Psychiatric Misdiagnosis Due To Cultural Differences

As seen in this recent article at Philly.com

[...]

Interpreting language is complex, and many things can get in the way of effective communications, says Price-Wise. First, many people don’t know much about physiology and anatomy. It’s difficult to communicate what’s not well understood by the patient or interpreter. Second, the interpreter must be able to remember what the patient said, and the patient may have taken quite a bit of time to describe his or her problems. Third, the interpreter may give a summary of what he or she thought was important and, unwittingly, leave out clinically-relevant information; alternatively, the interpreter may decide not to relay information, because it’s embarrassing, or the interpreter may not relay information from the doctor to the patient to avoid upsetting the patient. Untrained interpreters may also add their own opinions. These errors and omissions can impact a diagnosis or treatment plan, Price-Wise notes. Trained interpreters, on the other hand, have the same conversation as if they spoke the same language, Price-Wise says.

Further complicating communications are false cognates, words that sound alike in two languages but have different meanings. For example, “embarrasada” in Spanish means pregnant, not “embarrassed.”

Price-Wise also broached a case in which a teenager who arrived in the emergency room was treated for a drug overdose, because his family believed he had food poisoning, “intoxicado,” in Spanish. In fact, he had a brain hemorrhage that was overlooked as a result of the misinterpretation of a word that sounded like “intoxicated.” He was left a quadriplegic.

[...]

“Our work suggests that, in African Americans compared with both Latino and non-Latino whites, clinicians excessively weight psychotic symptoms…in African-Americans as the expense of mood and anxiety symptoms during clinical assessments, leading to an erroneous conclusion of schizophrenia in the former,” says Stephen M. Strakowski, a professor of psychiatry and behavioral neuroscience, psychology, and biomedical engineering at the University of Cincinnati College of Medicine.

Strakowski points out that hallucinations, delusions, and thought disorders are not disease specific. They can occur as a result of a brain tumor, stroke, or infection, among other non-psychiatric conditions, or drug abuse, depression, post traumatic stress disorder (PTSD), bipolar disorder, or schizophrenia, among others.

“Schizophrenia is not supposed to be diagnosed until other causes of psychosis are ruled out,” Strakowski says.

Strakowski says the reasons for the overweighting are not known, but he thinks it could be that clinicians are misinterpreting distrust of doctors among African Americans as paranoia, or clinicians may be missing the symptoms of PTSD, which, Strakowski says, can mimic psychotic symptoms. He also thinks it’s possible that it could result from a delay among African Americans in getting treatment so that they are more ill on presentation. Or, it may be due to a failure among clinicians to understand the cultural differences in idioms of distress with regard to mood symptoms.

[...]

The Top Ten Reasons Psychiatrists Get Sued

This is the text of a paper/talk presented at a conference on medical malpractice in Texas in 1993, and is focused on Texas Law.

How I Decided to Sue You: Misadventures in Psychiatry

It is an interesting read, but is 24 pages long, including cover sheet, etc.

As a quick summary, The top ten reasons psychiatrists get sued are

A. Failure to Prevent Suicides or Self Inflicted Injuries
B. Sex with the Sick
C. Informed Consent (or lack thereof)
D. Inappropriate Administration of Electro Convulsive Therapy
E. Inappropriate Use or Non Use of Physical or Chemical Restraints
F. Liability for Locking Them Up
G. Injuries Resulting from Escapes or Elopements
H. Medication Errors
I. Failure to Diagnose Intracranial Lesions
J. the Psychiatrist Duty to Warn Third Persons

Overall, an interesting read. This is a PDF Document

Brain scan studies busted by statistics

As seen in New Scientist, regarding a paper published in Nature NueroScience

There is fresh evidence that the budding field of social neuroscience is producing misleading results because of statistical methods often used to analyse brain scans.

In January, Hal Pashler of the University of California, Davis, and colleagues, sparked controversy when they criticised the statistical methods used by a clutch of high-profile research teams to link brain activity to emotions. They said the teams' results could be inflated because random noise was not properly accounted for.

Now Nikolaus Kriegeskorte of the National Institute of Mental Health in Bethesda, Maryland, and his colleagues report that of more than 100 brain-imaging papers in five top journals that they looked at, 40 per cent use similar methods (Nature Neuroscience, DOI: 10.1038/nn.2303).

Russell Poldrack of the University of California, Los Angeles, says the latest study "will drive more people to take the problem seriously".

We monitor all this with a mildly skeptical eye.

Psychiatrist faces review in wake of massacre - Hearing to decide competency of Toronto doctor who treated man who killed his wife and children

As seen in the Globe and Mail. Edited for Space

The competency of a Toronto psychiatrist who was treating Chau Huc Minh at the time he massacred his family in 2006 is under scrutiny by the College of Physicians and Surgeons of Ontario.

The College has scheduled a hearing to determine whether the psychiatrist - Dr. Hung-Tat Lo - is competent to continue practising in light of his actions in the Chau case and 15 other unspecified cases.

The main complaint behind the hearing appears to be one lodged last year by Mr. Chau's sister, Jenny Chu. Ms. Chu alleged that Dr. Lo refused her plea to have Mr. Chau sent to a hospital for an assessment and possible treatment on Jan. 6, 2006. Five weeks later - on Feb. 9, 2006 - Mr. Chau used a meat cleaver to inflict fatal injuries on his wife, Shao-Fang, his three-year-old daughter, Vivian, and his five-month-old baby, Ivan.

A CPSO document states that its disciplines committee will decide whether Dr. Lo "failed to maintain the standard of practice and is incompetent in his care and treatment - including, but not limited to - his assessments, diagnoses, treatment and record-keeping, of 15 patients whose identities have been made known to Dr. Lo, between about July, 1983, and July, 2007."

It said the probe will also consider whether Dr. Lo displayed "a lack of knowledge, skill or judgment or disregard for the welfare of his patients of a nature," to the point that his practice should be restricted or terminated.

In the meantime, Dr. Lo has been told to submit sample medical charts and other patient information at least once every two weeks to a doctor appointed by the College to monitor his work.

CPSO spokesman Jill Hefley said in an interview yesterday that a complaint is referred to a disciplines hearing only if there has been a determination that "reasonable and probable cause" exists to believe it may be well founded.

Ms. Chu complained that she told Dr. Lo that her brother's behaviour had grown alarmingly erratic. "I was concerned that he might hurt his two young kids and wife" she said in her complaint. "Therefore, I urged Dr. Lo to send him to hospital with detailed descriptions of his strange behaviour."

[...]

Upon leaving Dr. Lo's clinic that day - Jan. 6, 2006 - Ms. Chu claimed that she tried to coax her brother to go straight to the hospital. She said that Mr. Chau became furious, and said: "Even Dr. Lo said that I was okay. Why must you make me go to a hospital?"

Mr. Chau was found not criminally responsible in the killings earlier this week by a Toronto judge.

According to a transcript from Mr. Chau's 2007 preliminary hearing, Dr. Lo denied that Ms. Chu asked him to admit her brother to hospital at the Jan. 6, 2006, meeting. Dr. Lo acknowledged that he saw Mr. Chau for just 140 minutes during the 12 years that he treated him. However, Dr. Lo, who stated he sees 15-20 patients a day, said that he didn't see it as necessary to spend more time with Mr. Chau.

Dr. Lo's office was closed this week, and he did not return telephone messages.

Peter Lindsay, Mr. Chau's defence lawyer, expressed misgivings yesterday about the quality of care his client was given. "The compelling story here is that Dr. Lo sees him so little. If you do the math, he saw him for just over 11 minutes a year. I'm not a doctor, but I think that's far short of what he should be seeing this guy."

[...]

Other victim

Chau Huc Minh was not the first of psychiatrist Hung-Tat Lo's mentally ill patients to explode into violence.

In 2004, two years before Mr. Chau's killing rampage, a 36-year-old Chinese immigrant, Xuan Peng, drowned her four-year-old, autistic baby in a bathtub at her Scarborough home.

She had been under Dr. Lo's care at the time.

According to a 2005 bail ruling that freed Ms. Peng pending her first-degree murder trial, Dr. Lo was treating her for a bipolar disorder at the time that her daughter, Scarlett, drowned.

The presiding judge at the bail hearing was Ontario Superior Court Judge David McCombs.

He was persuaded to grant Ms. Peng bail partly based on testimony from Dr. Lo, who said that she was capable of being managed in the community and agreed to supervise her treatment.

[...]

Police arrested Ms. Peng seven months after Scarlett's death. Last March, she was found guilty of second-degree murder, notwithstanding her history of mental illness.

Psychiatric Ward video shows no one helped dying woman

A report out of Brooklyn from the NY Daily News, we also have the video in question at the bottom of this report

A shocking video shows a woman dying on the floor in the psych ward at Kings County Hospital, while people around her, including a security guard, did nothing to help.

After an hour, another mental patient finally got the attention of the indifferent hospital workers, according to the tape, obtained by the Daily News.

Worse still, the surveillance tape suggests hospital staff may have falsified medical charts to cover the utter lack of treatment provided Esmin Green before she died.

"Thank God for the videotape because no one would have believed this could have happened," said Donna Lieberman, executive director of the New York Civil Liberties Union.

"There's a clear possibility of criminal wrongdoing with regard to recordkeeping, and that has to be investigated."

The city Department of Investigation is part of a sweeping probe that has brought some changes to the ward known as G Building.

A federal suit filed last year in Brooklyn alleged neglect and abuse of mental patients at the hospital. The suit sparked an investigation by the Brooklyn U.S. attorney's civil rights unit before the June 19 death.

Two different security guards spotted Green, a native of the island of Jamaica, prone on the floor and did nothing, the tape shows. They have been fired, along with four other staffers.

Green, 49, taken to the unit for "agitation," keels over out of her chair at 5:32a.m., according to the time stamp on the video. She had been sitting about 3feet from an observation window. Two other patients were in the room.

Green is lying facedown on the floor, her legs splayed, when a security guard strolls by at 5:53 a.m., looks at her for about 20 seconds and then walks away.

She is writhing on the floor, thrashing her legs, about 6 a.m., when her medical chart contends she was "awake, up and about, went to the bathroom."

Green rolls on her back at 6:04a.m. She stops moving at 6:08 a.m., but two minutes later a security guard pushed his chair into camera view.

He never gets out of the chair, but looks at Green and scoots away. A female patient who was in and out of the room finally brings a clinic staffer to check the woman and a crash cart is summoned.

The medical chart claims she was "sitting quietly in [the] waiting room" at 6:20 a.m., although she was already dead. The cause of death is still under investigation.

"We are shocked and distressed by this situation," the Health and Hospitals Corp. said in a statement.

and of course we have the video:

New York psychiatrist settles malpractice lawsuit

As reported in News Day

A former psychiatrist who confided to a patient that he wanted to kill six people, and asked the patient to help him find a handgun, has settled a medical malpractice lawsuit with the man.

Richard Karpf agreed to pay $365,000 to Dennis White, a former patient who called police in January 2003 telling them of Karpf's intentions. The settlement came Monday, while a Nassau County jury was in its second day of deliberations in the civil lawsuit.

Karpf was arrested after purchasing a pistol and silencer from someone who turned out to be an undercover officer. He pleaded guilty in 2004 to illegal weapon possession and was sentenced to three months in jail. He remains on probation through next year.

Attorneys for both sides said they were satisfied with the settlement.

New And Improved Drugs? No Thanks

As seen on CNN Money

New York psychiatrist Jeffrey Lieberman has heard Johnson & Johnson's (JNJ) sales pitch for the new anti-schizophrenia drug Invega, but he's not too impressed.

Problem is, Invega isn't much different than one of J&J's best-selling drugs, the antipsychotic Risperdal. In late June, Risperdal is scheduled to lose its U.S. patent protection, clearing the way for competing generic copies that are cheaper than Invega, which could further diminish Invega sales, already characterized as a disappointment by J&J.

"I don't think they have a strong case to make," says Lieberman, chairman of the psychiatry department at Columbia University's medical school. "It's basically a me-too drug, and the company hasn't done the studies that would be required to really distinguish it."

Lieberman's skepticism is shared by health insurers and points to a rising challenge for drug makers: a tougher market for so-called follow-on drugs. As a result, some companies - including Wyeth (WYE) and Shire PLC (SHPGY) - are setting prices lower or emphasizing improved dosing for the newer drugs to help overcome any skepticism that they're not much more effective than the older drugs set to lose patent protection.

The growing disdain for follow-on drugs also should reinforce the need for drug makers to come up with truly innovative products, not just marginally better ones, industry watchers say.

Drug companies have used follow-on drugs to try to offset some of the revenue lost when older, top-selling drugs lose patent protection and become exposed to generic knockoffs. The goal is to convince patients, doctors and drug plans to switch to the newer drug that carries a brand-name price and patent protection for years.

A successful example was AstraZeneca PLC's (AZN) promotion of the Nexium heartburn pill when its older drug, Prilosec, became exposed to U.S. generic competition in 2002. Nexium went on to become a huge blockbuster despite being chemically similar to Prilosec, which became available as both a cheaper generic and over-the-counter product.

Such tactics, however, might not work as well in today's environment, in which drug-benefit plans are demanding steeper discounts and pushing use of generic drugs in order to lower costs and bolster profit margins.

"We don't think those opportunities are really going to fly," Deutsche Bank pharmaceutical analyst Barbara Ryan said. "I think managed-care sees them for what they are, extending the franchise."

The skepticism around Invega has contributed to a financial disappointment for J&J. The New Brunswick, N.J., healthcare giant hasn't broken out Invega sales but acknowledges they've been below expectations. Invega's share of U.S. antipsychotic prescriptions was only around 2% for the week ended May 9, according to Verispan, a drug-data marketer. In comparison, Risperdal, which had 2007 sales of more than $4 billion, held a 21% market share.

Insurer Pressure

Some insurers aren't putting certain follow-on drugs on their lists of preferred drugs, or they're requiring members to pay higher out-of-pocket costs for these drugs than for other branded and generics.

"It's a marketing scheme that is not looking at improving healthcare, it's looking at maintaining their revenues coming in," said Mirta Millares, in commenting on the industry's follow-on drug strategy.

Millares is manager of drug information services at Kaiser Permanente, a California health insurer that doesn't include Invega on its list of preferred drugs. The active ingredient of Invega is derived from that of Risperdal, Millares noted, though it was different enough to get a new patent and regulatory approval.

Minneapolis-based UnitedHealth Group Inc. (UNH), the nation's largest health insurer by revenue, has Invega on the "third tier" of its preferred drug list, which means members have to pay higher copays than if they were to use other schizophrenia drugs on the first and second tiers. The insurer deemed Invega clinically similar to other atypical antipsychotics.

Clinical studies supporting Invega's December 2006 Food and Drug Administration approval primarily compared it with a fake drug, or placebo, but not with Risperdal. In 2007, J&J released data showing Invega improved symptoms over AstraZeneca's Seroquel antipsychotic, which is the market leader for U.S. antipsychotic prescriptions. Also, J&J touts Invega's long-acting formulation and once-daily dosing.

J&J says it's not encouraging patients who are stable on Risperdal to switch to Invega. But it had hoped for Invega's performance to be better by now, making Risperdal's loss of U.S. market exclusivity next month less painful. "We need to do a better job at drawing a differentiation in a difficult-to-treat population, " David Norton, J&J's group chairman of pharmaceuticals, said earlier this month.

Norton said J&J should have ensured Invega had more favorable coverage by drug plans at the time of market launch. Still, he noted that new antipsychotics have historically taken a while to gain acceptance.

J&J has said it plans to seek FDA approval for Invega as a treatment for bipolar disorder, which could bolster sales. It also has applied for FDA approval of a long-acting, injectable version of Invega.

New Marketing Strategies

Despite the challenges, drug-company marketing remains a powerful tool, and it might be too early to write off follow-on campaigns such as that for Invega. The real test may come when Risperdal goes off patent, and J&J reduces its active promotion of Risperdal, leaving sales reps to focus on Invega.

"There are plenty of studies showing physicians are susceptible to marketing practices in their prescribing patterns," said Aaron Kesselheim, an instructor in medicine at Harvard Medical School who researches drug marketing. "My perception is that hasn't changed substantially."

A new marketing campaign that might be meeting with more success is underway at Shire, Basingstoke, U.K., which last year began selling a new drug for attention deficit hyperactivity disorder, Vyvanse. Shire's top drug, Adderall XR for ADHD, will face generic competition beginning next year.

So far, Vyvanse has captured about 7% of U.S. ADHD drug prescriptions, according to Verispan, which Chief Executive Matthew Emmens calls good progress. Although Shire recently said it expected 2008 Vyvanse sales to come in at the lower end of its forecast range of $350 million to $400 million, Emmens said in an interview he was confident that Vyvanse's market share will eventually surpass Adderall XR's peak market share of about 26%.

Emmens noted that Vyvanse is a different chemical entity than Adderall XR, and he thinks its pricing is attractive to health insurers. "In a general nature, the market has become more price sensitive in the last 10 years," he said. Not incidentally, in the 1990s, Emmens headed the AstraZeneca partnership with Merck & Co. (MRK) that marketed Prilosec and he was involved in the planning for Nexium's marketing.

The next test of the drug-switch campaign?

Wyeth, Madison, N.J., recently began selling Pristiq, an antidepressant that is chemically similar to Wyeth's older antidepressant Effexor XR, which is expected to face limited generic competition this year. Deutsche Bank's Ryan thinks the odds of Pristiq's success are slim because it appears to offer few benefits beyond those of Effexor.

Wyeth has said Pristiq is effective at treating depression, offers a convenient dose regimen for most patients, and is being priced at a 20% discount to Effexor.

VA faulted in diagnosing suicide candidates, Senators want VA's mental health chief to resign

There are plenty reports on this to choose from. Here's one from the Seattle Post Intelligencer

Sen. Patty Murray, D-Wash., on Tuesday called for the chief mental health official of the U.S. Department of Veterans Affairs to resign, saying he tried to cover up the rising number of veteran suicides.

Murray, the senior member of the Senate Veterans Affairs Committee, said Dr. Ira Katz, the VA's mental health director, deliberately withheld crucial information on the true suicide risk among veterans.

"Dr. Katz's irresponsible actions have been a disservice to our veterans and it is time for him to go," Murray said. "The number one priority of the VA should be caring for our veterans, not covering up the truth."

Murray and other Democratic senators said they were appalled at e-mails showing that Katz and other VA officials tried to conceal the number of suicides by veterans. An e-mail message from Katz revealed at a lawsuit this week starts with "Shh!" and refers to the 12,000 veterans per year who attempt suicide while under department treatment.

"Is this something we should (carefully) address ourselves in some sort of release before someone stumbles on it?" the e-mail asks.

A lawyer for a veterans group showed the e-mail as part of a lawsuit being heard in San Francisco that alleges the VA failed to properly treat thousands of veterans for mental illness.

An e-mail revealed at the trial said an average of 18 military veterans kill themselves each day - and five of them are under VA care when they commit suicide.

"It is completely outrageous that the federal agency charged with helping veterans would instead cover up the hard truth - that more and more Americans coming home after bravely fighting for their country are suffering from mental illnesses and in the most tragic circumstances, committing suicide," said Sen. Tom Harkin, D-Iowa. "Anyone at the VA who is involved in this cover-up should be removed immediately."

Harkin, Murray and Sen. Russ Feingold, D-Wis., introduced legislation Tuesday calling on the VA to track how many veterans die by suicide each year. Currently, VA facilities record the numbers of suicide deaths and attempts in VA facilities - which have increased from 492 in 2000 to 790 in 2007 - but do not record how many veterans overall take their own lives.

The new bill would require the VA to report to Congress within 180 days the number of veterans who have died by suicide since Jan. 1, 1997, and continue reports annually.

"We are looking at a real crisis among our veterans and it is high time the VA recognizes it," said Harkin. "Tracking the number of suicides among our veterans will help us to better understand the true depths of this crisis, so we may ensure we are doing everything we can to address their mental health needs."

A spokesman for the VA declined immediate comment Tuesday.

A government lawyer on Monday urged a judge to dismiss a class-action lawsuit against the VA, saying the agency runs a "world class" medical care system.

Two veterans groups filed suit against a sprawling VA system that handled a record 838,000 claims last year. A federal judge in San Francisco is hearing the case in a two-week, non-jury trial.

The Minnesota Multiphasic Personality Inventory is invalid as forensic lie detector, courts rule

The original Wall Street Journal article on all this can be seen via the WSJ Blog here (here's a snippet)

Today, a WSJ front-pager looks at a psychology test, used increasingly by defendants in personal injury lawsuits, called the Fake Bad Scale. In hundreds of cases, says the story, expert witnesses have testified that the test provided evidence that plaintiffs were lying about their injuries. The test gained credibility recently after being endorsed by the Minnesota Multiphasic Personality Inventory.

But now psychologists and plaintiffs’ lawyers claim that the Fake Bad Scale identifies too many real victims as fakers, known as malingerers, people who exaggerate their symptons to win judgments in court. “Virtually everyone is a malingerer according to this scale,” says a leading critic, James Butcher, a retired University of Minnesota psychologist who has published research faulting the Fake Bad Scale. “This is great for insurance companies, but not great for people.”

We now have an extended article on this mess. As found and reposted from Karen Franklin's Forensic Psychology Blog, linked from the Sentencing Law & Policy blog, with a tip of the hat to one of our readers

Psychology's most widely used personality test, the MMPI, jumped into the national spotlight today in a fascinating David-and-Goliath controversy pitting corporate interests such as Halliburton against the proverbial little guy.

At issue is the "Fake Bad" scale that was incorporated into the Minnesota Multiphasic Personality Inventory last year for use in personal injury litigation. A front-page critique in today's Wall Street Journal includes publication of the items on the contested scale, a test security breach that will no doubt have the publisher seeing red.

Although a majority of forensic neuropsychologists said in a recent survey that they use the scale, critics say it brands too many people - especially women - as liars. Research finding an unacceptably large false-positive rate includes a large-scale study by MMPI expert James Butcher, who found that the scale classified high percentages of bonafide psychiatric inpatients as fakers.

One possible reason for this is that the scale includes many items that people with true pain or trauma-induced disorders might endorse, such as "My sleep is fitful and disturbed" and "I have nightmares every few nights." Yet hearing the term "Fake Bad" will likely make a prejudicial impact on jurors even if they hear from opposing experts who say a plaintiff is not faking.

The controversy came to a head last year in two Florida courtrooms, where judges barred use of the scale after special hearings on its scientific validity. In a case being brought against a petroleum company, a judge ruled that there was "no hard medical science to support the use of this scale to predict truthfulness.” Other recent cases in which the scale has been contested include one against Halliburton brought by a former truck driver in Iraq.

The 43-item scale was developed by psychologist Paul Lees-Haley, who works mainly for defendants in personal injury cases and charges $600 an hour for his depositions and court appearances, according to the Journal article. In 1991, he paid to have an article supportive of the scale published in Psychological Reports, which the WSJ describes as "a small Montana-based medical journal."

The scale was not officially incorporated into the MMPI until last year, after a panel of experts convened by the University of Minnesota Press reported that it was supported by a "preponderance of the current literature." Critics maintain that the review process was biased: At least 10 of the 19 studies considered were done by Lees-Haley or other insurance defense psychologists, while 21 other studies – including Butcher's – were allegedly excluded from consideration.

Later last year, the American Psychological Association's committee on disabilities protested to the publisher that the scale had been added to the MMPI prematurely.

Lees-Haley, meanwhile, defends the scale as empirically validated and says criticism is being orchestrated by plaintiff's attorneys such as Dorothy Clay Sims, who has written guides on how to challenge the Fake Bad scale in court.

Even if the scale was valid before today, questions are certain to arise about the extent to which it will remain valid once litigants start studying for it by using today's publication of all 43 items along with the scoring key.

The lesson for forensic practitioners: Be aware of critical literature and controversy surrounding any test that you use in a forensic context, and be prepared to defend your use of the test in court.

The article, "Malingerer Test Roils Personal-Injury Law; 'Fake Bad Scale' Bars Real Victims, Its Critics Contend," which includes ample details on the controversy, is only available to Wall Street Journal subscribers, but you can try retrieving it with a Google news search using the term "MMPI Fake Bad." The University of Minnesota Press webpage on the contested scale is here, along with a list of research citations.

---

Here are citations to the major pro and con research articles:

"Meta-analysis of the MMPI-2 Fake Bad Scale: Utility in forensic practice," Nelson, Nathaniel W., Sweet, Jerry J., & Demakis, George J., Clinical Neuropsychologist, Vol 20(1), Feb 2006, pp. 39-58 (pdf available here)

"The construct validity of the Lees-Haley Fake Bad Scale: Does this measure somatic malingering and feigned emotional distress?: Butcher, James N., Arbisi, Paul A., & Atlis, Mera M., Archives of Clinical Neuropsychology, Vol 18(5), Jul 2003, pp. 473-485. (pdf available here)

The original source of the scale is known, see this item:

Dr. Paul Lees-Haley, a psychologist, who makes his living primarily helping insurance companes in personal injury cases has designed a "Fake Bad Scale" psychological test to challenge personal injury claimants. An article in the March 5, 2008 Wall Street Journal describes how Dr. Lees-Haley developed the test and convinced the Minnesota Multiphasic Personality Inventory, MMPI, to make the Fake Bad Scale an official subset of the MMPI. This Fake Bad Scale has been used by the KBR unit of Halliburton Inc. to deny disability claims of truck drivers who worked in Iraq by labeling them as malingerers.

However, the court in two Tampa, Florida auto personal injury cases has rightly excluded the Fake Bad Scale from the courtroom. The scientific basis of this test has not been properly demonstrated. Furthermore, it has long been the jury's job to evaluate the credibility of courtroom witnesses.

Using a psychological test such as the Fake Bad Scale as evidence in a trial invades the proper province and job of the jury to make that evaluation. The use of a lie detector test is not admissible in court for the same reasons.

In essence, Dr. Lees-Haley and the auto insurance companies are attempting to use this Fake Bad Scale as a lie detector test. Our jury system does and should provide justice though jury trials on all the issues, not through a machine or a test designed by an insurance company consultant.

Mental Health Screwup: Girl Must Repeat High School

Another fine example of how the mental health industry keeps screwing things up, this time in the realm of public education. Seems like a typical bureaucratic attitude of typical attitude of "Not Our Fault, Not Our Problem".

From this report from WGCL-TV, CBS 46, Atlanta Georgia.

A Gwinnett County teenager will have to spend another four years in high school while other teens her age go to college, her family said Tuesday.

Daphne and Brian Adams said that several years ago, Gwinnett County schools improperly placed their daughter in classes for the mentally impaired, instead of addressing her language disability.

The school district has told the family that the girl must start over to get a diploma. Her family said their daughter, who is 18, is embarrassed to be in classes with students who are 13 and 14.

“The track that she's on, she's set up to fail,” said Daphne Adams.

Special education attorney Chris Vance said Tuesday that the school system should have realized their mistake. Tests have shown that the girl has an average IQ score of 91.

Her parents said they have spent their retirement savings to help their daughter catch up. They said they want Gwinnett County to reimburse them and pay for private schooling until their daughter graduates.

“She wants a real diploma. She doesn't want a piece of paper,” Adams said.

Tuesday, the school district issued this statement: "There are legal constraints on what a school system can say about individual students. That said, we can assure you that processes and procedures are in place to address students' educational needs and placement."

Australian Judge who spoke out against Ritalin kids ordered to shut up

This has the smell of political corruption in the Australian legal system. Report from the Daily Telegraph

The judge who accused doctors of creating a generation of Ritalin kids who become criminals has been gagged in an extraordinary move by the state's Judicial Commission.

An ADHD support group which supports the use of drugs like Ritalin complained to the commission that Judge Paul Conlon had got it wrong, The Daily Telegraph has learned.

Judge Conlon criticised the over-diagnosis of ADHD, the over-use of medication and its effect on children.

Instead of dismissing the complaint, as it does in 75 per cent of cases, the commission referred it to Judge Conlon's boss, District Court Chief Judge Reg Blanch. In such cases, the chief judge is expected to counsel the judge or "make administrative arrangements within his or her court" to make sure it doesn't happen again.

Judge Conlon, a former Crown prosecutor, sparked fresh controversy about the use of Ritalin when he made his comments last year during the sentencing of a 20-year-old man who was prescribed the powerful stimulant at the age of six.

Judge Conlon, who jailed the man for 15 months for assault and an act of indecency, was told by a psychiatrist the man had become addicted to methamphetamine because of his Ritalin use.

At the time, the judge said he had huge concerns because of the "amazing tide" of cases coming before him involving people prescribed Ritalin as children who went on to commit violent crimes.

His remarks led to a review of the treatment of ADHD in NSW, which earlier this month reported that it had found no overprescribing of drugs.

However, sources say many doctors refused to co-operate with the study, which had no public input.

Three members of the committee have also served as expert advisers to drug companies, including Novartis, which produces Ritalin. The doctors all declared no conflict of interest.

At the same time, a prominent Sydney psychiatrist, Professor Joseph Rey, wrote in the Medical Journal of Australia that doctors should review their patients' need for the medications.

The Loose Screw Awards -- psychology's top 10 misguided ideas.

As seen in Psychology Today.

The mental health fields have, now and then, spawned and nurtured some completely crazy ideas. Physicians in the 18th and 19th centuries, for example, inflicted strange and extremely cruel treatments on their mentally ill patients based on equally bizarre theories of human nature. To try to shock schizophrenics into "regaining consciousness of the true self," for example, doctors bled them until they fainted, or blindfolded them and allowed them to fall through a trapdoor into cold water -- the so-called "Bath of Surprise." It's unlikely that such techniques had any therapeutic value.

Our own era has also produced theories and techniques of dubious worth. In the 1990s, for example, practitioners by the thousands began "facilitating communication" with nonverbal children by strategically guiding their clients' hands over keyboards. Some of these children appeared to claim that they had been sexually abused, and one even wrote a novel this way. A barrage of research soon demonstrated that the technique was nonsense; all of the ideas came from the facilitators, not the children. Unfortunately, no matter how persuasive the evidence, people often cling to bad ideas, including facilitated communication.

Here are 10 faulty concepts from the mental health professions that have yet to disappear. Sometimes their effects have been benign; other times, put into practice, such ideas have harmed many people.

We are providing a quick summation, for the full details, see the full article at the link.

Psychology's top 10 misguided ideas.


1. Projective Tests - Things like the Rorschach test, and Skinner's muffled audio tests with similar results.
2. Recovered Memories - which lead to the recall of hundreds of memories of satanic child sex abuse and other monstrosities which simply did not occur.
3. Correctional Boot Camps for the misbehaving teen
4. The Cult of Self-Esteem - rewards without accomplishment.
5. Codependency, Enabling and Tough Love
6. Mozart Babies - music education for the very young does not make them geniuses.
7. Stages of Dying never was scientifically tested, and many people are unique, any how
8. Rebirthing Therapy which led to the deaths of a few innocents.
9. Adolescent Angst - the trauma of growing up
10. Catharsis - rebirthing therapy for all the other traumas of your life, stirring up much, accomplishing nothing.

As with every thing, there is probably a kernel of truth that inspired each of these, but the kernel was so buried by the time they got rolling, nothing good came out of these efforts.

Outrage over psychiatric patient's files mix-up

From the Australian Herald Sun

Geelong Hospital is under investigation after sending a psychiatric patient's confidential medical records to the wrong person.

The documents -- wrongly included in a Freedom of Information response provided to another mental health patient -- detail extremely sensitive medical records of a woman with schizophrenia living in the same region.

Privacy Victoria and the Victorian Ombudsman have been notified of the breach and Health Services Commissioner Beth Wilson has confirmed she is investigating an incident of psychiatric records going to the wrong person.

But the woman who received the files said she was outraged by the careless record-keeping and worried her records could fall into the wrong hands.

She has visited the patient named in the files to inform her of the incident and both have lodged complaints with authorities.

The Herald Sun will not reveal their names to protect their privacy.

"I can't trust the system," the woman who received the files said. "I have no confidence in a system that dismisses this as a filing error and vague assurances that something will be done about this."

The woman placed a Freedom of Information request with Barwon Health to gain access to her psychiatric records.

She was shocked when she received five pages about the second woman, including details of an examination by a psychiatrist, an Involuntary Treatment Order, a Community Treatment Order and a treatment plan.

The documents detailed a diagnosis of schizophrenia, that the woman has a history of psychosis and does not believe she has a mental illness, suffers hallucinations and hyper religiosity.

The pages also had the name of the woman's psychiatrist, case manager and register.

The papers were returned to the hospital last Friday.

Ms Wilson said complaints about medical records being sent to the wrong person were rare but must be taken very seriously.

"Psychiatric records are particularly sensitive because of the propensity for misuse and discrimination," she said.

"This is one of the reasons why we have health-specific privacy legislation in Victoria."

Mental health charity SANE Australia's deputy director Paul Morgan said the Geelong case was "mind-boggling irresponsible incompetence" and health services needed to better protect patients.

"It doesn't matter if someone had schizophrenia or prostate cancer or anything else," he said.

"It is very private information and when people are handling files they need to understand that the whole person's life is documented there and it needs treating with respect.

"It's not enough for the response to be, 'Sorry, and we won't do it again'. There need to be systemic steps to make damn sure this doesn't happen again.

"If something is being sent out FoI there needs to be somebody going through every page to make sure there is not misfiling."

APA Fellow And President Of Arizona Psychiatric Society Gets Slap On Wrist For Patient Death

The following case was brought to our attention via email, with valuable links to internet references

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APA Fellow And President Of Arizona Psychiatric Society Gets Slap On Wrist For Patient Death

On December 16, 2007 the Arizona Medical Board reprimanded psychiatrist Stephen O. Morris for failure to diagnose and monitor a patient considered to be high risk for drug abuse; for inappropriate prescribing and for inadequate medical records.

Board documents allege that Dr. Morris’ “inappropriate and excessive prescribing” contributed to a 56-year-old patient’s overdose death.

Specifically, the documents state that Dr. Morris, who is a Fellow of the American Psychiatric Association and President of the Arizona Psychiatric Society, “prescribed multiple psychoactive prescriptions often in higher than standard practice doses”; “wrote multiple prescriptions for the same class of medication”; “prescribed methyphenidate [Ritalin] for several months with a higher than necessary number of pills” and “wrote prescriptions too close together in time, indicating over-use or abuse.”

Further, Dr. Morris prescribed both a tricyclic (older generation) antidepressant concurrent with an SSRI (new generation) antidepressant whose interaction results in symptoms of “serotonin syndrome,” exhibited by increasing bodily tremors.

The Board charged Dr. Morris with deviation from the standard of care for failing to have the patient’s tricyclic blood levels monitored while concurrently on an SSRI and for prescribing a large quantity of tricyclic antidepressants and Ritalin to a patient who was a known overdose risk.

It lastly cites that Dr. Morris’ records contain no rationale for the high doses of potentially dangerous drugs he prescribed to the patient, why certain medications or types or combinations were used.

The Board found that his records failed to support diagnosis, justify treatment, accurately document results, indicate advice/cautionary warnings to the patient or provide sufficient information for another practitioner to assume continuity of the patient’s care.

Here is a link to the original Arizona Medical Board Finding

It looks like Psychiatrist Stephen Morris has not suffered any loss in professional status despite the death of his patient.

Judge slams psychologist’s evidence for being out of touch with reality.

Another psychologist who seems to be in a world all their own. Report from South Africa.

A judge trashed the testimony of a psychologist during pre-sentencing evidence of a man convicted of murdering a former senior official in the Premier’s office.

Judge Yusuf Ebrahim lashed out at East London-based psychologist Luyanda Mapekula in the Bhisho High Court yesterday for failing to read his judgment.

Mapekula was testifying during mitigation of sentence of Bonisile Grey, convicted last year of the premeditated murder of Siphiwe Mgoduso. Mgoduso was stabbed at a family member’s funeral in Mdantsane in July 2005.

Ebrahim said he was trying to establish the actual status of Grey’s mental condition after Mapekula testified his “psychology” had diminished prior, during and after the incident. “All I have been asking since (Tuesday) is (whether) the accused is suffering from mental illness or defect,” said Ebrahim.

Mapekula replied that Grey was under severe stress and depressed because of the disintegration of his family. “It is my view that his psychological state was compromised ... there should have been intervention in the form of psychiatric evaluation to return him into a normal state.”


Ebrahim said he could not understand why Mapekula was giving the court such an assessment because it did not seem to link with Grey’s argument that he acted in self-defence.

“Did you read the court’s judgment? Because you are relying on the accused’s version, which by the way this court has rejected. I have difficulty with the way you are speculating about (his mental state). You are acting solely on what the accused has told you.

“You have not read the court judgment and what other witnesses have told the court about the events that happened on the day.”

Mapekula admitted to Ebrahim that she did not interview Qaga – whom Grey regards as his wife – because the psychologist thought she would be hostile.

Sentencing will resume today.

Hartford Hospital On Probation, - Problems include a variety of psychiatric abuses.

We highlight the deficiencies in the psychiatric departments, but it sounds like the whole place is a mess. From the Hartford Courant

Citing multiple lapses in patient care — including four cases in which patients died — the state health department placed Hartford Hospital on probation Friday, demanding sweeping changes in the way the 800-bed teaching hospital delivers care.

"Frankly, we thought we were doing a better job than is identified in the report," said John Meehan, president and chief executive officer of the hospital.

[...]

The disciplinary action — one of the most serious the state can impose — grew out of an investigation that started after the health department received at least 28 complaints from dissatisfied patients or families from 2005 to 2007.

[...]

The fourth death was that of Marcia Maglisco, a Newington grandmother who was taken to Hartford Hospital in October 2007 after her grandson was found dead in a bathtub while she was caring for him.

Although Maglisco was distraught and spoke about suicide, she was discharged from the emergency room several hours after police brought her in. A psychiatrist told her to return to the hospital if she had further problems,the state report says. There was no written documentation of further follow-up instructions.

Maglisco hanged herself in her home a short time later.

[...]

A nurse slapped a distraught psychiatric patient in the face after the patient spit at the nurse, the state says. A psychiatric technician who was punched by a patient retaliated by punching the patient back multiple times.

The report also details deficiencies in the buildings at Hartford Hospital's psychiatric facility, the Institute of Living, that made it possible for patients there to attempt suicide. One patient tried to kill himself by hanging himself from a bedsheet attached to a closet door hinge.

[...]

Complaints on the rise against psychiatrists and other doctors

We would like to see a breakdown of the complaint statistics by specialty. There is evidence supporting the notion that there are more sexual misconduct complaints against psychiatrists, for example. A report from Victoria, Australia

Formal complaints about Victorian doctors have jumped significantly, and the number deemed unfit to practice due to serious health issues has also risen, a report has revealed.

A psychiatrist who had sex with two vulnerable patients and a doctor who prescribed illegal levels of morphine were among those to be struck off for serious misconduct.

Figures tabled in State Parliament show there was a 9% jump in professional conduct complaints to the Medical Practitioners Board — from 582 in 2006 to 633 last year.

And 70 doctors were investigated over serious health concerns such as psychiatric illness or drug and alcohol abuse — up from 59 the previous year.

A doctor who made sexual advances to a teenage patient he was counselling for a serious eating disorder was allowed to keep his licence. And a GP who sexually harassed a staff member, putting his hand down her jumper to touch her breast, also escaped with a reprimand.

In a tragic case at the Royal Children's Hospital, a trainee doctor gave a four-week old baby 10 times the appropriate concentration of glucose in a drip, causing irreversible brain damage. The board allowed her to continue practising and ordered her to undergo counselling, feeling she was "genuinely remorseful."

In 16 cases finalised at formal hearings, 15 doctors were found to have engaged in serious professional misconduct. Four were struck off, one had their licence suspended and 10 were either cautioned, reprimanded or ordered to undergo counselling.

The board president, Dr Joanna Flynn, said the rise in complaints was consistent with national and international trends. "It is not unexpected and may reflect gradual awareness within the community of the board and its role in protecting the public," she said.

Psychologist's Book Slammed on Amazon After Fox News Debacle

As Reported on Gaming Daily

Syndicated radio talk-show host and psychologist Cooper Lawrence is now getting a taste of the gaming and Internet community following her appearance on Fox News in which she criticized Mass Effect (a game she never played) and appeared to talk in an almost condescending tone to GameTrailers' Geoff Keighley (who was barely given the time of day to defend the game).

In the past few days Lawrence's book The Cult of Perfection: Making Peace with Your Inner Overachiever has been slammed with negative reviews on Amazon.com as backlash for her comments on Mass Effect. As of press time, out of 565 reviews 503 are 1-star and 48 are 2-star. Only 12 people have rated her book with a 5-star review.

Moreover, the tags customers associated with the product were telling: ignorant (350), hypocrisy (286), garbage (284), hypocrite (267), junk (264), hack (254), terrible (231), bigot (217), bigoted (197), bias (168).

Yesterday Electronic Arts (owner of Mass Effect developer BioWare) sent a letter to Fox News requesting a correction.

Oprah’s reportedly furious with Dr. Phil

Report from MSNBC

The fallout from Dr. Phil McGraw’s controversial meeting with pop wreck Britney Spears just keeps on coming. Now it’s not just Brit’s parents and mental health professionals giving the good doc a hard time. Queen of Talk Oprah Winfrey has had it with her tell-it-like-it-is protégé, reports the National Enquirer.

“Oprah is furious,” an insider told the magazine. “She expected Phil to apologize before the situation got out of hand. Instead he used the spotlight to tout his struggling talk show. … Oprah thinks he has completely lost his sense of right and wrong.”

No stranger to her own scandals, Oprah’s upset about how Phil’s handled his public embarrassment. “Oprah has made mistakes but the difference is that she’s known when to step back and apologize,” a friend revealed. “She feels Phil should have done that when he had the chance. … He betrayed her trust.”

A show source told the Enquirer that Oprah warned Phil before, and her angry reaction was “coming for a long time.” Seems the two talk titans clashed over several issues in the past. In 2005, Phil “threw a hissy fit” when Oprah’s close pal Maria Shriver failed to wrangle hubby Arnold Schwarzenegger to introduce him at an obesity conference. He also earned O’s ire after his “Shape Up!” diet products failed to deliver and later led to a $10.5 million settlement.

Phil may have his own show, but getting on Oprah’s bad side caries a hefty price. “Phil got a whopping $75 million deal, but Oprah is still his boss,” another close source explained. “She even has control of what time slots he’s in. If she doesn’t want him around, she can make him disappear.”

Psychiatrist Fired after Death of Patient

A psychiatrist has been implicated and disciplined in the the death of a wounded veteran under going treatment at Fort Knox, Kentucky. The family is understandably upse and demanding investigations, etc. From the Courier journal in Louisville, Kentucky

A psychiatrist who treated Sgt. Gerald Cassidy, the wounded Iraq veteran from Indiana found dead in his Fort Knox barracks, has been "relieved of his duties," a spokesman for U.S. Sen. Evan Bayh said yesterday.

Bayh press secretary Jonathan Swain identified the psychiatrist as Dr. William Kearney.

The civilian doctor, contracted by the Army, is the fourth person to face job action in connection with the Sept. 21 death. Three soldiers in Cassidy's chain of command have already lost their posts.

Bayh, an Indiana Democrat, has linked the Westfield man's death to inadequate staffing and problems with care at the Fort Knox Warrior Transition Unit, which opened in June and is devoted to healing the wounds of war.

"The fact that (Kearney) has been relieved of his duties confirms the validity of the questions Sen. Bayh and the family have been asking," Swain said.

Although the Army is still investigating the death and its cause, preliminary reports show that the brain-injured National Guardsman may have been unconscious for days and dead for hours before someone checked on him.

Cassidy left a wife, a 5-year-old daughter and a 3-year-old son.

"This was a beautiful young man who did nothing wrong," said Cassidy's mother, Kay McMullen of Carmel, Ind.

She declined to comment specifically on the psychiatrist, but said: "The Army killed him with incompetent care."

Bayh is seeking clarification from the Army about whether Kearney's departure is temporary or permanent, and Kearney could not be reached for comment.

Constance Shaffery, public affairs officer at Fort Knox, confirmed that the psychiatrist is no longer working at Ireland Army Community Hospital but would not comment further, saying it is a personnel matter.

She also confirmed that representatives of Sens. Barbara Boxer of California and Joe Lieberman of Connecticut were on the base yesterday, although she said "it isn't primarily about Sgt. Cassidy."

"Staffers from the offices of Senators Lieberman and Boxer came to Fort Knox as one in a series of visits to Army installations to look at mental health care and Warrior Transition Units throughout the Army," Shaffery said. "Our elected officials often send staffers to visit Fort Knox and other Army posts to learn more (about) the Army and our missions."

Lieberman is a member of the Senate Armed Services Committee and Boxer has been working with other senators to examine mental health care for service members returning from Iraq and Afghanistan.

Natalie Ravitz, Boxer's communications director, said the visit is part of a series of planned visits to bases nationwide, "but Sgt. Cassidy's death did prompt our staff to move up their visit to Fort Knox.

"One of the issues Senators Boxer and Lieberman have been looking at closely is treatment for Traumatic Brain Injury and PTSD," Ravitz said.

Cassidy, 32, suffered brain injuries in a roadside blast in Iraq and was assigned to one of 35 transition units that were created after The Washington Post revealed substandard outpatient care at Walter Reed Army Medical Center.

Bayh said Cassidy received "substandard care" at Fort Knox and tried unsuccessfully for five months to get transferred to a specialized private facility in Indianapolis that could deal with his condition.

[...]

McMullen's voice broke with emotion as she said she hopes Bayh's efforts prevent other families from suffering like hers.

"I think things have gotten better" at Fort Knox, she said. "But I think they've got a long way to go."