Sunday, February 18, 2007

My Three Shrinks Podcast 11: Lovely Spam


[10] . . . [11] . . . [12] . . . [All]

We almost didn't make a podcast this week, as both Dinah and Clink were under the weather; but I brought my hazard suit and gel scrub and we managed to complete it. It did go a bit long, about 50 minutes.


February 18, 2007:


Topics include:


  • FDA Antidepressants Hearing, Revisited. We had previously blogged about suicide and antidepressants, followed by Roy's first-hand account of the December 2006 FDA hearing which Roy attended, where the committee voted to expand the black box warnings on antidepressants to indicate the risks of untreated depression and to mention the protective effects that antidepressants appear to have on older folks. The FDA has now released two transcripts of the hearing (Transcript 1 and Transcript 2), as well as the slide presentations from some of the speakers. These are excellent resources if you want to find out more on the subject. The recommended changes (see summary) to the black box include text to highlight the following:
    • increased risk of antidepressant-associated suicidal thoughts and behaviors up to around age 25
    • protective effect of antidepressants against suicidal thoughts and behaviors for older folks, particularly seniors
    • balancing language which points out the increased risks associated with NOT treating depression (eg, suicide rates have increased for children since the 2004 decision to add black box warnings for antidepressants)

  • Finland, Finland, Finland. The Finnish study that Dinah mentioned is discussed here. The Monty Python audio was found here.
  • The Zyprexa Documents. The FuriousSeasons blog details the concerns that Lilly is holding out on important information about its antipsychotic drug.
  • NYT: Bipolar toddler dead from medications. Raises questions about diagnosing severe mental illness in very young children.
  • Lovely Spam. on YouTube.
  • Q&A at mythreeshrinksATgmailDOTcom. Schizoid personality disorder: Is it real and does it predispose to schizophrenia? By Seamonkey. Diagnostic criteria. Pubmed review.
  • Amygdala size and eye contact in Autism.
  • Asperger's syndrome.

Next week: Side effects of psychotherapy; evolutionary psychopathology; what happens in Vegas.
Last week's musical snippet was from the 2000 release, Strangelove Addiction, from the self-titled album by Supreme Beings of Leisure.


Find show notes with links at:
http://psychiatrist-blog.blogspot.com/2007/02/my-three-shrinks-podcast-11-lovely-spam.html
This podcast is available on iTunes (feel free to post a review). You can also listen to or download the .mp3 or the MPEG-4 file from mythreeshrinks.com. Thank you for listening.




13 comments:

Sarebear said...

Autism usually having language deficits, at least early on?

My daughter (high-functioning, very), would be an exception to that. Lots and lots of words. Exceptional reading for her age, reading (and spelling!) early on, too. Walked out the morning after her 4th birthday to find the new letter magnets spelling yes and no on the fridge, and neither I nor hubby had done it.

Anyway, I guess that's one reason she's only been diagnosed for less than two years . . . . something was different, we didn't know what, tho.

Sarebear said...

I asked if she was Asperger's, but she said no.

She does have the sensory integration dysfunction thing . . . I have a nephew w/Asperger's, and they just seem to be . . . different but related brain miswirings . . . cousins, half-siblings? Something. I know the spectrum can be different, people AT or near the same level of functioning can be rather different, but . . . I've been told I have an instinctive feel for the ways in which my daughter thinks, feels, and experiences the world differently; my old iatrist told me I was more intelligent than he was, and for someone w/a huge ego, that's saying something; I am extremely perceptive to ways of thinking and problems interacting . . . . and yet not putting too much of my OWN thing on what I see happening with her. For the most part.

I was really surprised to hear the word Autism related to my daughter; I had thought it was just severe stuff.

I still haven't processed this, it was a little over a year and a half ago when she was diagnosed . . . .

I worry that my mental illnesses made her genetically prone to this . . . .

Sarebear said...

Eye contact is still an issue for my daughter. Makes me wonder about her amygdyla, and how they seem to be kinda as positively negative as they can be about how she's still having problems w/that at school . . .

And that's from the special ed teacher (she has had an IEP for the last year, in Math and social skills group (the latter meets once a week) that they pull her out of class every day a little for).

In other words, I had thought BEFORE this that they could be a bit more understanding and less . . . on her about the eye contact thing, while still working on it, but now I'm even more so.

Sorry for so many comments on this, but it touches near and dear to my heart. Very.

Altho it's such a huge issue that I'm only just now realizing how much I HAVEN'T processed or dealt emotionally with my daughter (now 8) getting this diagnosis . . . .

Although I must say I was in shock for awhile, after I first heard "that word" used about my daughter.

Oh, one more thing. Though to most people hers may seem subtle, it is, in some ways, severe in that it does affect her whole way of interfacing/interacting with the world; I can SEE this, feel it, intellectually understand it, whereas most people wouldn't grasp that.

I was told by the psych evaluating her that we as parents (much of it being my sensitivity to her, and because of my own horrid childhood), have done an excellent job at keeping her from getting an anxiety disorder, as many kids w/this tend to get. I guess because other parents just think the child is being picky, stubborn, acting up, misbehaving, and not understanding or being able to see the way the child is interfacing differently.

Sorry, I've gone on again.

It's my daughter, though; this subject is as close as it gets.

sophizo said...

I can't wait to listen to this one! Unless you recorded this podcast after 8:30pm, then you obviously did it before 60 Minutes aired last night. Did any of you watch it? One of the stories was about autism and lowering the diagnosing age to about 12 months old.

Diagnosis:Autism

I'll write more after I listen to the podcast. All the topics sound very interesting this week!

Roy said...

Yes, we recorded this on Saturday. I did catch the 60 Minutes show on Autism. Interesting how they used a video set-up to assess infants' eye contact. Also, this simple screeening they do by calling the infant's name to see if s/he responds with a head turn.

Sara, it's good for her to have someone like you who is so in tune with her.

Not sure if the 60 Minutes clip is online.

sophizo said...

Anti-psychotics - I may just email my comment on this one. Not asking for any answer, just view it as if I wrote my comment/question on here.

Schizoid - I'm glad you brought up how close the description sounds to autism. I know that is a huge topic among people who have AS. They often ask about the differences between schizoid and AS and whether or not you can have both. One woman used schizoid as a r/o on some testing for me, but the psychiatrist I worked for said no way was I schizoid. Phew! To me...it was a very scary thought that someone would even think that about me. That's when the AS was introduced to me for the 2nd time and I just couldn't deny it anymore.

Obviously it is known that autism is hereditary. What % of people diagnosed with autism/AS do you think is a result of genetics and how many from non-hereditary causes? That might be a good question to ask your autism specialist friend what she thinks. Maybe you can get her to write a post about it since it is such big news now.

Amygdyla - I know I don't look at someone's eyes because it feels aggressive and scary. I don't know how to even explain it. The closest I can get to looking at someone's eyes is the mouth and/or forehead (like what was shown on the 60 Minutes show). The whole fear thing is real and it isn't until only recently that I even learned about this. I think it would be really fun to have my brain scanned while doing that eye contact test. :-)

Sara - Yeah, anxiety is very often found in someone somewhere on the spectrum. You're definitely looking at a prime example here! At least now that you know, you can be an advocate for your daughter. Most kids either didn't or don't have that. I didn't and I know it really screwed up a lot of my life (granted, this was before 1994 when AS became "official" in the DSM). If you haven't already, I highly recommend joining a parent support group. I know out here they are everywhere and it is very helpful for parents to be around other parents going through the same thing.

BTW...the video is now on the 60 minutes website. Use the link I put up in my first comment.

Word verification: tdiie (what some people supposedly want to do after starting an SSRI) - ok...maybe in bad taste, but it's a funny word verification!

Sarebear said...

A note on the hereditary thing:

The only other two of my 5 siblings who have kids, have three each. I have one, so far, she's 8.

My oldest brother, his third child has autism, he is lightly moderate in severity.

My next oldest brother, his first child, a son, is Asperger's, although he wasn't diagnosed until age 15. Explained alot, though.

I wish statistics worked such that, hey, my two brothers have 3 kids each, and only 1 each on the spectrum, that'd mean my next one at least is highly likely not to be ., . . . but stats don't work that way, do they . . .

Liked the podcast, it was nice to have some longer discussion of fewer subjects sometimes. Not that more subjects is bad, it's just nice to have variety! When it was over, I couldn't believe it had been 50 minutues . . . my husband is getting into these too, he thinks you guys are funny sometimes (and he likes the Monty Python stuff, hee hee!)

SEAMONKEY said...

SPAM!SPAM!SPAM! Ahem. Thanks so much for answering my questions about schizoid PD. Perhaps its present inclusion in the DSM is a hangover from the days when SPD and schizophrenia were thought to belong to the same continuum of disease. It's very good to hear that even though relatives of schizophreic probands are (I wonder how much?) more likely to have schizoid traits, that doesn't mean they're going to become psychotic.
Three cheers for introverts: Spam!Spam!SPAM!

On a related note, I picked up RD Laing's book The Divided Self a few days ago, and it's fascinating. Horribly unscientific, but fascinating.

SPAM!

Dinah said...

So we rambled about that tragic story of the young child who died, presumably because of a mixture of toxic psychiatric medications (cold meds too, apparently). I felt a bit irresponsible talking about a case--in a somewhat judgemental, what-Were-They-Thinking sort of way when I'd neither examined the little patient nor heard any input from the psychiatrist.

The Last Psychiatrist, www.thelastpsychiatrist.com
also posted on this topic, and Marie, a psychiatry resident, did as well. Her post is more thoughtful than my rambling and includes some references and links:

http://www.intueri.org/2007/02/17/the-question-of-bipolar-disorder-in-kids/

SEAMONKEY said...

Now that I've given it a bit of thought, I'd like to respond to the issue of giving low doses of Seroquel to people who aren't psychotic. I'm such a person.

That little dose of Seroquel makes me just a little less depersonalized; it makes life and other people just a little more real; it screens me, just a little, from the invasion of thoughts and images which I detest.

Please don't underestimate the beneficial changes in consciousness which can be effected by this little pill. And really, who's going to get EPS from 25mg? (So if you wanna take my quetiapine away, you're gonna hafta pry it out of my fat, temperature dysregulated, twitchy diabetic little hand!!)

Midwife with a Knife said...

Interesting podcast! There's so much here to comment on... where to start.

Ah, Aspergers. Some say that some of the autism spectrum disorders may be related to paternal epigenetic changes due to advanced paternal age. Apparently some people think that the DNA packaging in sperm may have more problems in older men (kinda like meiosis in older women). That's also why Turners/45XO is more common with advanced paternal age. The lost X chromosome is usually paternal. (OK, does it show that I'm doing a combined MFM/Genetics fellowship?) Beckwith Wiedeman syndrome is a congenital macrosomia/overgrowth syndrome also (probably) related to paternal imprinting (of the IGF-1 (I think) gene or the pre-packaged IGF-1 (IGF-1 is a growth factor) mRNA that come in the sperm is different, it's not quite clear), and is probably due to problems with DNA unpackaging, because it's more common in people who have IVF with ICSI (Intra-cytoplasmic sperm injection) because the normal capacitance (activaiton) of the sperm is changed, the acrosomal reaction is kind of eliminated, and these things seem to effect the very early programming and polarity of the embryo.

Chromatin is cool.

I'm such a geek.

Midwife with a Knife said...

Oh, clink: Sorry about your car accident. I'm glad you're all right, though.

Dinah: feel better soon!

Mrs. Dreamer said...

I've just discovered you blog. I've been enjoying it.