COI resulted in lower credibility ratings.</p

Ghostwriting at Elite Academic Medical Centers in the United States

Jeffrey Lacasse and Jonathan Leo assess ghostwriting policies at 50 academic medical centers in the United States and find that only 10 explicitly prohibit ghostwriting

Distribution of misfolded prion protein seeding activity alone does not predict regions of neurodegeneration

Protein misfolding is common across many neurodegenerative diseases, with misfolded proteins acting as seeds for "prion-like" conversion of normally folded protein to abnormal conformations. A central hypothesis is that misfolded protein accumulation, spread and distribution is restricted to specific neuronal populations of the central nervous system and thus predict regions of neurodegeneration. We examined this hypothesis using a highly sensitive assay system for detection of misfolded protein seeds in a murine model of prion disease. Misfolded prion protein seeds were observed widespread throughout the brain accumulating in all brain regions examined irrespective of neurodegeneration. Importantly neither time of exposure nor amount of misfolded protein seeds present determined regions of neurodegeneration. We further demonstrate two distinct microglia responses in prion infected brains, a 11 novel homeostatic response in all regions and an innate immune response restricted to sites of 12 neurodegeneration. Therefore accumulation of misfolded prion protein alone does not define targeting 13 of neurodegeneration which instead results only when misfolded prion protein accompanies a specific 14 innate immune response