Post by mary on Feb 16, 2007 14:34:37 GMT -5
Subject: 4-year old Rebecca Riley,a Casualty of Psychiatric
"Treatment"
ALLIANCE FOR HUMAN RESEARCH PROTECTION (AHRP)
Promoting Openness, Full Disclosure, and Accountability
www.ahrp. org and http://ahrp. blogspot. com
FYI
Boston residents are jolted by news reports detailing the drug-induced death
of 4 year old Rebecca Riley who had been "diagnosed" as suffering from both
ADHD and Bipolar disorder at the tender age of 28 months. She was prescribed
three powerful psychotropic drugs whose toxic effects have never been shown
to be safe or appropriate. Her two older siblings were likewise "diagnosed"
and prescribed the same drug regimen by a licensed child psychiatrist at
Tufts-New England Medical Center.
Dr. Gabrielle Carlson, a professor of psychiatry and pediatrics at Stony
Brook University School of Medicine on Long Island, told The New York
Times: “To me one of the miracle of children’s brains is that we don’t see
more harm from these treatments.”
Neither the ADHD/ Bipolar diagnosis nor the toxic drug cocktail which the
child was prescribed -- Seroquel, an antipsychotic drug; Depakote, an
equally powerful mood medication; and Clonidine, a blood pressure drug--are
backed by medical-scientific evidence. However, the four year old's
treatment reflects the prevailing practice in U.S. psychiatry, the
pharmaceutical industry’s most lucrative specialty.
Indeed, the Boston Globe reports (below) that Dr. Jennifer Harris, a
clinical instructor at Harvard University (and supervisor at Cambridge
Health Alliance) acknowledges: "I think clinical practice got way ahead of
the science. . . . There are so many pressures -- some conscious, some
unconscious -- to medicate these kids that I think clinicians jumped on this
diagnosis way ahead of the evidence."
The New York Times reports (below) that “the practice of aggressive drug
treatment for young children labeled bipolar has become common across the
country. In just the last decade, the rate of bipolar diagnosis in children
under 13 has increased almost sevenfold, according to a study based on
hospital discharge records. And a typical treatment includes multiple
medications.”
However, the most influential child psychiatrists have endorsed such
medically unsupportable "aggressive" prescribing of toxic drugs for children
on the basis of vague faith-based assumptions: "We support early diagnosis
and treatment because the symptoms of this disorder are extremely
debilitating and impairing," said Dr. Janet Wozniak , director of the
Pediatric Bipolar Program at Mass. General. "it's incumbent on us as a field
to understand more which preschoolers need to be identified and treated in
an aggressive way."
The Pediatric Bipolar Program at Mass General has been in the forefront of
aggressive recruitment campaigns for manic-depression studies. A television
ad (November, 2001), MGH sought 4 to 18 year old child subjects is an
example of disease mongering. The MGH ad made false claims suggesting:
"Your child may be facing a chemical problem that you can't manage without
help.”
“We're Mass General, and we can help."
The number given to call is 617-724-4 MGH.
What scientific basis suggests a chemical rather than a behavioral problem?
The truth about these drugs' lethal effects is finally breaking through the
carefully crafted layers of false claims about their safety and
effectiveness.
The Boston Globe reports: "Evidence has been mounting, however, that
antipsychotic drugs can cause health problems, such as diabetes and
significant weight gain."
Even Dr. S. Nassir Ghaemi , director of the Bipolar Disorder Research
Program at Emory University, who has been a booster of the new antipsychotic
drugs, now acknowledges: "the concern is that if you have kids on these
medications for extensive periods of time, then they may develop major
medical problems as adults."
Dr. Carson states: “Bipolar is absolutely being overdiagnosed in children,
and the major downside is that people then think they have a solution and
are not amenable to listening to alternatives, which may not include drugs.”
The Boston Globe notes that one of the factors that have led to a spiraling
increase of the bipolar diagnosis is the growing awareness among
psychiatrists that SSRI antidepressants "could make the child dangerously
worse, possibly even suicidal and psychotic."
"Similarly, if a child has underlying bipolar disorder but is diagnosed as
having attention deficit hyperactivity disorder and prescribed a stimulant,
the symptoms could worsen," said Cambridge Health Alliance psychiatrist
Nancy Rappaport.
Like the myth of “chemical imbalances” the suggestion that treatment
emergent manic symptoms are an indication of an "underlying bipolar
disorder" is entirely speculative without scientific evidence to back it up.
The more plausible, direct trigger for such manic symptoms in children
taking a psychotropic drug--psychostimula nt or antidepressant- -is that these
drugs have a propensity to induce mania. See any of these drugs'
FDA-approved labels.
The Globe reports: "the bipolar label has proliferated to the point that
some psychiatrists now suspect the diagnosis may be sometimes misused,
placing some children at unnecessary risk from the serious medications that
usually follow."
A diagnosis of bipolar disorder is highly profitable: A bipolar diagnosis
opens the insurance cash flow and increases the use of antipsychotics- .
"As the diagnosis gained popularity in recent years, so did prescriptions
for powerful anti psychotic drugs such as Risperdal and Zyprexa -- which
have been approved for use in adults, but are prescribed for children."
Mental health professionals are beginning to acknowledge that:
"It's a tail-wagging- the-dog kind of thing. The treatments affect our
observations and our labeling as well. "
Antipsychotics have proven to be industry’s most profitable blockbusters
because psychiatrists and its professional institutions have been close
collaborators with drug manufacturers. Indeed, they are industry’s most
effective sales promoters.
The tragedy is, we have not yet begun to count the human casualties that
these treatments have caused.
Unless this irresponsible profession is reined, we are a party to child
sacrifice.
Contact: Vera Hassner Sharav
212-595-8974
veracare@ahrp. org <mailto:veracare@ahrp. org>
www.boston. com/news/ local/massachuse tts/articles/ 2007/02/15/ bipolar_l
abels_for_children_ stir_concern/
THE BOSTON GLOBE
Bipolar labels for children stir concern
Hull case highlights debate on diagnosis
Rebecca Riley's parents are accused of deliberately poisoning her with her
prescription medication.
By Carey Goldberg
February 15, 2007
The case of Rebecca Riley highlights a hot debate in psychiatric circles
over the growing number of children who are diagnosed with bipolar disorder
-- a battle centered largely in Boston but affecting the treatment of young
patients nationwide.
Riley, the Hull 4-year-old who died of an overdose of psychiatric
medications, was exceptionally young when she was diagnosed, just 2 1/2. But
among somewhat older children, the bipolar label has proliferated to the
point that some psychiatrists now suspect the diagnosis may be sometimes
misused, placing some children at unnecessary risk from the serious
medications that usually follow.
Others argue that many children are given different diagnoses, such as
depression, when they should really be considered bipolar, a disorder that
involves intense mood swings and hitting, biting, kicking, and screaming
rages.
One thing is clear: In the past decade or so, the number of children
diagnosed with bipolar disorder has risen dramatically. A study of mentally
ill children in community hospitals, published last month in the Archives of
General Psychiatry, found the proportion of children diagnosed as bipolar
shot up from less than 3 percent in 1990 to 15 percent in 2000.
Psychiatrists say the rate has continued to climb.
Why the increase? Psychiatrists at Massachusetts General Hospital were
among those who spurred it. In 1995, they published research that
contradicted the prevailing notion that bipolar disorder was exceedingly
rare in children. Rather, they said, 16 percent of the children referred to
their psychopharmacology clinic fit the diagnosis. Overall, that would mean
perhaps 1 percent of all children may be affected.
"We support early diagnosis and treatment because the symptoms of this
disorder are extremely debilitating and impairing," said Dr. Janet Wozniak ,
director of the Pediatric Bipolar Program at Mass. General. They "bring
reckless and impulsive behaviors here and now and a long-term risk" for
suicide, drug abuse, and crime, she said.
The psychiatric controversy is over diagnosing children before their teen
years. There is virtually no scientific research on children younger than 6.
"Diagnosing and treating preschoolers is what I would call uncharted
waters," Wozniak said, but research suggests the disorder often begins that
early, and "it's incumbent on us as a field to understand more which
preschoolers need to be identified and treated in an aggressive way."
Rebecca was prescribed an antipsychotic medication, a drug used to treat
bipolar disorder in adults, and a blood pressure medication that is
sometimes used to help hyperactive children sleep. She died in December. Her
parents are charged with murder, and the Board of Registration in Medicine
is investigating the role played by her psychiatrist, Dr. Kayoko Kifuji of
Tufts-New England Medical Center.
Recent studies document a steep increase in prescriptions of anti
psychotic
drugs to children of all ages. That probably stems from the increasing
diagnosis of bipolar disorder, said Wozniak, who gets about 90 percent of
her research funding from the federal government, 5 percent from
philanthropies, and 5 percent from companies that make psychiatric drugs.
"Still," she said, "the overall number of prescriptions is probably small
relative to the number of children who need help."
The opposing camp, psychiatrists who want to define bipolar disorder more
narrowly and sparingly, questions whether the disorder really affects so
many children and whether the benefits of the diagnosis outweigh the risks
of the drugs in many cases.
"Particularly over the last five to eight years, people like myself have
become more alarmed at what we see as the misdiagnosis and the over use of
medications, " said Dr. Jennifer Harris , a clinical instructor at Harvard
University and supervisor at Cambridge Health Alliance. "I think clinical
practice got way ahead of the science. . . . There are so many pressures --
some conscious, some unconscious -- to medicate these kids that I think
clinicians jumped on this diagnosis way ahead of the evidence."
Harris and others point out that a diagnosis of bipolar disorder is
considered more serious than attention deficit hyperactivity disorder or
post traumatic stress disorder. A child diagnosed as bipolar thus tends to
have much easier access to a range of help, from a spot in a therapeutic
school to insurance coverage for hospitalization.
Another factor in the increased use of the diagnosis is the availability of
new, potentially effective drugs, particularly anti psychotics and mood
stabilizers. As the diagnosis gained popularity in recent years, so did
prescriptions for powerful anti psychotic drugs such as Risperdal and
Zyprexa -- which have been approved for use in adults, but are prescribed
for children.
If there's a chance that a drug may calm down a dangerously out-of-control
child and the drug is indicated for bipolar disorder, then it may make sense
to diagnose the child with bipolar disorder, said Dr. George Dominiak ,
medical director of Westwood Lodge, a private psychiatric hospital in
Massachusetts.
"It's a tail-wagging- the-dog kind of thing," he said. "The treatments affect
our observations and our labeling as well. "
Evidence has been mounting, however, that antipsychotic drugs can cause
health problems, such as diabetes and significant weight gain.
"These are bad enough in themselves, but the concern is that if you have
kids on these medications for extensive periods of time, then they may
develop major medical problems as adults," said Dr. S. Nassir Ghaemi ,
director of the Bipolar Disorder Research Program at Emory University. (He
has consulted for most of the drug companies that make the anti psychotics.)
Another possible factor in the increase of the bipolar diagnosis is the
growing awareness among psychiatrists that if they diagnose a bipolar child
as being only depressed and prescribe antidepressants, the drugs could make
the child dangerously worse, possibly even suicidal and psychotic.
Similarly, if a child has underlying bipolar disorder but is diagnosed as
having attention deficit hyperactivity disorder and prescribed a stimulant,
the symptoms could worsen, said Cambridge Health Alliance psychiatrist Nancy
Rappaport.
Further complicating the diagnosis: Abused or traumatized children can
seem
to have bipolar disorder when they are actually reacting to horrors in their
lives.
Academic researchers have begun to make progress in refining the outlines of
what constitutes bipolar disorder in children. But still, Rappaport said,
the question of whether to diagnose a child with bipolar disorder can be "an
agonizing clinical decision."
"Still," she said, "the overall number of prescriptions is probably small
relative to the number of children who need help."
The opposing camp, psychiatrists who want to define bipolar disorder more
narrowly and sparingly, questions whether the disorder really affects so
many children and whether the benefits of the diagnosis outweigh the risks
of the drugs in many cases.
"Particularly over the last five to eight years, people like myself have
become more alarmed at what we see as the misdiagnosis and the over use of
medications, " said Dr. Jennifer Harris , a clinical instructor at Harvard
University and supervisor at Cambridge Health Alliance. "I think clinical
practice got way ahead of the science. . . . There are so many pressures --
some conscious, some unconscious -- to medicate these kids that I think
clinicians jumped on this diagnosis way
ahead of the evidence."
Harris and others point out that a diagnosis of bipolar disorder is
considered more serious than attention deficit hyperactivity disorder or
post traumatic stress disorder. A child diagnosed as bipolar thus tends to
have much easier access to a range of help, from a spot in a therapeutic
school to insurance coverage for hospitalization.
Another factor in the increased use of the diagnosis is the availability
of
new, potentially effective drugs, particularly anti psychotics and mood
stabilizers. As the diagnosis gained popularity in recent years, so did
prescriptions for powerful anti psychotic drugs such as Risperdal and
Zyprexa -- which have been approved for use in adults, but are prescribed
for children.
If there's a chance that a drug may calm down a dangerously out-of-control
child and the drug is indicated for bipolar disorder, then it may make sense
to diagnose the child with bipolar disorder, said Dr. George Dominiak ,
medical director of Westwood Lodge, a private psychiatric hospital in
Massachusetts.
"It's a tail-wagging- the-dog kind of thing," he said. "The treatments
affect our observations and our labeling as well. "
Evidence has been mounting, however, that antipsychotic drugs can cause
health problems, such as diabetes and significant weight gain.
"These are bad enough in themselves, but the concern is that if you have
kids on these medications for extensive periods of time, then they may
develop major medical problems as adults," said Dr. S. Nassir Ghaemi ,
director of the Bipolar Disorder Research Program at Emory University. (He
has consulted for most of the drug companies that make the anti psychotics.)
Another possible factor in the increase of the bipolar diagnosis is the
growing awareness among psychiatrists that if they diagnose a bipolar child
as being only depressed and prescribe antidepressants, the drugs could make
the child dangerously worse, possibly even suicidal and psychotic.
Similarly, if a child has underlying bipolar disorder but is diagnosed as
having attention deficit hyperactivity disorder and prescribed a stimulant,
the symptoms could worsen, said Cambridge Health Alliance psychiatrist Nancy
Rappaport.
Further complicating the diagnosis: Abused or traumatized children can
seem
to have bipolar disorder when they are actually reacting to horrors in their
lives.
Academic researchers have begun to make progress in refining the outlines of
what constitutes bipolar disorder in children. But still, Rappaport said,
the question of whether to diagnose a child with bipolar disorder can be "an
agonizing clinical decision."
Carey Goldberg can be reached at goldberg@globe. com.
© Copyright 2007 Globe Newspaper Company.
~~~~~~~~~~
www.nytimes. com/2007/ 02/15/us/ 15bipolar. html
THE NEW YORK TIMES
February 15, 2007
Debate Over Children and Psychiatric Drugs
By BENEDICT CAREY
Early on the morning of Dec. 13, police officers responding to a 911 call
arrived at a house in Hull, Mass., a seaside town near Boston, and found a
4-year-old girl on the floor of her parents’ bedroom, dead.
She was lying on her side, in a pink diaper, the police said, sprawled
across some discarded magazines and a stuffed brown bear. Last week,
prosecutors in Plymouth County charged the parents, Michael and Carolyn
Riley, with deliberately poisoning their daughter Rebecca by giving her
overdoses of prescription drugs to sedate her.
The police said the girl had been taking a potent cocktail of psychiatric
drugs since age 2, when she was given a diagnosis of attention deficit
disorder and bipolar disorder which is characterized by mood swings.
The parents have pleaded not guilty, with their lawyers questioning whether
the child should have been prescribed such powerful drugs.
The case has shaken a region known for the excellence of its social and
medical services. The director of the state’s Department of Social Services
has had to defend his agency, which had been investigating the case before
the girl’s death.
The girl’s treating psychiatrist has taken a voluntary, paid leave until the
case is resolved. And New Englanders are raising questions that are now
hotly debated within psychiatry, and which have broad implications for how
young children like Rebecca Riley are cared for.
Tufts-New England Medical Center, where the child was treated, released a
statement supporting its doctor and calling the care “appropriate and within
responsible professional standards.”
Indeed, the practice of aggressive drug treatment for young children labeled
bipolar has become common across the country. In just the last decade, the
rate of bipolar diagnosis in children under 13 has increased almost
sevenfold, according to a study based on hospital discharge records. And a
typical treatment includes multiple medications.
Rebecca was taking Seroquel, an antipsychotic drug; Depakote, an equally
powerful mood medication; and Clonidine, a blood pressure drug often
prescribed to calm children.
The rising rates of diagnosis and medication use strike some doctors and
advocates for patients as a dangerous fad that exposes ever-younger children
to powerful drugs. Antipsychotics like Seroquel or Risperdal, which are
commonly prescribed for bipolar disorder, can cause weight gain and changes
in blood sugar — risk factors for diabetes
Some child psychiatrists say bipolar disorder has become an all-purpose
label for aggression.
“Bipolar is absolutely being overdiagnosed in children, and the major
downside is that people then think they have a solution and are not amenable
to listening to alternatives,” which may not include drugs, said Dr.
Gabrielle Carlson, a professor of psychiatry and pediatrics at Stony Brook
University School of Medicine on Long Island.
Paraphrasing H. L. Mencken, Dr. Carlson added, “Every serious problem has an
easy solution that is usually wrong.”
Others disagree, insisting that increased awareness of bipolar disorder and
use of some medications has benefited many children. “The first thing to
say is that the world does not see the kids we see; these are very difficult
patients,” said Dr. John T. Walkup, a child and adolescent psychiatrist at
the Johns Hopkins University School of Medicine.
Dr. Walkup said that when drug treatment was done right, it could turn
around the life of a child with a diagnosis of bipolar disorder.
Dr. Jean Frazier, director of child psychopharmacology at Cambridge Health
Alliance and an associate professor at Harvard, said that up to
three-quarters of children who exhibit bipolar symptoms become suicidal, and
that it is important to treat the problem as early as possible. “We’re
talking about a serious illness with high morbidity, and mortality,” Dr.
Frazier said, “and for some of these children the medications can be
life-giving.”
Still, most child psychiatrists agree that there are still questions about
applying the diagnosis to very young children. Recent research has found
that most children who receive the diagnosis are emotionally explosive but
do not go on to develop the classic features of the disorder, like euphoria.
They are far more likely to become depressed.
And many therapists have found that some patients referred to them for
bipolar disorder are actually suffering from something else. “Most of the
patients I see who have been misdiagnosed have been told they have bipolar
disorder,” said Dr. Bessel van der Kolk, a professor of psychiatry at Boston
University who runs a trauma clinic.
“The diagnosis is made with no understanding of the context of their life,”
Dr. van der Kolk said. “Then they’re put on these devastating medications
and condemned to a life as a psychiatry patient.”
Details about what happened to Rebecca are still emerging. A relative of her
mother, Carolyn Riley, 32, told the police that Rebecca seemed “sleepy and
drugged” most days, according to the charging documents. One preschool
teacher said that at about 2 p.m. every day the girl came to life, “as if
the medication Rebecca was on was wearing off,” according to the documents.
Defense lawyers are also focusing on the question of medication. “What I
want to know,” said John Darrell, a lawyer for Mr. Riley, “is how in the
world you diagnose a 2-year-old and give her these strong medicines that are
not approved for children.”
A lawyer for Rebecca’s psychiatrist, Dr. Kayoko Kifuji of Tufts-New England
Medical Center, did not return calls seeking comment.
Some experts say the temptation to medicate can be powerful. “Parents very
often want a quick fix,” Dr. Carlson said, “and doctors rarely have much
time to spend with them, and the great appeal of prescribing a medication is
that it’s simple.”
“To me one of the miracle of children’s brains is that we don’t see more
harm from these treatments.”
Katie Zezima contributed reporting from Boston.
copyright 2007
<http://www.nytimes. com/ref/memberce nter/help/ copyright. html> The New York
Times Company <http://www.nytco. com/>
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"Treatment"
ALLIANCE FOR HUMAN RESEARCH PROTECTION (AHRP)
Promoting Openness, Full Disclosure, and Accountability
www.ahrp. org and http://ahrp. blogspot. com
FYI
Boston residents are jolted by news reports detailing the drug-induced death
of 4 year old Rebecca Riley who had been "diagnosed" as suffering from both
ADHD and Bipolar disorder at the tender age of 28 months. She was prescribed
three powerful psychotropic drugs whose toxic effects have never been shown
to be safe or appropriate. Her two older siblings were likewise "diagnosed"
and prescribed the same drug regimen by a licensed child psychiatrist at
Tufts-New England Medical Center.
Dr. Gabrielle Carlson, a professor of psychiatry and pediatrics at Stony
Brook University School of Medicine on Long Island, told The New York
Times: “To me one of the miracle of children’s brains is that we don’t see
more harm from these treatments.”
Neither the ADHD/ Bipolar diagnosis nor the toxic drug cocktail which the
child was prescribed -- Seroquel, an antipsychotic drug; Depakote, an
equally powerful mood medication; and Clonidine, a blood pressure drug--are
backed by medical-scientific evidence. However, the four year old's
treatment reflects the prevailing practice in U.S. psychiatry, the
pharmaceutical industry’s most lucrative specialty.
Indeed, the Boston Globe reports (below) that Dr. Jennifer Harris, a
clinical instructor at Harvard University (and supervisor at Cambridge
Health Alliance) acknowledges: "I think clinical practice got way ahead of
the science. . . . There are so many pressures -- some conscious, some
unconscious -- to medicate these kids that I think clinicians jumped on this
diagnosis way ahead of the evidence."
The New York Times reports (below) that “the practice of aggressive drug
treatment for young children labeled bipolar has become common across the
country. In just the last decade, the rate of bipolar diagnosis in children
under 13 has increased almost sevenfold, according to a study based on
hospital discharge records. And a typical treatment includes multiple
medications.”
However, the most influential child psychiatrists have endorsed such
medically unsupportable "aggressive" prescribing of toxic drugs for children
on the basis of vague faith-based assumptions: "We support early diagnosis
and treatment because the symptoms of this disorder are extremely
debilitating and impairing," said Dr. Janet Wozniak , director of the
Pediatric Bipolar Program at Mass. General. "it's incumbent on us as a field
to understand more which preschoolers need to be identified and treated in
an aggressive way."
The Pediatric Bipolar Program at Mass General has been in the forefront of
aggressive recruitment campaigns for manic-depression studies. A television
ad (November, 2001), MGH sought 4 to 18 year old child subjects is an
example of disease mongering. The MGH ad made false claims suggesting:
"Your child may be facing a chemical problem that you can't manage without
help.”
“We're Mass General, and we can help."
The number given to call is 617-724-4 MGH.
What scientific basis suggests a chemical rather than a behavioral problem?
The truth about these drugs' lethal effects is finally breaking through the
carefully crafted layers of false claims about their safety and
effectiveness.
The Boston Globe reports: "Evidence has been mounting, however, that
antipsychotic drugs can cause health problems, such as diabetes and
significant weight gain."
Even Dr. S. Nassir Ghaemi , director of the Bipolar Disorder Research
Program at Emory University, who has been a booster of the new antipsychotic
drugs, now acknowledges: "the concern is that if you have kids on these
medications for extensive periods of time, then they may develop major
medical problems as adults."
Dr. Carson states: “Bipolar is absolutely being overdiagnosed in children,
and the major downside is that people then think they have a solution and
are not amenable to listening to alternatives, which may not include drugs.”
The Boston Globe notes that one of the factors that have led to a spiraling
increase of the bipolar diagnosis is the growing awareness among
psychiatrists that SSRI antidepressants "could make the child dangerously
worse, possibly even suicidal and psychotic."
"Similarly, if a child has underlying bipolar disorder but is diagnosed as
having attention deficit hyperactivity disorder and prescribed a stimulant,
the symptoms could worsen," said Cambridge Health Alliance psychiatrist
Nancy Rappaport.
Like the myth of “chemical imbalances” the suggestion that treatment
emergent manic symptoms are an indication of an "underlying bipolar
disorder" is entirely speculative without scientific evidence to back it up.
The more plausible, direct trigger for such manic symptoms in children
taking a psychotropic drug--psychostimula nt or antidepressant- -is that these
drugs have a propensity to induce mania. See any of these drugs'
FDA-approved labels.
The Globe reports: "the bipolar label has proliferated to the point that
some psychiatrists now suspect the diagnosis may be sometimes misused,
placing some children at unnecessary risk from the serious medications that
usually follow."
A diagnosis of bipolar disorder is highly profitable: A bipolar diagnosis
opens the insurance cash flow and increases the use of antipsychotics- .
"As the diagnosis gained popularity in recent years, so did prescriptions
for powerful anti psychotic drugs such as Risperdal and Zyprexa -- which
have been approved for use in adults, but are prescribed for children."
Mental health professionals are beginning to acknowledge that:
"It's a tail-wagging- the-dog kind of thing. The treatments affect our
observations and our labeling as well. "
Antipsychotics have proven to be industry’s most profitable blockbusters
because psychiatrists and its professional institutions have been close
collaborators with drug manufacturers. Indeed, they are industry’s most
effective sales promoters.
The tragedy is, we have not yet begun to count the human casualties that
these treatments have caused.
Unless this irresponsible profession is reined, we are a party to child
sacrifice.
Contact: Vera Hassner Sharav
212-595-8974
veracare@ahrp. org <mailto:veracare@ahrp. org>
www.boston. com/news/ local/massachuse tts/articles/ 2007/02/15/ bipolar_l
abels_for_children_ stir_concern/
THE BOSTON GLOBE
Bipolar labels for children stir concern
Hull case highlights debate on diagnosis
Rebecca Riley's parents are accused of deliberately poisoning her with her
prescription medication.
By Carey Goldberg
February 15, 2007
The case of Rebecca Riley highlights a hot debate in psychiatric circles
over the growing number of children who are diagnosed with bipolar disorder
-- a battle centered largely in Boston but affecting the treatment of young
patients nationwide.
Riley, the Hull 4-year-old who died of an overdose of psychiatric
medications, was exceptionally young when she was diagnosed, just 2 1/2. But
among somewhat older children, the bipolar label has proliferated to the
point that some psychiatrists now suspect the diagnosis may be sometimes
misused, placing some children at unnecessary risk from the serious
medications that usually follow.
Others argue that many children are given different diagnoses, such as
depression, when they should really be considered bipolar, a disorder that
involves intense mood swings and hitting, biting, kicking, and screaming
rages.
One thing is clear: In the past decade or so, the number of children
diagnosed with bipolar disorder has risen dramatically. A study of mentally
ill children in community hospitals, published last month in the Archives of
General Psychiatry, found the proportion of children diagnosed as bipolar
shot up from less than 3 percent in 1990 to 15 percent in 2000.
Psychiatrists say the rate has continued to climb.
Why the increase? Psychiatrists at Massachusetts General Hospital were
among those who spurred it. In 1995, they published research that
contradicted the prevailing notion that bipolar disorder was exceedingly
rare in children. Rather, they said, 16 percent of the children referred to
their psychopharmacology clinic fit the diagnosis. Overall, that would mean
perhaps 1 percent of all children may be affected.
"We support early diagnosis and treatment because the symptoms of this
disorder are extremely debilitating and impairing," said Dr. Janet Wozniak ,
director of the Pediatric Bipolar Program at Mass. General. They "bring
reckless and impulsive behaviors here and now and a long-term risk" for
suicide, drug abuse, and crime, she said.
The psychiatric controversy is over diagnosing children before their teen
years. There is virtually no scientific research on children younger than 6.
"Diagnosing and treating preschoolers is what I would call uncharted
waters," Wozniak said, but research suggests the disorder often begins that
early, and "it's incumbent on us as a field to understand more which
preschoolers need to be identified and treated in an aggressive way."
Rebecca was prescribed an antipsychotic medication, a drug used to treat
bipolar disorder in adults, and a blood pressure medication that is
sometimes used to help hyperactive children sleep. She died in December. Her
parents are charged with murder, and the Board of Registration in Medicine
is investigating the role played by her psychiatrist, Dr. Kayoko Kifuji of
Tufts-New England Medical Center.
Recent studies document a steep increase in prescriptions of anti
psychotic
drugs to children of all ages. That probably stems from the increasing
diagnosis of bipolar disorder, said Wozniak, who gets about 90 percent of
her research funding from the federal government, 5 percent from
philanthropies, and 5 percent from companies that make psychiatric drugs.
"Still," she said, "the overall number of prescriptions is probably small
relative to the number of children who need help."
The opposing camp, psychiatrists who want to define bipolar disorder more
narrowly and sparingly, questions whether the disorder really affects so
many children and whether the benefits of the diagnosis outweigh the risks
of the drugs in many cases.
"Particularly over the last five to eight years, people like myself have
become more alarmed at what we see as the misdiagnosis and the over use of
medications, " said Dr. Jennifer Harris , a clinical instructor at Harvard
University and supervisor at Cambridge Health Alliance. "I think clinical
practice got way ahead of the science. . . . There are so many pressures --
some conscious, some unconscious -- to medicate these kids that I think
clinicians jumped on this diagnosis way ahead of the evidence."
Harris and others point out that a diagnosis of bipolar disorder is
considered more serious than attention deficit hyperactivity disorder or
post traumatic stress disorder. A child diagnosed as bipolar thus tends to
have much easier access to a range of help, from a spot in a therapeutic
school to insurance coverage for hospitalization.
Another factor in the increased use of the diagnosis is the availability of
new, potentially effective drugs, particularly anti psychotics and mood
stabilizers. As the diagnosis gained popularity in recent years, so did
prescriptions for powerful anti psychotic drugs such as Risperdal and
Zyprexa -- which have been approved for use in adults, but are prescribed
for children.
If there's a chance that a drug may calm down a dangerously out-of-control
child and the drug is indicated for bipolar disorder, then it may make sense
to diagnose the child with bipolar disorder, said Dr. George Dominiak ,
medical director of Westwood Lodge, a private psychiatric hospital in
Massachusetts.
"It's a tail-wagging- the-dog kind of thing," he said. "The treatments affect
our observations and our labeling as well. "
Evidence has been mounting, however, that antipsychotic drugs can cause
health problems, such as diabetes and significant weight gain.
"These are bad enough in themselves, but the concern is that if you have
kids on these medications for extensive periods of time, then they may
develop major medical problems as adults," said Dr. S. Nassir Ghaemi ,
director of the Bipolar Disorder Research Program at Emory University. (He
has consulted for most of the drug companies that make the anti psychotics.)
Another possible factor in the increase of the bipolar diagnosis is the
growing awareness among psychiatrists that if they diagnose a bipolar child
as being only depressed and prescribe antidepressants, the drugs could make
the child dangerously worse, possibly even suicidal and psychotic.
Similarly, if a child has underlying bipolar disorder but is diagnosed as
having attention deficit hyperactivity disorder and prescribed a stimulant,
the symptoms could worsen, said Cambridge Health Alliance psychiatrist Nancy
Rappaport.
Further complicating the diagnosis: Abused or traumatized children can
seem
to have bipolar disorder when they are actually reacting to horrors in their
lives.
Academic researchers have begun to make progress in refining the outlines of
what constitutes bipolar disorder in children. But still, Rappaport said,
the question of whether to diagnose a child with bipolar disorder can be "an
agonizing clinical decision."
"Still," she said, "the overall number of prescriptions is probably small
relative to the number of children who need help."
The opposing camp, psychiatrists who want to define bipolar disorder more
narrowly and sparingly, questions whether the disorder really affects so
many children and whether the benefits of the diagnosis outweigh the risks
of the drugs in many cases.
"Particularly over the last five to eight years, people like myself have
become more alarmed at what we see as the misdiagnosis and the over use of
medications, " said Dr. Jennifer Harris , a clinical instructor at Harvard
University and supervisor at Cambridge Health Alliance. "I think clinical
practice got way ahead of the science. . . . There are so many pressures --
some conscious, some unconscious -- to medicate these kids that I think
clinicians jumped on this diagnosis way
ahead of the evidence."
Harris and others point out that a diagnosis of bipolar disorder is
considered more serious than attention deficit hyperactivity disorder or
post traumatic stress disorder. A child diagnosed as bipolar thus tends to
have much easier access to a range of help, from a spot in a therapeutic
school to insurance coverage for hospitalization.
Another factor in the increased use of the diagnosis is the availability
of
new, potentially effective drugs, particularly anti psychotics and mood
stabilizers. As the diagnosis gained popularity in recent years, so did
prescriptions for powerful anti psychotic drugs such as Risperdal and
Zyprexa -- which have been approved for use in adults, but are prescribed
for children.
If there's a chance that a drug may calm down a dangerously out-of-control
child and the drug is indicated for bipolar disorder, then it may make sense
to diagnose the child with bipolar disorder, said Dr. George Dominiak ,
medical director of Westwood Lodge, a private psychiatric hospital in
Massachusetts.
"It's a tail-wagging- the-dog kind of thing," he said. "The treatments
affect our observations and our labeling as well. "
Evidence has been mounting, however, that antipsychotic drugs can cause
health problems, such as diabetes and significant weight gain.
"These are bad enough in themselves, but the concern is that if you have
kids on these medications for extensive periods of time, then they may
develop major medical problems as adults," said Dr. S. Nassir Ghaemi ,
director of the Bipolar Disorder Research Program at Emory University. (He
has consulted for most of the drug companies that make the anti psychotics.)
Another possible factor in the increase of the bipolar diagnosis is the
growing awareness among psychiatrists that if they diagnose a bipolar child
as being only depressed and prescribe antidepressants, the drugs could make
the child dangerously worse, possibly even suicidal and psychotic.
Similarly, if a child has underlying bipolar disorder but is diagnosed as
having attention deficit hyperactivity disorder and prescribed a stimulant,
the symptoms could worsen, said Cambridge Health Alliance psychiatrist Nancy
Rappaport.
Further complicating the diagnosis: Abused or traumatized children can
seem
to have bipolar disorder when they are actually reacting to horrors in their
lives.
Academic researchers have begun to make progress in refining the outlines of
what constitutes bipolar disorder in children. But still, Rappaport said,
the question of whether to diagnose a child with bipolar disorder can be "an
agonizing clinical decision."
Carey Goldberg can be reached at goldberg@globe. com.
© Copyright 2007 Globe Newspaper Company.
~~~~~~~~~~
www.nytimes. com/2007/ 02/15/us/ 15bipolar. html
THE NEW YORK TIMES
February 15, 2007
Debate Over Children and Psychiatric Drugs
By BENEDICT CAREY
Early on the morning of Dec. 13, police officers responding to a 911 call
arrived at a house in Hull, Mass., a seaside town near Boston, and found a
4-year-old girl on the floor of her parents’ bedroom, dead.
She was lying on her side, in a pink diaper, the police said, sprawled
across some discarded magazines and a stuffed brown bear. Last week,
prosecutors in Plymouth County charged the parents, Michael and Carolyn
Riley, with deliberately poisoning their daughter Rebecca by giving her
overdoses of prescription drugs to sedate her.
The police said the girl had been taking a potent cocktail of psychiatric
drugs since age 2, when she was given a diagnosis of attention deficit
disorder and bipolar disorder which is characterized by mood swings.
The parents have pleaded not guilty, with their lawyers questioning whether
the child should have been prescribed such powerful drugs.
The case has shaken a region known for the excellence of its social and
medical services. The director of the state’s Department of Social Services
has had to defend his agency, which had been investigating the case before
the girl’s death.
The girl’s treating psychiatrist has taken a voluntary, paid leave until the
case is resolved. And New Englanders are raising questions that are now
hotly debated within psychiatry, and which have broad implications for how
young children like Rebecca Riley are cared for.
Tufts-New England Medical Center, where the child was treated, released a
statement supporting its doctor and calling the care “appropriate and within
responsible professional standards.”
Indeed, the practice of aggressive drug treatment for young children labeled
bipolar has become common across the country. In just the last decade, the
rate of bipolar diagnosis in children under 13 has increased almost
sevenfold, according to a study based on hospital discharge records. And a
typical treatment includes multiple medications.
Rebecca was taking Seroquel, an antipsychotic drug; Depakote, an equally
powerful mood medication; and Clonidine, a blood pressure drug often
prescribed to calm children.
The rising rates of diagnosis and medication use strike some doctors and
advocates for patients as a dangerous fad that exposes ever-younger children
to powerful drugs. Antipsychotics like Seroquel or Risperdal, which are
commonly prescribed for bipolar disorder, can cause weight gain and changes
in blood sugar — risk factors for diabetes
Some child psychiatrists say bipolar disorder has become an all-purpose
label for aggression.
“Bipolar is absolutely being overdiagnosed in children, and the major
downside is that people then think they have a solution and are not amenable
to listening to alternatives,” which may not include drugs, said Dr.
Gabrielle Carlson, a professor of psychiatry and pediatrics at Stony Brook
University School of Medicine on Long Island.
Paraphrasing H. L. Mencken, Dr. Carlson added, “Every serious problem has an
easy solution that is usually wrong.”
Others disagree, insisting that increased awareness of bipolar disorder and
use of some medications has benefited many children. “The first thing to
say is that the world does not see the kids we see; these are very difficult
patients,” said Dr. John T. Walkup, a child and adolescent psychiatrist at
the Johns Hopkins University School of Medicine.
Dr. Walkup said that when drug treatment was done right, it could turn
around the life of a child with a diagnosis of bipolar disorder.
Dr. Jean Frazier, director of child psychopharmacology at Cambridge Health
Alliance and an associate professor at Harvard, said that up to
three-quarters of children who exhibit bipolar symptoms become suicidal, and
that it is important to treat the problem as early as possible. “We’re
talking about a serious illness with high morbidity, and mortality,” Dr.
Frazier said, “and for some of these children the medications can be
life-giving.”
Still, most child psychiatrists agree that there are still questions about
applying the diagnosis to very young children. Recent research has found
that most children who receive the diagnosis are emotionally explosive but
do not go on to develop the classic features of the disorder, like euphoria.
They are far more likely to become depressed.
And many therapists have found that some patients referred to them for
bipolar disorder are actually suffering from something else. “Most of the
patients I see who have been misdiagnosed have been told they have bipolar
disorder,” said Dr. Bessel van der Kolk, a professor of psychiatry at Boston
University who runs a trauma clinic.
“The diagnosis is made with no understanding of the context of their life,”
Dr. van der Kolk said. “Then they’re put on these devastating medications
and condemned to a life as a psychiatry patient.”
Details about what happened to Rebecca are still emerging. A relative of her
mother, Carolyn Riley, 32, told the police that Rebecca seemed “sleepy and
drugged” most days, according to the charging documents. One preschool
teacher said that at about 2 p.m. every day the girl came to life, “as if
the medication Rebecca was on was wearing off,” according to the documents.
Defense lawyers are also focusing on the question of medication. “What I
want to know,” said John Darrell, a lawyer for Mr. Riley, “is how in the
world you diagnose a 2-year-old and give her these strong medicines that are
not approved for children.”
A lawyer for Rebecca’s psychiatrist, Dr. Kayoko Kifuji of Tufts-New England
Medical Center, did not return calls seeking comment.
Some experts say the temptation to medicate can be powerful. “Parents very
often want a quick fix,” Dr. Carlson said, “and doctors rarely have much
time to spend with them, and the great appeal of prescribing a medication is
that it’s simple.”
“To me one of the miracle of children’s brains is that we don’t see more
harm from these treatments.”
Katie Zezima contributed reporting from Boston.
copyright 2007
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