The American Psychiatric Association

The APA has also been busy trying to dampen, and even to obliterate, the effects of the FDA black-box warnings. A June 2007 editorial in the association s American Journal of Psychiatry (Pfeffer, 2007) lamented, these policy actions may have had the unintended effect of discouraging the prescription of antidepressants for pediatric patients and pediatric utilization of antidepressants without compensatory increases in other specific treatments (p. 845). What was the purpose of warning about suicidality, if not to discourage the use of antidepressants  

The viewpoint of the editorial is so warped that it does not even mention that the FDA also found that the vast majority of clinical trials showed that antidepressants are ineffective in treating depression in children. As already noted, only 3 of 15 placebo-controlled clinical trials showed any efficacy. (Two of the three positive studies were sponsored by Eli Lilly, with Graham Emlsie, a close Lilly collaborator, as the first author see subsequent discussion.) Also remember FDA committee member and epidemiologist Thomas Newman s (2004) observations that the adverse effects of the antidepressants were much better established than their efficacy, which could largely be accounted for by the placebo effect. 

Dangerous and ineffective—that should discourage the use of a treatment in children. 

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Changes in perceived physical and mental health status of a schizophrenia patient population following initiation of a conventional or an atypical antipsychotic medication. Poster presented at the American Psychiatric Association Annual Meeting, Toronto, June 1998. 

The diagnostic criteria for, and general features of, disorders in which anxiety is a prominent component are described in detail in the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-IV, 4th edition (1994)) and are regarded as either phobias or anxiety states ... 

Premenstrual syndrome (PMS) is a constellation of symptoms including mild mood disturbance and physical symptoms that occur prior to menses and resolve with initiation of menses. It is estimated that up to 70% of menstruating women experience symptoms of PMS. However, a spectrum of premenstrual mood disturbances exists and the most severe is premenstrual dysphoric disorder (PMDD). Approximately 4% to 7% of women have PMDD. A summary of the American Psychiatric Association s criteria for PMDD is as follows1,21 ... 

Dubovsky, S. L., Generalized anxiety disorder New concepts and psychophar-macologic therapies. 142nd Annual Meeting of the American Psychiatric Association (1989, San Francisco, California). Journal of Clinical Psychiatry 51(Suppl) 3-10, 1990. 

Tasman, A. (2000). Lost in the DSM-IV checklist empathy, meaning, and the doctor-patient relationship. Presidential address, Proceedings of the 153rd Annual Meeting of the American Psychiatric Association, Chicago, IL. 

A number of diagnostic tools for alcoholism have been developed, with the most well known being the American Psychiatric Association s (APA, 2000) Diagnostic Statistical Manual (DSM-IV). The diagnostic criteria are summarised below. 

DSM-IV The fourth edition of the American Psychiatric Association s Diagnostic and Statistical Manual of Mental Disorders which along with the tenth edition of the World Health Organisation s International Classification of Diseases (ICD-10) are widely used for psychiatric evaluation, especially in clinical pharmacology. 

The American Psychiatric Association diagnostic criteria are listed in Table 19.1. Table 19.2 describes the clinical features and Table 19.3 lists medical illnesses and drugs that can cause depressive symptoms. 

The practice guideline of the American Psychiatric Association recommends that after 6 to 8 weeks of antidepressant treatment, partial responders should consider changing the dose, augmenting the antidepressant, or adding psychotherapy or ECT. For those with no response, options include changing to another antidepressant or the addition of psychotherapy or ECT. 

The DSM was produced by the American Psychiatric Association primarily as a manual for American clinicians and has been largely guided by research on the U.S. population. As a result, the document reflects an American version of psychopathology that may not accurately describe psychopathology found in other cultures. Cross-cultural epidemiological studies suggest that certain disorders (e.g., anorexia nervosa, dissociative identity disturbance) exist mainly in industrialized countries and are rarely seen in... 

Encouraged by this polite treatment, I requested approval to show an edited videotape entitled The Many Faces of LSD at the 1969 meeting of the American Psychiatric Association. Although I m sure the security officer may have been uneasy about potential backlash, he nevertheless decided to clear it. This surprised me a bit, since the footage showed volunteers under the influence of a dmg that had been declared illegal 3-4 years earlier. 

Jolly was a wunderkind who became Chairman of Psychiatry Department at the University of Oklahoma at the age of 29. I first met him in 1962, at a cocktail party sponsored by the American Psychiatric Association during their armual convention. By then, I had heard about his infamous elephant blunder at the Lincoln Park Zoo in Chicago. 

In the 1970s, Murray Jarvik and others, postdated that the powerful reinforcing effects of tobacco for humans were most likely explained by substances in addition to nicotine in the tobacco and smoke (Jarvik 1977 Russell 1979). Addiction to tobacco has been designated by the nomenclature as nicotine dependence and nicotine withdrawal by the American Psychiatric Association since 1987 because of the presence of nicotine (American Psychiatric Association 1994, 1987 Stratton et al. 2001). In fact, tobacco products are complex chemical cocktails, with the modem commercial cigarette representing perhaps the most complex of all. Therefore, there is also strong merit in the approach of the WHO in its International Classification of Diseases to use the terms tobacco dependence and tobacco withdrawal. ... 

The term "bipolar disorder" originally referred to manic-depressive illnesses characterized by both manic and depressive episodes. In recent years, the concept of bipolar disorder has been broadened to include subtypes with similar clinical courses, phenomenology, family histories and treatment responses. These subtypes are thought to form a continuum of disorders that, while differing in severity, are related. Readers are referred to the Diagnostic and Statisticial Manual of Mental Disorders of the American Psychiatric Association (DSM-IV) for details of this classification. 

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... 

Several widely used diagnostic classifications currently include sections on tic disorders. These include both the classification system published by the American Psychiatric Association (1994) and the criteria by the World Health Organization (1996). A third classification system, the Classification of Tic Disorders (CTD), has been offered by the Tourette Syndrome Classification Study Group (1993). Although clear differences exist comparing these classification schemes, they are broadly congruent. 

Sallee, F.R., Miceli, J.J., Wilner, K.D., and Robarge, L. (2000b) Pharmacokinetics of ziprasidone in children and adolescents with Tourette s syndrome. In New Research Abstracts from the American Psychiatric Association Annual Meeting, Chicago, IL NR563. 

In the 1990s the psychiatric profession attempted to delineate the indications for ECT in minors and the way the treatment should be administered. For example, the American Psychiatric Association (APA) in 1990 (American Psychiatric Association, 1990) and Royal College of Psychiatrists in 1995 (Freeman, 1995) devoted special sections to the use of ECT in the young in their ECT guidelines. In 1999, the Royal Australian... 

Birmaher, B., McCafferty, J.P., Bellow, K.M., and Beebe, K.L. (2000b) Comorbid ADHD and disruptive behavior disorders as predictors of response in adolescents treated for major depression. Presented at the American Psychiatric Association Annual Meeting, Chicago, IL. 

Geller, D., Biederman, J., Emslie, G., and Carpenter, D. (2001b) Comorbid psychiatric illness and response to treatment in pediatric OCD. Presented at Scientific Proceedings of the American Psychiatric Association, New Orleans, LA. 

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