The making and taking of psychotropic drugs, whether on medical prescription or as self-medication, whether marketed by pharmaceutical companies or clamoured for by an anxious population, has been an integral part of the twentieth century. In this modern era of speed, uncertainty, pleasure and anguish the boundaries between healing and enhancing the mind by chemical means have been redefined. Long before Prozac would become a household name for an ‘emotional aspirin’ did consumers embrace the idea and practice of (...) taking psychotropics not only to treat mental illness but also to make them feel better about living in a modern world. The Freudian promise that each individual can remake him- or herself in the pursuit of health and happiness was helpful in promoting and legitimizing the idea and practice of seeking wellness on prescription. We will argue that the modern consumer-driven political culture of medicine will continue to transverse the boundaries of therapy and enhancement of the mind into the largely unexplored territories of human cognition and behaviour. However exciting, this endeavour will come at the cost of further widening the problem of iatrogenic addiction in the age of happiness pills as ‘botox’ for the mind. (shrink)

Many children in the USA are prescribed psychotropic drugs that have not been fully investigated in paediatric clinical trials. The common practice of prescribing psychotropic drugs off-label poses unknown and potentially serious short- and long-term consequences for these children. This paper briefly reviews the factors associated with the lack of paediatric clinical trials. We advocate a shift toward increasing paediatric trials with psychotropic drugs through a combination of adequate safety controls, additional reimbursement/compensation, a more (...) organised and large-scale effort to collate results and outcomes across researchers and studies and additional public education about the importance of this research. In addition, we encourage the re-examination of the ethical standards for children's participation in phase 1 clinical trials as well as argue for longitudinal developmental studies on children who are prescribed off-label psychotropic drugs. (shrink)

ZusammenfassungDer Einsatz von Psychopharmaka im Altenpflegeheim unterliegt aufgrund institutioneller und struktureller Besonderheiten dieses Versorgungsbereiches, aber auch aufgrund der großen Abhängigkeit und Vulnerabilität eines großen Teils der Altenpflegeheimbewohner in besonderer Weise der Gefahr, in inadäquater und missbräuchlicher Weise durchgeführt zu werden. Die Beachtung der ethischen Grundprinzipien des Wohltuns und des Nichtschadendürfens sowie des Respekts vor der Autonomie der Bewohner sollte für alle an der Versorgung unmittelbar und mittelbar Beteiligten handlungsleitend sein. Zum Schutz der Heimbewohner, aber auch mit dem Ziel die Versorgungsqualität (...) in diesem Bereich nachprüfbar zu verbessern, werden in diesem Beitrag Kriterien zur Definition einer inadäquaten bzw. adäquaten Anwendung von Psychopharmaka explizit formuliert, sowie deren Implementierung in prozessorientierte Handlungsalgorithmen und Behandlungsleitlinien vorgeschlagen. Darüber hinaus sollen die Möglichkeiten und Grenzen nicht-pharmakologischer, psychologischer Interventionen als Alternative zur Psychopharmakamedikation diskutiert und hinsichtlich ihrer ethischen Implikationen reflektiert werden. (shrink)

Presently, women receive two-thirds of the prescriptions for psychotropic drugs and Canadian studies have shown that, at any one time, 15–20% of women are taking the drugs. The authors suggest that this difference in prescription rates to men and women is rooted in the unrecognized stresses of women's traditional role and the pervasive sentiment that women who deviate from, or complain about, their traditional role as wife, mother, sex object and self-sacrificing nurturer must be sick. Thus a (...) rationale for the prescription of psychoactive drugs to women has grown up within the framework of the ideology surrounding the institution of the family, and both reflects and reinforces traditional stereotypes about women's status and role. (shrink)

Usage of psychotropics during pregnancy and lactation has always been a topic of debate and controversy. The debate stems from the potential adverse effects on the growing fetus or infants due to the transfer of psychotropic drugs through placenta or breast milk of mothers receiving them; and the problem of discontinuing psychotropics in lactating mother considering chances of relapse. However, most of the psychotropics are found to be relatively safe when used cautiously during the lactation phase. This article (...) describes available data on the use of psychotropics in lactating mothers, in particular, in relation to the safety profile of infants. (shrink)

BackgroundEnhancement involves the use of biomedical technologies to improve human capacities beyond therapeutic purposes. It has been well documented that enhancement is sometimes difficult to distinguish from treatment. As a subtype of enhancement, neuroenhancement aims to improve one’s cognitive or emotional capacities.Main bodyThis article proposes that the notion of neuroenhancement deserves special attention among enhancements in general, because apart from the notion of treatment, it also overlaps with other concepts such as prevention, pain relief, and pleasure seeking. Regarding prevention, patients’ (...) mental endurance can be enhanced when a patient is prescribed a selective serotonin reuptake inhibitor for the purpose of preventing the relapse of depression following a stressful situation. As for pain relief, psychiatrists use medication to alleviate distress in patients who experience various types of anxiety; the alleviation of distress is equal to psychological pain relief, but is also an enhancement of the patient’s temperamental traits. Regarding pleasure seeking, insidious transition exists between neuroenhancement and pleasure seeking when using psychotropic drugs. It is well known that people use psychostimulants for recreational purposes and to induce overconfidence in one’s performance. The polysemy of psychotropics derives from their effects on human sensibility. Therefore, when using psychotropic agents, psychiatrists should pay close attention to what the agent is used for on each patient in each situation, and explicitly share the continuity and overlap in the purpose of prescribing a medication with the patients to make a better clinical decision.ConclusionsThe notion of neuroenhancement overlaps not only with the notion of treatment, but also with other concepts of prevention, pain relief, and pleasure seeking. The continuity between those concepts makes the issues concerning the prescription of psychotropic drugs subtler. Psychiatrists should explicitly share the continuity with the patients to make a better clinical decision. (shrink)

The paper presents major ethical, legal and methodological problems related to the use of placebo in mental disorders, especially in depression. It is pointed out that although authoritative groups of experts and numerous publications in the field of psychopharmacology indicate advisability of the double blind design with placebo in clinical trials of antidepressants, in recent years there have been more and more voices questioning legitimacy of this method. Objections of an ethical nature are raised, and reliability of this approach is (...) put into doubt from the methodological viewpoint. These issues are discussed in more detail in the paper. Available alternative solutions should be implemented in psychotropic drug studies. The author shares these objections and doubts of an ethical nature, and believes that the placebo procedure is not a necessity in clinical trials of antidepressants. (shrink)

Most people who are regular consumers of psychoactive drugs are not drug addicts, nor will they ever become addicts. In neurobiological theories, non-addictive drug consumption is acknowledged only as a “necessary” prerequisite for addiction, but not as a stable and widespread behavior in its own right. This target article proposes a new neurobiological framework theory for non-addictive psychoactive drug consumption, introducing the concept of “drug instrumentalization.” Psychoactive drugs are consumed for their effects on mental states. Humans are able (...) to learn that mental states can be changed on purpose by drugs, in order to facilitate other, non-drug-related behaviors. We discuss specific “instrumentalization goals” and outline neurobiological mechanisms of how major classes of psychoactive drugs change mental states and serve non-drug-related behaviors. We argue that drug instrumentalization behavior may provide a functional adaptation to modern environments based on a historical selection for learning mechanisms that allow the dynamic modification of consummatory behavior. It is assumed that in order to effectively instrumentalize psychoactive drugs, the establishment of and retrieval from a drug memory is required. Here, we propose a new classification of different drug memory subtypes and discuss how they interact during drug instrumentalization learning and retrieval. Understanding the everyday utility and the learning mechanisms of non-addictive psychotropic drug use may help to prevent abuse and the transition to drug addiction in the future. (shrink)

Lithuania’s legislation, establishing criminal liability for illegal disposition of narcotic drugs and psychotropic substances, uses two different terms while identifying the subject matter for criminal deeds: “narcotic and psychotropic substances” and “plants, incorporated into the lists of controlled substances.” The legislation in article 269 of the Lithuanian criminal code explains that narcotic and psychotropic substances, indicated in the respective chapter of the Lithuanian criminal code, shall be those substances that are included in the lists of narcotic (...) and psychotropic substances as approved by the Ministry of Health of the Republic of Lithuania. Plants having narcotic drugs and psychotropic substances are not introduced into this definition although the exception of the coca bush is enumerated in the lists of controlled substances. This described present position brings in a certain intricacy when deciding when a perpetrator should be punished only for illegal cultivation of plants and when he should be punished also for other illegal acts with narcotic and psychotropic substances. (shrink)

Today in Japan psychoactive drugs are widely prescribed for various psychiatric disorders including so-called ‘functional’ disorders. They are undoubtedly effective in relieving various psychological and behavioral symptoms. However, Japan has yet to address some basic questions: (1) uncertainty concerning the cause of various psychiatric functional disorders; (2) unknown factors that affect the function of psychotropic drugs in patients; (3) the difficulty in obtaining objective data concerning the effects of these medications * both on the brain and the (...) psychological symptoms (behavior); and most importantly, (4) due to both the behavioral and organic (brain and CNS) effects of psychoactive drugs, the difficulty in evaluating the risk/benefit ratio between the behavioral (primary) effect and the organic (side) effect. In addition, there are bioethical problems, since these uncertainties tend to permit too broad a range of intention and too many modes of intervention in (a) prescribing and (b) taking psychoactive drugs on the part of therapists and patients, respectively. Though the increased risk of the inappropriate use of these drugs – the non-therapeutic uses, and their over-prescription – has been indicated in other industrialized countries, it has not yet been fully recognized and adequately discussed in Japan. Moreover, it is necessary to establish a sound basis for the ‘somato-psychic’ evaluation of these effects in the context of the physician-patient relationship, including the patient's family and even the broader society. Keywords: bioethics, pharmacological treatment, primary and secondary effects, psychiatric-functional disorders, risk/benefit ratio CiteULike Connotea Del.icio.us What's this? (shrink)

Today, a rapidly spreading drug addiction is one of the most relevant problems in Lithuania. It is possible to state without reservation that it has become a threatening social phenomenon. Drug addiction is considered to be one of the national threats. Trafficking in narcotic and psychotropic substances is being conducted on an international level, destroying states’ economic and political welfare. The use of these substances has a negative impact on human mental and physical health, ruins human personality and produces (...) other negative effects. In the article bodies of criminal acts, namely, an object, a subject, an act, an entity, guilt and a purpose, set forth in Articles 259, 260 of the Criminal Code of the Republic of Lithuania, are analysed. (shrink)

Recent years have witnessed an intensification of historical and philosophical research on the link between psychotropic drugs and psychiatric theories. For example, Kendler and Schaffner detailed how the dopamine hypothesis of schizophrenia was intimately linked to the dopamine theory of antipsychotic drug action. Here, a related case is explored: the use of antidepressants' neurochemical effects to speculate about the pathophysiology of depression.This rationale was central to American psychiatrist Schildkraut's landmark article on the catecholamine hypothesis of affective disorders. Accordingly, (...) the paper's hypothesis—that depressions may relate to decreased... (shrink)

Drug phenomenon is relatively new in our country; it became relevant only in the ninth decade of the last century. A new phenomenon or a process is usually dynamic in the initial stages and only later does it acquire features of stability and the main trends that have become prominent several years ago remain unchanged. The author shows the data of drugs crime and other indicators and the aspects of their perspectives. In the article, a question about drug crimes (...) in Lithuania is considered in all aspects. The author maintains that the rapid emergence of many new non‑controlled psychoactive substances represents an increasing challenge for current models of drug control. (shrink)

This article contends that the enterprise of neuroleptic drug treatment of schizophrenia is conceptually and clinically - though not economically - bankrupt. Although new drugs spur hope and reinforce the dominant treatment paradigm, evidence from reports published during the last five years in leading psychiatric journals suggests that psychopharmacologists do not know what are the optimal doses of the most widely-used neuroleptics; that most patients do not "respond" to neuroleptic treatment; that toxic effects are routinely misdiagnosed; that prescribing guidelines (...) may have no impact on actual prescription patterns; that claims that the popular "atypical" neuroleptic clozapine is free of extrapyramidal symptoms are completely false; and finally, that penetration of the double-blind in studies of the effectiveness of psychotropics over placebos may be a common occurrence. In the light of these findings, it is argued that the field is in crisis and that major, paradigmatic change is absolutely necessary. (shrink)

In this article, I examine children's reported experiences with stimulant drug treatments for attention deficit hyperactivity disorder in light of bioethical arguments about the potential threats of psychotropic drugs to authenticity and moral agency. Drawing on a study that involved over 150 families in the USA and the UK, I show that children are able to report threats to authenticity, but that the majority of children are not concerned with such threats. On balance, children report that stimulants improve (...) their capacity for moral agency, and they associate this capacity with an ability to meet normative expectations. I argue that although under certain conditions stimulant drug treatment may increase the risk of a threat to authenticity, there are ways to minimise this risk and to maximise the benefits of stimulant drug treatment. Medical professionals in particular should help children to flourish with stimulant drug treatments, in good and in bad conditions. (shrink)

This paper provides a brief visual history of the ways women patients, and specifically women patients whose marital status is identified in conjunction with their illness, have been constructed as abnormal in the images of advertisements designed to promote psychotropic medications to an audience of psychiatrists. The advertisements I discuss come from the two largest circulation American psychiatric journals, The American Journal of Psychiatry and Archives of General Psychiatry, between the years 1964 and 2001. I use the ads to (...) focus on two concomitant narratives. On one hand, I show how the advertisements situate the rise of wonder drugs in the context of an era described as the golden age of psychopharmacology, during which time drug treatments helped revolutionize the diagnosis and treatment of anxiety, depression, and other outpatient mental illnesses in the United States. On the other hand, the advertisements also illustrate the ways in which these new scientific treatments could not function free of the culture in which they were given meaning. In the space between drug and wonder drug, or between medication and metaphor, the images thus hint at the ways psychotropic treatments became imbricated with the same gendered assumptions at play in an American popular culture intimately concerned with connecting normal and heteronormal when it came to defining the role of women in civilization. (shrink)

Singh's study of 150 UK and US children diagnosed with attention deficit hyperactivity disorder and prescribed psychotropic medication concludes on the basis of interviews with the children that ‘stimulants improve their capacity for moral agency … an ability to meet normative expectations’.1 Reinterpreted in lay language, she finds that, when taking Ritalin, the children conform to the wishes and expectations of their parents and teachers. They get better grades at school and show less ‘oppositional-defiance’. This is not surprising as (...) it is precisely what Ritalin is supposed to do. However, it begs a number of crucial questions. Might it not be that the failure of the child to conform to the expected norms in the non-medicated state is a legitimate expression of the child's own moral agency, rebelling against what he/she experiences as inappropriate …. (shrink)

In this essay, I use the theological anthropology of the apostle Paul as a diagnostic lens in order to bring into focus some implicit assumptions about human personhood in the goals and methods of treatment with psychotropic medications. I argue that Paul views the body as a mode of participation in larger relational matrices in both vulnerable and vital ways. He thus sees the self as constituted relationally rather than as fundamentally isolated and self-determining. Such an understanding of personhood (...) yields an account of human agency as co-constituted and freedom as interpersonally mediated and sustained. From this perspective, the proper goal for psychiatric medication is the removal of barriers to life-giving human connections; methods of care for persons in psychological distress may include medication, but they also require embodied personal encounter. (shrink)

Psychopharmacology - a remarkable development -- Philosophical questions raised by psychopharmacology -- How to think about science, language, and medicine : classical, critical, and integrated perspectives -- Conceptual questions about psychotropics -- Explanatory questions about psychotropics -- Moral questions about psychotropics.

Developments in neuroscience have raised the possibility that pharmaceuticals may be used to enhance memory, mood, and attention in people who do not have an illness or disorder, a practice known as “cognitive enhancement.” We describe historical experiences with two medicinal drugs for which similar enhancement claims were made, cocaine in the late 19th and early 20th centuries, and amphetamines in the mid 20th century. These drugs were initially introduced as medicinal agents in Europe and North America before (...) becoming more widely used for a variety of purposes, including what would nowadays be considered cognitive enhancement. Their trajectory of use conformed to the typical use cycle of psychotropic drugs. There was an initial steep rise in prescribing for medical use, followed by expanded nonmedical use that was fueled by enthusiasm for the drugs’ effects. As the number of regular users increased, problems related to use (such as addiction) became apparent, societal concern increased, and laws were passed banning nonmedical use and eventually, medical use. This historical experience draws attention to the adverse side effects of enhancement use that only become apparent with regular, wide-scale use of a drug. We highlight the similarities between the enthusiasms for cocaine and amphetamines and the current enthusiasms for using prescription stimulants for cognitive enhancement. We argue bioethicists should not encourage the cognitive enhancement use of drugs such as methylphenidate in the absence of evidence on the efficacy and safety of their use for cognitive enhancement purposes. (shrink)

Children who experience well-being are engaging more confidently and positively with their caregiver and peers, which helps them to profit more from available learning opportunities and support current and later life outcomes. The goodness-of-fit theory suggests that children’s well-being might be a result of the interplay between their temperament and the environment. However, there is a lack of studies that examined the association between children’s temperament and well-being in early childhood education and care, and whether this association is affected by (...) ECEC process quality. Using a multilevel random coefficient approach, this study examines the association between toddlers’ temperament and well-being in Norwegian ECEC and investigates whether process quality moderates this association. Results reveal an association between temperament and well-being. Staff-child conflict moderates the association between shyness and well-being, and between activity and well-being. Moreover, high emotional behavioral support moderates the association between activity and well-being. Extra attention should be paid by the staff to these children’s needs. (shrink)

In The Ethics of Food, Gregory E. Pence brings together a collection of voices who share the view that the ethics of genetically modified food is among the most pressing societal questions of our time. This comprehensive collection addresses a broad range of subjects, including the meaning of food, moral analyses of vegetarianism and starvation, the safety and environmental risks of genetically modified food, issues of global food politics and the food industry, and the relationships among food, evolution, and human (...) history. (shrink)

Long-standing psychiatric practice confirms the pervasive use of pharmacological therapies for treating severe mental disorders. In many circumstances, drugs constitute the best allies of psychotherapeutic interventions. A robust scientific literature is oriented on finding the best strategies to improve therapeutic efficacy through different modes and timing of combined interventions. Nevertheless, we are far from triumphal therapeutic success. Despite the advances made by neuropsychiatry, this medical discipline remains lacking in terms of diagnostic and prognostic capabilities when compared to other branches (...) of medicine. An ethical principle remains as the guidance of therapeutic interventions: improving the quality of life for patients. Unfortunately, psychotropic drugs and psychotherapies do not always result in an efficient remission of symptoms. In this paper I corroborate the idea that therapists should provide drug-resistant patients with every effective and available treatment, even if some of such interventions could be invasive, like Electroconvulsive Therapy (ECT). ECT carries upon its shoulders a long and dramatic history that should be better investigated to provide new insights. In fact, ECT has attracted renewed interest in recent years. This is due to the fact that antidepressant drugs in younger patients show often scarce effectiveness and unpleasant side-effects. Moreover, I show that, thanks to modern advances, ECT may work as a successful form of treatment for specific and rare cases, such as severe depression (with suicide attempts) and catatonia. (shrink)

Traditional understanding of how psychotropic drugs work emphasize highly specific actions at subcellular levels. This model appears to have implications that seriously conflict with our usual view of human agency and autonomy, raising not just theoretical quandaries but contributing to patient reluctance to utilize these drugs. Furthermore, it discourages both meaningful treatment integration and appreciation of the uniqueness of patients. Through a consideration of antidepressants in particular, this paper argues for a more comprehensive model based on nonlinear (...) dynamics and chaos theory that can be applied across multiple domains. This model yields important suggestions for reconciling perspectives in neuroscience with traditional views of human agency. It also encourages real integration of clinical and research approaches in psychiatry, and further defines the components of respectful treatment of patients. (shrink)

Background: Patients prescribed with medication that treats mental health conditions benefit the most compared to those prescribed with other types of medication. However, they are also the most difficult to adhere. The development of mobile health (mHealth) applications (‘apps’) to help patients monitor their adherence is fast growing but with limited evidence on their efficacy. There is no evidence on the content of these apps for patients taking psychotropic medication. The aim of this study is to identify and evaluate (...) the aims and functioning of available apps that are aiming to help and educate patients to adhere to medication that treats mental health conditions. Method: Three platform descriptions (Apple, Google and Microsoft) were searched between October 2015 and February 2016. Included apps need to focus on adherence to medication that treats mental health conditions and use at least a reinforcement strategy. Descriptive information was extracted and apps evaluated on a number of assessment criteria using content analysis. Results: Sixteen apps were identified. All apps included self-monitoring properties like reminders and psycho-educational properties like mood logs. It was unclear how the latter were used or how adherence was measured. Major barriers to medication adherence like patients’ illness and medication beliefs and attitudes were not considered nor where information to patients about mediation side effects. Very few apps were tailored and none was developed based on established theories explaining the processes for successful medication adherence like cognitions and beliefs. Reported information on app development and validation was poor. Discussion: A variety of apps with different properties that tackle both intentional and unintentional non-adherence from a different perspective are identified. An evidence-based approach and co-creation with patients is needed. This will ensure that the apps increase the possibility to impact on non-adherence. Theories like social cognition models can be useful in ensuring that patients’ education, motivation, skills, beliefs and type of adherence are taken into consideration when developing the apps. Findings from this study can help clinicians and patients make informed choices and pursue policy-makers to integrate evidence when developing future apps. Quality-assurance tools are needed to ensure the apps are systematically evaluated. (shrink)

The discovery of psychoanalysis and of psychotropic medications represent two radical events in understanding and treatment of mental suffering. The growth of both disciplines together with the awareness of the impracticality of curing mental suffering only through pharmacological molecules – the collapse of the “Great Illusion” - and the experience of psychoanalysts using psychotropic medications along with depth psychotherapeutic treatment, have led to integrated therapies which are arguably more effective than either modality alone. The authors review studies on (...) the role of pharmacotherapy with psychoanalysis, and the role of the analyst as the prescriber. The psychotic disorders have specifically been considered from this perspective. (shrink)

This article will examine how the notion of emotional authenticity is intertwined with the notions of naturalness and artificiality in the context of the recent debates about ‘neuro-enhancement’ and ‘neuro-psychopharmacology.’ In the philosophy of mind, the concept of authenticity plays a key role in the discussion of the emotions. There is a widely held intuition that an artificial means will always lead to an inauthentic result. This article, however, proposes that artificial substances do not necessarily result in inauthentic emotions. The (...) literature provided by the philosophy of mind on this subject usually resorts to thought experiments. On the other hand, the recent literature in applied ethics on ‘enhancement’ provides good reasons to include real world examples. Such case studies reveal that some psychotropic drugs such as antidepressants actually cause people to undergo experiences of authenticity, making them feel ‘like themselves’ for the first time in their lives. Beginning with these accounts, this article suggests three non-naturalist standards for emotions: the authenticity standard, the rationality standard, and the coherence standard. It argues that the authenticity standard is not always the only valid one, but that the other two ways of assessing emotions are also valid, and that they can even have repercussions on the felt authenticity of emotions. In conclusion, it sketches some of the normative implications if not ethical intricacies that accompany the enhancement of emotions. (shrink)

Rapid advances in the field of neuroimaging techniques including magnetoencephalography (MEG), electroencephalography (EEG), functional MRI (fMRI), diffusion tensor imaging (DTI), voxel based morphomentry (VBM), and optical imaging, have allowed neuroscientists to investigate neural processes in ways that have not been possible until recently. Combining these techniques with advanced analysis procedures during different conditions such as hypnosis, psychiatric and neurological conditions, subliminal stimulation, and psychotropic drugs began transforming the study of neuroscience, ushering a new paradigm that may allow neuroscientists (...) to tackle the hard problem of consciousness. (shrink)

In light of the magnitude of interpersonal harm and the risk of greater harm in the future, Ingmar Persson and Julian Savulescu have argued for pharmacological enhancement of moral behaviour. I discuss moral bioenhancement as a set of collective action problems. Psychotropic drugs or other forms of neuromodulation designed to enhance moral sensitivity would have to produce the same or similar effects in the brains of a majority of people. Also, a significant number of healthy subjects would have (...) to participate in clinical trials testing the safety and efficacy of these drugs, which may expose them to unreasonable risk. Even if the drugs were safe and effective, a majority of people would have to co-operate in a moral enhancement programme for such a project to succeed. This goal would be thwarted if enough people opted out and decided not to enhance. To avoid this scenario, Persson and Savulescu argue that moral enhancement should be compulsory rather than voluntary. But the collective interest in harm reduction through compulsory enhancement would come at the cost of a loss of individual freedom. In general, there are many theoretical and practical reasons for scepticism about the concept and goal of moral enhancement. (shrink)

Within the broad field of human enhancement, pediatric cognitive neuro-enhancement appears to arouse particular interest. The increasing importance of cognitive capacities in our contemporary and cultural context appears to be the main reason for the focus on cognition as the preferred trait of enhancement, while the choice of pharmacological means is based on factors of feasibility, accessibility, and cost. While the ethical issues arising in the adult context have already been extensively covered in the literature, pediatric neuro-enhancement brings with it (...) additional ethical challenges requiring further attention. Although there are numerous important ethical considerations, the focus of this chapter is on the pursuit of normalcy as the goal in pediatric neuro-enhancement. Parental attempts to shape children are not new, and the resources available for them to do so include widespread and mostly uncontroversial tools, such as education. The increasing use of psychotropic drugs, however, reveals the significant impact of the concept of normalcy, which has resulted in a trend to medicalize what used to be considered “normal” behavior. In this context, special challenges are posed by psychiatric disorders, where the familiar treatment-enhancement distinction continues to be relied upon to justify interventions in children. Drawing on the examples of attention deficit/hyperactivity disorder and autism spectrum disorder, it will be argued that children are already being enhanced within psychiatric practice and that this is incompatible with an understanding of disability under a mixed model. (shrink)

BackgroundDespite five decades of increasingly elegant studies aimed at advancing the pathophysiology and treatment of mental illness, the results have not met expectations. Diagnoses are still based on observation, the clinical history, and an outmoded diagnostic system that stresses the historic goal of disease specificity. Psychotropic drugs are still based on molecular targets developed decades ago, with no increase in efficacy. Numerous biomarkers have been proposed, but none have the requisite degree of sensitivity and specificity, and therefore have (...) no usefulness in the clinic. The obvious lack of progress in psychiatry needs exploration.MethodsThe historical goals of psychiatry are reviewed, including parity with medicine, a focus on diagnostic reliability rather than validity, and an emphasis on reductionism at the expense of socioeconomic issues. Data are used from Thomas Picketty and others to argue that our failure to advance clinical care may rest in part on the rise in social and economic inequality that began in the 1970s, and in part on our inability to move beyond the medical model of specificity of disease and treatment.ResultsIt is demonstrated herein that the historical goal of specificity of disease and treatment has not only impeded the advance of diagnosis and treatment of mental illness, but, in combination with a rapid increase in socioeconomic inequality, has led to poorer outcomes and rising mortality rates in a number of disorders, including schizophrenia, anxiety, and depression.ConclusionsIt is proposed that Psychiatry should recognize the fact of socioeconomic inequality and its effects on mental disorders. The medical model, with its emphasis on diagnostic and treatment specificity, may not be appropriate for investigation of the brain, given its complexity. The rise of scientific inequality, with billions allocated to connectomics and genetics, may shift attention away from the need for improvements in clinical care. Unfortunately, the future prospects of those suffering from mental illness appear dim. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.3 (2003) 227-231 [Access article in PDF] World Traveling as a Clinical Methodology for Psychiatric Care Suzanne M. Jaeger Keywords embodiment, dialogical consciousness, interpersonal communication, epistemic responsibility, self-knowledge, understanding IN HER ARTICLE "Moral Tourists and World Travelers," Nancy Potter suggests a way in which psychiatrists and psychologists could gain a better understanding of their mentally ill patients' experiences. Rather than assuming that hallucinations and incoherent (...) speech and behavior are merely senseless disconnections from reality, Potter argues that mental health care clinicians ought to spend time engaging patients on their own terms. Even when mental illness is a result of brain disease, much can be learned about the patient's experiences of their disease by temporarily setting aside the scientific frameworks of diagnosis and medical treatment. Potter uses Maria Lugones' concept of world traveling and recommends playfully accepting, and even entering into the patient's world (Lugones 1990). She calls world traveling a methodology and explains it in some detail. Moreover, at the close of her essay, Potter suggests that clinicians have a moral obligation to understand the mentally ill patient's world from the patient's perspective. This obligation is based on an appeal to our sense of what it is to be a responsible knower who attends to issues of trust and truth. Relying on arguments made by Lorraine Code (1987), Potter asserts that to try to understand the other's perspective is the responsible thing to do.My discussion focuses on the notion of play to which Potter appeals, as well as on what she sees as the moral obligation of clinicians to communicate with their mentally ill patients in extra-professional ways. This moral obligation arises because (a) the theoretical and professional frameworks of medical science are seen as inadequate, and (b) playfulness opens up mutually respectful, authentic interaction between persons. I generally agree with Potter's claims, and I want to situate them in the wider framework of an epistemological debate about the status of our knowledge of others. A broader context will help to elucidate the strengths of Potter's analysis as well as some points for critical discussion. I begin with the relationship of trust between clinicians and patients.Few people would disagree with the claim that patients need to be able to trust that their physicians are not harming them, but helping them to get better. If patients feel misunderstood, they will not trust their caretakers. This is probably even truer for psychiatric patients, whose conditions and loss of autonomy make establishing trust even more challenging. Psychiatric patients [End Page 227] often have their own ways of compensating for the symptoms of their mental illness. If either their will to survive or their compensatory strategies go unrecognized or misinterpreted, patients may respond by rejecting the well-intentioned efforts of caretakers to restore them to a degree of ease, measured as it must be by the standards of the professionals under whose care the patient remains. 1 Despite the fact that these standards are established through scientific testing procedures for the treatment of diseases, they may be experienced by patients as indifferent to the particular and unique features of their condition. Nestled within the issue of trust is thus a question of truth.Although current scientific knowledge of the human brain, and of human behavior, has made available a range of sophisticated therapies and psychotropic drugs, there are still many mental illnesses that leave families and clinicians wondering whether the treatment plans are providing any help. Alzheimer's disease and schizophrenia are two examples. There is a difference between, on the one hand, containing the patient's behavior by admitting the patient to a psychiatric ward and managing symptoms with psychotropic medications, and, on the other hand, understanding what is happening for the patient, from his or her perspective. Although psychiatric patients may not have a realistic sense of either their abilities or the extent and nature of their disease, there may be much about their experiences that ought to be known and understood by the professionals caring for them... (shrink)

This paper examines the culture, the dynamics and the financial underpinnings that determine how medical research is being conducted on children in the United States. Children have increasingly become the subject of experiments that offer them no potential direct benefit but expose them to risks of harm and pain. A wide range of such experiments will be examined, including a lethal heartburn drug test, the experimental insertion of a pacemaker, an invasive insulin infusion experiment, and a fenfluramine "violence prediction" experiment. (...) Emphasis, however, is given to psychoactive drug tests because of the inherent ethical and diagnostic problems involved in the absence of any objective, verifiable diagnostic tool. Effort is made to provide readers comprehensive reference sources to evidence-based reports about the serious risks these drugs pose for adults and children so that the reader may judge whether the benefits (if any) outweigh the risks for children. The first ethical issue raised by these experiments is: did the severity of illness in these children justify their exposure to short and long-term risks? The ethics of the experiments will be evaluated by referring to existing codes of medical research ethics-the Nuremberg Code, the Declaration of Helsinki, and the federal Code of Regulations. The thirteen cases presented will demonstrate that children are being used in ever more speculative experiments, often in the absence of a therapeutic intent, but a significant chance for causing harm and / or discomfort. Some of the experiments were designed to explore the mechanisms of pathology and pharmacological interventions, or the response of neurological brain receptors to chemical provocation ("challenge"). Others were designed to test the safety or efficacy of new drugs, even to test these drugs on healthy children who were hypothesized to be "at risk." Children and adolescents have been subjected to "forced dose titration" experiments that induced a spectrum of severe adverse effects, including insomnia, extreme restlessness, agitation, (akathisia) and self-injurious behavior. FDA reports show that suicide is a significant issue in psychotropic drug trials-in pediatric trials the problem is even greater. The paper aims to demonstrate how the enactment of the Better Pharmaceuticals for Children Act (incorporated into the Food and Drug Administration Modernization Act, FDAMA), set in motion a radical shift in public policy by providing huge financial incentives to pharmaceutical companies to test new or patented drugs in children. Federal policy shifted from one aimed at protecting children by setting limits on permissible research risks, to a policy aimed at broadening the inclusion of children as test subjects. It will be shown how the FDA and the Department of Health and Human Services lifted regulatory restrictions to permit research involving greater than minimal risk to be conducted on healthy children, claiming that all children are potentially "at risk" of a future condition. Children were in this way deprived of regulatory protections. An argument will be made that the approval of nontherapeutic, harmful experiments-such as exposure of toddlers to lead poison-under the current gate keeping system raises serious doubts about the sustainability of institutional review boards (IRBs) as protectors of human research subjects. Children, who are precluded from exercising the adult human's right to informed consent, are being exploited as commodities for commercial ends. It is the position of the author that nothing less than the enactment of a federal law mandating a radical overhaul of the current research review system, with independent checks and balances, will provide children the legal protections they need. Ten specific recommendations are offered to protect children from harmful experiments. (shrink)

BackgroundSocial cognitive impairments adversely affect social functioning in patients with schizophrenia. Although pharmacological interventions have been suggested to provide some benefits on social cognition, little information is available on the comparative efficacy of pharmacotherapy. Thus, the aim of this planned systematic review and network meta-analysis is to perform a quantitative comparison of the effects of various psychotropic drugs, including supplements, on social cognition disturbances of schizophrenia.MethodsThe literature search will be carried out using the PubMed, Embase, Cochrane Central Register (...) of Controlled Trials, PsycINFO, ClinicalTrials.gov, and International Clinical Trials Registry Platform databases from inception onward. Randomized controlled trials that examined the efficacy of drugs in social cognitive disturbances will be included, based on the most recent studies and the broader literature than previously searched. This protocol defines a priori the methods that will be used for study selection, data collection, quality assessment, and statistical syntheses.DiscussionThe findings this work are expected to help promote the development of better therapeutics of social cognitive impairments in schizophrenia and related psychiatric conditions.Systematic Review Registration[www.crd.york.ac.uk/prospero], identifier [CRD42021293224]. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Psychodramatic Psychotherapy for Schizophrenic IndividualsJohn Nolte, MD, PhD (bio)As a long-time student, practitioner, trainer, author and advocate of J. L. Moreno, MD,’s works and specifically the psychodramatic method, I am always appreciative of efforts, like Chapy’s, to commend and advocate for psychodrama. This is especially so because for a time, Moreno and psychodrama were heavily criticized, even maligned in the mental health professions. At the same time, considering how (...) poorly Moreno and his methods have been understood as well as the difficulty of accessing his original material, I feel an obligation to set the record straight when confronted with incomplete, inadequate, or sometimes incompetent expositions of Moreno’s psychodrama.Chapy’s article recommends psychodrama as a treatment method for schizophrenic people by calling upon existentialist and phenomenological concepts. Psychodrama, he proposes, opens up existence by allowing “schizophrenic patients to incorporate the experience of an ‘absolutely other.’”There are major flaws in Chapy’s presentation. His “clinical illustration,” the presentation of a psychodrama with a schizophrenic patient, while it may be considered psychodrama under the broadest definition of the term, hardly fulfills the requirements of a psychotherapeutic psychodrama. We must question the competence of the psychodramatist in Chapy’s example. Chapy’s description of the drama itself falls short of being an adequate account of a psychodrama, failing to convey the emotional intensity and realness which a well directed and reported psychodrama achieves. We do not learn, for example, if Damien’s perception of his father is introduced through role reversal with the father, a standard psychodramatic technique which is done in order to give the auxiliary ego taking that role an understanding how Damien experiences his father. We do not know if role reversals are made throughout the drama so that Damien can experience how he is perceived by father, can feel the force of his confrontation in the role of father, and is required to reply as his father to his confrontation. We are given little information about the psychodramatic techniques employed by the director other than the scene setting of the studio in which the psychodramatic [End Page 227] encounter takes place, and the soliloquy in which Damien expresses his worry and hopes for the outcome of the confrontation. It should be clear in the description of the drama whether the father’s statements in the drama were produced by Damien in role reversal, or by the auxiliary ego playing the role. There is a difference and it is significant. Although we are told that Damien “evokes a systematic relationship between him and his father” during the psychodrama, we do not see how this happens. Every psychodrama is an existential experience and its description should fully communicate its meaning and emotion.A more serious problem, however, is that this drama does not deal with Damien’s psychosis. Although Damien may be diagnosed as schizophrenic, his disorder is obviously in remission or controlled by psychotropic drugs. The drama reveals none of the hallucinations, delusions, or disorder characteristic of schizophrenic disorders. It could be psychodrama of any young man with a complaint about his father.The notion that people with schizophrenia can be successfully treated by psychodrama is not new. Moreno began developing psychodramatic psychotherapy at his Beacon Hill Sanitarium, established in 1936. He and psychodrama gained some fame because of his success in treating schizophrenic patients at a time when schizophrenic individuals were considered incapable of benefitting from psychotherapy. Moreno’s approach to the treatment of schizophrenic patients was much more robust than the psychodrama described by Chapy. During a psychotic attack, the individual’s perception of the world and self are distorted in ways that made action and interaction in the world of conventional reality impossible. Additionally, the psychotic episode makes the psychotic person incapable of being comprehended by anyone else, including the psychiatrist. Moreno’s solution was to make the chaotic, bewildering, sometimes violent and always terrifying inner world visible and tangible in the surplus reality of the psychodramatic stage. In moments of lucidity following the psychotic episode, he asked his schizophrenic patients to reenact their psychotic experiences. The result was that, “In this imaginary reality on the psychodramatic stage, the... (shrink)

Antipsychotic medications are sometimes imposed on psychiatric patients deemed dangerous to themselves and others. This is based on the assumption that treatment is safe and effective, and that recovery depends on biological adjustment. Under new laws, patients can be required to remain on these medications after leaving hospitals. However, survivors attest that forced treatment used as a restraint can feel like torture, while the consequences of withdrawal can also be severe.

IntroductionWe aimed to study post-traumatic stress disorder symptoms in breast cancer patients during the coronavirus disease pandemic.Materials and methodsWe included BC patients receiving medical treatment during the first COVID-19 lockdown in France. PTSD symptoms were evaluated using the Impact of Event Scale-Revised questionnaire. Quality of life [Functional Assessment of Cancer Therapy-General ], cognitive complaints [Functional Assessment of Cancer Therapy–Cognitive Function ], insomnia [Insomnia Severity Index ], and psychosocial experiences during lockdown were also evaluated. Multivariable logistic regression was used to identify (...) clinical factors and psychosocial factors associated with PTSD symptoms.ResultsAmong the 253 included BC patients, 46% had metastatic cancer and 52% were treated by chemotherapy alone. COVID-19-induced adjustments in medical oncology practices were experienced by 27% of patients. No case of COVID-19 was reported; 23% of BC patients had PTSD symptoms. Compared to other patients, patients with PTSD symptoms had more fears relative to COVID-19 infection, had more feeling of isolation, and had more prescription or increased use of psychotropic drugs. In the multivariable model adjusted for clinical factors, fears relative to COVID-19 and increased use of psychotropic drugs were independently associated with PTSD symptoms. Besides, patients with PTSD symptoms had poor quality of life, and more cognitive complaints and insomnia.ConclusionPost-traumatic stress disorder symptoms were observed in 23% of BC patients during the first COVID-19 lockdown in France. Psychological supports are needed for patients treated during the COVID-19 pandemic. (shrink)

In his "Let the drugs lead the way! On the unfolding of a research program in psychiatry," Shai Mulinari nicely lays out the evolution of theories of depression since the late 1950s; that is, understanding depression as ultimately a brain disorder centering on the functioning of monoamine neurotransmitters. Moreover, the emergence of various psychotropic drug treatments have provided researchers with a "pharmacological bridge" to gain a more precise understanding of depression by observing the effects of these drugs (...) on patients' monoamines and mood. This evolution, Mulinari argues, fits Imre Lakatos's concept of a research program. Mulinari's narrative is clear, compelling, and informative and it generates some... (shrink)