WHY HAS ADHD BIOMEDICAL DIAGNOSIS BECOME SO DOMINANT?

ADHD is today the most frequently diagnosed mental health condition among children and adolescents. The common belief is that it is a mental illness, and doctors and psychiatrists have solid scientific evidence to make the diagnosis and provide safe and effective psychopharmacological treatment. However, the scientific literature does not support this belief so widespread in our society. The article reviews the historical way in which this belief has been constructed and analyzes a scientific article that supposedly supports this way of approaching the behavioral and emotional problems of children of our times. The conclusion is that society today has no evidence to support this belief.El TDAH es hoy la afección de salud mental más frecuentemente diagnosticada entre niños y adolescentes. El sentido común es que es una enfermedad mental, y los médicos y psiquiatras tienen evidencia científica sólida para hacer el diagnóstico y proporcionar un tratamiento psicofarmacológico seguro y efectivo. Sin embargo, la literatura científica no respalda esta creencia tan extendida en nuestra sociedad. El artículo revisa la forma histórica en que se ha construido esta creencia y analiza un artículo científico que supuestamente respalda esta forma de abordar los problemas conductuales y emocionales de los niños de nuestro tiempo. La conclusión es que la sociedad actual no tiene evidencia para apoyar esta creencia.TDAH é hoje a condição de saúde mental mais frequentemente diagnosticada entre crianças e adolescentes. A crença comum é que se trata de uma doença mental, e que médicos e psiquiatras contam com sólidas evidências científicas para dar o diagnóstico e fornecer tratamento psicofarmacológico seguro e eficaz. Porém, a literatura científica não dá suporte a essa crença tão fortemente difundida em nossa sociedade. O artigo faz uma revisão histórica de como essa crença vem sendo construída e analisa um artigo científico que supostamente dá sustentação a esse modo de abordar os problemas comportamentais e emocionais das crianças dos nossos tempos. A conclusão é que a sociedade não conta hoje com evidências que deem suporte a essa crença

Policy Issues Facing Boston: 1984, A Summary

In the Fall of 1983 the John W. McCormack Institute of Public Affairs asked a number of experts in various fields from within and outside the University to prepare an analysis of the major policy issues facing the City of Boston in 1984. In December 1983, the Boston School Committee and City Council, in separate half-day seminars, came to the University for discussions on the issues identified. At the same time, the papers prepared were delivered to the transition teams of the Flynn Administration. This report briefly summarizes the major findings of the effort

A new wrinkle on the enhancon

We generalize the basic enhancon solution of Johnson, Peet and Polchinski by constructing solutions without spherical symmetry. A careful consideration of boundary conditions at the enhancon surface indicates that the interior of the supergravity solution is still flat space in the general case. We provide some explicit analytic solutions where the enhancon locus is a prolate or oblate sphere.Comment: 19 pages, no figure

Improving mental health literacy in year 9 high school children across Wales: a protocol for a randomised control treatment trial (RCT) of a mental health literacy programme across an entire country

Background: Adolescence is a crucial period for developing and maintaining good habits for mental health and well-being. This is important for future mental health, as most mental health problems manifest during adolescence. Mental health literacy is the foundation for mental health prevention, stigma reduction, and increased help-seeking efficacy particularly among adolescents. The mental health literacy programme “The Guide”, which was developed in Canada, has shown success in increasing mental health literacy in North American 16-17 year olds. “The Guide Cymru” is an adaptation of The Guide designed for a younger age group (13-14 year olds) and for the Welsh culture and context and is being offered to all state schools in Wales. Methods: This two-armed cluster randomised control trial (RCT) will evaluate the effectiveness of The Guide Cymru. All 205 secondary schools in Wales will be invited to take part, involving up to 30,000 year 9 pupils. Schools will be randomised to either the immediate implementation of The Guide Cymru or to a wait-list control. The wait-list control will receive The Guide Cymru around 12 weeks later. Measures of mental health literacy (assessed via the Knowledge and Attitudes to Mental Health scale) and mental health problems (via the PedsQL and Strengths and Difficulties Questionnaire) will be taken at baseline (pre-intervention), 12 weeks later (after the active group has received The Guide Cymru), and 24 weeks later (after the wait-list control has received The Guide Cymru).Discussion: The trial aims to evaluate if The Guide Cymru increases mental health literacy, including reduced stigma to others and to the self, and increased levels of good mental health behaviours and help-seeking for mental health problems. Trial Registration: ISRCTN15462041. Registered 03/10/2019. https://doi.org/10.1186/ISRCTN15462041Keywords: Mental health literacy, Randomised Control Trial, Early intervention, Self-stigma, Stigma, Education, Adolescence, Help-seeking efficacy, School-based intervention

Three Strategies for Changing Attributions about Severe Mental Illness

The effects of three strategies for changing stigmatizing attitudes—education (which replaces myths about mental illness with accurate conceptions), contact (which challenges public attitudes about mental illness through direct interactions with persons who have these disorders), and protest (which seeks to suppress stigmatizing attitudes about mental illness)—were examined on attributions about schizophrenia and other severe mental illnesses. One hundred and fifty-two students at a community college were randomly assigned to one of the three strategies or a control condition. They completed a questionnaire about attributions toward six groups—depression, psychosis, cocaine addiction, mental retardation, cancer, and AIDS—prior to and after completing the assigned condition. As expected, results showed that education had no effect on attributions about physical disabilities but led to improved attributions in all four psychiatric groups. Contact produced positive changes that exceeded education effects in attributions about targeted psychiatric disabilities: depression and psychosis. Protest yielded no significant changes in attributions about any group. This study also examined the effects of these strategies on processing information about mental illness

BAT117213:Ileal bile acid transporter (IBAT) inhibition as a treatment for pruritus in primary biliary cirrhosis: study protocol for a randomised controlled trial

BACKGROUND: Pruritus (itch) is a symptom commonly experienced by patients with cholestatic liver diseases such as primary biliary cholangitis (PBC, previously referred to as primary biliary cirrhosis). Bile acids (BAs) have been proposed as potential pruritogens in PBC. The ileal bile acid transporter (IBAT) protein expressed in the distal ileum plays a key role in the enterohepatic circulation of BAs. Pharmacological inhibition of IBAT with GSK2330672 may reduce BA levels in the systemic circulation and improve pruritus. METHODS: This clinical study (BAT117213 study) is sponsored by GlaxoSmithKline (GSK) with associated exploratory studies supported by the National Institute for Health Research (NIHR). It is a phase 2a, multi-centre, randomised, double bind, placebo controlled, cross-over trial for PBC patients with pruritus. The primary objective is to investigate the safety and tolerability of repeat doses of GSK2330672, and explore whether GSK2330672 administration for 14 days improves pruritus compared with placebo. The key outcomes include improvement in pruritus scores evaluated on a numerical rating scale and other PBC symptoms in an electronic diary completed twice daily by the patients. The secondary outcomes include the evaluation of the effect of GSK2330672 on total serum bile acid (BA) concentrations, serum markers of BA synthesis and steady-state pharmacokinetics of ursodeoxycholic acid (UDCA). DISCUSSION: BAT117213 study is the first randomised controlled crossover trial of ileal bile acid transporter inhibitor, a novel class of drug to treat pruritus in PBC. The main strengths of the trial are utility of a novel, study specific, electronic symptom diary as patient reported outcome to measure the treatment response objectively and the crossover design that allows estimating the treatment effect in a smaller number of patients. The outcome of this trial will inform the trial design of future development phase of the IBAT inhibitor drug. The trial will also provide opportunity to conduct metabonomic and gut microbiome studies as explorative and mechanistic research in patients with cholestatic pruritus. TRIAL REGISTRATION: EudraCT number: 2012-005531-84, ClinicalTrials.gov Identifier: NCT01899703, registered on 3(rd) July 201

Transformative sensemaking: Development in Whose Image? Keyan Tomaselli and the semiotics of visual representation

The defining and distinguishing feature of homo sapiens is its ability to make sense of the world, i.e. to use its intellect to understand and change both itself and the world of which it is an integral part. It is against this backdrop that this essay reviews Tomaselli's 1996 text, Appropriating Images: The Semiotics of Visual Representation/ by summarizing his key perspectives, clarifying his major operational concepts and citing particular portions from his work in support of specific perspectives on sense-making. Subsequently, this essay employs his techniques of sense-making to interrogate the notion of "development". This exercise examines and confirms two interrelated hypotheses: first, a semiotic analysis of the privileged notion of "development" demonstrates its metaphysical/ ideological, and thus limiting, nature especially vis-a-vis the marginalized, excluded, and the collective other, the so-called Developing Countries. Second, the interrogative nature of semiotics allows for an alternative reading and application of human potential or skills in the quest of a more humane social and global order, highlighting thereby the transformative implications of a reflexive epistemology.Web of Scienc

Neurogenic inflammation after traumatic brain injury and its potentiation of classical inflammation

Background: The neuroinflammatory response following traumatic brain injury (TBI) is known to be a key secondary injury factor that can drive ongoing neuronal injury. Despite this, treatments that have targeted aspects of the inflammatory pathway have not shown significant efficacy in clinical trials. Main body: We suggest that this may be because classical inflammation only represents part of the story, with activation of neurogenic inflammation potentially one of the key initiating inflammatory events following TBI. Indeed, evidence suggests that the transient receptor potential cation channels (TRP channels), TRPV1 and TRPA1, are polymodal receptors that are activated by a variety of stimuli associated with TBI, including mechanical shear stress, leading to the release of neuropeptides such as substance P (SP). SP augments many aspects of the classical inflammatory response via activation of microglia and astrocytes, degranulation of mast cells, and promoting leukocyte migration. Furthermore, SP may initiate the earliest changes seen in blood-brain barrier (BBB) permeability, namely the increased transcellular transport of plasma proteins via activation of caveolae. This is in line with reports that alterations in transcellular transport are seen first following TBI, prior to decreases in expression of tight-junction proteins such as claudin-5 and occludin. Indeed, the receptor for SP, the tachykinin NK1 receptor, is found in caveolae and its activation following TBI may allow influx of albumin and other plasma proteins which directly augment the inflammatory response by activating astrocytes and microglia. Conclusions: As such, the neurogenic inflammatory response can exacerbate classical inflammation via a positive feedback loop, with classical inflammatory mediators such as bradykinin and prostaglandins then further stimulating TRP receptors. Accordingly, complete inhibition of neuroinflammation following TBI may require the inhibition of both classical and neurogenic inflammatory pathways.Frances Corrigan, Kimberley A. Mander, Anna V. Leonard and Robert Vin

Baseline factors associated with early and late death in intracerebral haemorrhage survivors

Background and purpose: The aim of this study was to determine whether early and late death are associated with different baseline factors in intracerebral haemorrhage (ICH) survivors. Methods: This was a secondary analysis of the multicentre prospective observational CROMIS‐2 ICH study. Death was defined as ‘early’ if occurring within 6 months of study entry and ‘late’ if occurring after this time point. Results: In our cohort (n = 1094), there were 306 deaths (per 100 patient‐years: absolute event rate, 11.7; 95% confidence intervals, 10.5–13.1); 156 were ‘early’ and 150 ‘late’. In multivariable analyses, early death was independently associated with age [per year increase; hazard ratio (HR), 1.05, P = 0.003], history of hypertension (HR, 1.89, P = 0.038), pre‐event modified Rankin scale score (per point increase; HR, 1.41, P < 0.0001), admission National Institutes of Health Stroke Scale score (per point increase; HR, 1.11, P < 0.0001) and haemorrhage volume >60 mL (HR, 4.08, P < 0.0001). Late death showed independent associations with age (per year increase; HR, 1.04, P = 0.003), pre‐event modified Rankin scale score (per point increase; HR, 1.42, P = 0.001), prior anticoagulant use (HR, 2.13, P = 0.028) and the presence of intraventricular extension (HR, 1.73, P = 0.033) in multivariable analyses. In further analyses where time was treated as continuous (rather than dichotomized), the HR of previous cerebral ischaemic events increased with time, whereas HRs for Glasgow Coma Scale score, National Institutes of Health Stroke Scale score and ICH volume decreased over time. Conclusions: We provide new evidence that not all baseline factors associated with early mortality after ICH are associated with mortality after 6 months and that the effects of baseline variables change over time. Our findings could help design better prognostic scores for later death after ICH