Another good one from Tom!
"..They suggest that patients should be
able to alert authorities to problems with psychotherapies they
receive by use of a similar scheme to the one through which adverse
drug events are reported which Sharpe and Nutt suggest could be
administered by the Medicines and Healthcare Regulatory Agency, the
body responsible for dealing with drug reports.."
http://www.eurekalert.org/pub_releases/2008-01/spu-psb011408.php
Public release date: 14-Jan-2008
SAGE Publications UK
Psychotherapy should be subject to rigorous regulation just like drug
treatments, say academics
Los Angeles, London, New Delhi, and Singapore (14 January, 2008) –
Psychotherapies such as cognitive behaviour therapy (CBT) are
under-regulated in the UK and should be subject to the same standards
of evidence as drugs, assert two experts in psychological medicine
writing in the Journal of Psychopharmacology (January issue published
today by SAGE). They say the largely unrecognized potential for
serious adverse effects resulting from talking therapies means rules
should be tightened, particularly in light of the UK Government's
recent £150m investment in psychotherapy services for depression and
anxiety, which will result in many more therapists practising in the UK.
"While welcoming the increased profile that mental health problems
have been given by the Government and the expansion of scientifically
validated psychological treatment…we wish to urge a note of caution,"
says Professor Michael Sharpe, Psychological Medicine & Symptoms
Research Group, School of Molecular & Clinical Medicine, University of
Edinburgh, UK, who co-authored the editorial with Professor David Nutt
of the Psychopharmacology Unit, Department of Community Based
Medicine, University of Bristol, UK.
"Our concern is about the tendency to consider psychological
treatments less critically than pharmacological ones. It is important
that both are seen as having a place in treating depression and that
both are subject to the same standards of scrutiny and regulation."
According to Nutt, few psychotherapy trials meet therequirements
demanded of drug tests, and even those that do frequently show that
psychotherapy performs no better—and often worse—than pharmacological interventions. What is more, he points out, many psychotherapy trials do not even consider the possibility that their treatment could harm. Yet all therapists should be aware that therapy can have adverse effects on some patients and a major part of psychotherapy training is
how to deal with issues such as counter-transference that can mediate
these negative effects.
"We need a much more sophisticated view than `psychotherapy good; drug
treatment bad' if we are to effectively and safely improve the mental
health of the population," says Sharpe.
Potential adverse effects of psychotherapy include worsening of the
patient's condition, the development of psychological dependency on
the therapist, and wastage of patient and therapist time when the
treatment is ineffective. In addition, the editorial cites evidence
that a small minority of therapists take advantage of vulnerable
patients and exploit them emotionally, financially, and sexually.
"Given that psychotherapy is not necessarily always the benign yet
efficacious therapy that seems to be generally assumed, patients
should be made aware of the risks as well as the benefits especially
now we have a government initiative to improve psychotherapy provision
on the NHS," write the authors. They suggest that patients should be
able to alert authorities to problems with psychotherapies they
receive by use of a similar scheme to the one through which adverse
drug events are reported which Sharpe and Nutt suggest could be
administered by the Medicines and Healthcare Regulatory Agency, the
body responsible for dealing with drug reports.
Nutt and Sharpe urge therapists to ensure patients are aware of the
risks as well as the benefits of psychotherapy. In addition, they
suggest that therapists should to commit to performance and practise
standards and agree to be monitored or audited on their professional
records.
"Up-scaling the provision of psychological therapy to the degree
[proposed by the UK Government] is a major challenge for quality
assurance. Bad therapy will not work and may harm. It will be essential therefore that the increase in number of therapists is done
incrementally with (a) rigorous monitoring of the quality of the
therapy given and (b) professional regulation of therapists to
minimise the risk of exploitation of patients," concludes Sharpe.
###
Uncritical positive regard -- Issues in the efficacy and safety of
psychotherapy is published on SAGE Journals Online today (Monday 14th
January) at http://jop.sagepub.com/cgi/reprint/22/1/3 . The article
will be free online for two months.
The Journal of Psychopharmacology is a fully peer-reviewed,
international journal that publishes original research and review
articles on preclinical and clinical aspects of psychopharmacology.
The journal provides an essential forum for researchers and practising
clinicians on the effects of drugs on animal and human behavior, and
the mechanisms underlying these effects. The Journal of
Psychopharmacology is published by SAGE, in Association with British
Association for Psychopharmacology
www.sagepub.co.uk
* * *
On a similar note, MDs should not be able to place a psych diagnosis in a patient's file until that diagnosis has been confirmed by a licensed psych practitioner. Too many MDs, playing amateur psychologist, have placed depression diagnoses in the records of patients who had a medical illness.
I've had experience with two of them. When confronted with the opinion of a professional counselor/psychiatrist that my symptoms are those of physical illness because the emotional component required for a depression diagnosis was missing, these MDs -- with little more than Psych 101 -- decided that they were more qualified than the licensed psychs to render a psych diagnosis and completely disregarded the expert's explanation that someone with the flu would have fatigue, difficulty concentrating, sleeping a great deal, pain, etc., but that I did not report suicidal ideation, crying, low self-esteem, etc., which would be required for them to diagnose depression.
In fact, my self-esteem is quite strong, as evidenced by my conviction that I was right that I was physically ill, and the doctor was wrong in insisting it was all in my head. I refused to back down in the face of bullying, which (according to a friend who was a psych nurse) should have indicated to any doctor with half a brain that I wasn't a weak-willed depressive, and that the depression diagnosis should be discarded and a more appropriate diagnosis considered ... perhaps the diagnosis that I told the doctor I already had: post-viral fatigue syndrome.
CBT, while seemingly harmless, can cause a patient to miss out on that critical time window of getting proper treatment for CFS in the crucial early months when the disease can be stopped before it gets too bad. If the therapist keeps pushing the patient to exercise, on the theory that exercise lifts depression, the destructive effect of exercise on a CFS patient who should *not* do aerobic exercise can be permanent.
Let's get the word out that there are ways to differentiate CFS from depression, and make sure that every doctor knows that they don't even have to order an expensive lab test: just send the patient out for a brisk walk and believe the patient when she comes back and says "I collapsed into bed" instead of accusing her of not wanting to exercise because the sweat would ruin her hair and make-up. A depressive would return energized and feel good the rest of the day; a CFS patient will be exhausted and suffer more of the flu-like symptoms. So easy a lay person like me can tell the difference.
Many medical disorders present as psychological disturbances. Pancreatic cancer can cause visual hallucinations. Adrenal tumors will cause behavior that can seem psychotic. So you have to be very careful not to accept psychiatric diagnoses at face value. –– Sheila Bastien, Ph.D.
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