The social and cultural construction of psychiatric knowledge: an analysis of NICE guidelines on depression and ADHD.

The current paper presents an analysis of the NICE guidelines on depression and attention deficit hyperactivity disorder (ADHD) from the perspective of the philosophy of science, guided particularly by Foucault's notion of the symbiosis of knowledge and power. It examines how data that challenged the orthodox position on the validity and drug treatment of these conditions was managed in the process of guideline development. The depression guideline briefly considered the complexity and heterogeneity of depression, and numerous methodological problems with evaluating treatments, including antidepressants. However, the guideline recommendations made no reference to these issues and ignored evidence that questioned the analysis of antidepressant trials. The guideline on ADHD reviewed validity, but did not consider evidence from the critical literature, and overlooked inconsistencies in the data. The guideline identified that drug trials have shown no long-term benefit in ADHD, but still recommended treatment with stimulant drugs for children with severe symptoms and for all adults claiming consensus for this position. Both guidelines demonstrate how contradictory data are managed so as not to jeopardise the currently predominant view that ADHD and depression are valid and un-contentious medical conditions that should be treated with drugs. The subjective nature of guideline formation that is revealed illustrates Foucault's suggestion that the authority of medicine operates to promote a technological view of the nature of certain human problems, which in turn strengthens medical hegemony over these areas

Trends in SEN identification: contexts, causes and consequences

This is the final version. freely available from the SEN Policy Research Forum via the link in this recordThis policy seminar addressed these current issues and questions: i. Are there shifts from an interactive to within-child model of identification? And if so, what are the factors that are contributing to this, ii. What are the changing relationships between parents, schools and LAs and their influence on identification practice? And iii. What kind of identification and assessment framework do we need for the future? The first speaker Jo Hutchinson, from the Education Policy Institute, presented on “How fairly and effectively special educational needs and disabilities (SEND) are identified?’ in which she summarised her interim findings about school attainment and inclusion questions. One of her key findings was that about four in ten children have some interaction with the SEND system over the course of their schooling This is a lot more than the commonly held assumptions about SEN incidence (one in five or six). Further analysis indicated that factors that best predicted the identification of SEN Support in primary schools were measures of deprivation and prior attainment. There were moderate effects for absences, ethnicity, looked after child status and child in need status. Lesser but still significant factors were sex, months of birth, EAL status and school mobility. The communication language and literacy scale of the Early Years Foundation Stage Profile was the best predictor of being identified with SEND at the SEN Support level. Also, analysis showed that most of variation in SEN Support identification was predicted by school variations, indicating that individual effects were halved once school factors were taken into account. Analyses for secondary and SEN at the EHC Plan level were still be completed. Dr Sami Timimi, Consultant Child and Adolescent Psychiatrist, presented on ‘the social construction of autism’. In his presentation he deconstructs the ‘common sense’ understanding of autism to argue that it is a construct that lacks a coherent basis in science and can result in therapeutically unhelpful dynamics. In presenting a historical background to psychiatric diagnosis he argues that there is no such thing as a psychiatric diagnosis of autism. Part of this argument is that concepts like ASD do not even work well as a descriptive classification as they operate as ‘thin descriptions’, overlooking what matters about individual people. He concluded his presentation by pointing out that an ASD diagnosis can be a ticket to services but also a reason to exclude from services and that it can disempower parents and teachers by accident. The third presenter Neil McKay, a consultant and trainer, presented on ‘dyslexia – definitions and identification’. Though he started by acknowledging the problems with the IQ discrepancy diagnosis of dyslexia, he took a particular perspective on the ‘dyslexia debate’ based on his teaching and advisory practice. He questioned whether a dyslexia diagnosis unlocks provision at the expense of others, arguing that all children with a reading difficulty regardless of IQ, should be encouraged to seek intervention. His central point was that Elliott and Grigorenko (who question dyslexia) rely on a narrow view of reading by concentrating on accuracy. This is the basis for the argument that, because dyslexic and non-dyslexic poor readers show almost identical patterns of difficulty, that dyslexia does not exist. McKay’s position is to focus on “unexpected difficulties” by interpreting unexpected difficulties as being about comprehension; a position which derives from practitioners’ experience of children with “unexpectedly good” comprehension despite poor reading accuracy. He advocates the Scottish HMIE concept of dyslexia as ‘marked differences in certain areas, especially with regard to oral versus text-based skills’. From this stance, he concludes that high quality teaching based on validated synthetic phonic approaches empowers most learners, regardless of label, to learn to read. But, it is the unexpected gap between reading accuracy and higher order comprehension and thinking skills that often typifies the dyslexic learner. In the group discussions there were common themes about an increase in prevalence of several conditions, with some questions about whether this was due to getting better at diagnosing particular types of need and / or that only by a focus on a within-child model of identification would parents be taken seriously. Several groups believed that the role of parental expectations was central to this increased prevalence and the growing tensions between parents, schools and authorities. The kind of identification and assessment framework that was supported in several groups involved these features: multidisciplinary, collaborative, independent from budget holders, transparent, one aiming to build parental trust in the system and one that is values driven. There was some concern about whether there was proper scrutiny of environmental factors, and if not, whether this can lead to adopting a reduced within-child model and a sense of learned helplessness in schools. A graduated response was endorsed by some as an appropriate model for an identification framework

Ssri and Snri Withdrawal Symptoms Reported on an Internet Forum

BACKGROUND: Antidepressant withdrawal symptoms are well-recognised, but their potential duration remains uncertain. OBJECTIVE: We aimed to describe the characteristics of withdrawal associated with two popular classes of antidepressants, including duration. METHODS: We analysed the content of a sample of posts on an antidepressant withdrawal website. We compared the characteristics of withdrawal associated with SSRIs and SNRIs, including time of onset, duration and nature of symptoms. RESULTS: 110 posts about SSRI withdrawal, and 63 concerning SNRI withdrawal, were analysed. The mean duration of withdrawal symptoms was significantly longer with SSRIs than SNRIs: 90.5 weeks (standard deviation, SD, 150.0) and 50.8 weeks (SD 76.0) respectively; p = 0.043). Neurological symptoms, such as 'brain zaps,' were more common among SNRI users (p = 0.023). Psychosexual/genitourinary symptoms may be more common among SSRI users (p = 0.054). LIMITATIONS: The website aims to help people with antidepressant withdrawal, and is therefore likely to attract people who have difficulties. Length of prior use of antidepressants was long, with a mean of 252.2 weeks (SD 250.8). CONCLUSIONS: People accessing antidepressant withdrawal websites report experiencing protracted withdrawal symptoms. There are some differences in the characteristics of withdrawal associated with different classes of antidepressants

Book review: Re-Thinking Autism: Diagnosis, Identity and Equality

Re-Thinking Autism: Diagnosis, Identity and Equality seeks to contribute to the growing field of critical autism studies and, according to one commentator quoted on the back cover, inaugurates this area of study – a bold and yet inaccurate statement, given previous texts and events that have sought to explore this area (for example, Arnold 2012 Arnold, L. 2012; Davidson and Orsini 2013 Davidson, J., and M. Orsini, eds. 2013; Greenstein 2014 Greenstein, A. 2014)

The death and the resurrection of (psy)critique: the case of neuroeducation

A rapidly emerging hegemonic neuro-culture and a booming neural subjectivity signal the entry point for an inquiry into the status of the signifier neuro as a universal passe-partout. The wager of this paper is that the various (mis)appropriations of the neurosciences in the media and in academia itself point to something essential, if not structural, in connection with both the discipline of the neurosciences and the current socio-cultural and ideological climate. Starting from the case of neuroeducation (the application of neuroscience within education), the genealogy of the neurological turn is linked to the history of psychology and its inextricable bond with processes of psychologisation. If the neurological turn risks not merely neglecting the dimension of critique, but also obviating its possibility, then revivifying a psy-critique (understanding the academified modern subject as grounded in the scientific point of view from nowhere) might be necessary in order to understand today’s neural subjectivity and its place within current biopolitics

Twist, tilt, and orientational order at the nematic to twist-bend nematic phase transition of 1¿, 9¿-bis(4-cyanobiphenyl-4'-yl) nonane: A dielectric, H 2 NMR, and calorimetric study

The nature of the nematic-nematic phase transition in the liquid crystal dimer 1¿, 9¿-bis(4-cyanobiphenyl-4'-yl) nonane (CB9CB) has been investigated using techniques of calorimetry, dynamic dielectric response measurements, and H2 NMR spectroscopy. The experimental results for CB9CB show that, like the shorter homologue CB7CB, the studied material exhibits a normal nematic phase, which on cooling undergoes a transition to the twist-bend nematic phase (NTB), a uniaxial nematic phase, promoted by the average bent molecular shape, in which the director tilts and precesses describing a conical helix. Modulated differential scanning calorimetry has been used to analyze the nature of the NTB-N phase transition, which is found to be weakly first order, but close to tricritical. Additionally broadband dielectric spectroscopy and H2 magnetic resonance studies have revealed information on the structural characteristics of the recently discovered twist-bend nematic phase. Analysis of the dynamic dielectric response in both nematic phases has provided an estimate of the conical angle of the heliconical structure for the NTB phase. Capacitance measurements of the electric-field realignment of the director in initially planar aligned cells have yielded values for the splay and bend elastic constants in the high temperature nematic phase. The bend elastic constant is small and decreases with decreasing temperature as the twist-bend phase is approached. This behavior is expected theoretically and has been observed in materials that form the twist-bend nematic phase. H2 NMR measurements characterize the chiral helical twist identified in the twist-bend nematic phase and also allow the determination of the temperature dependence of the conical angle and the orientational order parameter with respect to the director

Adult women and ADHD: on the temporal dimensions of ADHD identities

This paper uses conceptual resources drawn psychosocial process thinking (Stenner, 2017, Brown and Reavey, 2015, Brown and Stenner, 2009) and from G.H. Mead in particular, to contribute to an emerging body of work on the experiences of adult women with ADHD (Singh, 2002, Waite and Ivey, 2009, Quinn and Madhoo, 2014, Horton-Salway and Davies, 2018). It has a particular focus on how ADHD features in the construction of women’s identities and life-stories and it draws upon findings from a qualitative investigation of adult women diagnosed or self-diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). A theoretically informed ‘thematic decomposition’ of 16 depth interviews reveals how complex processes of identity transformation are mediated by the social category of ADHD. Through this process, pasts are reconstructed from the perspective of an ‘emergent’ identity that offers participants the potential for a more enabling and positive future

Factors Associated With 5-Year Glaucomatous Progression In Glaucoma Suspect Eyes: A Retrospective Longitudinal Study

Purpose: To study the association of 5-year glaucomatous progression with several demographic, clinical, visual field and optical coherence tomography (OCT) variables in glaucoma suspect eyes. Methods: A retrospective chart review of 365 eyes of 288 patients were included (323 eyes with suspicious cup-to-disc ratio and 42 eyes with ocular hypertension). The study subjects were divided into two groups: eyes that progressed to glaucoma and those that did not. We calculated the percentage of glaucoma suspect eyes that progressed to glaucoma within 5 years. The inclusion criteria were glaucoma suspect eyes (i.e., suspicious cup-to-disc ratio and/or intraocular pressure \u3e21 mm Hg), age ≥ 30 years old, follow-up time of 5 years, best-corrected visual acuity 20/100 or better, spherical equivalent better than −8 diopters and astigmatism less than 3 diopters. We excluded eyes with any significant retinal or neurological disease, and glaucoma which was determined by at least 2 consecutive reliable visual field tests regardless of the appearance of the optic disc. Results: Bivariate analysis showed eyes that progressed to glaucoma had significantly worse mean deviation, higher pattern standard deviation (PSD), less visual field index, thinner average, superior, and inferior retinal nerve fiber layer thickness (RNFL), and more severe average, superior, and inferior RNFL damages (i.e., color grading scale) at baseline. Logistic regression analysis showed only PSD and severe inferior RNFL damage (i.e., red color) were significantly associated with 5-year glaucomatous progression. Conclusions: Segmental RNFL damage and PSD are associated with 5-year glaucomatous progression in glaucoma suspect eyes