This is my fourth day in San Francisco at the American Psychiatric Association’s annual meeting. To recap:
Morning: Time off.
1:00 PM: I’m back on the job, checking out the posters. “Deep Brain Stimulation [DBS] of the Ventral Capsule/Ventral Striatum for Treatment-Resistant Depression” reads the heading to a poster.
“That does it,” I tell the researcher in an accusatory tone. “Now you’ve really gone out and confused me.” Helen Mayberg and others have already been applying the same technique to Brodman area 25 in the anterior cingulate, and yesterday I was treated to an equivalent of a masters class on the topic.
Now I have to learn about another area of the brain? I hold my ground. I demand my masters class.
1:45: I’m early for a session on “me-too” medications. Frederick Goodwin is on the panel, and we greet each other warmly. This is the first time I’ve seen Dr Goodwin since the NY Times published an account that irresponsibly smeared him in relation to a show that aired on “The Infinite Mind,” which used to be run on NPR.
The NY TImes piece was a mugging, and clinicians who should know better such as physician blogger Dan Carlat and psychologist John Grohol of PsychCentral engaged in the equivalent of kicking Dr Goodwin in the face. Antipsychiatry bloggers such as Philip Dawdy of Furious Seasons predictably piled on without checking the facts.
To the best of my knowledge, I am the only blogger who defended Dr Goodwin. I wasn’t sticking my neck out. The facts were - and still are - on his side. I was very pleased to see Dr Goodwin in a chipper mood. We enjoyed a very pleasant conversation, then I took my seat in the audience.
The first speaker, William Carpenter of the University of Maryland, made the telling point that new meds development is held up by the prevailing single disease mindset (Dr Carpenter used “paradigm,” but I forgive him). For example, we tend to equate psychosis with schizophrenia. Psychosis, however, features in other illnesses and conditions. Individuals with schizophrenia, in the meantime, have a lot more to contend with than just psychosis.
For instance, avolition (lack of motivation) looms large in schizophrenia. Yet, there is no med for this, and there may never be one if drug companies have to run clinical trials based on old precepts. Suppose, for instance, a drug company tested an “avolition med” on a population of individuals with schizophrenia. But if only say one-third of those being tested had to contend with avolition, then, said Dr Carpenter, the trial would fail.
Ironically, such a cognition med may be efficacious across a whole range of disorders. Dr Carpenter informed his audience that the FDA is aware of the situation and is working to fast-track cognition meds (Google “MATRICS”).
Dr Goodwin pointed out that clinical trials do not reflect clinical practice. For instance, those with severe mania can’t get into trials as it is impossible to obtain from them “informed consent.”
Clinical trials are based on finding results that apply across large populations. This, combined with “hierarchies of evidence” (which devalue smaller studies and clinical experience) are forcing patients “into a one-size-fits-all straightjacket.”
Here’s where the danger lies, according to Dr Goodwin: Treatment guidelines based on unrealistic clinical trials (but which are at the top of the evidence hierarchy) create uniform menus. These menus are increasingly being employed by government and private insurance to ration services.
For instance, what if third-party payers decided not to approve of the use of an antidepressant added to a mood stabilizer for bipolar patients because a large STEP-BD study did not find them effective across a large population?
Dr Goodwin described his experiences dealing with out-of-touch academic researchers back in the nineties. “I couldn’t imagine them ever managing a patient,” he said. (And they didn’t.)
Evidence-based medicine, Dr Goodwin said, is based on what we already know. Innovation tends to come from clinicians breaking the rules, which is how lithium and antipsychotics found their way into psychiatric practice. It isn’t just about the NIH translating scientific research into treatment.
4:00 PM: Afternoon posters. The first one I bump into is about unidentified “threadlike and/or spherical particles” in the cerebrospinal fluid of bipolar patients.
Dang! This looks interesting. Now I really have to budget my time. A few posters down: “Inhaled Loxapine Rapidly Improves Acute Agitation in Patients with Bipolar Disorder.”
Recall what Dr Carpenter had to say about the need to test for a specific part of the illness (such as avolition), not just the illness. Loxapine is an ancient antipsychotic, so we’re not talking about a new med, but the principle is the same. The treatment, if approved, would be taken on an as-needed basis, say when you felt yourself freaking out over a missed plane at midnight in Las Vegas airport (which happened to me). Unlike “popping a Klonnie,” sucking into the inhaler would work instantly, presumably without sedating effects.
Right now, we’re simply talking promising. Maybe the promise of the med won’t play out, but - dang! This looks interesting. There is only 30 minutes to go to this poster session and I’m still not out of the first aisle ...
This is John McManamy, live from my fleabag hotel room, on my way out to grab a burger.
Showing posts with label American Psychiatric Association annual meeting. Show all posts
Showing posts with label American Psychiatric Association annual meeting. Show all posts
Wednesday, May 20, 2009
Tuesday, May 19, 2009
Tooting from San Francisco - III: A Major Sea Change
I’m actually thinking with a clear brain. So THAT’S what it’s like. Trouble is I need to be winding down for sleep. To recap my day:
Tuesday 6:00 AM. I’m up way too early and can’t get back to sleep. I’m headed into my third day of the American Psychiatric Association’s annual meeting in San Francisco with precious little sleep in my bank account.
8:45 AM. I’m seated for my first talk of the day. “Have you heard the news?” I ask the psychiatrist next to me. I hand him a print-out. The heading reads:
“Breaking News: Psychiatry Comes Up with New Diagnosis of Asshole.”
The piece is a hard copy of a blog piece I wrote a couple of weeks back. We’re about to hear a talk by Robert Cloninger on “Developing a Positive Psychiatry of the Person,” and it’s nice to know I’m doing my bit.
“Treating symptoms is not enough,” Dr Cloninger opens. It’s all about well-being. Dr Cloninger has been a major paradigm-shifter in mapping out the fine points of personality and their interacting dynamics. Personality, he explains, is non-linear, involving the way we learn and adapt, plus the internal and external forces that pull on the self.
We are shaped by our genes and environment, but our self-awareness (a uniquely human trait) allows us to modify these influences and move forward with our lives.
Personal change, he said, can happen very rapidly, if you can get the person to recognize their strengths and weaknesses.
11:00 AM: I’m struggling to stay awake. Marc Schuckit of UCSD is about to talk on the fine points of the genetic and environmental influences involving alcoholism, and my cortex is running on empty.
I’m at the talk by virtue of Kenneth Kendler’s presentation the day before. Dr Kendler used alcoholism as an example of gene-environment interaction, and I figure this is a way of getting deeper into the topic.
I’m not disappointed. Dr Shuckit’s research into the area began some 30 years ago when he started asking a few simple questions. There are many causes of alcoholism, involving many genes and environmental influences, but Dr Shuckit noticed that when those with alcoholism described their early drinking experiences, they tended to remark about how they could drink everyone under the table.
The technical term is “level of response” (LR). These individuals need to have a lot more drinks to feel the same effect as their peers, and kids drink for effect. Once you get into the pattern of heavy drinking, Dr Shuckit said, then the environment kicks in: You hang out with heavy drinkers; they expect you to engage in heavy drinking.
Dr Shuckit has tracked more than 400 offspring of alcoholics and control subjects for 25 years, and found that LR is a reliable predictor of alcoholism. He is also getting a reading on the genes involved.
So, say you know that your 12-year-old has a genetic predisposition to LR, is there anything you can do about his environment to protect him? Different peers? Different expectations?
12:30 PM: I meet up with a good online buddy, Gina Pera, who has a great ADHD blog. Nearby, we grab some gyros and take them outside. Gina’s been a great moral and intellectual support to me, and I could literally sit out in the sun all day with her, but an afternoon of dark rooms beckons ...
2:05 PM: I walk in late to a very large packed room where an expert panel is discussing borderline personality disorder. What is wrong with this picture?
A mere three years before, at a featured lecture at the APA in Toronto, one of the pre-eminent leaders in the field, Joel Paris, spoke to mostly empty chairs. Earlier, at a bipolar session, one leading expert had been dissing the borderline diagnosis.
In three years, something has dramatically shifted in psychiatry. Earlier - at a session at the same time as Robert Cloninger’s - leading borderline expert John Gunderson had spoken to a packed house. Add to that the packed house from Dr Cloninger’s presentation.
At a brief pause in the proceedings, I ask the psychiatrist next to me what is going on, and he confirms my impressions. In essence, the bloom has gone off biological psychiatry, which translates into sending patients out the door with just a prescription. We’re seeing the pendulum swing back toward an earlier era when psychiatrists used to spend time working with their patients to find solutions to their personal problems.
It is reasonable to infer from this that the profession is becoming receptive to the goal of recovery.
It’s as if at some point in time in the last three years psychiatrists had suddenly woken up. I have no idea how this will play out in the real world, where psychiatric practice is dictated by the insurance industry and where old habits die hard. But I can assure you, this is a major story, perhaps the biggest event in my 10 years of reporting on mental illness, and one readily quantifiable - just count the people in the room.
4:00 PM: I am literally sleep-walking through the afternoon poster session. This is usually a great learning opportunity for me, my chance for one-on-one face time with the experts. But my brain isn’t tracking. I’m not engaged. No sense hanging around ...
5:00 PM: I’m back in my room at my fleabag hotel. Sleep, glorious sleep. One minute later it’s 8:00 PM. I get up and splash water on my face, taking an inventory of my brain.
My sleep is not messed up, I decide. I’ll be out like a light before midnight. Moreover, I’m taking tomorrow morning off. Late sleep. A little sight-seeing. Time to wind down ...
Tuesday 6:00 AM. I’m up way too early and can’t get back to sleep. I’m headed into my third day of the American Psychiatric Association’s annual meeting in San Francisco with precious little sleep in my bank account.
8:45 AM. I’m seated for my first talk of the day. “Have you heard the news?” I ask the psychiatrist next to me. I hand him a print-out. The heading reads:
“Breaking News: Psychiatry Comes Up with New Diagnosis of Asshole.”
The piece is a hard copy of a blog piece I wrote a couple of weeks back. We’re about to hear a talk by Robert Cloninger on “Developing a Positive Psychiatry of the Person,” and it’s nice to know I’m doing my bit.
“Treating symptoms is not enough,” Dr Cloninger opens. It’s all about well-being. Dr Cloninger has been a major paradigm-shifter in mapping out the fine points of personality and their interacting dynamics. Personality, he explains, is non-linear, involving the way we learn and adapt, plus the internal and external forces that pull on the self.
We are shaped by our genes and environment, but our self-awareness (a uniquely human trait) allows us to modify these influences and move forward with our lives.
Personal change, he said, can happen very rapidly, if you can get the person to recognize their strengths and weaknesses.
11:00 AM: I’m struggling to stay awake. Marc Schuckit of UCSD is about to talk on the fine points of the genetic and environmental influences involving alcoholism, and my cortex is running on empty.
I’m at the talk by virtue of Kenneth Kendler’s presentation the day before. Dr Kendler used alcoholism as an example of gene-environment interaction, and I figure this is a way of getting deeper into the topic.
I’m not disappointed. Dr Shuckit’s research into the area began some 30 years ago when he started asking a few simple questions. There are many causes of alcoholism, involving many genes and environmental influences, but Dr Shuckit noticed that when those with alcoholism described their early drinking experiences, they tended to remark about how they could drink everyone under the table.
The technical term is “level of response” (LR). These individuals need to have a lot more drinks to feel the same effect as their peers, and kids drink for effect. Once you get into the pattern of heavy drinking, Dr Shuckit said, then the environment kicks in: You hang out with heavy drinkers; they expect you to engage in heavy drinking.
Dr Shuckit has tracked more than 400 offspring of alcoholics and control subjects for 25 years, and found that LR is a reliable predictor of alcoholism. He is also getting a reading on the genes involved.
So, say you know that your 12-year-old has a genetic predisposition to LR, is there anything you can do about his environment to protect him? Different peers? Different expectations?
12:30 PM: I meet up with a good online buddy, Gina Pera, who has a great ADHD blog. Nearby, we grab some gyros and take them outside. Gina’s been a great moral and intellectual support to me, and I could literally sit out in the sun all day with her, but an afternoon of dark rooms beckons ...
2:05 PM: I walk in late to a very large packed room where an expert panel is discussing borderline personality disorder. What is wrong with this picture?
A mere three years before, at a featured lecture at the APA in Toronto, one of the pre-eminent leaders in the field, Joel Paris, spoke to mostly empty chairs. Earlier, at a bipolar session, one leading expert had been dissing the borderline diagnosis.
In three years, something has dramatically shifted in psychiatry. Earlier - at a session at the same time as Robert Cloninger’s - leading borderline expert John Gunderson had spoken to a packed house. Add to that the packed house from Dr Cloninger’s presentation.
At a brief pause in the proceedings, I ask the psychiatrist next to me what is going on, and he confirms my impressions. In essence, the bloom has gone off biological psychiatry, which translates into sending patients out the door with just a prescription. We’re seeing the pendulum swing back toward an earlier era when psychiatrists used to spend time working with their patients to find solutions to their personal problems.
It is reasonable to infer from this that the profession is becoming receptive to the goal of recovery.
It’s as if at some point in time in the last three years psychiatrists had suddenly woken up. I have no idea how this will play out in the real world, where psychiatric practice is dictated by the insurance industry and where old habits die hard. But I can assure you, this is a major story, perhaps the biggest event in my 10 years of reporting on mental illness, and one readily quantifiable - just count the people in the room.
4:00 PM: I am literally sleep-walking through the afternoon poster session. This is usually a great learning opportunity for me, my chance for one-on-one face time with the experts. But my brain isn’t tracking. I’m not engaged. No sense hanging around ...
5:00 PM: I’m back in my room at my fleabag hotel. Sleep, glorious sleep. One minute later it’s 8:00 PM. I get up and splash water on my face, taking an inventory of my brain.
My sleep is not messed up, I decide. I’ll be out like a light before midnight. Moreover, I’m taking tomorrow morning off. Late sleep. A little sight-seeing. Time to wind down ...
Monday, May 18, 2009
Tooting from San Francisco - II: I Love Smart People
Monday, 9 PM: I’m in my hotel room, chilling out after a very stimulating day. To recap:
Morning, 9 AM. I have a front row seat for a lecture by the legendary psychiatric geneticist Kenneth Kendler, who executes a stunning fly-over. Brief sample:
The environment may neutralize genes. Say, for instance, it is difficult for a kid to obtain alcohol. Then certain alcoholism vulnerability genes have less chance to kick in. Conversely, “our brains have feet.” We’re not just passive recipients of our environment. Rather, our genes cause us to create the environment around us.
Genes and environment, in other words, dance a very intricate two-step.
10:15 AM: I step out into the sunlight. I’m headed from Muscone North to Muscone South. As I negotiate my way past the median strip separating two traffic lanes, someone with a bullhorn and a clown nose hands me an antipsychiatry flier.
I hurl it back at him. “F___ing idiot,” I inform him, as I keep walking. I’m across to the other side when I hear the idiot through the bullhorn: "Ooh, f___ing idiots, the best kind.”
No more Mr Nice Guy. “F___ you,” I shout in a voice that carries much louder than his puny bullhorn. “I’m a patient, and I’m going inside where the SMART people are.”
Damn! That felt good.
11:00 AM: I’m listening to an extremely smart individual, Elyn Saks, author of the highly-acclaimed “The Center Cannot Hold: My Journey Through Madness.” Despite psychotic episodes, Elyn graduated valedictorian from Vanderbilt with a major in philosophy (she learned ancient Greek so she could read Aristotle), then went to Oxford where her deteriorating condition resulted in a lengthy hospitalization. An enlightened psychiatrist urged her to go back to doing what she loved and got her hooked up with an equally-enlightened psychoanalyst.
After graduating Oxford, she earned a law degree from Yale, but not before another hospitalization that involved her being placed in restraints 20 hours a day. The “benign neglect” of English care, she said, is “much preferable to the over-intervention in US hospitals.”
Elyn graduated from Yale and procured a teaching position at USC (where she is now a professor specializing in legal-psychiatric issues). Her attempts there to get off her meds simply resulted in the return of florid psychosis. After 20 years she finally got smart and accepted the fact she was mentally ill, which meant her illness had less power over her.
She eventually got married in her 40s and joked with her husband that they’d both skipped their first marriage.
12:30 PM: My first poster session of the day. “Cingulate gyrus” I read on the heading of one poster I walk past. I freeze in my tracks, and address the researcher standing in front. “I’m going to ask a stupid question,” I warn holding up my name badge which shows I’m a journalist. “Can you explain to me the difference between the cingulate gyrus and the anterior cingulate?”
Next thing, I’m being treated to an individualized masters class in brain science. I love listening to smart people.
2:05 PM: I arrive a few minutes late for a session on the DSM-V (due out in 2012). Darryl Regier, vice-chair of the DSM-V task force is raising the topic of “categorical” vs “dimensional.”
This really gets my attention. As opposed to our current categorical system of assigning illnesses to separate pigeon holes, a dimensional approach would recognize the overlap.
The second speaker is Ellen Frank of the University of Pittsburgh, who five years ago opened my eyes to the “spectrum” way of looking at mental illness. Thus symptoms that do not necessarily cluster together over a specific period of time are regarded as clinically significant.
Think of bipolar, for instance, plus a little bit of anxiety. That small dose of anxiety, Dr Frank said, is likely to result in greater illness severity and make treatment more difficult, and she has the studies to prove it.
Dr Frank is pushing for a “simultaneous approach” to the next DSM.
3:15 PM: In the hallway, I say a warm hello to Eduard Vieta from the University of Barcelona. Two years ago, Dr Vieta and I shared the same stage at the Seventh International Conference on Bipolar Disorders, as recipients of the Mogens Schou Award (in recognition of his research and my public service, respectively).
Then it’s over to my second poster session of the day to ask my dumb questions (which is how you get smart answers). Two separate posters concern themselves with the topic of the relationship between impulsivity and suicide. Immediately, I think of my good friend Kevin, who last September threw himself in front of a train. My voice catches. I need to pause.
Kevin is my reminder why I’m here. I may be enjoying myself, but this is no game. We’re playing against our will with a rigged deck, our lives on the line. I’m here to gather in all the information I can, try to make sense out of it, connect the dots, and put it out there in a way that somehow allows us a slightly better advantage.
5:30 PM: Dinner on Fisherman’s Wharf with a “neuro-immunologist.” This is a new field that you will be hearing a lot more from, along with other fields of enquiry that are bound to lead to improvements in our lives - assuming funding is available.
8:00 PM: Chilling in my room. Another long day tomorrow ...
Morning, 9 AM. I have a front row seat for a lecture by the legendary psychiatric geneticist Kenneth Kendler, who executes a stunning fly-over. Brief sample:
The environment may neutralize genes. Say, for instance, it is difficult for a kid to obtain alcohol. Then certain alcoholism vulnerability genes have less chance to kick in. Conversely, “our brains have feet.” We’re not just passive recipients of our environment. Rather, our genes cause us to create the environment around us.
Genes and environment, in other words, dance a very intricate two-step.
10:15 AM: I step out into the sunlight. I’m headed from Muscone North to Muscone South. As I negotiate my way past the median strip separating two traffic lanes, someone with a bullhorn and a clown nose hands me an antipsychiatry flier.
I hurl it back at him. “F___ing idiot,” I inform him, as I keep walking. I’m across to the other side when I hear the idiot through the bullhorn: "Ooh, f___ing idiots, the best kind.”
No more Mr Nice Guy. “F___ you,” I shout in a voice that carries much louder than his puny bullhorn. “I’m a patient, and I’m going inside where the SMART people are.”
Damn! That felt good.
11:00 AM: I’m listening to an extremely smart individual, Elyn Saks, author of the highly-acclaimed “The Center Cannot Hold: My Journey Through Madness.” Despite psychotic episodes, Elyn graduated valedictorian from Vanderbilt with a major in philosophy (she learned ancient Greek so she could read Aristotle), then went to Oxford where her deteriorating condition resulted in a lengthy hospitalization. An enlightened psychiatrist urged her to go back to doing what she loved and got her hooked up with an equally-enlightened psychoanalyst.
After graduating Oxford, she earned a law degree from Yale, but not before another hospitalization that involved her being placed in restraints 20 hours a day. The “benign neglect” of English care, she said, is “much preferable to the over-intervention in US hospitals.”
Elyn graduated from Yale and procured a teaching position at USC (where she is now a professor specializing in legal-psychiatric issues). Her attempts there to get off her meds simply resulted in the return of florid psychosis. After 20 years she finally got smart and accepted the fact she was mentally ill, which meant her illness had less power over her.
She eventually got married in her 40s and joked with her husband that they’d both skipped their first marriage.
12:30 PM: My first poster session of the day. “Cingulate gyrus” I read on the heading of one poster I walk past. I freeze in my tracks, and address the researcher standing in front. “I’m going to ask a stupid question,” I warn holding up my name badge which shows I’m a journalist. “Can you explain to me the difference between the cingulate gyrus and the anterior cingulate?”
Next thing, I’m being treated to an individualized masters class in brain science. I love listening to smart people.
2:05 PM: I arrive a few minutes late for a session on the DSM-V (due out in 2012). Darryl Regier, vice-chair of the DSM-V task force is raising the topic of “categorical” vs “dimensional.”
This really gets my attention. As opposed to our current categorical system of assigning illnesses to separate pigeon holes, a dimensional approach would recognize the overlap.
The second speaker is Ellen Frank of the University of Pittsburgh, who five years ago opened my eyes to the “spectrum” way of looking at mental illness. Thus symptoms that do not necessarily cluster together over a specific period of time are regarded as clinically significant.
Think of bipolar, for instance, plus a little bit of anxiety. That small dose of anxiety, Dr Frank said, is likely to result in greater illness severity and make treatment more difficult, and she has the studies to prove it.
Dr Frank is pushing for a “simultaneous approach” to the next DSM.
3:15 PM: In the hallway, I say a warm hello to Eduard Vieta from the University of Barcelona. Two years ago, Dr Vieta and I shared the same stage at the Seventh International Conference on Bipolar Disorders, as recipients of the Mogens Schou Award (in recognition of his research and my public service, respectively).
Then it’s over to my second poster session of the day to ask my dumb questions (which is how you get smart answers). Two separate posters concern themselves with the topic of the relationship between impulsivity and suicide. Immediately, I think of my good friend Kevin, who last September threw himself in front of a train. My voice catches. I need to pause.
Kevin is my reminder why I’m here. I may be enjoying myself, but this is no game. We’re playing against our will with a rigged deck, our lives on the line. I’m here to gather in all the information I can, try to make sense out of it, connect the dots, and put it out there in a way that somehow allows us a slightly better advantage.
5:30 PM: Dinner on Fisherman’s Wharf with a “neuro-immunologist.” This is a new field that you will be hearing a lot more from, along with other fields of enquiry that are bound to lead to improvements in our lives - assuming funding is available.
8:00 PM: Chilling in my room. Another long day tomorrow ...
Tooting from San Francisco - I
Today, Monday, 4 AM: What the hell am I doing wide awake this time in the morning? Let’s pick up from where I left off yesterday.
Yesterday, Sunday, 1 PM: I touch down at San Francisco Airport, collect my bag, and take the BART into town. My hotel is a fleabag in a colorful part of town within walking distance of the Muscone Center where the American Psychiatric Association annual meeting is taking place.
Sunday, 3 PM: I pick up my media credentials at the conference, shake the sleep out of my system, and plot my next course of action. Nothing much going on, so I head out to the exhibit hall. Pharma’s out in force, but it is looking like their last hurrah. Conspicuously absent is GSK (Lamictal, Wellbutrin, Paxil), which pulled out a year or two ago, along with Abbott (Depakote) and Novartis (Tegretol). All their drugs, of course, are off-patent.
Bristol-Myers Squibb is there by virtue of Abilify, which is still on-patent, along with Astra-Zeneca, with its blockbuster Seroquel. Eli Lilly is no longer flying their Zyprexa and Prozac flags - they have set up their tent by virtue of Cymbalta. Other companies are looking tired trying to generate excitement over new versions of old products.
There is very little taste of the future in the exhibit hall. The biotech companies, with nothing to market, are nowhere in sight. Neuronetics, which recently obtained FDA approval to treat depression with an rTMS device, is basically showing off a new application of an old technology.
In short, for now, the party is over.
6:30 PM: I feel a desperate urge break Rip Van Winkle’s record. Nevertheless, I grab a seat at the grand ballroom of the Hilton Hotel, where Shire is sponsoring a dinner symposium on the pathophysiology of ADHD. This is the last year of industry-sponsored symposia at the APA. Reform is in the air, but the truth is Pharma has lost interest in staging these events. Over the years, as meds have gone off-patent, fewer and fewer of these events have been staged.
Industry-sponsored symposia are a mixed bag. Some of them come across as infomercials, but tonight’s presentation is outstanding. A panel of experts - mainly from Harvard - articulate the underlying biology to ADHD, both on the cellular level (namely what happens when a neuron fails to correctly process information that dopamine is supposed to be delivering) and on a systems level (such as when certain parts of the brain aren’t talking to each other).
Brain scan technology has revolutionized mental illness research. I’m seeing it in all fields - depression, stress, schizophrenia, bipolar, personality disorders, you name it, most of it having taken place in the last three or four years. Thanks to MRI technology, we can now see structural abnormalities in the brain compared to healthy subjects, as well as functional deficits. Example:
A slide of the anterior cingulate cortex goes up. The ACC plays a major role in modulating thoughts - in selecting relevant ones and filtering out irrelevant ones - and is wired into both the thinking cortical areas and primitive reacting limbic system. A series of superimposed markers represents the ADHD brain scan studies performed on this area of the brain. Significantly, the study results testing for an emotional response show activity in the bottom half of the ACC while the study results testing for cognitive response show activity at the top.
Many individuals with bipolar also display cognitive deficits, so what I am learning tonight is shedding light on my own illness.
This is why I am here, to listen to smart people who have dedicated their lives to improving mine. Five minutes into the first presentation and I am wide awake. Last week I got tied down in doing stories about idiots - people like Andy Behrman who have walked away with $400,000 by lying to us, people like Pat Risser who pushes an antipsychiatry agenda predicated on the belief that there is no science to support the concept of mental illness.
Those idiots are irrelevant, as are those who try to legitimize them. Before our very eyes, a picture of the brain at work is emerging, one that is displaying a dramatic interplay between genes, biology, environment, and symptoms/behaviors. This is the real story, the one we need to be paying attention to.
This is the story of the future, as in terms of new drug development. But it’s also the story of the here and now, as in putting recovery principles into practice.
9:15 PM: I’m back in my fleabag hotel, just one block from the Hilton. I flop onto the mattress and am asleep before my head hits the pillow.
Today, 4 AM: The reason I’m awake right now is obvious. I crashed three hours earlier than usual, and had a much sounder sleep. But later today my brain will demand a settling of accounts.
This morning I head out to hear the legendary Kenneth Kendler expound on psychiatric genetics, then the highly-acclaimed author Elyn Saks discuss her journey through madness. Later on, the DSM, new research, and other cool stuff. No way I can sleep through this ...
Yesterday, Sunday, 1 PM: I touch down at San Francisco Airport, collect my bag, and take the BART into town. My hotel is a fleabag in a colorful part of town within walking distance of the Muscone Center where the American Psychiatric Association annual meeting is taking place.
Sunday, 3 PM: I pick up my media credentials at the conference, shake the sleep out of my system, and plot my next course of action. Nothing much going on, so I head out to the exhibit hall. Pharma’s out in force, but it is looking like their last hurrah. Conspicuously absent is GSK (Lamictal, Wellbutrin, Paxil), which pulled out a year or two ago, along with Abbott (Depakote) and Novartis (Tegretol). All their drugs, of course, are off-patent.
Bristol-Myers Squibb is there by virtue of Abilify, which is still on-patent, along with Astra-Zeneca, with its blockbuster Seroquel. Eli Lilly is no longer flying their Zyprexa and Prozac flags - they have set up their tent by virtue of Cymbalta. Other companies are looking tired trying to generate excitement over new versions of old products.
There is very little taste of the future in the exhibit hall. The biotech companies, with nothing to market, are nowhere in sight. Neuronetics, which recently obtained FDA approval to treat depression with an rTMS device, is basically showing off a new application of an old technology.
In short, for now, the party is over.
6:30 PM: I feel a desperate urge break Rip Van Winkle’s record. Nevertheless, I grab a seat at the grand ballroom of the Hilton Hotel, where Shire is sponsoring a dinner symposium on the pathophysiology of ADHD. This is the last year of industry-sponsored symposia at the APA. Reform is in the air, but the truth is Pharma has lost interest in staging these events. Over the years, as meds have gone off-patent, fewer and fewer of these events have been staged.
Industry-sponsored symposia are a mixed bag. Some of them come across as infomercials, but tonight’s presentation is outstanding. A panel of experts - mainly from Harvard - articulate the underlying biology to ADHD, both on the cellular level (namely what happens when a neuron fails to correctly process information that dopamine is supposed to be delivering) and on a systems level (such as when certain parts of the brain aren’t talking to each other).
Brain scan technology has revolutionized mental illness research. I’m seeing it in all fields - depression, stress, schizophrenia, bipolar, personality disorders, you name it, most of it having taken place in the last three or four years. Thanks to MRI technology, we can now see structural abnormalities in the brain compared to healthy subjects, as well as functional deficits. Example:
A slide of the anterior cingulate cortex goes up. The ACC plays a major role in modulating thoughts - in selecting relevant ones and filtering out irrelevant ones - and is wired into both the thinking cortical areas and primitive reacting limbic system. A series of superimposed markers represents the ADHD brain scan studies performed on this area of the brain. Significantly, the study results testing for an emotional response show activity in the bottom half of the ACC while the study results testing for cognitive response show activity at the top.
Many individuals with bipolar also display cognitive deficits, so what I am learning tonight is shedding light on my own illness.
This is why I am here, to listen to smart people who have dedicated their lives to improving mine. Five minutes into the first presentation and I am wide awake. Last week I got tied down in doing stories about idiots - people like Andy Behrman who have walked away with $400,000 by lying to us, people like Pat Risser who pushes an antipsychiatry agenda predicated on the belief that there is no science to support the concept of mental illness.
Those idiots are irrelevant, as are those who try to legitimize them. Before our very eyes, a picture of the brain at work is emerging, one that is displaying a dramatic interplay between genes, biology, environment, and symptoms/behaviors. This is the real story, the one we need to be paying attention to.
This is the story of the future, as in terms of new drug development. But it’s also the story of the here and now, as in putting recovery principles into practice.
9:15 PM: I’m back in my fleabag hotel, just one block from the Hilton. I flop onto the mattress and am asleep before my head hits the pillow.
Today, 4 AM: The reason I’m awake right now is obvious. I crashed three hours earlier than usual, and had a much sounder sleep. But later today my brain will demand a settling of accounts.
This morning I head out to hear the legendary Kenneth Kendler expound on psychiatric genetics, then the highly-acclaimed author Elyn Saks discuss her journey through madness. Later on, the DSM, new research, and other cool stuff. No way I can sleep through this ...
Sunday, May 17, 2009
Tooting to San Francisco
Sunday, 10 AM: I’m at San Diego Airport waiting for my flight to San Francisco. I’ll be attending the American Psychiatric Association’s annual meeting as a journalist. I’ve been attending each year since 2002.
Consider this “Tooter” and these are my “toots.”
Yesterday, Saturday afternoon: I should have had everything organized for my trip by now, but I’m still tied down with my work. Pre-travel days are always a bummer, It’s as if my system shuts down in anticipation of the energy I need to conserve for the road.
Saturday evening, just before midnight: I’m finally organized. But I know at least one thing had to have gone wrong. What will it be this time? No underwear? I get to San Fran only to find the conference is in Philly?
A few minutes later: I plop onto the mattress, bone tired, but my mind is racing. Oh, crap. This always happens.
Sunday, 7 AM: I’m ready to head out the door. I grab my cell phone, which has been charging all night. I turn it on. It won’t come on. I’m holding a paperweight with buttons. I’m about to hit the road with no phone. No time to worry about that. Gotta plane to catch ...
Consider this “Tooter” and these are my “toots.”
Yesterday, Saturday afternoon: I should have had everything organized for my trip by now, but I’m still tied down with my work. Pre-travel days are always a bummer, It’s as if my system shuts down in anticipation of the energy I need to conserve for the road.
Saturday evening, just before midnight: I’m finally organized. But I know at least one thing had to have gone wrong. What will it be this time? No underwear? I get to San Fran only to find the conference is in Philly?
A few minutes later: I plop onto the mattress, bone tired, but my mind is racing. Oh, crap. This always happens.
Sunday, 7 AM: I’m ready to head out the door. I grab my cell phone, which has been charging all night. I turn it on. It won’t come on. I’m holding a paperweight with buttons. I’m about to hit the road with no phone. No time to worry about that. Gotta plane to catch ...
Subscribe to:
Posts (Atom)
Posts
