28.6.13

BBC om stemmehøring

BBC-serien The Truth About Mental Health tar denne uken opp blant annet stemmehøring. Det er intervju med Jacqui Dillon, leder av det britiske stemmehørernettverket. Innslaget starter 17 minutter ut podkasten.

Jacqui Dillon. Skjermdump fra Vimeo
(severdig videoforedrag)

27.6.13

Musikk som medisin

Helsedirektoratet anbefaler musikkterapi som behandlingsform for personer med psykoselidelser. Det skriver nettavisen På Høyden i dag.

Faglitteratur om musikkterapi:  
En ressursorientert musikkterapi av Randi Rolvsjord
Musikk i psykisk helsearbeid med barn og unge av Even Ruud (red.)
Tidsskriftet Musikkterapi 

- Internasjonal menneskerettighetslov begynner å støtte oss

I går var det FN-dagen til støtte for torturofre. I den anledning skrev jurist og menneskerettighetsaktivist Tina Minkowitz et innlegg hos Mad in America om psykiatrisk tvang som tortur. Internasjonal menneskerettighetslov begynner å støtte oss, sier hun. Utdrag:

Foto: FN/Flickr
"Juan E. Méndez, the current Special Rapporteur on Torture, acknowledges that nonconsensual medical interventions against persons with disabilities – including restraint or solitary confinement for any period of time, as well as nonconsensual administration of electroshock, psychosurgery or mind-altering drugs such as neuroleptics – always amount to at least inhuman and degrading treatment, arguably meet the criteria for torture, and are always prohibited by international law. He calls for an absolute ban on forced psychiatric interventions, saying it is an immediate obligation that cannot be postponed due to scarce financial resources. In a statement to the Human Rights Council, Méndez said that detention on mental health grounds is never justified and in particular that it is not justified based on a motivation to protect the safety of the person or others."

21.6.13

Kritikk av regjeringens tilleggserklæring

Hvor mye tvang skal man tillate å bruke i psykiatrien? Norge ratifiserer i juni FNs konvensjon om rettighetene til mennesker med nedsatt funksjonsevne, men vil reservere seg på to viktige punkter.

WSOs leder er blant dem som kritiserer tolkningserklæringene til CRPD i siste nummer av Advokatbladet.

20.6.13

Den biologiske psykiatriens nye narrativ

[...] the new story that is emerging in biological psychiatry. Whereas psychiatry once told of psychiatric drugs that fixed chemical imbalances, the field is now telling of how the drugs may be “neuroprotective,” protecting against some toxic disease process; or how they may stir the growth of new neurons in select areas of the brain, which is seen as helpful; or that, in the case of stimulants, they somehow counter abnormal brain development said to be common to youth with ADHD. All of these tell of how the drugs, in some manner or another, are good for the brain. 

Robert Whitaker

Når psykiatere får psykiske lidelser

En engelsk studie har intervjuet psykiatere om deres syn på å søke profesjonell hjelp dersom de får en psykisk lidelse i fremtiden: Barriers to mental healthcare for psychiatrists.

17.6.13

Kommentar fra Arve Kirkevik til forskning på ECT

Eg har lese studien på 96 sider – peikar frå forskning.no:

Det er trist å lesa at psykiatrien framleis underkjenner røynslene frå dei mange ofra som får permanente skadar på hugset etter elektrosjokkbehandling.

Sitat:
Side 30-31
In addition to a reduced ability to encode and store new memories, ECT can result in a temporarily reduced ability to retrieve old memories. The degree of impairment can vary over the treatment pe-riod. Some patients have longstanding memory gaps throughout the treat-
ment period, and both the disease and the treatment could contribute to this phenomenon.
Some cognitive functions, including attention and concentration, tend to
improve during treatment in parallel with reduction of disease symptoms.

A recent meta-analysis showed that objective memory functions were restored within two weeks of treatment (137). Although some studies indicate that subjective memory impairments can remain for longer periods of time (34), most patients do not show any residual impairments by two to six months after the completion of treatment (138). However, even if there are no evident objective dysfunctions, temporary anterograde amnesia
during the treatment period could influence confidence in memory, and decreased confidence in memory functions may affect the subjective perception of memory (151).  influence confidence in memory, and decreased confidence in memory functions may affect the subjective perception of memory (151).

Retrograde amnesia
Neuropsychologists evaluate retrograde amnesia by testing functions important for retrieval of long-term memory (67). A recent meta-analysis concluded that there were no long-lasting impairments in these functions after ECT at the group level (137). However, some patients reported retrograde amnesia after ECT. Memories from time points around the treatment
periods are most vulnerable. However, a causal link is difficult to demonstrate from these case reports.  Sitat slutt.

Elektrosjokkofra sine røynsler vert altså reduserte til «case reports» som sjokklækjarane ikkje legg vekt på. Det er påfallande, med tanke på at Axel Nordenskjöld presenterte ei solskinnshistorie i artikkelen sin:

Sitat:
Side 17
I would like to share a personal anecdote that contributed to my continuing interest in electroconvulsive therapy (ECT). One of the patients I met early during my time in the psychosis department had been in compulsory inpatient care for more than one year. The patient did not speak, laid on the floor for several hours each day with a pillow over her head and occasionally started shouting and waving her arms. She had an earlier diagnosis of bipolar disorder, but her current diagnosis was “psychosis”. Several hospitalisations had been necessary after lithium treatment had been terminated due to a reduction in renal capacity. In the previous year, antidepressant medications and intramuscular antipsychotics were administered, but the patient’s status was deteriorating. The situation became urgent
when the patient stopped eating and drinking. ECT was recommended for psychotic depression with catatonia. The patient fiercely resisted and had to be escorted by four persons to the ECT treatment. After the first treatment, the patient was calm, started to eat and drink, and slept for more than twelve hours. The patient cooperated fully during the following
treatments. Within two weeks she had completely recovered. Afterwards, the patient and her family were very grateful for the ECT and for being able to celebrate Christmas together.
Sitat slutt.

Så brukarrøynsler er gangbar mynt når det (ifylgje psykiatrien) går bra – då skal det tilskrivast elektrosjokka, men ikkje når det øydelegg hugset og livet til folk, då er det berre «case report» som det ikkje vert lagt vekt på.

Harold Sackeim sin vidgjetne studie «The cognitive effects of electroconvulsive therapy in community settings» (nr. 127 på referanselista) omtalar Nordenskjöld slik:

Sitat:
Side 31
In one observational study, there was a dose-response relation between the number of treatments with bilateral electrode placement and memory performance as assessed with an autobiographical memory inventory short form at six months after treatment (127). However, this questionnaire has been criticised and is not validated (139). The answers given in the de-
pressed state before ECT are recorded. All later deviations from the pre-treatment answers are considered incorrect. Therefore, the patients cannot improve their performance after ECT. If something is remembered incorrectly in a depressed and confused state, but is remembered differently and clearly in a non-depressed state, then the score is zero points. This type of
construction risks that the association between the performance on the questionnaire and the different treatment intensities is biased by the severity of the disease. Therefore, although this study is interesting and widely cited, there is no firm evidence that retrograde amnesia occurs after ECT.
Sitat slutt.

Altså, når ein studie påviser skadar på hugset, vert han underkjent som «no firm evidence». Og når studiar med slike resultat vert underkjende, konkluderer dei slik når det kjem resultat som dei soknar etter:

Sitat:
Side 31
In fact, the results from a controlled trial indicated that long-term memory functions are similar in patients treated with ECT and patients treated pharmacologically. The authors of this trial concluded that potential memory problems are not a reason to refrain from ECT (145).
Sitat slutt.

Det verste med Nordenskjöld sin studie, er at han tilrår vedlikehaldsbehandling med elektrosjokk over lengre tid og i tillegg litium og antidepressiva for å unngå tilbakefall til depresjon etter ein serie med elektrosjokkbehandlingar. Med ei slik grotesk behandling er det ikkje rart det ikkje vert mange symptom att – det vert jo ikkje rom for å tenkja og føla noko som helst!


Den gamle lygna om at det er (berre) depresjonen (og ikkje elektrosjokk) som er årsaka til minneproblema, er tidlegare tilbakevist av Harold Robertson and Robin Pryor i artikkelen «Memory and cognitive effects of ECT: informing and assessing patients» i tidsskriftet Advances in Psyhiatric Treatment:

«People who have experienced the effects of both depression and ECT rarely mistake one for the other (Food and Drug Administration, 1982; Donahue, 2000): ECT’s effects are different and worse, they occur only after ECT and they persist in the absence of depression and drugs.» jf. link 1) nedanfor.

Alle referansane under er gamle.
1)
http://apt.rcpsych.org/cgi/content/full/12/3/228
 -------------------------
2)
-------------------------
Cognitive rehabilitation: assessment and treatment of persistent memory impairments following ECT
Maeve A. Mangaoang and
Jim V. Lucey:
http://apt.rcpsych.org/cgi/content/full/13/2/90
-------------------------

3)
-------------------------
Final Report
January 2002
Review of Consumers’ Perspectives On Electro Convulsive Therapy
Service User Research Enterprise (SURE)
Institute of Psychiatry
Commissioned by Department of Health:
http://www.healthyplace.com/images/stories/depression/ec-consumerperspectives.pdf
-------------------------

4)
-------------------------
International Journal of Risk & Safety in Medicine 11 (1998) 5–40 5
IOS Press
Electroshock: scientific, ethical, and
political issues:
Peter R. Breggin
http://www.breggin.com/Electroshockscientific.pdf
-------------------------
5)
-------------------------
Dr. Peter Breggin
Posted: April 1, 2007 06:46 PM
Disturbing News for Patients and Shock Doctors Alike
http://www.huffingtonpost.com/dr-peter-breggin/disturbing-news-for-patie_b_44734.html
-------------------------

6)
-------------------------
LETTER TO THE
EDITOR:
Response to Drs
Abrams and Kellner

Harold A. Sackeim, PhD
Joan Prudic, MD
Mark Olfson, MD
http://www.ect.org/wp-content/uploads/2007/06/00124509-200706000-00004.pdf
-------------------------

7)
-------------------------
Shock Treatment: Efficacy, Memory Loss,
and Brain Damage – Psychiatry’s
Don’t Look, Don’t Tell Policy
Richard A. Warner
Email: windwarner@msn.com:
http://www.ect.org/wp-content/uploads/2006/09/shock-treatment.pdf
-------------------------

8)
-------------------------
J ECT. 2008 Mar;24(1):40-5..
Neurobiological correlates of the cognitive side effects of electroconvulsive therapy.
Nobler MS, Sackeim HA.
http://www.ncbi.nlm.nih.gov/pubmed/18379334
-------------------------

9)
-------------------------
J ECT. 2000 Jun;16(2):110-20.
Electrophysiological correlates of the adverse cognitive effects of electroconvulsive therapy.
Sackeim HA, Luber B, Moeller JR, Prudic J, Devanand DP, Nobler MS.
http://www.ncbi.nlm.nih.gov/pubmed/10868321
-------------------------

For Informasjonssenteret Hieronimus,
venleg helsing Arve Kirkevik

13.6.13

Historier fra beltesenga

Sykepleieren sier «Nå gråter du sånn som små babyer gjør»! Jeg reagerer og ber henne slutte å si sånt. «Jeg er også et menneske, jeg har også rett til å si det jeg synes», sier hun så. Deretter får jeg høre at min reaksjon på hennes ord, har bevist at jeg ikke er rolig, etterfulgt med trusselen om å bli liggende enda lenger i beltene. 

Timene i beltesenga, og de formanende kommentarene fra sykepleieren gjorde at jeg satt igjen med følelsen av verdiløshet og mismot. «Du vet godt hva du gjør», og «Dette er veldig kontrollert», var sykepleierens ord. «Liker du å ligge i belter?» sier hun så.

Les blogginnlegget Historier fra beltesenga.

Innlegg av Joar Tranøy

Forsker og psykolog Joar Tranøy har skrevet innlegget Mental Helses svik.

1.6.13

Debatt om diagnoser

Podcast der psykoterapeut og forfatter Gary Greenberg, direktør Thomas Insel ved USAs største forskningsinstitusjon innen psykisk helse, og president Jeffrey Lieberman i den amerikanske psykiaterforeningen debatterer diagnoser. http://www.sciencefriday.com/segment/05/31/2013/bad-diagnosis-for-new-psychiatry-bible.html#path/segment/05/31/2013/bad-diagnosis-for-new-psychiatry-bible.html