Are There Dangerous Side Effects Connected with Use of Suboxone?

If you’re not familiar with it, Suboxone is the brand name of a drug that is used in the treatment of opiate addiction. It was recently in the news because the young man who shot and killed several people in South Carolina had been recently arrested for possessing Suboxone that wasn’t prescribed for him. Could Suboxone have been involved in mental problems that contributed to his shooting these people? To determine this possibility, it’s necessary to take a closer look at this drug and its side effects.

What’s in Suboxone?

The primary drug in this formula is buprenorphine, a synthetic opioid (meaning “similar to opiate”). This drug prevents an opiate-addicted person from going into withdrawal but does not create as much euphoria as heroin or painkillers. So it is broadly used in the treatment of opiate addiction, enabling people to stop using heroin or painkillers without the sickness that would normally result. One report estimated that three million Americans have been treated with Suboxone.

Despite the high not being as potent as that of heroin, it’s still a popular drug of abuse, with many drug dealers offering their customers their choice of heroin or Suboxone. If there are any hazardous mental side effects to using or abusing Suboxone, all those people illicitly using this drug will not have the support of a doctor to cope with those effects.

Suboxone Side Effects

The website for the manufacturer, Reckitt Benckiser of the UK, notes these side effects of the drug: Nausea, vomiting, headache, numb mouth, constipation, intoxication, disturbance in attention, irregular heartbeat, decrease in sleep, back pain, fainting, and dizziness.

Pharmaceutical company Reckitt Benckiser lists no mental effects of this drug. Their website only states that there are “nervous system” effects such as: Anxiety, depression, dizziness, nervousness and insomnia.

The Substance Abuse and Mental Health Services Administration notes this side effect: Dysphoria, defined as a state of depression, restlessness, or unpleasant dissatisfaction with life.

But What Do Actual Users Say about Suboxone?

Some recent news reports have ventured into online forums that permit drug users to discuss the effects of the drugs to find out what these actual users say about side effects. While these are not authoritative sites by any means, it might be useful in this circumstance to sample their comments.

In 2011, a woman described her experience using buprenorphine in a patch as prescribed for pain: “I became extremely angry and irritable. I was having other problems with it and wound up taking the patch off. When I put a new one on last night, the same thing happened. Ten minutes and tears just started pouring. I couldn’t stop it! Half an hour after that I was high as a kite, not happy but talkative. Twenty minutes later I felt the need to punch someone in the face, and I’ve been irritable and bitchy ever since. I feel like gruesomely and meticulously dismembering every other person I come across, just because.”

This person stopped using Suboxone while he was taking 6 milligrams per day: “On the fourth day I wanted to kill myself. Whoever says Suboxone is easy to come off is a better person then I am.”

In 2013, a fellow who was trying to get clean after using 2 mg Suboxone for six months said: “I set a new world’s record, at least my personal best, 27 days with no sleep! On a 2 a.m. walk at night 26 I was seriously ready to jump out into traffic, I was hallucinating and could barely walk, and once you think you’re getting better, it comes back and kicks you in the ***!”

In 2014, a person who had been taking Suboxone for two years and then went off it said: “The INSANE anxiety has settled in to stay. I make myself sick obsessing over what I need to be doing and what is about to go wrong and how in the world I am going to make it through. I sit and think and in the middle of everything I do, chores, driving, watching TV, suddenly my heart sinks as I sit and entertain one of my negative thoughts in my head.”

A man with the forum name of “Dan Steely” described the effect of taking one to two mg of buprenorphine a day for eight months: “It took me months to figure out I had turned into a zombie. Like I said I could function pretty well but my life had become very flat. I no longer enjoyed or looked forward to the things that made my life fun.”

A person with the forum name “Shanellie” mentioned in 2012: “Subs are just not for everyone. I tried that route and basically spent an entire year feeling weird, sick and miserable.”

There’s no drug in the world that works for every single person which is why it’s vital for a patient to stay in touch with a doctor when starting treatment. When a person is abusing this drug or does not have a trusting relationship with his doctor, it’s possible for things to go very wrong, as these people have noted.

Was Suboxone Abuse Related to this Recent Tragedy?

This is a question that doctors and other qualified experts will need to answer. What does seem clear is that Suboxone and buprenorphine don’t work for every patient and have some serious mental side effects for some. When these drugs are being used without medical supervision, there’s no telling what could happen.

Drug poisoning statistics in the US

Note how prevalent psych drugs are as a danger to kids.

Information on drug poisoning suicide deaths in the US is not available at a very granular level. However, the following table¹ does give a breakdown of 2012 suicide drug poisoning deaths:

Method	No.	%
Other and unspecified drugs, medicaments and biological substances	3,632	54.0%
Other gases and vapours	1,003	14.9%
Anti-epileptic, sedative-hypnotic, anti-parkinsonism and psychotropic drugs, not elsewhere classified	969	14.4%
Narcotics and psychodysleptics [hallucinogens], not elsewhere classified	662	9.8%
Non-opioid analgesics, antipyretics and anti-rheumatics	160	2.4%
Organic solvents and halogenated hydrocarbons and their vapours	126	1.9%
Other and unspecified chemicals and noxious substances	78	1.2%
Alcohol	47	0.7%
Other drugs acting on the autonomic nervous system	42	0.6%
Pesticides	10	0.1%
Total	6,729

According to the CDC¹, 81% of intentional poisoning suicides were caused by drugs - both legal and illegal. The most commonly used drugs identified in drug-related suicides were psychoactive drugs, such as sedatives and antidepressants, followed by opiates and prescription pain medications¹. Self-harm poisoning was the leading cause of emergency department visits for intentional injury in 2010². In 2011, it was estimated by SAMHSA³ that attempted suicide led to 228,366 emergency department (ED) visits. Almost all involved a prescription drug or over-the-counter medication. It is worth noting that with only 5,465 actually succeeding in suicide using drugs, it means there were 42 ED visits for every successful suicide. Sobering odds of success, and there are probably lots of attempts that don’t even end up in hospital. Most patients attempting drug-related suicide had some form of follow-up after their ED visit, with the outcomes of their ED visits as follows:

• 49% were admitted for inpatient hospital care (18.3% to an intensive or critical care unit [ICU]), 9% to a psychiatric unit, and 22% to other units including combination psychiatric/detox units)
• 25% were transferred to another health care facility for specialist treatment
• 7% were referred to detox/treatment
• 15% treated and discharged to home

Evidence suggests that alcohol had been ingested in around a third of people who died by suicide, and in 29% of those admitted to ED departments. In nearly two thirds of cases more than one drug was involved. Pain relievers were found to be involved in 38% of drug-related suicide attempts. Narcotic pain relievers were involved in over a third of that number, and cetaminophen products were involved in just under a third. Benzodiazepines (anti-anxiety drugs) were found to be involved in 29.3% of drug - related suicide attempts. Alprazolam (Xanax) and clonazepam each accounted for about a third. Antidepressants appeared in 19.6% of visits. About half of those visits involved an SSRI antidepressant such as citalopram, sertraline, or fluoxetine. Trazodone, a SARI antidepressant, was involved in about a quarter. Antipsychotics, as a whole, appeared in 12.9% of visits, with the vast majority being the newer types of atypical anti-psychotics e.g. Quetiapine. The American Association of Poison Control Centers (AAPCC)⁴ publishes data on phone calls they receive into their 55 centers which are designed to track the incidence of poison exposure (both intentional and unintentional) nationally. In 2012 they recorded 2,873 deaths by poisons (itself some way short of the figures provided by US Department of Health and Human Services for suicide alone), and the table below shows the drugs that appeared most frequently as the cause of death by poisoning. Top 25 substance categories associated with deaths reported by 55 U.S. Poison Centers 2012

Substance	No.	%
Sedative/hypnotics/antipsychotics	377	14.1%
Miscellaneous cardiovascular drugs	350	12.2%
Opioids	255	8.9%
Acetaminophen (paracetamol) in combination	183	6.4%
Miscellaneous stimulants and street drugs	176	6.1%
Acetaminophen (paracetamol) only	159	5.5%
Miscellaneous alcohols	145	5.0%
Miscellaneous antidepressants	126	4.4%
Selective serotonin reuptake inhibitors	89	3.1%
Miscellaneous antihistamines	69	2.4%
Tricyclic antidepressants	69	2.4%
Miscellaneous fumes/gases/vapors	67	2.3%
Acetylsalicylic acid	65	2.3%
Miscellaneous muscle relaxants	57	2.0%
Miscellaneous anticonvulsants	56	1.9%
Oral hypoglycemic	56	1.9%
Non-nonsteroidal anti-inflammatory drugs	50	1.7%
Miscellaneous unknown drug	44	1.5%
Miscellaneous unknown drugs	44	1.5%
Miscellaneous chemicals	33	1.1%
Miscellaneous hormones and hormone antagonists	31	1.1%
Anticonvulsants: gamma aminobutyric acid & analogs	29	1.0%
Miscellaneous anticoagulants	23	0.8%
Miscellaneous diuretics	23	0.8%
Cannabinoids and analogs	20	0.7%
Miscellaneous hydrocarbons	19	0.7%

It should be noted that these percentages from their source do not add up to 100% as they are only the top 25 causes. It should also be noted that the above figures each represent the number of mentions in cause of death, not number of deaths. Any one fatality may have had exposure to more than one substance. Indeed, consistent with data from SAMHSA, the breakdown of drugs shown for many of the fatalities reported by AAPCC showed more than one drug. Sources

1. Centers for Disease Control and Prevention, Web-based Injury Statistics Query and Reporting System (WISQARS), fatal injuries report figures (http://webappa.cdc.gov/sasweb/ncipc/leadcaus10_us.html).
2. National Hospital Ambulatory Medical Care Survey: 2010 Emergency Department Summary Tables (10 and 17) (www.cdc.gov/nchs/data/ahcd/nhamcs_emergency/2010_ed_web_tables.pdf). See also Centers for Disease Control and Prevention, National Center for Injury Prevention and Control (NCIPC), Prescription Drug Overdose in the United States: Fact Sheet www.cdc.gov/homeandrecreationalsafety/overdose/facts.html.
3. Substance Abuse and Mental Health Services Administration (SAMHSA), Office of Applied Studies. Drug Abuse Warning Network (DAWN): National estimates of drug-related emergency department visits for 2011, Table 22 (www.samhsa.gov/data/sites/default/files/DAWN2k11ED/DAWN2k11ED/DAWN2k11ED.pdf).
4. James B Mowry, PHARMD; Daniel A Spyker PHD, MD; Louis R Cantilena  JR, MD, PHD; J Elise Bailey MSPH; and Marsha Ford MD; 2012 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 30th Annual Report, Clinical Toxicology vol. 51 Oct 2013 (available from www.aapcc.org/annual-reports).

Mental health professionals 'may have committed war crimes', report says

As reported in the Guardian

Much more at the link

Health professionals who assisted in the CIA’s torture programme of terror suspects “betrayed the most fundamental duty of the healing professions” and may have committed war crimes, according to a hard-hitting report released on Tuesday.

Physicians for Human Rights (PHR) called for a federal commission to investigate the full extent of health professionals’ participation in CIA torture following last week’s release of the US Senate Select Committee on Intelligence (SSCI) report on the agency’s detention and interrogation programme.

“Under the auspices of the Bush administration, the CIA systematically tortured suspected terrorist detainees, in at least one instance to the point of death. This torture program heavily relied on the participation and active engagement of health professionals to commit, conceal, and attempt to justify these crimes,” PHR concludes.

The report comes days after Dick Cheney, the former US vice president, defended the practices disclosed in the report including “rectal feeding” – arguing the practice was done for medical reasons. Former CIA director Michael Hayden has also claimed that the practice was carried out on medical grounds.

According to PHR, rectal hydration is almost never practiced in medicine because there are more effective methods, and it is never considered as a first option for rehydration or nutritional support. PHR notes that the report indicates that rectal hydration was used to “control and/or punish the detainees ... Insertion of any object into the rectum of an individual without his consent constitutes a form of sexual assault.”

“Rather than reject such brutal practices, medical officers appear to have modified them to increase pain: ‘we used the largest Ewal [sic] tube we had,’ stated one officer in a February 2004 email,” writes PHR.

Dr Vincent Iacopino, PHR’s senior medical advisor and an author of the analysis, said Cheney was “either terribly misinformed or propagating a lie. Any reasonable person knows feeding does not take place rectally.”

The report sets out eight areas where doctors, psychologists and physician assistants may have violated “medical and psychological ethics, domestic and international law, and federal research guidelines”:

• Designing, directing and profiting from the torture program;
• Intentionally inflicting harm on detainees;
• Enabling US department of justice lawyers to create a fiction of “safe, legal and effective” interrogation practices;
• Engaging in torture research that could potentially violate the Nuremberg Code, brought in after World War II to ban “experiments” like those practiced by the Nazis, and could constitute a crime against humanity;
• Monitoring torture and calibrating the level of pain;
• Evaluating and treating detainees for the purposes of torture;
• Conditioning medical care on cooperation with interrogators;
• Failing to document physical and/or psychological evidence of torture.

The report is especially damning of the work of psychologists James Mitchell and Bruce Jessen. The SSCI described how the pair – given the pseudonyms “Grayson Swigert” (Mitchell) and “Hammond Dunbar” (Jessen) in the report– designed the so-called “enhanced interrogation techniques” (EITs) used to interrogate suspects.

Much more at the link

Emergency Department Visits Attributed to Overmedication That Involved the Insomnia Medication Zolpidem (Ambien)

As seen in this government report from SAMSA.GOV

In Brief:

• The total estimated number of zolpidem-related emergency department (ED) visits involving overmedication increased for both males and females between 2005-2006 and 2009-2010. 
• In 2010, females accounted for two thirds (68 percent) of zolpidem-related ED visits involving overmedication; patients aged 45 to 54 represented the largest proportion of zolpidem-related ED visits involving overmedication. 
• More than half of zolpidem-related ED visits involving overmedication in 2010 included other pharmaceuticals combined with zolpidem (57 percent). 
• Nearly half (47 percent) of zolpidem-related ED visits involving overmedication resulted in either a hospital admission or transfer in 2010, 26 percent of which were admissions to a critical or intensive care unit.

Read the Full Report at this link

How do I file a complaint against a mental health care facility/professional?

As documented on the NAMI Website FAQ section

Complaints about an individual physician/psychiatrist: 

If the physician/psychiatrist works for a hospital or agency, you may contact the doctor's supervisor. You can also file a complaint with the state medical board or the American Psychiatric Association (APA) (some psychiatrists are members, some are not). The APA might also refer you to its APA District Branch or state psychiatric society.

Complaints about other mental health professionals: 

If employed by a hospital or agency, you may file complaints with the therapist's supervisor, the hospital ombudsman or the administrator. Therapists are regulated by their licensing boards (e.g. the state board of health and mental hygiene, counseling or other licensing board). They may also be members of their professional associations (such as the National Association of Social Workers, the American Psychological Association, etc.). Your NAMI State Organization may have the appropriate number and listing.

Abuse or neglect in an institutional setting: 

Protection and Advocacy Agencies advocate on behalf of individuals with mental illness who are in institutional settings (such as jails, correctional facilities or state psychiatric hospitals); allegations of abuse or neglect are one of their top priorities.

Complaints of abuse, neglect or mistreatment in the hospital setting:

As mentioned above, you may file a complaint directly to the hospital ombudsman or administrator.

Or, you may contact The Joint Commission (formerly known as JCAHO, the Joint Commission on Accreditation of Healthcare Organizations) online or call their toll-free Compliant Hotline at (800) 994-6610 to share concerns regarding quality of care. The Joint Commission accredits hospitals, home health agencies, nursing homes, outpatient clinics, behavioral health care programs and managed care plans among others. Complaints should be related to patient rights, quality of care, safety, infection control, medication use and/or security. They are unable to assist with billing, insurance or payment disputes.

Complaints about a CMHC (community mental health center):

You may file a complaint with the state mental health agency. Medicaid and Medicare recipients with complaints about CMHCs have the following options: Medicare beneficiaries may contact the Centers for Medicare and Medicaid Services (CMS) regional Medicaid Service and the state Peer Review Organization. Medicaid beneficiaries may contact the state Medicaid official, and perhaps the state medical review board could help.

What’s Behind the Dramatic Decline in ECT Treatment Over the Past 15 Years?

As Reported in the Psychiatric News.

Here are some of the highlights:

There has been a dramatic decline in the use of electroconvulsive therapy in U.S. general hospitals over the past 15 years.

[...]

This finding comes from a study published online October 10 in Biological Psychiatry. The lead researcher was Brady Case, M.D., an assistant professor of psychiatry at Brown University and director of the Health Services Research Program at Bradley Hospital in East Providence, R.I.

The study conducted by Case and his colleagues appears to be the first study on the use of inpatient ECT in U.S. general hospitals since 1992. They examined trends in the use of ECT in a national hospital sample over a 17-year period from 1993 to 2009. The hospitals were nonfederal, short-term general or specialty hospitals, including both public and private facilities and academic medical centers. However, freestanding psychiatric hospitals were excluded. In their paper, Case and his coworkers referred to all of the analyzed hospitals as “general hospitals.”

Here are several of their most salient findings:

• The percentage of general hospitals conducting ECT decreased from 15 percent to 11 percent, and the percentage of hospitals with psychiatric units conducting ECT decreased from 55 percent to 35 percent.
• The number of stays in general hospitals involving ECT rose from 1993 to 1995 from 13/100,000 residents to 16/100,000 residents, but then fell gradually after that, to 7/100,000 residents in 2009. This decline appeared to be due, to a large extent, to reduced use of ECT with elderly patients, a group traditionally thought to benefit most from it. (?!!)
• For inpatients with severe recurrent depression, the percentage whose treating hospitals conducted ECT fell from 71 percent to 45 percent.
• Throughout the study period, depressed inpatients from poor neighborhoods and those who were publicly insured or uninsured were less likely to receive care from hospitals conducting ECT.

“The data strongly support the impression that psychiatric units of general hospitals are ceasing to conduct ECT and that this is driving the decline in the number of patients receiving ECT,” Case told Psychiatric News. But why are hospitals dropping the procedure?

Possible explanations, Case said, are “growing pressures to avoid the inpatient treatment costs and length of stay associated with ECT and declining familiarity and more negative attitudes toward the procedure among providers and patients…. We didn’t have information on provider and patient attitudes, but as more facilities cease conducting ECT, we can expect that fewer clinicians and inpatients will be exposed to the option…. On the other hand, it is clear that popular perceptions of mental illness are increasingly biological, and where ECT is conducted, there has been no decline in patients electing to receive it.”

[...]

The findings have widespread implications, Case believes. For example, “most Americans admitted to general hospitals for severe, recurrent depression are now being treated in facilities that do not conduct ECT. This is the consequence of a solid 15-year trend in which psychiatric units appear to be discontinuing use of the procedure…. If the trends of the last 15 years hold, the number and proportion of general hospital psychiatric units conducting ECT will continue to decline, and fewer people will receive it.”

He added that regulations expected to be issued by the FDA will influence how ECT is used in the future, “but as far as I know, the decision about how to classify ECT devices is still pending. If the FDA follows its panel recommendation and ultimately retains Class III—high risk—status for ECT devices, then I would expect the decline to accelerate.”

[...]

Misuse of Psychological Tests in Forensic Settings: Some Horrible Examples

As seen on ParentingPlan.net We have not quoted the entire paper, but only the introductory section with a few of the smaller examples.

The original post has many fine examples, plenty of detailed references, and is oriented to situations where parents are separated. Unfortunately, given other news reports of recent years, this paper is still quite relevant

Misuse of Psychological Tests in Forensic Settings: Some Horrible Examples

Ralph Underwager and Hollida Wakefield

American Journal of Forensic Psychology, Volume 11, Issue 1

Psychological tests are often used inappropriately and are misinterpreted and overinterpreted in the forensic setting. This harms the person being evaluated and interferes with the cause of justice. It also does a disservice to the reputation of psychologists and the science of psychology. Actual examples of misuse of particular techniques and tests and misinterpretation illustrate what has been done in forensic settings.

A forensic evaluation is different from a clinical evaluation. When an evaluation is done in the clinical setting, the conclusions are used to develop a treatment plan. These conclusions form working hypotheses which can be confirmed or rejected during treatment. However, in the forensic setting, a one-time decision is made about the individual — a decision which can markedly affect the person's life.

If tests are misinterpreted in the clinical setting, the treatment plan developed from the evaluation may not be the most effective for the client. However, since treatment plans are generally modified and revised throughout the course of treatment, the mistaken conclusions can be corrected. But, an erroneous decision in the forensic setting can result in immediate and severe consequences, such as losing custody of a child or being jailed. If decisions and recommendations by the psychologist are not based on adequate data, the psychologist is acting both incompetently and unethically.

In addition, conclusions drawn by the psychologist are subject to cross-examination in the adversarial setting. If the conclusions are not based upon adequate data, the psychologist's testimony will be discredited or impeached by a skillful opposing attorney. Therefore, the psychologist should only present conclusions in reports and testimony which can be defended when challenged in cross-examination.

In the course of examining hundreds of reports, we have seen many examples of tests that are misadministered, misinterpreted, overinterpreted, or should never have been given in the particular setting. We are presenting a sample of these to illustrate what should be avoided by any psychologist who does forensic evaluations.

DRAWINGS

Tests such as the House-Tree-Person (HTP) and Kinetic Family Drawings are often overinterpreted and misinterpreted. There is a lack of validity and reliability in the use of drawings as projective assessment devices. In a review of the Draw-A-Person test in the Seventh Mental Measurements Yearbook, Harris (1) notes that there is very little evidence for the use of "signs" as valid indicators of personality characteristics. With children's drawings there is so much variability from drawing to drawing that particular features of any one drawing are too unreliable to say anything about them. The Tenth Mental Measurements Yearbook (2), in reviews by Cundick and Weinberg (p.422-425) continues the consistent finding since the first edition, 1938, that interpretations of drawings (as are often done in forensic evaluations) are unsupported by empirical evidence. Both reviewers note that there are no normative data establishing reliability and validity of the Kinetic Drawing System.

Here are some of the examples as given:

Example 2

A four-year-old girl was asked to draw a picture of herself and the family doing something. She instead, according to the school psychologist who was evaluating her, "seemed to be preoccupied with drawing circles within circles which she called 'caves.' Her second representation bore a significant resemblance to male genitalia (when asked what it represented, she reported that it was a ball rolling into a lion's cave)." This was interpreted as being suggestive of sexual abuse and the fact that the child has been subjected to some type of traumatic experience.

When we saw the child, now age five, we tested her and found borderline to low-average intelligence and no ability to draw anything other than scribbled circles. The child clearly had difficulties with visual motor perception and indeed, could not draw, a fact which was ignored by the other evaluator. This example, therefore, illustrates the importance of recognizing the child's developmental level.

Example 5

A four-year-old girl's drawing of a tree in the HTP was considered significant because the child, when asked to draw a tree, also drew a cactus. This was interpreted in terms of "unconscious expression of danger and fearfulness." However, the child was not asked if she had a cactus in her yard (this was in Texas).

The child also brought a drawing of a clown's face to the therapist which she had ostensibly drawn while in the waiting room with her parents. The clown was interpreted as being significant because "there is an element of sadness in the clown's eyes." This clown is of much greater sophistication and detail than the child's other drawings. When pressed about this in his deposition, the psychologist acknowledged that the parents probably drew it and she colored it. This example illustrates both problems in administration and in interpretation.

Example 20

A baby was returned to the foster mother following a visit with the parents and was described as having the "smell of sex." An emergency hearing was held in which social services attempted to cut off visits because this "smell of sex" triggered the suspicion that the parents were having sex with their baby. A psychologist agreed that the sex smell was significant and indicated probable abuse on the part of the parents. Fortunately, the parents had been at a church potluck dinner during the entire visit so they were able to disprove, the accusations.

We can just imagine the horror that happens when this gets involved with separation and divorce proceedings.

Attorneys begin closing arguments in William Ayres trial

As reported in the San Mateo County Times

Closing arguments are expected to conclude today in the trial of Dr. William Ayres, the once-prominent child psychiatrist accused of lewdly touching half a dozen boys under the guise of medical necessity.

Prosecutor Melissa McKowan and defense attorney Doron Weinberg began their closing statements Monday in San Mateo County Superior Court. Ayres, 77, faces nine counts of lewd and lascivious conduct with a minor younger than 14. The charges are based on the accusations of six former patients who argue that they were molested by Ayres between the ages 9 and 13.

McKowan said Monday that a 10th charge had been dropped during the course of the trial that stemmed from the accusations of a man referred to in court as Eric B., who testified that Ayres masturbated him during a physical exam when he was 13. He originally was going to testify that a second incident had occurred, McKowan said.

She told the jury Monday that Ayres performed physical and genital exams exclusively on male patients because he is a pedophile — a psychiatrist who desired to undress, touch and see the bodies of young boys. She referred to the exams he conducted as "sloppy, drop your pants and sit on the table" procedures.

"If genital exams are necessary in the diagnosis of adolescent children with psychological or mental health issues, why would you only conduct those exams on boys?" she asked the jury.

McKowan urged the jury to consider why Ayres kept poor notes of the exams and the unusual conditions under which he gave them. She also pointed out that no witness ever testified for the defense that Ayres taught the importance of physical exams at UC San Francisco, something he told the court last week that he had done.

Judge Beth Freeman issued jury instruction before closing arguments. She told the jury that four former patients who accused Ayres of molesting them but whose charges fall outside the state's statute of limitations can be considered in deciding if Ayres has a disposition to commit sexual offenses, or if their testimony can show that Ayres had a plan to lewdly touch the in-statute accusers.

Weinberg told the jury that there is simply no evidence Ayres committed a crime. He said the case rests entirely on memory, asking jurors to recall the testimony of memory expert Dr. Elizabeth Loftus.

"This case is about memory and memory alone," Weinberg argued. "There is no physical evidence."

[...]

Science and the Psychiatric Publishing Industry

A paper in the journal Ethical Human Psychology and Psychiatry, Volume 11, Number 1, 2009 , pp. 29-36(8) Publisher: Springer Publishing Company, by McLaren and Niall

Abstract

Objective: An empirical examination of the scientific status of psychiatry.

Method and Results: Analysis of the publications policy of the major English-language psychiatric journals shows that no journal meets the minimum criteria for a scientific publishing policy.

Conclusion: Psychiatry lacks the fundamental elements of any field claiming to be a science. Furthermore, its present policies are likely to inhibit scientific development of models of mental disorder rather than facilitate them. The psychiatric publishing industry is in urgent need of radical reform.

We told you so.

Trial for psychiatrist Dr. William Ayres, accused of molestation begins

Report from the San Mateo County Times

After two years of events worthy of a prime time legal drama, embattled child psychiatrist Dr. William Ayres will finally stand trial Monday. He is accused of molesting seven of his young male patients.

Ayres, 77, was a prominent member of the San Mateo medical community and served as president of the American Academy of Child and Adolescent Psychiatry.

He also performed physical examinations and inspected the genitalia of many of his juvenile psychiatric patients.

The once well-respected doctor was arrested in April 2007 and charged with 14 counts of lewd and lascivious acts with three victims, ages 9, 11 and 12 at the time of the alleged abuse.

The case's publicity brought forward four more accusers, bringing the number of Ayres' felony molestation counts to 20. He was freed on $750,000 bail.

The shocking story made international headlines, and the trial beginning Monday is expected to draw more public attention.

"We are exceedingly pleased that we are now on the doorstep of getting justice," San Mateo County Chief Deputy District Attorney Steve Wagstaffe said Friday.

A trial judge will be selected by Judge James Ellis in San Mateo County Superior Court in Redwood City on Monday morning.

Wagstaffe predicted jury selection and pretrial motions would take two weeks, but that the entire trial would last eight to 10 weeks.

Ayres practiced for decades in San Mateo County, seeing patients referred to him
through local school districts and the county's juvenile court, in addition to his private practice.

[...]

Police first began investigating him in 2002 after being told by a man who was a patient of Ayres in the 1970s that the doctor had molested him on multiple occasions. But the case had to be dropped after a U.S. Supreme Court ruling effectively changed the statute of limitations on such cases.

Childhood molestation can only be brought by victims who are younger than 29 or whose alleged abuse occurred after Jan. 1, 1998.

The San Mateo Police Department reopened the case in March 2006, at the urging of a friend of one of the victims to seek out other possible victims who fell within the legal statute of limitation.

That friend was New York-based freelance writer Victoria Balfour, who made it a personal crusade to unearth possible molestation victims of Ayres and help authorities build a case against him.

A search warrant was executed for Ayres' records, and a list was compiled of more than 800 patients.

Prosecutors believe they know of at least 39 former patients of Ayres who had been molested by him, but most did not fall under the state's statute of limitations.

After seven months of exhaustive and painful interviews with patients on the list, police took Ayres into custody at his San Mateo home on April 5, 2007.

Ayres' medical license was suspended, and has since expired.

On April 28, 2007, the child psychiatrist accused of molesting dozens of pre-adolescent boys in San Mateo County for decades declared his innocence of the multiple counts against him.

Now, more than two years later, the once-prominent child psychiatrist's fate will likely be left to a jury.

[...]

Ayres was known nationally as one of the country's top child psychiatrists; he was just as well respected on the Peninsula where he ran a private practice for decades.

He was probably one of fewer than 10 San Mateo County psychiatrists with a subspecialty in child and adolescent psychiatry, according to San Mateo County Medical Association Executive Director Sue Malone.

He told colleagues he performed medical examinations because that was the way he had been trained. He had done his residency in the early 1960s at the Judge Baker Center in Boston, one of the country's premier centers for the study of child psychology.

While most child psychiatrists admit that administering physical exams to patients is uncommon today, many professionals defend the practice as another instrument in a psychiatrist's toolbox.

A spokeswoman from the American Academy of Child and Adolescent Psychiatry, of which Ayres was president for more than a decade, told MediaNews that performing physicals on patients in a psychiatric setting can be "consistent with good medical practice."

Wagstaffe said he expected attorneys on both sides to present expert opinions on the matter.

While the passing of time between charges and trial can often damage prosecutors' cases, Wagstaffe said all their witnesses were ready to go.

"This case is more than ripe for trial," he said.

Bitterness To Be Classified As a Mental Illness

Some psychiatrists are trying to get excessive bitterness identified as a mental illness named post-traumatic embitterment disorder. Of course this has some people who live perfect little lives, and always get what they want, questioning the new classification. The so called "disorder" is modeled after post-traumatic stress disorder because it too is a response to a trauma that endures. "They feel the world has treated them unfairly. It's one step more complex than anger. They're angry plus helpless," says Dr. Michael Linden, the psychiatrist who put a name to how the world works. Reported in the LA Times, via Slashdot

US soldier who shot five troops was 'broken' by counsellors

As seen in the Telegraph

Army Sgt. John M. Russell, 44, has been charged with murder and aggravated assault in the Baghdad shootings, which his father said took place about six weeks before the end of his third tour of duty in Iraq.

Wilburn Russell, 73, alleged his son had been treated poorly at the stress centre and had e-mailed his wife calling two recent days the worst in his life.

"I hate what that boy did," said Mr Russell, speaking in front of the two-story suburban home his son is buying with his wife. "He thought it was justified. That's never a solution."

Excerpts of his military record, obtained by The Associated Press, show Sgt. Russell previously did two one-year tours of duty in Iraq, one starting in April 2003 and another beginning November 2005. The stress of repeat and extended tours is considered a main contributor to mental health problems among troops serving in Iraq and Afghanistan.

His father said the soldier, an electronics technician, was at the stress centre to transition out of active duty. He said his son was undergoing stressful mental tests that he didn't understand were merely tests, "so they broke him."

"John has forfeited his life. Apparently, he said (to his wife), 'My life is over. To hell with it. I'm going to get even with 'em,"' he said.

"He lived for the military," Mr Russell said. "We're sorry for the families, too. It shouldn't have happened."

The soldier's son, John M. Russell II, said that he has communicated with his father by e-mail regularly. In the last message he received from him, April 25, his father sounded normal and planned to be back in Texas to visit in July.

"He's not a violent person," he said. "He's just a loving, caring guy.

He doesn't like to see anyone get hurt. For this to happen, it had to be something going on that the Army's not telling us about."

Related Articles

• US soldier shoots dead five comrades in Baghdad
• US soldier kills 5 troops in Iraq
• US soldier jailed for 'execution' murders in Iraq
• Iraq withdrawal: background to the war
• US army soldier sentenced to life in prison for murder of Iraqi prisoners
• US Army sergeant convicted of murdering four Iraqi detainees

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.

Waterboarding, Interrogations: The CIA's $1,000 a Day Specialists

As reported on ABC News

As the secrets about the CIA's interrogation techniques continue to come out, there's new information about the frequency and severity of their use, contradicting an 2007 ABC News report, and a new focus on two private contractors who were apparently directing the brutal sessions that President Obama calls torture.

According to current and former government officials, the CIA's secret waterboarding program was designed and assured to be safe by two well-paid psychologists now working out of an unmarked office building in Spokane, Washington.

Bruce Jessen and Jim Mitchell, former military officers, together founded Mitchell Jessen and Associates.

Both men declined to speak to ABC News citing non-disclosure agreements with the CIA. But sources say Jessen and Mitchell together designed and implemented the CIA's interrogation program.

Click here to see Jessen refusing to talk to ABC News.

"It's clear that these psychologists had an important role in developing what became the CIA's torture program," said Jameel Jaffer, an attorney with the American Civil Liberties Union.

Click here to see Mitchell refusing to talk to ABC News.

Former U.S. officials say the two men were essentially the architects of the CIA's 10-step interrogation plan that culminated in waterboarding.

Associates say the two made good money doing it, boasting of being paid a $1,000 a day by the CIA to oversee the use of the techniques on top al Qaeda suspects at CIA secret sites.

"The whole intense interrogation concept that we hear about, is essentially their concepts," according to Col. Steven Kleinman, an Air Force interrogator.

Both Mitchell and Jessen were previously involved in the U.S. military program to train pilots how to survive behind enemy lines and resist brutal tactics if captured.

Mitchell and Jessen Lacked Experience in Actual Interrogations

But it turns out neither Mitchell nor Jessen had any experience in conducting actual interrogations before the CIA hired them.

"They went to two individuals who had no interrogation experience," said Col. Kleinman. "They are not interrogators."

The new documents show the CIA later came to learn that the two psychologists' waterboarding "expertise" was probably "misrepresented" and thus, there was no reason to believe it was "medically safe" or effective. The waterboarding used on al Qaeda detainees was far more intense than the brief sessions used on U.S. military personnel in the training classes.

"The use of these tactics tends to increase resistance on the part of the detainee to cooperating with us. So they have the exact opposite effect of what you want," said Sen. Carl Levin (D-Mich).

The new memos also show waterboarding was used "with far greater frequency than initially indicated" to even those in the CIA.

Abu Zubaydah was water boarded at least 83 times and Khalid Sheikh Mohamed at least 183 times.

Former CIA Officer John Kiriakou Says Waterboarding is Torture

That contradicts what former CIA officer John Kiriakou, who led the Zubaydah capture team, told ABC News in 2007 when he first revealed publicly that waterboarding had been used.

He said then, based on top secret reports he had access to, that Zubaydah had only been water boarded once and then freely talked.

Kiriakou now says he too was stunned to learn how often Zubaydah was waterboarded, in what Kiriakou says was clearly torture.

"When I spoke to ABC News in December 2007 I was aware of Abu Zubaydah being waterboarded on one occasion," said Kiriakou. "It was after this one occasion that he revealed information related to a planned terrorist attack. As I said in the original interview, my information was second-hand. I never participated in the use of enhanced techniques on Abu Zubaydah or on any other prisoner, nor did I witness the use of such techniques."

A federal judge in New York is currently considering whether or not to make public the written logs of the interrogation sessions.

The tapes were destroyed by the CIA, but the written logs still exist, although the CIA is fighting their release.

A CIA spokesperson declined to comment for this report, except to note that the agency's terrorist interrogation program was guided by legal opinions from the Department of Justice.

The Drugs, They Do Nothing!

Some selected snippets from this report

Short-term Intensive Treatment Not Likely to Improve Long-term Outcomes for Children with ADHD

Initial positive results gleaned from intensive treatment of childhood attention deficit hyperactivity disorder (ADHD) are unlikely to be sustained over the long term, according to a recent analysis of data from the NIMH-funded Multimodal Treatment Study of Children with ADHD (MTA). The study was published online ahead of print March 2009 in the Journal of the American Academy of Child and Adolescent Psychiatry.

Using reports from parents and teachers as well as self-reports from the children, now high school-aged, the researchers found that the youth’s functioning remained improved overall compared to their functioning at the beginning of the study, suggesting that available treatments can still be effective. However, they also found the following:

• The eight-year follow-up revealed no differences in symptoms or functioning among the youths assigned to the different treatment groups as children. This result suggests that the type or intensity of a one-year treatment for ADHD in childhood does not predict future functioning.
  
• A majority (61.5 percent) of the children who were medicated at the end of the 14-month trial had stopped taking medication by the eight-year follow-up, suggesting that medication treatment may lose appeal with families over time. The reasons for this decline are under investigation, but they nevertheless signal the need for alternative treatments.
  
• Children who were no longer taking medication at the eight-year follow-up were generally functioning as well as children who were still medicated, raising questions about whether medication treatment beyond two years continues to be beneficial or needed by all.

Basically, parents become disillusioned with the failed promise of the easy fix of drugs for the treatment of this "condition"

Anna Nicole's doctors Sandeep Kapoor and Khristine Eroshevich charged in her death

As reported in the Independent, psychiatrist Khristine Eroshevich has been charged with others for misconduct in the death of Anna Nicole Smith. Documents obtained after Smith's death showed Eroshevich authorized all 11 prescription medications found in the model's hotel room the day she died. Most of the drugs were prescribed in the name of Stern, her lawyer-turned-companion, and none were prescribed in Smith's own name.

Anna Nicole Smith's boyfriend Howard K. Stern and two doctors have been charged with giving thousands of prescription drugs to the former Playboy Playmate in the years leading up to her fatal drug overdose in 2007.

Stern and doctors Sandeep Kapoor and Khristine Eroshevich were each charged yesterday with three felony counts of conspiracy and several other charges of fraudulent prescriptions. Prosecutors said the doctors gave the drugs — including opiates and sedatives — to Stern, who then gave them to Smith.

The prescriptions were issued between June 2004 and January 2007, just weeks before Smith's death.

"These individuals repeatedly and excessively furnished thousands of prescription pills to Anna Nicole Smith, often for no legitimate medical purpose," California Attorney General Jerry Brown said in a statement.

Brown's spokesman, Scott Gerber, told The Associated Press that Stern and Kapoor surrendered last night and posted $20,000 bond, and that Eroshevich will surrender Monday. An arraignment date was not set.

The medical examiner's office has said Eroshevich, a Los Angeles psychiatrist and friend of the starlet's, authorized all the prescription medications found in the Hollywood, Florida, hotel room where the 39-year-old Smith was found unresponsive shortly before her death in Feb. 8, 2007.

Eroshevich's attorney, Adam Braun, acknowledged his client wrote some of the prescriptions using fictitious names for Smith, but said that the intent wasn't to commit fraud.

"It was done for privacy reasons," Braun told the AP. "She did the best she could under difficult circumstances in the best interest of the patient."

Braun said Eroshevich began treating Smith following the death of the playmate's son in September 2006. The doctor traveled on several occasions over a six-month period to the Bahamas where Smith was living with Stern and wrote the prescriptions.

The criminal complaint also alleges Kapoor wrote prescriptions for Smith under a patient alias Michelle Chase. Prosecutors allege the doctor gave her excessive amounts of sleep aids, opiates, muscle relaxants and methadone-like drugs used to treat addiction, knowing she was an addict.

Messages left with attorneys for Stern and Kapoor were not immediately returned.

Brown said Eroshevich and Kapoor "violated their ethical obligations as physicians, while Mr. Stern funneled highly addictive drugs to Ms. Smith."

The criminal complaint includes eight other felony charges, including obtaining fraudulent prescriptions and unlawfully prescribing a controlled substance. In all, Stern faces six felonies and the doctors each are charged with seven. Prosecutors did not immediately know how many years in prison they faced if convicted.

Rumors swirled for weeks after Smith's death, but police cleared those around Smith of any wrongdoing and the medical examiner's probe deemed it an accidental overdose.

Because the playmate was found unresponsive in a hotel on American Indian land, the case was handled by tribal police and their exemption from public records laws kept most of the investigation from being made public.

Documents obtained by The Associated Press after Smith's death showed Eroshevich authorized all 11 prescription medications found in the model's hotel room the day she died. Most of the drugs were prescribed in the name of Stern, her lawyer-turned-companion, and none were prescribed in Smith's own name.

The quantity was staggering. More than 600 pills — including about 450 muscle relaxants — were missing from prescriptions that were no more than five weeks old. Ultimately, it was a syrup — the powerful sleeping aid chloral hydrate — blamed with tipping the balance in the toxic mix of drugs and causing her death.

Stern, who initially claimed he was the father of Smith's infant daughter, Dannielynn, appeared distraught as he spoke last year at a memorial marking the one-year anniversary of Smith's death.

"Few people who knew Anna might not realize how smart she actually was because unless she wanted you to know you didn't know," Stern said.

Stern, who came to the Bahamas with Smith during her pregnancy in 2006, gave up custody of Dannielynn in spring 2007 after DNA tests proved Smith's ex-boyfriend Larry Birkhead was the father.

Dannielynn has been named the sole heir of her late mother's estate, with Birkhead and Stern as co-trustees. Dannielynn could inherit millions of dollars if the estate wins an ongoing court fight over the oil fortune of Anna Nicole's late second husband, J. Howard Marshall.

Photos of notorious abandoned "Children's Center" in Maryland

A Photo set on Flickr:

Wikipedia says: "Forest Haven was a children's developmental center in Laurel, Maryland. It is sometimes referred to (inaccurately) as "DC Children's Center", although this was not an official moniker.

It was notorious for its poor conditions and abuse of patients. It was shut down in 1991 by a federal court."

We spent more than 5 hours walking around the campus and probably only saw half of the buildings. Just a huge area of urban decay to explore.

An interesting write-up of Forest Haven can be found here:

http://www.washingtonpost.com/wp-srv/local/daily/march99/grouphome14.htm

If you want to see more photos from Forest Haven, check out the photosets from Jon and Chris.

FDA Approves Depressant Drug For The Annoyingly Cheerful

A Satire from the Onion, although the way drug companies operate, it makes you wonder sometimes.


FDA Approves Depressant Drug For The Annoyingly Cheerful

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