California Lawmakers blast overuse of psychiatric drugs on foster kids

from this report in the Tribune in San Luis Obispo

California lawmakers on Tuesday blasted the overuse of psychiatric drugs on the state's foster children and pledged to improve the lives of thousands of vulnerable teens after more than a decade of government inaction.

"We can't let another decade go by without creating a system of care, a system of care that is capable of helping kids heal from the challenging experiences they have lived through or protecting them from further harm," said Sen. Mike McGuire, D-Healdsburg, in opening a joint Senate Human Services Committee and Senate Select Committee on Mental Health.

Advocates said the state's foster children are being prescribed psychiatric drugs at three times the rate of other youth. Since 2006, the use rate of psychotropic medications has nearly doubled, McGuire said. He noted that it's costing taxpayers millions of dollars through the state's low-income health program Medi-Cal.

Iris Hoffman, a member of the California Youth Connection in Sonoma County, told lawmakers how she spent her childhood in juvenile homes, group homes and treatment centers while heavily medicated on the anti-psychotic drugs Abilify and Seroquel. She and other foster children were fearful of retribution if they refused drugs that made them drowsy in class, Hoffman said.

"When you're in those situations, there's all kinds of punishments and things you have to be fearful of if you are to refuse medications prescribed to you by a psychiatrist that only meets with you for an hour a month," she said.

Democratic lawmakers are proposing several pieces of legislation to improve oversight after an investigation by the Bay Area News Group found that thousands of vulnerable teens in foster care are being prescribed antipsychotics that could trigger diabetes, tics, weight gain and drowsiness.

Sen. Jim Beall, D-San Jose, said Tuesday that the hearing at the Capitol is only a step in determining whether the drugs are being administered as part of a therapeutic regimen or "being used as a chemical straitjacket solely to control their behavior."

Beall and Sen. Holly Mitchell, D-Los Angeles, have proposed SB238, which would alert caretakers when drugs are overprescribed and warn of dangerous drug interactions.

Beall also plans to introduce two other bills — one calling for public health nurses to oversee the medical monitoring of children's medication, and the other to establish treatment protocols and oversight in group homes.

Lawmakers on Tuesday heard from medical professionals, child welfare directors, family service advocates, foster youth and officials from California's health and social services agencies.

The use of psychiatric drugs has increased even though the state's foster care population has dropped. As a result of reforms that emphasize keeping children with their families whenever possible, the number of children in foster care has dropped from 103,000 in 2000 to about 55,000 in 2013.

Lawmakers say nearly a quarter of adolescents in California's foster care youth system are prescribed powerful psychotropic drugs. According to the National Center for Youth Law with data provided by the state, 36 percent of them are taking multiple medications that carry harmful side effects.

Antipsychotics, antidepressants, ADHD drugs, anti-anxiety medications and mood stabilizers are some of the psychotropic drugs.

Judge: State of Alaska can't hold foster kids at mental hospital for indefinite stretches

From a report in the Alaska Dispatch News

More details at the link

Facing allegations that it improperly warehoused foster children at North Star psychiatric hospital in Anchorage, the Alaska Office of Children’s Services has been ordered by a state Superior Court judge not to keep children at the facility for indefinite periods of time.

The order is part of a preliminary injunction issued by Superior Court Judge Erin Marston that said a minor, admitted to the acute psychiatric hospital during an emergency, cannot remain there longer than 30 days without court approval.

But that length of time may change. As a next step, the judge has asked parties in the case to offer recommendations on the appropriate period of time a minor should be kept at the hospital before a court can weigh in.

The case was brought a year ago by the Southwest Alaska tribal governments of Hooper Bay and Kongiganak on behalf of the tribes’ children.

Alaska Legal Services, representing the tribes, argued that the state was improperly placing and holding children in the hospital. It provided examples of three Alaska Native teenage girls from two foster families who had been held at the hospital for at least four weeks without a judge’s approval, though their admission was based on questionable evidence.

One of the girls, a teenager referenced as C.A. for her initials, was held at the hospital for about a month, though a hearing judge later found there was no evidence supporting the decision to send her there, wrote Marston.

“OCS decided to send C.A. to North Star, although the reason for this decision is unclear,” Marston wrote.

Marston’s Feb. 12 preliminary order said that indefinite stays by children at North Star may violate U.S. constitutional rights and lead to “irreparable harm.”

“Continuing treatment of foster children without a judicial hearing raises the question of a violation of the fundamental right to due process,” he wrote.

The hospital provides a secure, locked facility where 24-hour services are given under the care of psychiatrists to children with severe emotional and behavioral disorders, he wrote.

But long, unnecessary placement at a mental hospital is not good for adolescents, said Jim Davis, the attorney arguing the case for Alaska Legal Services.

“This is not to say North Star is ‘One Flew Over the Cuckoo’s Nest,’ but a mental hospital is not a good place for kids” with typical teenage behaviors, said Davis. “It can disempower and otherwise undermine a kid’s sense of self if they don’t really have a mental illness requiring them to be there.”

North Star Behavioral Health System was a defendant in the case along with Christy Lawton, OCS director. Like OCS, North Star must change its practices because of the preliminary order, Davis said.

Officials representing and working for North Star did not return phone calls seeking comments.

Though the case is not settled, the judge’s preliminary order is in part a victory for the tribal governments.

[...]

The state’s policy was insufficient because it proposed no timeline, leaving that up to the scheduling of the courts, Davis said. Getting a hearing can take far too long, sometimes leaving a child in the mental hospital long after they should have been released, said Davis.

The girl had caused alarm after it was believed she had overdosed on antidepressants, leading to a trip to the hospital emergency room in the hub city of Bethel. There, the girl showed no physical signs of overdosing and the girl’s foster mother found the bottle of pills the next day.

[...]

D.S. was held for 38 days, while J.S. was held for 47 days, Davis said. They were released after a Superior Court judge said they shouldn’t be there, he said.

“The process isn’t working when it takes weeks and weeks to have a hearing,” Davis said.

In his order, the judge wants the parties by March 12 to recommend the appropriate length of time to hold minors before a court can weigh in.

Davis said he will argue that minors, just like adults, should not be involuntarily held longer than 72 hours without a court’s input. That is more than enough time to determine whether a minor is being improperly held at the hospital, he said.

Bookman, of the OCS, said a child admitted by a guardian is in a situation different from that of an involuntarily admitted adult, so 72 hours may not be appropriate. He said he would “talk to OCS about it, do some research and come up with a position.”

3 Skilled Nursing Facility staff arrested for drugging deaths of patients

Report from thje Kern Valley Sun

Attorney General Jerry Brown today announced the arrests of a nurse, physician, and a pharmacist of the Kern Valley Healthcare District's Skilled Nursing Facility for “forcibly administering psychotropic medications for their own convenience, rather than for their patients’ therapeutic interests.” The Attorney General said these actions are alleged to have resulted in the deaths of three residents.

Taken into custody earlier today, Feb. 18, by California Department of Justice special agents were Gwen Hughes, the former Director of Nursing at the Skilled Nursing Facility of the Kern Valley Healthcare District in Lake Isabella, on charges of elder abuse and assault with a deadly weapon; Debbi Hayes, the former pharmacist at KVHD, on charges of elder abuse and assault with a deadly weapon; and Dr. Hoshang Pormir, a staff physician at Kern Valley Hospital, who was serving as the medical director of the Skilled Nursing Facility, on charges of elder abuse.

“These people maliciously violated the trust of their patients, by holding them down and forcibly administering psychotropic medications if they dared to question their care,” Attorney General Brown said. “This is appalling behavior, which amounts to assault with a deadly weapon.”

According to the statement issued by the Attorney General's office, Hughes, upon taking over as Director of Nursing in September 2006, ordered that Alzheimer’s and other dementia patients be given high doses of psychotropic medications to make them more tranquil and easy to control. It goes on to say, “She ordered the administration of these medications to patients who argued with her, were noisy, or who were otherwise disruptive.” Two patients who resisted were held down and forcibly given injections.

The complaint also alleges that Hughes directed Debbi Hayes, the hospital pharmacist, to fill prescriptions for these psychotropic medications. Hayes wrote and filled these prescriptions without first obtaining a doctor’s approval, the complain said.

According to complaint, Pormir approved these psychotropic medications only some time after they had been administered and without examining the patients first and determining whether these psychotropic medications were medically necessary.

Investigators allege that several of these patients had medical complications as a result of being given these psychotropic medications, including lethargy and the inability to eat or drink properly. It is believed that that three patients died and one patient suffered great bodily injury as a result.

The case came to the attention of authorities in January 2007, when an ombudsman reported to the Bakersfield office of the California Department of Public Health that a patient in the Skilled Nursing Facility had been held down and given an injection of psychotropic medication by force.

The Department of Public Health immediately sent an investigative team with a doctor, a nurse, and a doctor of pharmacology. They determined that 22 patients, including some who were suffering from Alzheimer’s at the Skilled Nursing Facility, were being given high doses of psychotropic medication not for therapeutic reasons, but to simply control and quiet them for the convenience of the staff.

The Department of Public Health issued a Certificate of Immediate Jeopardy which resulted in the immediate dismissal of the Ms. Hughes. The matter was then turned over to the California Department of Justice, Bureau of Medi-Cal Fraud and Elder Abuse.

Special Agents from the Bureau of Medi-Cal Fraud and Elder Abuse began a year-long investigation, with the co-operation and assistance of the Department of Public Health and the administration of the Kern Valley Healthcare District.

Pamela Ott, CEO at the time, left the district in May 2007. Current KVHD Board of Directors Chair Kay Knight said, “A lot of people don't understand that this happened more than two years ago and is not going on now.”

Chet Beedle, Chief Financial Officer, reported that CEO Rick Carter and Board of Directors spokesperson Victoria Alwin were unavailable. He added that he was prohibited from commenting on the arrests and that a formal statement was coming.

A search warrant was served on the facility in August 2008, resulting in the seizure of 36 patients' medical files and records.

Criminal charges were filed in Kern County Superior Court and the defendants are being held in Kern County Jail in Bakersfield. Pormir is charged with one felony count of causing harm/death of an elder of dependent adult. He is being held on $400,000 bail. Hughes and Hayes are each charged with two felony counts, one count of causing harm/death of an elder of dependent adult and another felony count of assault with a deadly weapon other than a firearm of great bodily force. The trio will be arraigned in Superior Court in Bakersfield Friday morning. If convicted, the defendants could face up to 11 years in prison.

The case is being prosecuted by the Attorney General’s Bureau of Medi-Cal Fraud and Elder Abuse, with the co-operation and assistance of the Kern County District Attorney’s Office.

More than half of all foster children in Texas above 6 are drugged, 41,3% of those who receive medication receive 3+ different classes of medicines

Who are the real child abusers here? More than half of all foster children in Texas above 6 receive psychotropic medication, 41,3% of those who receive medication receive 3+ different classes of medicines. A study published in Pediatrics, the Official Journal of the American Academy of Pediatrics

Psychotropic Medication Patterns Among Youth in Foster Care

Julie M. Zito, PhD a,b,
Daniel J. Safer, MD c,
Devadatta Sai, MS a,
James F. Gardner, ScM a,
Diane Thomas, BA d,
Phyllis Coombes, MA d,
Melissa Dubowski, BS d and
Maria Mendez-Lewis, MPA d

Departments of

a Pharmaceutical Health Services Research
b Psychiatry, University of Maryland, Baltimore, Maryland
c Department of Psychiatry and Pediatrics, Johns Hopkins Medical Institutions, Baltimore, Maryland
d Office of the Texas Comptroller of Public Accounts, Austin, Texas

---

ABSTRACT

CONTEXT. Studies have revealed that youth in foster care covered by Medicaid insurance receive psychotropic medication at a rate >3 times that of Medicaid-insured youth who qualify by low family income. Systematic data on patterns of medication treatment, particularly concomitant drugs, for youth in foster care are limited.

OBJECTIVE. The purpose of this work was to describe and quantify patterns of psychotropic monotherapy and concomitant therapy prescribed to a randomly selected, 1-month sample of youth in foster care who had been receiving psychotropic medication.

METHODS. Medicaid data were accessed for a July 2004 random sample of 472 medicated youth in foster care aged 0 through 19 years from a southwestern US state. Psychotropic medication treatment data were identified by concomitant pattern, frequency, medication class, subclass, and drug entity and were analyzed in relation to age group; gender; race or ethnicity; International Classification of Diseases, Ninth Revision, psychiatric diagnosis; and physician specialty.

RESULTS. Of the foster children who had been dispensed psychotropic medication, 41.3% received ≥3 different classes of these drugs during July 2004, and 15.9% received ≥4 different classes.

The most frequently used medications were antidepressants (56.8%), attention-deficit/hyperactivity disorder drugs (55.9%), and antipsychotic agents (53.2%).

The use of specific psychotropic medication classes varied little by diagnostic grouping.

Psychiatrists prescribed 93% of the psychotropic medication dispensed to youth in foster care. The use of ≥2 drugs within the same psychotropic medication class was noted in 22.2% of those who were given prescribed drugs concomitantly.

CONCLUSIONS. Concomitant psychotropic medication treatment is frequent for youth in foster care and lacks substantive evidence as to its effectiveness and safety.

Full Study at the Link

Report finds children overmedicated on purpose to keep them quiet

A report from MSNBC

Some children showing up in emergency rooms with overdoses of cough or cold syrup may have been intentionally medicated to keep them quiet, doctors cautioned on Thursday.

An analysis of 189 children who died from medication overdoses showed a significant percentage appeared to have been intentionally overdosed, the doctors reported in the Annals of Emergency Medicine.

"This is a heads up," said Dr. Richard Dart, director of the Rocky Mountain Poison and Drug Center in Denver.

In 79 of the cases, an adult gave the child nonprescription medicine. In 19 cases the adults clearly meant to help the child, but in 26 cases a panel of experts determined the intent was not to treat, Dart said.

He said a panel of experts had to agree that the intent was clear. "They were quite certain in all the cases they decided were intentional," Dart said in a telephone interview.

"We had some cases where the parent poured it into the kid's mouth directly from the bottle," he added.

In October, U.S. makers of over-the-counter cough and cold medications, urged by the U.S. Food and Drug Administration, advised that these drugs should not be used in children under 4 and the FDA is considering requests to ban their use in children under 12.

Dart said complications from accidental misuse are known and dangerous.

"We aren't trying to say there aren't accidents. I am concerned that we have blinders on and we don't want to admit that there is a group of parents who all the warnings in the world won't help because they did it knowingly," he said.

"What we have is a group of adults who want to control the behavior of children and do it in a variety of ways," Dart added.

"Sometimes it is physical violence and sometimes it is drugs. They tend to be lower-income, under-educated parents, often with a history of child abuse or violence in the home. I think there is a clear population here for us to focus on that are involved in these events."

Parents should also be aware that some of the adults who gave the medications to the children were day-care providers who probably were not malevolent in their actions but simply overwhelmed and looking for a way to quiet down their charges, Dart said.

An estimated 4 million children under the age of 12 are treated with over-the-counter cough and cold products each week in the United States.

Teaching kids to study works better than Ritalin

As seen in the Mercury News. Here's the essential tidbit:

"12-year-old Ryan was having trouble paying attention to the home-school tasks his mother, Cindy Withers of San Jose, set for him. Determined to avoid drugs such as Ritalin, Withers opted for brain-training instead.

At his psychologist's office, Ryan's treatment included specialized video games that responded to his brain waves. By remaining focused, the boy was able to propel digital spaceships or race cars. His mother says the therapy gave him a "can-do" attitude and improved his school work."

As noted elsewhere:

So here's the AMAZING CONCLUSION: Turns out that teaching your kids to pay attention works better than drugging them into submission. Amazing!

262 freed from Irish psychiatric hospitals in the past year.

Around 20 Irish psychiatric patients are now being released every month after pleading their case before special tribunals. They were originally detained in mental hospitals against their will, and now have the option of independent tribunals. The mental health tribunals were set up over a year ago to allow patients who were the subject of involuntary detention orders to make their case to have it lifted. Previously, they had to rely on the sympathy of psychiatrists to deem if they were suitable to have the order lifted. Apparently, there was an obvious need for this sort of procedure in the name of ordinary justice and human rights. From the Irish Idependent

New figures from the Mental Health Commission show that 262 involuntary patients had the orders removed after appearing before the tribunals between December 2006 and November 2007. There have been a total of 2,227 hearings to date.

The tribunals are made up of doctors, members of the public and psychiatrists. The patient is able to appear in person to put their case forward.

There were 1,504 people detained against their will during that time -- down on the previous year following the introduction of more complex procedures for admission.

The detainee can opt for a Mental Health Commission-appointed solicitor and can appeal a tribunal ruling in the circuit court.

Since the beginning of the new legislation, 216 children have been detained in adult psychiatric facilities because of a lack of beds. Five of these children were detained against their will, and 12 were aged between 13 and 14.

However, psychiatrist Dr Patricia Casey said this situation was unacceptable.

"The HSE and also the Department of Finance need to be reminded that this situation is in breach of all international standards for the treatment of children with mental health issues. Children need facilities of their own," she said.

More foster kids getting drugged.

From a much longer article in the Rochester Democrat and Chronicle. There are also a number of heart wrenching letters in the comments section following the original story, indicating the horrific need for political reform in the foster care system.

When Laticia Anderson's son entered foster care in 2005, a social worker described the 4-year-old as "an extremely smart little boy who loves school."

But over the next six months, as he was shuttled from an emergency foster-care placement to two foster homes, his personality changed.

The boy would explode in tantrums, gouge his own flesh, even consider killing himself. Social workers and pediatricians could not quell his outbursts.

Frustrated, they resorted to Depakote, an anti-seizure medication intended for adults but occasionally given to children to alter their moods.

And then her son's personality really changed, Anderson said. The boy she knew as playful and exuberant was, when she visited him, distant and withdrawn - "almost like a zombie."

Like Anderson's child, hundreds of foster children in Monroe County each year are placed on psychotropic, or mood-altering, drugs. Though questioned in some medical and psychiatric quarters because of long-term health risks, the use of the psychotropic medications on foster care children in Monroe County is on the rise, a Democrat and Chronicle investigation shows.

The investigation included analyzing data from county, state and federal agencies; interviewing experts locally and nationwide; interviewing families of some local foster children on medications; and reviewing public records of Monroe County Family Court cases in which the prescription of the drugs has been an issue.

The investigation reveals that:

• In 2002, about a third of the county's foster care population, 327 children, were prescribed one or more common psychotropic drugs. By the end of 2006, the number had increased about 40 percent to 457 foster children, or almost half of the county foster care population.
• In the five years from 2002 through 2006, according to state data, Medicaid expenditures for common psychotropic medications for Monroe County foster children nearly doubled - an increase almost four times the statewide rate.
• Psychotropic medications are also more commonly used at residential foster care treatment centers than in the past, according to medical and psychiatric staff. At the nonprofit Hillside Children's Center, for instance, 55 percent of the foster children are prescribed one or more psychotropic drugs.
• 2006 records show that more than one of every eight foster children in Monroe County is on some kind of drug to combat psychosis, a severe form of mental illness characterized by lost contact with reality.
• Very young children are also prescribed the psychotropic medications, according to county data.

Last year, a 1-year-old foster child was prescribed the antipsychotic drug Risperdal, and two 4-year-old foster children were prescribed Depakote. Pediatricians say Risperdal and Depakote, if properly monitored, can be safely prescribed for young children, but some medical experts worry about possible health effects. Risperdal has been associated with heart disease in older adults; Depakote has been linked to liver failure in children younger than 2.

Drugs a straitjacket?

Foster care advocates say children are a particularly vulnerable population, often invisible to the public and beset with higher rates of mental and emotional illness in large part because of the disruptive - and sometimes abusive - lives they've led.

This leads to a conundrum: Are foster children legitimately prescribed psychotropic drugs more commonly because they have so many needs? Or are the drugs used more as a convenient way to straitjacket troublesome behavior?

The use of such drugs "definitely has gone up, and I say that with much reluctance because I don't think these medications are necessarily safe medications," said Dr. Mohsen Emami, a staff psychiatrist at St. Joseph's Villa in Greece, a nonprofit residential facility for troubled youths.

Across the country, while the use of psychotropic medications for all children has increased, the rate of use for those in foster care has grown even faster. By some estimates, foster children receive psychotropic drugs at a rate two to three times that of other children.

"I have no doubt that many, many kids are overmedicated," said Dr. Martin Irwin, a Syracuse-area psychiatrist who has been contracted by counties and treatment centers around the state to help decrease the use of psychotropic drugs for foster children.

"It's out of control in general, but the worst problems are in foster care because there's basically nobody advocating for the kid."

There is also much more in this follow up article

A Democrat and Chronicle investigation shows an escalating use of psychotropic medications for foster children in Monroe County — reflecting a national trend. Some experts say that's because foster children have far greater rates of mental illness and emotional disturbance than other kids.

Yet physicians and lawmakers nationwide now fear that the increasing prescription of the drugs, without ironclad assurance of their safety, could be sentencing foster children to physical or mental ailments later in life. Two trends are especially worrisome:

• Many psychotropic drugs prescribed to children and teens have not been tested for effectiveness or safety in youths.
• The prescription of multiple psychotropic medications for individual children, such as Jessie Sayyeau, has become more common.

[...]

Eight years ago, between 75 percent and 80 percent of the drugs prescribed for children had not been studied for pediatric use, said FDA's Murphy. In 2002, Congress passed laws providing financial incentives to companies that conducted pediatric testing on medications. Under the law, the companies were granted exclusivity, meaning the time was extended before competing generic brands could be approved and reach the market.

Murphy said regulators are seeing results, but many drugs already commonly prescribed off-label probably won't be tested for pediatric use. A March study by the U.S. Government Accountability Office estimated that about two-thirds of drugs prescribed for children are used off-label, which, the report said, "places children at risk of being exposed to ineffective treatment or incorrect dosing."

Many critics say that, despite the congressional action, far more needs to be done.

"If the United States does not build a more adequate system for studying and monitoring drug safety, then it's reasonable to think, down the road, we're going to see (side effects) in children that are going to surprise us," Zito said.

Antipsychotic Drugs Abused as Chemical Restraints for Elderly

The WSJ Health Blog is carrying this item pointing to this expose in The Wall Street Journal

Nursing homes are loading up patients on antipsychotic drugs and regulators have started to take notice, the WSJ reports.

Almost a third of patients in nursing homes are receiving powerful antipsychotic drugs, the feds say. And patients can be given the medicines, whether they are psychotic or not. The drugs are often used to calm demented patients, some with Alzheimer’s disease, and to help maintain order in nursing homes, which are often understaffed and reluctant to use physical restraints. But the FDA hasn’t approved the drugs for these uses, compounding the ethical questions.

Nearly 21% of the nursing-home patients who receive the drugs don’t have a psychosis diagnosis and some think that’s too much. “You walk into facilities where you see residents slumped over in their wheelchairs, their heads are hanging, and they’re out of it, and that is unacceptable,” says Christie Teigland, director of informatics research for the New York Association of Homes and Services for the Aging, a not-for-profit industry group.

Commenting on the WSJ article, the blog Furious Seasons notes that the “numbers are alarming, especially since there is no scientific proof that these drugs work well in dementia patients and are, in fact, outperformed by placebo,” according to a federally funded study known as CATIE.

[...]

Spokane psychologist accused of seducing patient

From KREM and KING 5 TV, with a video report available on at the link.

UPDATE: More in this report from the Spokesman review, which also has a copy of the complaint

---

A lawsuit filed in Superior Court in Spokane Monday claims a Spokane psychologist used his position to seduce a patient.

According to the complaint, the Dr. John Moulton committed multiple acts of malpractice and negligence while treating a female patient.

Malpractice cited in the legal complaint against Moulton includes: seeing the patient outside of treatment sessions, buying her alcoholic beverages, consuming alcohol with her, and other boundary violations and negligent acts of both a sexual and non-sexual nature.

Among the allegations detailed in the complaint, Dr. Moulton sent emails to the patient where he admitted to her that he acted like an abusive predator: "I have acted like an abusive predator, which may be the most despicable kind of person there is."

The alleged malpractice began after the patient, who suffered from severe depression, checked herself into Spokane's Sacred Heart Medical Center in April of 2005. The hospital assigned Moulton to be treating psychiatrist. During this two-week hospital stay, the psychologist administered a series of nine electro-shock treatments to patient.

Following discharge from the hospital, the patient returned to her family in Alaska. On June 1, 2005, she again traveled to Spokane and re-entered Sacred Heart for additional treatment for depression. Again, Dr. Moulton was assigned to be her treating psychiatrist, and according to the patient's attorney, Michael S. Kolker, who said it was during the second hospital visit that Moulton told the patient he had feelings for her.

Upon her discharge from Sacred Heart on June 12th, Moulton arranged for the patient to spend time at an in-patient facility in Lake Chelan for continuing treatment for her depression. According to Kolker, Moulton drove the patient to the Spokane airport for the flight to Lake Chelan, and kissed her before she boarded the plane.

On June 23, 2005, the patient returned to Spokane to stay at the home of her brother for continued outpatient treatment with Moulton, whose boundary violations and acts of malpractice continued.

According to Kolker, for nearly a month while he was supposed to treat the patient for depression, Moulton saw the patient almost daily outside of therapy sessions. He took her out to bars and restaurants, consumed alcohol with her, fondled and kissed her.

"When a psychiatrist does it to a patient, it's not dating and it's not a relationship. It's a boundary violation and it is abusive," said Kolker.

Moulton then told the that he loved her and tried to convince her that she was in love with him. They made plans for the future. The suit said Moulton did all of this, knowing the patient was married and the mother of three children. He also knew she was on medication and had giving her multiple sessions of electro shock therapy.

In August, the patient's husband discovered Moulton's malpractice and confronted him. According to allegations in the complaint, Moulton sent the patient and her husband a number of emails in which he admitted and apologized for his misconduct. Excerpts of some of those emails are included in the complaint.

The complaint further alleges that Moulton's negligent conduct caused the patient exacerbated depression, pain and suffering and two suicide attempts.

UPDATE: More in this report from the Spokesman review, which also has a copy of the complaint

Drugs for ADHD 'not the answer'

Well, It seems that the BBC is starting to wake up and get something right

Treating children who have Attention Deficit Hyperactivity Disorder (ADHD) with drugs is not effective in the long-term, research has shown.

A study obtained by the BBC's Panorama programme says drugs such as Ritalin and Concerta work no better than therapy after three years of treatment.

The findings by an influential US study also suggested long-term use of the drugs could stunt children's growth.

It said that the benefits of drugs had previously been exaggerated.

The Multimodal Treatment Study of Children with ADHD has been monitoring the treatment of 600 children across the US since the 1990s.

'Exaggerated impact'

Most of the estimated 500,000 children in Britain with ADHD receive no treatment at all.

The Department of Health has issued a statement on the treatment of ADHD

But of those that do, most - about 55,000 last year - are prescribed stimulants like Ritalin and Concerta.

The cost of these drugs to the NHS is about £28m.

In 1999, the American study concluded that after one year medication worked better than behavioural therapy for ADHD.

This finding influenced medical practice on both sides of the Atlantic, and prescription rates in the UK have since tripled.

But now after longer-term analysis, the report's co-author, Professor William Pelham of the University of Buffalo, said: "I think that we exaggerated the beneficial impact of medication in the first study.

"We had thought that children medicated longer would have better outcomes. That didn't happen to be the case.

"There's no indication that medication's better than nothing in the long run."

Prof Pelham said there were "no beneficial effects" of medication and the impact was seemingly negative instead.

"The children had a substantial decrease in their rate of growth so they weren't growing as much as other kids both in terms of their height and in terms of their weight," he said.

Aggressive behaviour

The Panorama programme features disturbing footage of a 14-year-old from Stoke-on-Trent, who has been on ADHD medication for a decade.

Craig Buxton's family kept a video diary of his behaviour and captured on camera examples of just how explosive his behaviour can be.

He has self-harmed, suffers night terrors and is aggressive - he recently assaulted three school teachers.

And all I can do is go back to the doctors and say: 'Is there anything more you can do?'

His mother Sharon said things had gone from bad to worse.

"He has broke down and cried when he gets into situations," she said.

"He says: 'Why am I like this mum, I don't want to feel like this, I don't want to be like this, you know, help me'.

"And all I can do is go back to the doctors and say: 'Is there anything more you can do?'

"All they say is, well, we are doing what we can."

The National Institute for Clinical Excellence is currently revising the treatment guidelines for ADHD.

[...]

The Ritalin Wars, and The New Religion of ADHD

As snippet from a NY Times column on the recent study about brain development in children

So why, this week, did the gloves come out, with the armies of all that is Good taking on the usual forces of Evil psychopharmacology? Why did my stomach drop so quickly to my knees, why was I so quick to think it possible that, after countless interviews and lectures and hours of reading, I’d simply fallen for a hoax manufactured by the drug companies and wrested upon the innocent?

Facts don’t have much sway when you’re in the grip of a religion. And the beliefs underlying the Ritalin wars (I am using “Ritalin” here as shorthand for the whole practice of diagnosing children and treating them with psychotropic drugs) have truly now become like a creed. They’re only superficially about diagnosis and medication. For most people, they’re more profoundly about a sense of menace bearing down upon the world of our children.

There’s a sense that greater powers, profit-driven and amoral, are pulling the strings in our children’s lives. There’s a sense that those who should best protect us — our government and our doctors — are so corrupted that they can no longer do the job. There’s a sense that childhood has, in many ways, been denatured, that youth has been stolen, that the range of human acceptability has been narrowed for our kids to a point that it has become soul-crushingly inhuman.

The author backs away from this dark vision, saying that maybe it is not so, and muttering about the casualties of these Ritalin Wars, the children. This is certainly a hard pill to swallow for any one.

And yet, as we look back at the other scandals of our age, the Enrons and the Haliburtons, the scandal of the Iraq War, and others, we desperately want the drug industry to be pure as Snow White, and as pristine as the americas before the arrival of the White European. Sadly, it might not be so.

Girls get extra school help while boys get Ritalin

From USA Today. An important insight into another angle on ADHD

At last June's graduation at Franklin High School just outside of Milwaukee, three of the four students who tied for valedictorian were girls. Among the National Honor Society members, 76% were girls. And girls comprised 85% of the students on Franklin's 4.0 honor roll.

The superintendent of schools for this upper-middle-class suburb, Gerald Freitag, investigated those numbers after the parents of a boy filed a complaint. He found that the skewed performances by gender at Franklin pretty much mirror the imbalances across the state — and the nation.

This week, teachers at the middle school feeding into Franklin received training on how to reach out to boys. And high school teachers will continue the gender-sensitivity classes they began last school year.

But reversing the trend will not be easy. In classrooms nationwide, girls are pulling ahead of boys academically. Recent federal testing data show that what starts out as a modest gap in elementary-level reading scores turns into a yawning divide by high school. In 12th grade, 44% of girls rate as proficient readers on federal tests, compared with 28% of boys. And while boys still score slightly higher on federal math and science exams, their advantage is slipping.

Most startling is that little is being done to correct the imbalances. All of the major players — schools, education colleges and researchers — largely ignore the gender gap.

Instead of pursuing sound solutions, many educators merely advocate prescribing more attention-focusing Ritalin for the boys, who receive the drug at four to eight times the rate of girls, according to different estimates. "Too often the first reaction to an attention problem is 'Let's medicate,' " says Rockville, Md., child psychologist Neil Hoffman. "Some schools are quick to recommend solutions before they've fully evaluated the problem."

Playing to girls' strengths

One reason boys are losing academic ground to girls appears linked to a shift by schools to more word-based learning for which girls' brains are believed to have an advantage. Over the years, even math problems have become more word oriented, according to education researchers. But because schools are doing little to help boys adjust, males risk becoming second-class academic citizens. Already the academic success girls enjoy in high school translates into more college acceptances — 56% of the students on campuses are female.

The full impact from this shift is something society has yet to discover. But a drop in earnings for males is one likely result. Workers with only a high school diploma earn $20,000 a year less than those with a bachelor's degree.

One fact explains why educators are ignoring boys' needs: You can't address a problem that you don't admit exists. The U.S. Department of Education concedes that no serious research is available comparing different instructional methods that might help boys. In fact, many education researchers are hostile toward research aimed at exploring gender differences in learning.

Last April, when Kenneth Dragseth, superintendent of schools in Edina, Minn., presented a paper describing his district's gender gap at the American Educational Research Association's annual meeting in Chicago, he says the reception ranged from chilly to hostile. Female education researchers in the audience questioned whether helping boys would mean hurting girls.

Their attitude follows years of lobbying by groups such as the American Association of University Women, which alerted educators to the fact that girls were being shortchanged academically in the fields of math and science. The extra attention helped focus schools on girls' difficulties, but it has made it too easy for educators to overlook the problems of boys. Among them:

•Boys and girls learn differently. The best research on boy-girl learning differences is produced more by accident than by design. The lack of data in this field can hurt girls as much as boys. For instance, as part of an ongoing 20-year dyslexia study focusing on Connecticut schools, Yale neuroscientist and pediatrician Sally Shaywitz discovered that schools were identifying four times as many dyslexic boys as girls. Yet when her team entered schools to screen children, it diagnosed just as many dyslexic girls as boys. Shaywitz found that the mostly female teaching staff was quicker to identify rambunctious boys than quiet girls.

The results are just one example of what might be learned about the role gender plays in education, especially in elementary school, where 85% of teachers are women.

• Future teachers aren't trained to deal with learning differences. Therapist Michael Gurian, author of Boys and Girls Learn Differently!, has visited more than 100 education colleges. But he has not found one that offers courses on male-female brain differences. His discovery explains why many new teachers arrive in classrooms clueless about what teaching techniques might work best for boys' learning styles.

• Boys lack advocates. The special efforts made by schools to steer more girls into advanced math and science classes came after powerful advocacy groups embraced the problem. But Gurian and other advocates for boys say they run into resistance from educators who point to males' success in the workforce as proof that advocacy for boys is unnecessary.

In spite of the lack of research, anecdotal evidence shows that far more effective strategies are available for teaching boys than plying them with Ritalin. Patricia Henley runs a boy-friendly charter school in Kansas that hires many male teachers. It also recognizes boys' natural tendency to favor active learning by conducting more class work on the chalkboard and allowing more student movement within the classroom. And the school trains teachers to deal with boys' particular styles. For instance, because boys volunteer answers more slowly than girls do, teachers are told to count to 10 before calling on a student.

Beginning in the early 1990s, groups such as the American Association of University Women performed an important service by alerting the public to an educational failing. Their persistence helped convince educators that schools were ignoring important problems plaguing girls, such as the loss of self-esteem among middle school girls who had been successful students throughout elementary school.

Today's education system fails many boys. They deserve the same kind of attention to address why they are losing ground.

Dramatic Hike Forecast For ADHD Drugs Spending in UK - Marketing Campaign Projected to be Huge Success

We anticipate that a huge marketing campaign will produce the results anticipate. As seen in this report

The National Health Service in the UK is likely to face a 10-fold increase in the cost of drugs prescribed to children and adolescents with attention-deficit/hyperactivity disorder (ADHD) in the decade to 2012.

The research modelled various scenarios to determine possible costs to the National Health Service in England and the statutory health insurance providers in Germany.

Michael Schlander of the University of Heidelberg in Germany created a model based on demographic and epidemiological data, past spending trends, and an assessment of which drugs may soon be available for prescriptions. He calculated a range of the possible costs by varying the assumptions made for factors such as the likelihood of diagnosis and treatment, the level of treatment and the costs of drugs.

The cost of ADHD prescriptions to the NHS in England was £7 million in 2002 and the study predicted that this will rise to somewhere between £49 and £101 million per year by 2012. Prof Schlander stated: "The scenarios developed here strongly suggest that the trend of rising drug expenditures for ADHD may not abate in the near future."

At the same time Schlander emphasized that caution should be exercised when interpreting this data: "The mere focus of the present analysis is budgetary impact," and thus the data "illuminate just one half of the health economic equation; they do not provide information on 'value for money'."

The main characteristics of ADHD are inattention, hyperactivity and impulsivity. In the USA the percentage of children being treated for ADHD has been estimated at between 2.9 and 4.8%. The ADHD drugs bill in the USA is expected to top $4 billion by 2010 (for adults as well as children). In the UK it is thought that ADHD used to be under-diagnosed. The number of prescriptions is now rising sharply. One new drug that may become available in 2008 in the UK is Vyvanse(r), which is thought to have a lower potential for abuse and overdose than existing ADHD drugs.

Article: Impact of Attention-Deficit/Hyperactivity Disorder (ADHD) on Prescription Drug Spending for Children and Adolescents: Increasing Relevance of Health Economic Evidence, Michael Schlander, Child and Adolescent Psychiatry and Mental Health (in press)

Psychiatrists paid more for doing less, if they do anything at all

Shrink Rap has an interesting insight of private practice shrinks

Many psychiatrists in private practice don't take insurance, or don't 'accept assignment.' They require the to patient pay them and then the patient can submit to his health insurance company and reimbursement is made directly to the patient. This often means that the patient, having gone Out-Of-Network, has a higher co-pay &/or a higher deductible, and the hassle of paperwork. Generally, if a patient sees an In-Network psychiatrist, they make a copay and the hassle of getting the rest of the money falls on the doctor.

Psychiatrists fresh out of school generally go into private practice, because that is where the money is. So how does this work out?

So how and why does any psychiatrist accept insurance? Basically, the insurance companies pay okay for short appointments with a psychiatrist. While there are time standards for coding psychotherapy appointments (25 minutes, 45-50 minutes), nearly everyone charges more per hour for a 25 minute appointment than for a 50 minute appointment, even many of the out-of-network docs. So a psychiatrist who sees two patients in an hour makes more than a psychiatrist who sees one patient in an hour, and often the insurance companies-- perhaps eager to encourage their policy holders to seek psychotherapy with a cheaper provider-- will pay a reasonable amount for a shorter session-- perhaps they make this worth doing. And "Med Management" 90862 for those of you who like CPT codes-- has no time restrictions on it. If a psychiatrist can squeeze four or five patients into an hour, he can do okay by the insurance companies.

So the psychiatric profit margin is in putting patients on drugs, rather than actually sitting down with them, talking things over, and doing something for the human being sitting there in front of them.

It is very easy to make the prediction that psychiatric profit margins will go up with drug usage, and most psychiatrist will develop a lack of interest in doing anything else for their clients except other then prescribing them some pills to pop.

Another Case of Kids Over-Medicated on Psych Drugs

A report from Corpus Christi, Texas

The parents of three elementary students who showed up for school seemingly under the influence of drugs were back in court Tuesday to see if a judge would allow them to keep the children temporarily.

The kids, ages 6, 9 and 10, reportedly have been diagnosed with attention-deficit/hyperactivity disorder, or ADHD. They have been living with their paternal grandparents since they were taken from their mother and stepfather in September.

Tuesday judge Carl Lewis decided Tuesday the children would remain with the grandparents for at least the next 30 days.

In the courtroom, the kids' mother Jennifer Bartley and stepfather Edward Bartley avoided KRIS-TV cameras, and they would not say on-camera whether they intentionally overmedicated their children. But, police said, on Sept. 14, the children appeared drunk as the couple dropped off two of Jennifer's three children at Luther Jones Elementary

Investigators later found out the 10-year-old daughter tested positive for a drug similar to Xanax, a drug not prescribed to her.

A court document recently obtained by 6 News...read, "the children were admitted into the hospital for over a week". It went on to say, "there was sexual acting out by (the 10-year-old) with (the 6-year-old.)"

The document outlined a family service plan outlining tasks Jennifer and Edward Bartley must complete, including placing the children's medications in a lock box that includes a sign-in sheet listing times and dates medications are given.

The couple was also order to undergo family counseling. The Bartleys, along with the children's father, Joshua Davenport, also must submit to random drug testing.

Davenport did not want to talk on camera, but he told the judge he no longer uses drugs and that he hopes to get custody of his children someday.

The court did allow for the parents to see the children once a week.

Davenport said the 9-year-old suffers from bipolar disorder and ADHD, and he has been admitted into Padre Behavioral Hospital. Court documents said the child has made little progress with his conditions.

The other two children reportedly were also seeing a psychiatrist.

Lewis said he will review the case again in 30 days.

A police investigation has not determined whether the parents unnecessarily drugged the children. If it does, however, whoever is to blame could face a charge of injury to a child or endangering a child.

Hopefully this won't turn into another case where a psychiatrist misdiagnosed a case of child abuse as ADHD. Tragically, there is an awful chance that it will.

Fortunately, no child was killed due to drug side effects. Tragically, the psychiatrist in charge of this fiasco is not likely to be investigated.

The Political Use of Psychiatric Drugs in Deportation Proceedings

From the Dallas News

The federal government would like to forcibly sedate and deport an immigrant-restaurateur who resisted his removal last August with repeated screams because of fears he'd be murdered back in his native Albania.

But an unlikely champion from East Texas has penned a private bill in Congress that would allow 32-year-old Rrustem Neza to stay in the country until early 2009 – and give him time to receive a full rehearing of his political asylum case.

Rep. Louie Gohmert, R-Tyler, who sits on the House judiciary subcommittee on immigration, is opposed to loosening immigration. But he believes the government's treatment of Mr. Neza is "intolerable" and "callous."

Mr. Gohmert, a former district court judge, spoke to President Bush about the case this week, a staff aide said.


"I am a strong believer in following the laws regarding immigration," Mr. Gohmert said in a written statement. "However, we have laws to allow people to remain here based on asylum and the need to protect their lives."

Mr. Neza fears he will be killed back in his homeland because of his knowledge of a political assassination of a democracy leader in Albania, a European country of 3.6 million that fought off communism in the late 1990s.

Two of his brothers have won asylum. And two of his cousins were killed in Europe because of the knowledge they had regarding the assassination of Azem Hajdari, said Mr. Neza's Dallas attorney John Wheat Gibson.

The Gohmert bill could effectively stall Mr. Neza's deportation until early 2009.

Private bills have been issued before on behalf of individual immigrants. But the Gohmert measure is unusual because immigration now stirs such quick rancor.

Carl Rusnok, an ICE spokesman in Dallas, said he couldn't comment on the Neza case because of litigation in Los Angeles over the policy – "on rare occasions" – of forced druggings for certain deportees.

Such medications had been administered to deportees "for their own safety and the safety of people on the plane," he said. In the past, Mr. Rusnok has noted that Mr. Neza came into the U.S. using a false Italian passport and has an order for deportation against him.

On Aug. 8, at Dallas/Fort Worth International Airport, Mr. Neza repeatedly screamed, "I am not a terrorist," when immigration agents tried to board him on a flight.

Airline officials refused Mr. Neza's passage after he told them he was being "illegally deported," according to documents in a federal district court in Abilene.

Though Mr. Neza was denied political asylum, there are two pending appeals. And a judge is expected to make a decision on whether immigration officials can sedate him.

"My main concern is to prevent the deportation," said his attorney, Mr. Gibson. "The drugging is just one more mean thing they are doing to this guy to deliver him into the hands of the assassins. My ultimate goal is to keep him out of hands of the assassins."

Others see it differently.

Ira Mehlman, a spokesman for the Federation for American Immigration Reform, a group that wants tough enforcement of immigration laws, said it's "unwise for someone to go over the heads of those who have adjudicated the case."

As for the possibility of sedation, he added, "We cannot allow policy to exist that if someone yells and screams all bets are off and the laws are not enforced. Otherwise, we'll have a lot of kicking and screaming."

Due process

But such druggings by federal immigration agents are stirring controversy.

In early October, the ACLU filed a motion in federal court in Los Angeles to stop U.S. immigration authorities from forcibly drugging deportees about to board commercial flights.

The ACLU is seeking class action status for its suit, which stems from the forced drugging of an Indonesian minister and a Senegalese man with anti-psychotic drugs.

The issue of forced druggings gained prominence during the nomination hearing of ICE chief Julie Myers on Sept. 12. In her testimony, Ms. Myers said current ICE policy prohibits sedation without a court order, and, thus, the court order provides the deportee due process under the U.S. Constitution.

ACLU attorney Ahilan Arulanantham said the practice raises serious questions.

"Immigrants are not animals, and you cannot forcibly drug them," said Mr. Arulanantham, who has also been in contact with Mr. Gibson, the Dallas attorney for Mr. Neza.

At Cornell Law School, immigration law specialist Stephen Yale-Loehr said the "case raises serious concerns about when the government can forcibly sedate a person to carry out a deportation order."

"A court should review the allegations carefully to make sure Mr. Neza's due process rights are not violated," Mr. Yale-Loehr said.

Arguing safety

In the interim, U.S. government attorneys Scott Frost and Tracy Short argued in a court pleading that "there is exceptionally strong public interest in the enforcement of duly enacted laws of the United States."

Drugging Mr. Neza with a sedative by a psychiatrist employed by the U.S. Public Health Services will have multiple beneficial effects, the attorneys argue in their pleading. "It will prevent Neza from committing assaultive acts against others, it will allow the United States to enforce its immigration laws, and it will ensure the safety of Neza and others during the removal."

The federal government cites a 1996 Texas case involving a deportee with the surname of Bechara, who threatened to bring down the plane if he were forced on the plane.

But Mr. Gibson counters that Mr. Neza made no such threats.

Mr. Neza was apprehended after filing a liquor license application for his Lufkin restaurant, called Joe's Italian Grill.

The government, in court documents, also notes that a state application for a liquor license stated Mr. Neza was a U.S. citizen. False claims to citizenship can result in permanent bars from the country.

No charges have been brought against Mr. Neza, Mr. Gibson said. And the false claim to U.S. citizenship wasn't made by Mr. Neza but by someone filling out the application, Mr. Gibson said in court documents.

Child Psychistrist to be sued over faulty evidence, Disgraced pediatrician investigated in 'Child Experiment" case.

The impulse for human experimentation is not restricted to psychiatrists. Here we have a case from Britain involving a pediatrician. We also note that a child psychiatrist is being sued for giving false evidence in the matter. From the IC Wales website

A banned paediatrician whose evidence helped convict Sion Jenkins will next week face an investigation into allegations that he carried out secret experiments on children. [Ed. note - Sion Jenkins was later found fully innocent]

Professor David Southall gave evidence at the former deputy headmaster’s trial nine years ago in which he was found guilty of murdering 13-year-old foster daughter Billie-Jo in 1998.

Mr Jenkins, 50, whose parents live in Aberystwyth, was acquitted of the crime in 2005 after spending six years in jail. He was retried twice but a jury failed to reach a verdict on both occasions.

Next Monday, Prof Southall faces a full General Medical Council probe into experiments he is alleged to have carried out on children.

The month-long investigation will inquire into allegations that Prof Southall, who denies any wrongdoing, acted in a way which was inappropriate and added to the distress of a bereaved person. He is also accused of abusing his professional position in relation to a report he was instructed to prepare by a local authority in relation to the care proceedings of a child.

It is further alleged that Prof Southall kept secret medical records on children.

In the 1980s and 1990s, under the aegis of Dr Southall, thousands of sick children were given breathing tests – called ‘sleep studies’.

The experiments, authorised by hospital ethics committees, were carried out despite the doubts of worried parents.

It is alleged that some of the tiny babies were forced to breathe poisonous gases and deprived of oxygen. The results of these tests were then said to have been stored by the paediatrician in 4,500 files.

The Attorney General now wants to see the files to see if they were produced at court hearings in which parents were accused of child abuse.

Last November, one Swansea mother told a GMC hearing that the paediatrician, who was accused of tampering with her child’s hospital records, treated her son like a ‘lab rat’.

The GMC probe comes as South Wales Police investigate an allegation of assault concerning Prof Southall involving a child being treated within the University Hospital Wales in the Heath, Cardiff, in 1991.

Sources close to Mr Jenkins say the former deputy head will be watching next week’s probe with interest after making an independent complaint against Prof Southall to the GMC.

Mr Jenkins has also lodged a formal complaint against Dr Arnon Bentovim, a child psychiatrist whose evidence at his original trial in 1998 helped to secure his conviction.

Earlier this year Mr Jenkins said: “I have decided to take this action because I believe that Prof Southall and Dr Bentovim must answer for their false evidence.

“Together, these two men paved the way for the destruction of my family and my wrongful conviction, and also allowed the murderer of Billie-Jo to remain at liberty.”

At the time Mr Jenkins’ solicitor Frances Swaine said: “It is absolutely essential that any doctor who provides evidence in the prosecution of a murder suspect should do so with the highest possible regard for his professional conduct.

“Failure to do so – as we have seen in a number of cases in recent years – may lead directly to serious injustice”.

Prof Southall was banned from child-protection work by the GMC in 2004 for his ‘high-handed intervention’ in the case of solicitor Sally Clark, who was jailed in 1999 for murdering her two baby sons.

He accused Mrs Clark’s husband Stephen of killing the children after watching a Channel 4 Dispatches show about the case. Mrs Clark was freed on appeal in 2003 and died in March this year. In July, Prof Southall’s ban was extended for a year by a medical fitness to practice panel.

Stevie Nicks: a story of a psychiatric survivor

An excellent story about the adventurous life of Stevie Nicks, Rock and Roll Star. Here is a tidbit:

The psychiatrist, she says, put her on a tranquilliser called Klonopin - 'he said to calm my nerves a little. I didn't want to do it. He said, "You're nervous." And I was nervous; I'm a nervous person. So I finally just said, all right.' Klonopin, Nicks says, is a member of the Valium family. 'It's a tranquilliser, right? And you think, what does tranquilliser mean? It tranquillises you!' Particularly when, as Nicks claims, the drug is radically oversubscribed.

After a year, she realised she was beginning to put on weight and lose interest in her work. 'And the saddest thing, I did an interview in England, and somebody had sent the article to my mother and she read it to me over the phone. And it said, you could see Stevie Nicks in there, but she was very sad and very quiet and she was just a shadow of her former self. And that article broke my heart.

And after that, it got worse, because he kept upping my dose. 1988 into '89, I'm now not even writing songs any more. I was living in a beautiful rented house in the Valley, and just pretty much staying home. Ordering take-in and watching TV. And I've gained 30lb and I'm 5ft 1in tall, and I'm so miserable. And I started to notice that I was shaking all the time, and I'm noticing that everybody else is noticing it too. And then I'm starting to think, do I have some kind of neurological disease and I'm dying?'

So 1993 comes rolling round, and Stevie Nicks is finally convinced that the protracted high dosage of Klonopin might be killing her. So she does exactly what you or I might do. She instructs her personal assistant, Glenn, to take her daily dose - just to see what effect it has.

'I said, it won't kill you, because it hasn't killed me, but I just want to see what you think. Because Glenn was terribly worried about me - everybody was. So I was taking two in the morning, two in the afternoon and two more at night. At that point if I could find a Percoset, because I'm so miserable, I'd take that, or I'd take a Fiorocet - anything.

'So Glenn proceeds to take all my medicine. He was setting up a stereo in the living-room. Well, after half an hour he was just sitting there. And he said, "I can't fix the stereo and I don't think I can drive home." And I said, "Well, good - just stay there, because I'm studying you." And he was almost hallucinating. It was bad. And I called up my psychiatrist, and I said, "I gave Glenn every-thing you've prescribed for me." And the first words out of his mouth were, "Are you trying to kill him?" And the next words out of my mouth were, "Are you trying to kill me?" '

Nicks admitted herself to the Daniel Freeman Memorial Hospital in Venice Beach. It took her 47 days to detox. 'Dallas Taylor, the drummer for Crosby, Stills and Nash, was there the whole time. I nearly died. I moulted. My hair turned grey. My skin started to completely peel off. I was in terrible pain.' She shivers at the memory. 'I think it's very good to talk about this to get the message out into the world about addiction to this particular drug. That was the worst period of my life. They stole my forties. It was eight completely wasted years of my life.'

Here's the irony, she says: the 'powers that be' had sent her to the psychiatrist in order to keep her working, but the 'treatment' he gave her made work almost impossible. 'It's very Shakespearean. It's very much a tragedy.'

But what happened to Glenn?

Nicks throws back her hair. 'Glenn was OK, because it was just for one day.'

Bipolar madness?

Another OpEd editorial against the drugging of Kids, from the San Francisco Chronicle

Why did a two-day conference on the rather arcane subject of children's bipolar disorder that took place in Pittsburgh earlier this month attract intense media attention? The answer can only be the death last December of Rebecca Riley.

Rebecca was a 4-year-old girl who died, according to the medical examiner, from an overdose of clonidine, also known as Catapress. This drug is most widely prescribed to lower blood pressure but is also routinely employed by child psychiatrists to aid in sleep and to control unruly behavior in children. America is the only country that addresses the public health crisis of children's bad behavior with medications. No other society uses psychiatric drugs as widely as we do.

In this case, clonidine was one of only three psychiatric drugs given to Rebecca for the treatment of her purported psychiatric illness -- bipolar disorder. Her parents are being held for murder, charged with intentionally overdosing their daughter. Their defense: They were only following the doctor's orders.

Kayoko Kifuji, the child's psychiatrist, working at the Tufts-New England Medical Center, has withdrawn from her practice and is not answering any questions. Her license has been temporarily suspended. But she was not some extreme outlier practicing some voodoo alchemy on this child. Indeed, Tufts-New England issued a statement after the arrest of Rebecca's parents that her care "was appropriate and within responsible professional standards."

The Riley case is confusing, and responsibility for her death will ultimately decided by the courts. But her particular diagnosis and treatment have uncovered what one child psychiatrist called "the hidden tsunami" of children's mental health: the vast increase in the number of children receiving the bipolar diagnosis and the concomitant growth in the use of "mood stabilizing" drugs.

Rebecca was diagnosed at age 2 1/2 as having bipolar disorder, the new name for manic-depression. This diagnostic label conferred on Rebecca the same implications of being a chronic mental patient requiring drug treatment for the rest of her life. The conference in Pittsburgh fiercely debated the question: Can or should children that young be diagnosed with a disorder that ostensibly lasts a lifetime?

In addition to clonidine, Rebecca was also prescribed Seroquel, an anti-psychotic, and Depakote, an anti-convulsant. Neither drug is approved by the FDA for bipolar disorder in children. There are scant studies to justify such use. Is it appropriate to be prescribing these medications to someone so young?

There always have been unruly and difficult children. Rebecca's mother described her as, on the surface, very irritable, but the household was highly dysfunctional (Rebecca's older brother and sister were also on bipolar medications).

Nearly 3.5 million children in the United States take drugs for conditions such as attention deficit hyperactivity disorder. About 1.5 million children received an anti-psychotic prescription in 2006. While these drugs can be helpful in the short-term to improve children's behavior, they are not the moral equivalent to addressing aspects of their home life that are contributing to their problems. All these drugs have potential short and long-term side effects. Yet medication is often the desperate "quick fix" answer to chronic and difficult social problems.

Even if we agree on the need to medicate these children, should we be labeling children as young as age 2 as bipolar? Debate rages within professional circles. The most recent guidelines issued three months ago by the American Academy of Child and Adolescent Psychiatry specifically caution against the use of this diagnosis and its treatment in children younger than 6.

Still, it may not be coincidental that the Tufts Medical Center is only a short drive from Harvard University, where that institution's pre-eminent child psychopharmacology clinic has been at the forefront of broadening and promoting the bipolar diagnosis for more and younger children.

Many doctors question the tie between any child's behavior and the adult bipolar condition. Given the predictable turbulence of adolescence (not to mention the terrible 2s), shouldn't one wait until children reach their early 20s before assigning this lifelong sentence? Other doctors say we cannot afford to wait to aggressively treat these problems of childhood, even though clear prospective links between the behaviors of bipolar illness of children to the later adult disorder have not been established.

Of course, the pharmaceutical industry's influence also cannot be denied. It vigorously promotes with millions of dollars the research and professional "education" that supports the pediatric bipolar diagnosis.

While the conference in Pittsburgh raised troubling questions about the bipolar "epidemic" in children, it will not change in the short term the way America copes with very difficult children. In the meantime, the practical aspects of addressing children's extreme behavior in an otherwise underfunded mental health system will tilt doctors toward making such a diagnosis and using these sedating and potentially dangerous drugs.