Lynch, D, 2010, Cognitive behavioural therapy for major psychiatricdisorder: does it really work? A meta-analytical review of well-controlled trials, Psychological Medicine
http://journals.cambridge.org/download.php?file=/PSM/PSM40_01/S003329170900590Xa.pdf&code=b62ffa4b898268608a9e7b504bdd5319
Cognitive behavioural therapy - changing the way people think and behave by using talking techniques from therapists - doesn't really work according to this high quality review.The review uses a different inclusion criteria to the 'mega-analysis' which is often used to show that CBT really does work.
Butler, A. et al. 2006, The empirical status of cognitive-behavioral therapy: A review of meta-analyses, Clinical Psychology Review
http://www.sciencedirect.com/science/article/pii/S0272735805001005
So which one is true? The massive review (the 2006 one) which includes loads of papers but has a weaker inclusion criteria and, if I remember right, doesn't include a funnel plot or the smaller review of higher quality trials (the 2009 one at the top of the page)?
I'm afraid it's the one of controlled trials. At least based on the current paradigm of evidence based medicine. Blindness is so important.
The double blind randomised controlled trial gained success when it showed insulin shock or insulin coma therapy to be as effective as other treatments at the toime for...think it was schizophrenia. At the time
the insulin treatment was considered best practice around the world but the introduction of random assignment to the control or active treatment group showed that, in fact, it wasn't the best treatment.
Time and again it's the reviews that select the highest quality trials which show treatments thought to work suddenly don't. The recent noteable example is electro-convulsive therapy or ECT. This barbaric
treatment is what I hope is the last in the line of psychiatric treatments which induce seizures. The history of inducing seizures to treat mental disorder can be traced back to the work of Hippocrates who
notices paitents who had malaria seizures also had behavioural changes. The recent Bentall and Read review on ECT picked high quality trials with long term follow. This treatment of last resort was shown to be as
effective on follow up as sham ECT (where no electricity is used to shock a person into a seizure) and slightly more effective during treatment.
http://www.mindfreedom.org/kb/mental-health-abuse/electroshock/ect-review-2010-read-bentall.pdf/view
(Link to paper at the bottom of the page.)
Many, many people have died because of this treatment. Some people who've had it done are major advocates of the treatment. This presentation on TED is an example.
http://www.ted.com/talks/sherwin_nuland_on_electroshock_therapy.html
The speaker may have gotten the same benefit from sham ECT and less damage to his brain.
And so back to CBT. The controls in the trials are as effective as this new dogma of treatment for all but depression where the evidence for it's effect is small. The effect size is far below what got the Improve
Access to Psychological Therapies scheme approved.then factoring in publication bias...that demon of good
research....which is the effect of trials with negative results being hidden...well it knows off about a third of the effect size of CBT studies.
http://bjp.rcpsych.org/content/196/3/173.full
In a sense it's saddening that there's few effective cures for mental disorder. Perhaps it's all the hedonic treadmill.
http://en.wikipedia.org/wiki/Hedonic_treadmill
Or perhaps it's the operational cluster of symptoms approach doesn't provide a good way to assign treatment to diagnosis?
Showing posts with label treatment. Show all posts
Showing posts with label treatment. Show all posts
Monday, 29 August 2011
Tuesday, 3 August 2010
How ace is St John's wort
Image via WikipediaLots of people know the evidence for its usefulness in mild to moderate depression but the Mayo Clinic lists a huge range of uses (though the quality of the conclusions from the evidence is less strong).
Somatoform disorders, Anxiety, ADHD and OCD have lower quality evidence showing this herb can treat many disorders usually treated with stronger chemicals such as SSRIs.
I remember when I first came across St John's wort. It wasn't in relation to mental health directly. It was as a come down cure. After taking Ectsacy (MDMA though usually other compounds like MDEA) there is a period of low and it used to be pretty intense for me.
I looked for lots of treatments so I could keep on enjoying that drug and ended up finding lots of antidepressants, from drugs like 5-HTP (available over the counter), bananas, Marmite and, strangely, beer. Yes. A beer is a post-Ecstacy binge favourite for many clubbers though it's not used to combat the depression directly but used to help chill out during the Sunday comedown.
St John's wort is available over the counter. People who've tried antidepressants may be surprised at just how mild the side effects are and how nicer the effect can be. Many might ask their doctor why they're prescribed SSRIs instead of SJW. From what I've read in GP magazine doctors don't know what dose to use. This gap is probably because the BNF, the manual which doctors use to assess which chemical to use, doesn't have SJW in the CNS section as far as I am aware. My dad only has the Children's BNF lying around at the moment and the only advice there is that it shouldn't be used on kids because of the interactions (which are listed at length in the appendix).
In Germany it is commonly prescribed for mild to moderate depression and I've used the "sunshine herb" many a time for it's antidepressant action. The main side effect I notice is poor bladder control but that varies with time but this may be better with tablets rather than capsule pills.
Saturday, 17 April 2010
Waterboarding as psychotherapy
http://psychiatryandhistory.blogspot.com/2009/05/waterboarding-as-psychotherapy.html
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While we are properly horrified to learn about the use of deliberate near-drowning (waterboarding) as an interrogation technique, it is worth noting that for a period of nearly two hundred years the same procedure was regarded as a form of psychotherapy. The influential seventeenth century physician Jan Baptiste Van Helmont (1580-1644), originated this treatment after observing that a madman, who was revived following an accidental near-drowning, was relieved of his mental symptoms. The most influential eighteenth century physican Hermann Boerhaave. (1668-1738) mentions the use of submersion in the treatment of insanity but recommends it for only the most desperate cases. Boerhaave's student Jerome Gaub also discusses the treatment and attributes its efficacy to anxiety. "The most deeply seated mental defects and the most incurable forms of madness" he writes, "may sometimes be rooted out by anxiety." Perhaps, he speculates, this is "because the tormented and frightened mind is revived by the terrible punishment of her greatly depressed senses…." He cites "men with minds held captive by the violence of love or grief," who recovered their soundness of mind when revived after accidental near-drowning. He insists that the cause of this recovery is the "frightful torment that near loss of life from suffocation inflicts on the mind." Gaub acknowledges that "submersion therapy" is "a terrible remedy" but adds that it is "one hardly to be exceed in efficacy." Gaub took the trouble to attempt a medical explanation of "submersion therapy." He argued that "submersion therapy" worked by provoking anxiety, which he understood as a powerful emotion caused by bodily changes. The most frequent cause of anxiety, he felt, is interference with respiration, which hinders the passage of blood through the lungs and thus places life in jeopardy. These bodily events affect the "common sensorium" [where mind and body meet] so as to excite ideas in the mind that cannot be contemplated without horror and cannot be dispelled. The value of such shock therapy was widely recognized in the eighteenth century. "In mania," a Montpellier doctor wrote in Diderot and D'Alembert's encyclopédie, "therapy is directed to the body, in which it aims to produce a shock and a deep disturbance ." Such ideas even influenced Philippe Pinel, who cites Van Helmont. Although Pinel did not use "submersion therapy," he did include the role of powerful emotions like fear in dispelling fixed ideas as a component of his moral therapy.
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While we are properly horrified to learn about the use of deliberate near-drowning (waterboarding) as an interrogation technique, it is worth noting that for a period of nearly two hundred years the same procedure was regarded as a form of psychotherapy. The influential seventeenth century physician Jan Baptiste Van Helmont (1580-1644), originated this treatment after observing that a madman, who was revived following an accidental near-drowning, was relieved of his mental symptoms. The most influential eighteenth century physican Hermann Boerhaave. (1668-1738) mentions the use of submersion in the treatment of insanity but recommends it for only the most desperate cases. Boerhaave's student Jerome Gaub also discusses the treatment and attributes its efficacy to anxiety. "The most deeply seated mental defects and the most incurable forms of madness" he writes, "may sometimes be rooted out by anxiety." Perhaps, he speculates, this is "because the tormented and frightened mind is revived by the terrible punishment of her greatly depressed senses…." He cites "men with minds held captive by the violence of love or grief," who recovered their soundness of mind when revived after accidental near-drowning. He insists that the cause of this recovery is the "frightful torment that near loss of life from suffocation inflicts on the mind." Gaub acknowledges that "submersion therapy" is "a terrible remedy" but adds that it is "one hardly to be exceed in efficacy." Gaub took the trouble to attempt a medical explanation of "submersion therapy." He argued that "submersion therapy" worked by provoking anxiety, which he understood as a powerful emotion caused by bodily changes. The most frequent cause of anxiety, he felt, is interference with respiration, which hinders the passage of blood through the lungs and thus places life in jeopardy. These bodily events affect the "common sensorium" [where mind and body meet] so as to excite ideas in the mind that cannot be contemplated without horror and cannot be dispelled. The value of such shock therapy was widely recognized in the eighteenth century. "In mania," a Montpellier doctor wrote in Diderot and D'Alembert's encyclopédie, "therapy is directed to the body, in which it aims to produce a shock and a deep disturbance ." Such ideas even influenced Philippe Pinel, who cites Van Helmont. Although Pinel did not use "submersion therapy," he did include the role of powerful emotions like fear in dispelling fixed ideas as a component of his moral therapy.
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