American Psychiatric Association Report

The political nature of the APA (1990b) task force report is reflected in the membership of the panel that wrote it. The chairperson, Richard Weiner, was APA s official representative in defense of ECT at the FDA hearings and has for some time been APA s chief spokesperson on the subject. Two of the other six members are psychiatrist Max Fink and psychologist Harold Sackeim, whom we have already met as among the 

By contrast, the task force (APA, 1990b) sought no input from the several patient organizations that oppose the treatment, and none from psychologists, psychiatrists, neurologists, and other professionals who are critical of it. 

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Dissociation is the core feature of the dissociative disorders it is defined by the DSM-IV as a disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment (American Psychiatric Association, 1994, p. 477). Dissociation is usually assessed as a continuum, most often using the Dissociative Experiences Scale (DES Bemstein-Carlson Putnam, 1986), a 28-item self-report measure. The DES items are rated on a scale reflecting the frequency of dissociative experiences (O-to-100% in 10% intervals). Factor analyses of DES items have led to the development of three subscales (Carlson et al., 1993 Frischholz, Braun, Sachs, Schwartz, 1991 Ross, Joshi, Currie, 1991). They are (a) Absorption, which reflects dissociation from surroundings (e.g., daydreaming) (b) Amnesia, which reflects dissociation from past experiences and (c) Depersonalization-Derealization, which reflects dissociation from the body or senses. 

Guidance on the clinical indications for benzodiazepine therapy is available from various sources (Task Force Report of the American Psychiatric Association 1990 Ballenger et al. 1998a Bandelow et al. 2002). Long-term therapy is most likely to present problems with discontinuation and is usually reserved for cases that have proved resistant to treatment with antidepressants alone. Patients may benefit from a 2-4 week course of a benzodiazepine whilst antidepressant therapy is initiated, as this counteracts the increased anxiety caused by some drugs (Goddard et al. 2001). A benzodiazepine maybe useful as a hypnotic in some cases of anxiety disorder, and can be used by phobic patients on an occasional basis before exposure to a feared situation. 

Task Force Report of the American Psychiatric Association (1990) Benzodiazepine dependence, toxicity and abuse. American Psychiatric Press, Washington... 

Bradwejn and colleagues first administered CCK-4 to patients with panic disorder by using a double-blind, placebo-control methodology. Bolus injections of CCK-4 (50 pg] precipitated a panic attack, as defined by DSM-111 criteria (American Psychiatric Association 1980] and patient self-report. 

Because OCD is considered one of the anxiety disorders according to DSM-IV [American Psychiatric Association 1994] [but not according to ICD-10 [World Health Organization 1992]], it is not surprising that anxiolytics have been suggested for its treatment. Thus, alprazolam and clonazepam have been reported as efficient in several uncontrolled studies and case series [Hewlett et al. 1990 Tollefson 1985]. 

Benzodiazepines have a low abuse potential when they are properly prescribed and their use is supervised (American Psychiatric Association 1990). However, physical dependence often occurs when benzodiazepines are taken at higher-than-usual doses or for prolonged periods. If benzodiazepines are discontinued precipitously, withdrawal effects (including hyperpyrexia, seizures, psychosis, and even death) may occur. Signs and symptoms of withdrawal may include tachycardia, increased blood pressure, muscle cramps, anxiety, insomnia, panic attacks, impairment of memory and concentration, perceptual disturbances, and delirium. In addition, withdrawal-related derealization, hallucinations, and other psychotic symptoms have been reported. These withdrawal symptoms may begin as early as the day after discontinuation of the benzodiazepine, and they may continue for weeks to months. Evidence indicates that withdrawal reactions associated with shorter-half-life benzodiazepines peak more rapidly and more intensely. 

American Psychiatric Association Benzodiazepine Dependence, Toxicity, and Abuse A Task Force Report of the American Psychiatric Association. Washington, DC, American Psychiatric Association, 1990 Cohn JB, Wilcox CS Low-sedation potential of buspirone compared with alprazolam and lorazepam in the treatment of anxious patients a double-blind study. J Clin Psychiatry 47 409 12, 1986 Dolovich LR, Addis A, Vaillancourt JM, et al Benzodiazepine use in pregnancy and major malformations or oral cleft meta-analysis of cohort and case-control studies. BMJ 317 839-843, 1998 Goldberg HL, Finnerty RJ The comparative efficacy of buspirone and diazepam in the treatment of anxiety. Am J Psychiatry 136 1184—1187, 1979 Kupfer DJ, Reynolds CF 111 Management of insomnia. N Engl J Med 336 341-346, 1997... 

Lithium has been proven effective for acute and prophylactic treatment of both manic and depressive episodes in patients with bipolar illness (American Psychiatric Association 2002). However, patients with rapid-cycling bipolar disorder (i.e., patients who experience four or more mood disorder episodes per year) have been reported to respond less well to lithium treatment (Dunner and Fieve 1974 Prien et al. 1984 Wehr et al. 1988). Lithium is also effective in preventing future depressive episodes in patients with recurrent unipolar depressive disorder (American Psychiatric Association 2002) and as an adjunct to antidepressant therapy in depressed patients whose illness is partially refractory to treatment with antidepressants alone (discussed in Chapter 2). Furthermore, hthium may be useful in maintaining remission of depressive disorders after electroconvulsive therapy (Coppen et al. 1981 Sackeim et al. 2001). Lithium also has been used effectively in some cases of aggression and behavioral dyscontrol. 

As noted earlier, although it is often used as a treatment of last resort, there are situations in which ECT may be used as a first-line intervention. The American Psychiatric Association (APA) Task Force Report on ECT discusses four specific groups of patients ... 

ECT use also varied widely by geographic region. For example, patients in the north central states (Minnesota, Iowa, North Dakota, South Dakota, Nebraska, and Kansas) were approximately four times more likely to receive ECT than patients in the mountain states (Montana, Idaho, V oming, Colorado, New Mexico, Arizona, Utah, and Nevada). These differences are supported by data from the American Psychiatric Association s Professional Activities Survey, which show that rates varied from 0.4 to 81.2 patients per 10,000 population in the 202 metropolitan areas in which ECT use was reported ( 138). Of note, no ECT use was reported in 115 metropolitan areas. In addition, an analysis of these data found that less than 8% of all psychiatrists in the United States provide ECT ( 139). Finally, depressed... 

Kurland, A. A., Unger, S., Shaffer, J., Savage, C, Wolf, S., Leihy, R., and McCabe, O. L. Psychedelic Therapy (Utilizing LSD) in the Treatment of the Alcoholic Patient A Preliminary Report. Presented at the American Psychiatric Association meetings, Atlantic City, N.J., May 1966. 

Since the early 1960s, the BZDs have accounted for more than half the total world sales of tranquilizers. As of 2002, the BZDs were the most commonly prescribed class of tranquilizers in the United States. According to FDA data, however, there has been a dramatic decline in the use of minor tranquilizers and other antianxiety drugs since 1975, when prescriptions peaked at 103 million. An American Psychiatric Association task force report estimates that annual prescriptions for BZDs have leveled off since the mid-1980s to about 61 million. 

American Psychiatric Association 1980, Task force report tardive dyskinesia, American Psychiatric Association, Washington, DC. 

Five years later, the American Psychiatric Association (APA, 1975) published The Current Status of Lithium Therapy Report of the APA Task Force. Without citing evidence, the authors stated, The task force has concluded that lithium is a more specific anti-manic agent than neuroleptics and that its therapeutic results are achieved in a unique pharmacologic effect rather than nonspecific calming action. ... 

Grassley (2006) cited reports that ADHD drug sales had skyrocketed with a threefold increase in sales between 2000 and 2004, from a total of 759 million to 3.1 billion, and that more than 2.5 million children under age 17 were taking the drugs. He demanded to know why the FDA was so lax in evaluating the risks of these drugs. It is not just the FDA it is the entire psychopharmaceutical complex, including the scientific journal of the American Psychiatric Association. 

In regard to short-acting BZs such as Xanax and Halcion, the American Psychiatric Association (1990a) Task Force task force report on BZs made the following observations ... 

American Psychiatric Association. (1975). The current status of lithium therapy Report of the APA Task Force. American Journal of Psychiatry, 132, 997-1001. 

American Psychiatric Association. (1978). Electroconvulsive therapy A task force report. Washington, DC Author. 

Kane J, Honigfeld G, Singer J, et al Clozapine for the treatment-resistant schizophrenic a double-blind comparison with chlorpromazine. Arch Gen Psychiatry 45 789-796,1988 Kane JM, Jeste DV, Barnes TRE, et al Tardive Dyskinesia A Task Force Report of the American Psychiatric Association. Washington, DC, American Psychiatric Association, 1992 Karayalcin G, Rosner F, Sawitsky A Pseudoneutropenia in Negroes a normal phenomenon. N Y State J Med 72 1815-1817,1972 Kessler RC, McGonagle KA, Zhao S, et al Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry 51 8-19, 1994... 

Ackerman A, Cronin E, Rodman D, et al Lead poisoning from lead tetroxide used as a folk remedy—Colorado. MMWR Morb Mortal Wkly Rep 30 647-648,1982 Agency for Toxic Substances and Disease Registry The Nature and Extent of Lead Poisoning in Children in the United States A Report to Congress. Atlanta, GA, U.S. Department of Health and Human Services, 1987 American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000... 

For the client suffering from hypomanic episodes, a milder version of manic symptoms is reported. That is, the symptoms of mania can still exist within a hypomanic episode, but because they are not as severe and obvious as those during a manic state, those close to the individual can easily ignore them. The primary difference between the manic and the hypomanic episode is that during a hypomanic episode, the client should not report delusions or hallucinations (American Psychiatric Association, 1994). Early identification of the symptoms characteristic of the type of mood episode can help practitioners to complete more accurate diagnostic impressions, facilitating the assessment and treatment of psychiatric clients. 

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