Talk:Psychiatry/Archive 3

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Archive This is an archive of past discussions. Do not edit the contents of this page. If you wish to start a new discussion or revive an old one, please do so on the current talk page.

Contents

AIDS

I want to explain why I removed the AIDS refence. If nobody has a problem with it, this subject may be removed.

I removed the reference to AIDS possibly being discovered while treating a patient. Hormonal diagnoses as discovered due to looking into psychological issues makes sense; finding AIDS due to such issues doesn't. The only way I'm aware of AIDS affecting a person psychologically is because a person knows they have it.

-- nklatt

I don't understand your concern. If a patient has a history of many unsafe contacts, intravenous drug use, a suspicion of AIDS-related dementia or simply unfounded anxiety about carrying AIDS, it would be professionally negligent of the psychiatrist not to offer an AIDS test. I do agree the example is more far-fetched than thyroid disorders and diabetes, but I'm sure if I agree with the arguments for your removal. JFW | T@lk 19:51, 29 August 2005 (UTC)

Psychiatry nurse practioner

What's up with teh HUMANGEOUS nurse practioner section, wow is that overblown, there's around 10 lines of their different titles... I'm going to have to to a mega-edit djheart 03:10, 27 September 2005 (UTC) In Reading it over more carefully I really don't see the usefullness of keeping any of what was simply copy and pasted from another source into this section. If the editor wishes to write a short sysnpsis (approximately equal to the size of the psychiatry vs. psychology section) than it would be a usefull addition but in it's present state it's a large bloated, hard-to-read mess. djheart 03:14, 27 September 2005 (UTC)


My deletion of the nurse practioner section was reverted with the explanation that there was no explanation which simply isn't true (see above)... but if a more in depth explanation is needed here I go:

-An article about psychiatry should not be >50% of the time discussing the role of a psychiatric nurse practioner... in fact it seems to now be almost 2/3 talking about them... especially since it makes the entire psychiatry entry way too long -The nurse practioner section is clearly just an virtually unformatted, unedited cut and past from some other again I point your attention to the extremeley long list of various psychaitric nurse practioner designations - The encylopedia is supposed to be international in scope and discussing at length a psychiatric nurse practioners who do not exist worldwide (I know for a fact they do not exist in Canada (or more specifically in Ontario or Quebec where I have practiced), and I'm fairly confident that they do not exist in the majority of countries worldwide) to the detriment of psychiatrists who do exist worldwide is clearly a disbalance - There probably should some discussion of nurse practioners, but that would be best discussed either in seperate entry and/or in a small 1 paragraph summary in similar length to the comparison to psychology. I would do it myself, but unfortunately, I have never had exposure to this profession even though I am a psychiatry resident.

That said it is true that I didn't discuss outside of the history summary my reason for deleting the insurance company. I deleted it because completely POV with not even a slightest attempt to be balanced, it also adds nothing to the discussion of pscyhiatry. Hence why I deleted it and why I will now delete it again.

djheart 04:50, 27 September 2005 (UTC)

I reverted again, as the field of psychiatry remains a medical field, with APNs taking over some medical roles in some countries. This is no reason to fill the article with equalized language to reflect that APNs are actually doctors (quod non). JFW | T@lk 03:54, 14 October 2005 (UTC)

what's the point of having a section dedicated to psychiatrists in fiction?

I looked under the surgery section, only to find that there wasn't a section for surgeons in fiction. Perhaps someone has a list of fictional surgeons they would like to contribute.

anyone interested in an anti-neurology page?

Since there is so much attention paid to anti-psychiatry within this article, I thought I'd propose an anti-neurology section.

Possible topics for exploration could include the influence of large corporations like General Electric on the use of questionable data from MRI scans produced by multi-million dollar devices that are forced on clinics and research centers by political lobbyists.

Attention could also be drawn to the health risks of intense magnetic fields as these instruments are used more an more in "diagnosis" of mental illness.

Another issue for exploration is ethics of using those with brain injuries to draw conclusions about locations of functional behavior in the brain.

I've never heard of an anti-neurology movement. It personally doesn't concern me because neurologists don't inflict their services on unwilling patients. Psychiatry is the only branch of medicine that authorizes practitioners to treat people against their will and that's ironic considering it's the least medical field of all of medicine. Francesca Allan of MindFreedomBC 22:13, 13 November 2005 (UTC)

It uses the same principles as somatic medicine, but doesn't have the luxury of scans and blood tests in the majority of conditions. JFW | T@lk 22:24, 15 November 2005 (UTC)

Good grief! Psychiatry is as relevant to somatic medicine as astrology is. The "majority of conditions"??? How about you show me ONE psychiatric disorder that can be diagnosed via scan or blood test? And, in somatic medicine, I don't believe you'll find provision for incarceration and forced drugging. Francesca Allan of MindFreedomBC 17:54, 3 January 2006 (UTC)
Many diseases and syndroms can be easily identified by scans: Korsakoff's syndrome, Epilepsy, Creutzfeldt-Jakob disease, Minamata disease, etc. can all be diagnosed through scanning (EEG, MRI) or testing for chemical agents in the body. It's undeniable that the introduction of certain detectabel chemicals can induce psychotic symptoms into people: psylocibin, phencyclidine, dextromethorphan, etc. Semiconscious • talk 08:05, 7 February 2006 (UTC)

reversion re electroshock

I put the following back in

"and that each treatment lasts only about four weeks, or about the same amount of time the brain requires to heal from a mild closed head injury"

because it is neither subjective nor irrelevant, as the editor claimed. The brain does indeed mostly heal within four weeks from the injury of electroshock and that's why many psychiatrists promote "maintenance" electroshock, i.e. shocking the brain at monthly intervals indefinitely. This is evidence that whatever the short term results are do not last for any substantial length of time. This has to be factored in to the whole risk v. benefit equation when deciding whether to proceed with this very controversial treatment. Francesca Allan of MindFreedomBC 01:03, 16 November 2005 (UTC)

But what does it have to do with traumatic brain damage? It is certainly not relevant on this general page, and not without a source. The whole comparison with trauma in unduly alarmist. JFW | T@lk 01:06, 16 November 2005 (UTC)

It has *everything* to do with traumatic brain damage, as that is the method by which electroshock "works." And, no, it's not particularly relevant to the psychiatry page but then neither is electroshock itself. However, if the portion on electroshock remains, then the controversy portion shall also remain in the article. And, far from being unduly alarmist, it's actually completely accurate and it would be negligent to mention electroshock without talking about what it actually is -- a closed head injury. The link to Breggin's paper would be suitable here. Francesca Allan of MindFreedomBC 01:16, 16 November 2005 (UTC)

ECT induces a seizure. Whether it damages cerebral parenchyma is disputed. To state this as a fact is a violation of NPOV. "Negligence" is not applicable to an encyclopedia. There is already a link to the Breggin paper, by the way. JFW | T@lk 01:22, 16 November 2005 (UTC)
The sensible thing was to remove the "anti-psychiatry" paragraph altogether apart from the basics. The relevant information should be in anti-psychiatry anyway. JFW | T@lk 01:30, 16 November 2005 (UTC)

The fact that cigarette smoking causes lung cancer is also disputed. So to claim it as a fact is therefore also a violation of NPOV, right? Good. I'd hate to think the rules only applied to some subjects. The cause and effect relationship with electroshock and brain damage is about as clear as the cigarette cancer link. All that being said, I agree with removing the paragraph altogether. Francesca Allan of MindFreedomBC 02:09, 16 November 2005 (UTC)

The link between cigarette smoking and lung cancer is undisputed in current medical literature. The idea that ECT causes brain damage is at the very least extremely controversial, but more accurately just an remote idea from a vocal small minority and not really even discussed in the mainstream medical literature. djheart 06:28, 16 November 2005 (UTC)

The truth about electroshock is indeed a minority view in the scientific literature. However, the experts on the effects of electroshock are the people who have had it inflicted upon them. Survivor testimonies are disregarded by psychiatrists. The fact that something is pushed in the mainstream medical literature does not make it good. Let's not forget that insulin shock was also peer-reviewed and approved of by the vast majority of psychiatrists. The survivor testimony against electroshock is overwhelming. That a branch of medicine chooses to ignore it is merely sad and indicative of how little regard psychiatrists have for their patients. Francesca Allan of MindFreedomBC 15:10, 16 November 2005 (UTC)

You are depicting psychiatrists as malicious. All clinical trials on ECT meticulously document "survivor" experience, side-effects (qualitatively and quantitatively with formal testing) and possible confounders. If you think there are misrepresentations in these large and generally well-designed studies, you will have to explain why the investigators did not report certain experiences by their clients. We have all heart about isolated cases of scientific fraud, but it would be rather odd if all studies came to the same conclusion, wouldn't it?
I am not suggesting there are no side-effects, but I'm wondering whether those whose ECT experience was less than perfect aren't just particularly vocal (supported by Breggin and other ECT critics). Of course every medical treatment has side-effects; people die from organ transplants and even routine surgery. What proportion of ECT patients do you think report those harrowing experiences? JFW | T@lk 21:30, 16 November 2005 (UTC)

Please read the Breggin article as it answers your questions far more effectively than I could ever hope to. Breggin effectively slices and dices those "meticulous" electroshock trials. I don't believe psychiatrists as a group of people are malicious, although there are certainly sadists in that field but fortunately they are not too common. However, I do think psychiatry as a field is uncommonly arrogant and ignorant, which is a dangerous combination. "Less than perfect" is somewhat of a euphemism to describe the electroshock experience for many of us. Some of us were dragged out of seclusion cells kicking and screaming to the shock room. I wouldn't even be able to guess what proportion of electroshock patients report their experiences. Certainly the patients who were killed outright by electroshock did not report. Francesca Allan of MindFreedomBC 00:51, 17 November 2005 (UTC)

First off, deaths related to ECT are reported in the literature but they are extremely rare (far less than most procedures or medications) and almost always related to the use of anesthetics agents during the procedure and not the ECT itself. Second, standards of evidence are much higher in all fields of medicine since the advent of evidence-based medicine so many ideas that were accepted the past (e.g. insulin shock therapy's usefulness, that stress caused ulcers, that the medication Colace is useful for constipation etc. etc.) have been proven to be incorrect. Third, 'survivor' testinomony on anti-psychiatry websites may be overwhelming but certainly do not represent the overall patient experience. Forth, patients only receive ECT if they (or alternate decision maker if they are incapacitated) sign a consent form authorizing it's use.
Most importantly though, none of what you have written supports the contention that there is a widespread consensus in the scientific community that ECT causes brain damage so anything alluding to this idea is POV and has no place in a wikipedia article. djheart 04:10, 17 November 2005 (UTC)

You are wrong on just about all your points. Deaths following electroshock are relatively common, possibly as high as 1 in 1,000. "Evidence-based" medicine is something of a misnomer. Basically, it means ignoring individual experience. Survivor needs no quotation marks. And I wasn't suggesting that everybody had a bad electroshock experience. And your fourth point IS OUTRAGEOUSLY WRONG!!! In Canada and the USA and many countries in Europe, consent is simply not required. I never said there was widespread consensus within the medical community about the damaging effects of electroshock. But I did say that there is overwhelming evidence of same. NPOV doesn't just mean majority vote, you know. Francesca Allan of MindFreedomBC 04:40, 17 November 2005 (UTC)

How about continuing this discussion on talk:Electroconvulsive therapy, which seems to be the subject of this thread? JFW | T@lk 07:35, 17 November 2005 (UTC)

PIAGET was not a psychiatrist hence deleted

I think I need some guidance.Piaget and Overland are not psychiatrists but psychologists.Do we have to include them in the list of famous figures in psychiatry?Jk 1st Dec 2005

Both had a significant influence on psychiatry. JFW | T@lk 08:57, 1 December 2005 (UTC)

I agree.But I thought this column was only for qualified psychiatrists.That was the reason Kay Redfierld Jamieson was moved to another section.Otherwise we shall have to include Anna Freud,William James,Wolpe and a whole lot of others.I think we need some clarification.It would perfectly be in order to have another column for non psychiatrists who influenced psychiatry but I have a feeling this column should be left for qualified psychiatrists.JK 2nd Dec

savodnik's article

Recent LA Times article by a psychiatrist covering several criticisms of modern psychiatry. Francesca Allan of MindFreedomBC 02:30, 3 January 2006 (UTC)

Lab tests in Psychiatry

Francesca, stop deleting the reference to lab tests. They are frequently used in the diagnosis of psychiatric disoders, the most frequent example is TSH levels to ensure that the patient isn't suffering from a disbalance of thyroid hormone which can cause depression or anxiety. As for brain imaging, a CT scan in any first episode psychosis or new onset dementia is routine. djheart 05:16, 3 January 2006 (UTC)

It's the wording, djheart. The way it was worded suggested that mental illness could be diagnosed via lab test and that's patently false. Ruling out thyroid dysfunction is a good idea but that's not diagnosing mental illness. I don't know where in the world you are, djheart, but I can tell you that CT scans are the exception, not the norm, in psychiatric practice around here. Furthermore, when they are used, they can't diagnose mental illness either. Francesca Allan of MindFreedomBC 17:26, 3 January 2006 (UTC)

No, but if the psychosis is the result of cerebral vasculitis you'd rather that this is identified, uh? JFW | T@lk 17:44, 3 January 2006 (UTC)

Of course I would! But the sad reality is that physical diseases are not usually even considered, especially when you've already been slapped with a psychiatric label. Francesca Allan of MindFreedomBC 17:46, 3 January 2006 (UTC)

Pretending that medical procedures like lab tests and scans are actually used in diagnosis and treatment of psych disorders is dishonest. It would be closer to the truth to say that those procedures are used while the patient is still receiving medical care. Once those tests are over (assuming they're negative), then the patient is treated with psychiatry and there scientific medical procedure stops. Francesca Allan of MindFreedomBC 17:51, 3 January 2006 (UTC)

Lab tests and CT scans are used in what is called the differential diagnosis in medicine including psychiatry. Non-psychiatric medical conditions must be differentiated by purely psychiatric causes of the presenting symptoms. For example, you cannot diagnose someone with Major Depressive Disorder without doing a TSH test, which is sometimes forgotten by the family and emergency docs who refer patients to psychiatry (also the test takes 48-72 h to give back results so patients are often under the care of psychiatry before the results are in). As for the CT scans, ironically I live in the same country as you Francesca, and I can tell you that in Ontario CT scans for a first episode psychosis or a new onset dementia are indeed routine and a standard of care. djheart 21:33, 3 January 2006 (UTC)
Just read some of the 'clarifications' that were made to the lab tests section. Lab tests and medical imaging are useful to differentiate psychiatric illnesses from a long list of non-psychiatric conditions inluding: increased and decreased levels of cortisol, primary brain tumours, metastases to the brain from other cancers, epilepsy, drug intoxication, hepatic encephalophathy, stroke, normotensive hydrocephaly etc. etc. djheart 21:42, 3 January 2006 (UTC)

But the point is that these procedures (e.g. lab tests and brain scans) are only used to rule out true medical disorders. They don't "differentiate" psychiatric illness from medical illness. They are NOT used to diagnose/treat mental illness except by saying, for example, well we can't find a physical culprit therefore it must be mental. That should be reflected in the wording of the article. And if CT scans are routinely used in Ontario, then that's great, you're miles ahead of British Columbia. Francesca Allan of MindFreedomBC 23:21, 3 January 2006 (UTC)

In all areas of medicine ruling out is as important as ruling in when trying to diagnosis a patient. For example, if a 50 year old man comes in when a painful, red and swollen leg it is important to rule out a deep vein thrombosis with a doppler ultrasound. If that test is negative and the history is consistent than it will be treated as infectious cellulitis even though there is no lab or imaging test that can directly confirm the diagnosis. Psychiatry may be presently lacking in 'ruling in' diagnostic tests but this does not change the fact that lab tests and imaging are crucial aspects of the diagnosis of psychiatric signs and symptoms and that too should be reflected in the article. The present wording I think is satisfactory in not misleading readers in either direction... djheart 18:14, 4 January 2006 (UTC)
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