Penny Castagnimo

Guest Speaker Presentation: Mental Health and Personhood: Human Rights Perspectives, Dr Alicia Yarmin – 6 September 2024

Date: Friday 6 September 2024

Time: 8AM (EDT)/1PM (GMT)

Chair: Lisa Cosgrove

Location: Zoom https://essex-university.zoom.us/j/92831922870

RSVP: Please register here for the talk.

Where possible, we would appreciate if attendees could register for the talk, however this is not essential as the meeting link is included above.

In this talk, Alicia Ely Yamin will first give a brief overview of concepts and international norms related to health and psycho-social disability, and human rights-based approaches to health and disability justice. Based on personal experience working with Disability Rights International, she will then discuss a concrete case example of using human rights to advance mental health and critically explore impacts of that case. Finally, Alicia will highlight challenges to implementing human rights-based approaches to mental health care in our current context.

Dr Alicia Yamin (Harvard Law School)

Dr Alicia Yamin is a Lecturer on Law and the Director of the Global Health and Rights Project at the Petrie-Flom Center for Health Law Policy, Biotechnology and Bioethics at Harvard Law School and Adjunct Senior Lecturer on Health Policy and Management at the Harvard TH Chan School of Public Health; as well as Visiting Professor of Law at the Universidad Torcuato di Tella in Buenos Aires, Argentina. She also serves as Senior Adviser on Human Rights and Health Policy at the global health justice organization, Partners In Health.

Known globally for her trans-disciplinary work in relation to economic and social rights, reproductive justice, the right to health, and the intersections between development paradigms and human rights, Alicia’s career has bridged academia and activism. She has lived in Latin America and East Africa for much of her professional life and worked with local advocacy organizations, including co-founding a program on health and human rights in the Asociación Pro Derechos Humanos (Lima, Peru; 1999).

Alicia was appointed by the UN Secretary General as one of ten international experts to the Independent Accountability Panel for Women’s, Children’s and Adolescents’ Health in the Sustainable Development Goals (2016-2021). She was the chief consultant to the Office of the High Commissioner for Human Rights and drafter of the ‘Technical guidance on the application of a human-rights based approach to the implementation of policies and programmes to reduce preventable maternal morbidity and mortality,’ the first guidance on a ‘human rights-based approach to health’ to be adopted by the UN Human Rights Council. Alicia has served on numerous other UN, WHO and other global expert committees. She currently serves on WHO Global Advisory Group on Legislating Maternal Perinatal Death Surveillance and the Lancet Commission on Arctic and Northern Health.

The talk will be followed by a Q&A session with members of the audience and proceedings will conclude by 2 pm GMT / 9 am EDT.
See link for further information about the Centre for Mental Health, Human Rights and Social Justice.

Guest Speaker Presentation: Mental Health and Personhood: Human Rights Perspectives, Dr Alicia Yarmin – 6 September 2024 Read More »

Dainius Pūras, Keynote Speaker -“From Ticking Boxes to Transformation – A New Script for Mental Health”

On 10 October 2024, Prof Dainius Pūras, the former UN Special Rapporteur on the Right to Health, will be giving a keynote address at the event “From Ticking Boxes to Transformation – A New Script for Mental Health”, taking place from 10am at The MAC Arts Centre, Exchange St West, Belfast. Follow the link for further details and how to register for this event.

Dainius Pūras, Keynote Speaker -“From Ticking Boxes to Transformation – A New Script for Mental Health” Read More »

“Ending Psychiatric Coercion – Urgent Need for Effective Remedies and Reparations” – Centre Members to Speak at Upcoming Conference

Prof Dainius Pūras, the former UN Special Rapporteur on the Right to Health, and Alberto Vasquez, Co-director for the Center for Inclusive Policy, will be speaking at an upcoming conference in Oslo (in person and online) on 10 September 2024, organised by the Human Rights Foundation ReDo*.

Please see below for further details and how to register:

Topics that will be covered at the conference include –

  • Human rights standards relevant for ending psychiatric coercion & reparations 
  • Severity of human rights violations and harm done 
  • Legal reforms to end psychiatric coercion  
  • Access to justice, effective remedies and reparations – the important role of the courts
  • Strategic litigation & way forward (European Court of Human Rights & other regional human rights bodies, UN treaty bodies, regional and global perspectives) 

Speakers –

  • Dainius Pūras, Professor, Vilnius University, former UN Special Rapporteur on the right to health 
  • Carlos Rios Espinosa, Human Rights Watch (HRW), former member of the UN CRPD Committee 
  • Tina Minkowitz, Center for the Human Rights of Users and Survivors of Psychiatry (CHRUSP) 
  • Alberto Vasquez, Co-director, Center for Inclusive Policy (CIP) 
  • Oh-yong Kweon, Yein Law Office, World Network of Users and Survivors of Psychiatry (WNUSP)  
  • Steven Allen, Executive Director, Validity Foundation 
  • Jennifer Wairimu, Litigation Officer, Validity Foundation 

Location: Litteraturhuset, Wergelandssalen, Oslo

Time: 09:00 hrs – 16:30 hrs

The conference is open for everyone and free of charge and will be held both in person and broadcast online in passive mode. 

Please register here, for both in person participation and online participation 

For questions about the conference please contact Hege Orefellen at hegejo@kjemi.uio.no 

*The aim of the human rights foundation ReDo is to work against infringements, abuse, and coercion in the mental health system and to strengthen the human rights of persons with psychosocial disabilities, in line with the UN Convention on the Rights of Persons with Disabilities (CRPD).  Work is centred on documentation of human rights violations in the mental health system and support for strategic litigation.  

ReDo organizes an annual conference where a human rights award is given. This year’s conference focuses on ending psychiatric coercion and remedies and reparations needed for these human rights violations, and is co-organized by WSO – We Shall Overcome, Norway

“Ending Psychiatric Coercion – Urgent Need for Effective Remedies and Reparations” – Centre Members to Speak at Upcoming Conference Read More »

Guest Speaker Presentation: Can the Psyche Be Injured? Labour Politics and the Co-Production of Psychological Harm in the Workplace in Chile, Dr Sofía Bowen – 26 July 2024

Chair: Cristian Montenegro.

Historically, occupational health has identified workplace injuries as physical. However, with the global rise of psychiatric language, new conceptions of psychological injury are emerging. What do these mental health injuries enact concerning historical and current labour issues? What roles do workers, occupational healthcare professionals, and ‘psy’ specialists play in the emergence of these types of injuries? Using Chile as a case study, Dr Bowen’s talk examines the increase in mental health claims submitted to employee insurance companies and analyses how various social actors, including workers, ‘psy’ specialists, insurers, and state bureaucrats, interact in shaping the concept of psychological injury within a labour environment characterized by deep-rooted hierarchical relationships, neoliberal policies, and a lack of social security. Ultimately, the talk explores how recognizing the psyche as injured generates new meanings and social dynamics that impact workers’ rights, status, and the historical and ongoing power struggles within the labour and political landscape.

Image by rodrigoandrade3880, Pixabay

Dr Sofía Bowen is a Chilean medical anthropologist with a PhD from the Department of Global Health and Social Medicine at King’s College London, United Kingdom. She also holds a BSc in Social Anthropology from the University of Chile and an MSc in Medical Anthropology from the University of Edinburgh. Dr Bowen co-founded the Platform for Social Research in Mental Health in Latin America (PLASMA), an initiative fostering collaboration and reflection on the political, cultural, and social dimensions of mental health in the region. Currently, she works as an associate lecturer and research fellow at the School of Anthropology at the Pontificia Universidad Católica de Chile and the Center For Cancer Prevention and Control (CECAN). Her research interests focus on the intersection between mental health and psychiatry, health governance and citizenship, and socio-political processes in Chile and Latin America.

Guest Speaker Presentation: Can the Psyche Be Injured? Labour Politics and the Co-Production of Psychological Harm in the Workplace in Chile, Dr Sofía Bowen – 26 July 2024 Read More »

Global Burden Disease Estimates for Major Depressive Disorders (MDD): A review of diagnostic instruments used in studies of prevalence

Cosgrove L, Brhlikova P, Lyus R, Herrawi F, D’Ambrozio G, Abi-Jaoude E, Pollock AM, Community Mental Health Journal. 2024 doi: 10.1007/s10597-024-01302-6

Abstract:

Global Burden of Disease (GBD) estimates have significant policy implications nationally and internationally. Disease burden metrics, particularly for depression, have played a critical role in raising governmental awareness of mental health and in calculating the economic cost of depression. Recently, the World Health Organization ranked depression as the single largest contributor to global disability. The main aim of this paper was to assess the basis upon which GBD prevalence estimates for major depressive disorder (MDD) were made. We identify the instruments used in the 2019 GBD estimates and provide a descriptive assessment of the five most frequently used instruments. The majority of country studies, 356/566 (62.9%), used general mental health screeners or structured/semi-structured interview guides, 98/566 (17.3%) of the studies used dedicated depression screeners, and 112 (19.8%) used other tools for assessing depression. Thus, most of the studies used instruments that were not designed to make a diagnosis of depression or assess depression severity. Our results are congruent with and extend previous research that has identified critical flaws in the data underpinning the GBD estimates for MDD. Despite the widespread promotion of these prevalence estimates, caution is needed before using them to inform public policy and mental health interventions. This is particularly important in lower-income countries where resources are scarce. Read more …


Global Burden Disease Estimates for Major Depressive Disorders (MDD): A review of diagnostic instruments used in studies of prevalence Read More »

“Reducing the Treatment Gap” Poses Human Rights Risks

(2024)

Lisa Cosgrove, Cristian Montenegro, Lee Edson Yarcia, Gianna D’Ambrozio and Julie Hannah, Health and Human Rights Journal, June 2024, Vol 26, Number 1

Abstract:
The United Nations (UN) officially acknowledged the “global burden” of mental disorders in September 2015, when mental health was included in the UN Sustainable Development Goals (SDGs). In so doing, the UN identified mental health as a priority for global development. The call to “close the treatment gap” was seen as a way to both uphold the right to treatment and integrate mental health into the SDGs, with many asserting that this is a human rights-based approach to transforming mental health. Although using the SDG framework is a sensible and necessary approach to catalyze action on mental health, the integration of mental health into the SDGs has sparked debates about the relevance and role of human rights frameworks in this area. For example, the latest draft resolution on mental health and sustainable development, presented by Mexico to the UN General Assembly, has been met with renewed calls to avoid the psychiatrization of the SDGs. Psychiatrization, in this context, points to the process by which “psychiatric institutions, knowledge, and practices affect an increasing number of people, shape more and more areas of life, and further psychiatry’s importance in society as a whole.” Concerns about psychiatrization stem from the fact that the focus is predominantly on scaling up the diagnosis and treatment of mental disorders, without paying attention to how a biomedical approach is limited in addressing the environmental, social, economic, and political determinants of mental health. Further, the emphasis on “closing the treatment gap” selectively deploys human rights in order to promote increased access to Western biomedical treatments. In so doing, there is a risk that the foundational principles of interdependence and indivisibility of international human rights will not be brought to fruition. What is needed is a holistic, rights-based approach that focuses not only on the clinical or individual interventions and outcomes but also on the process and contexts of implementation. That is why it is critical to ask “what type of evidence is valued (and devalued).” Thus, any discussions about the meaning and logistics of including global mental health as a priority for global development must include the voices of those most affected. Read more …

“Reducing the Treatment Gap” Poses Human Rights Risks Read More »

Guest speaker presentation: Mental illness and identity, Dr Milutin Kostic – 24 april 2024

Date: 24 April 2024

Time: 8AM (EDT)/1PM (GMT)

Chair: Lisa Cosgrove

Location: Zoom https://essex-university.zoom.us/j/96540727782 

Recent decades have seen the rise of mental health speak in the general population and social media.  Even though most is done with the best intentions, this cultural change poses many questions and potential dangers that have been completely marginalized.  During this time awareness and anti-stigma campaigns have presented the story of mental health as the same as physical health, however there are qualitative differences that are overlooked.  One aspect that must be taken into account and that influences the cultural, scientific, clinical, social and even philosophical zeitgeist is the interplay of diagnosis and identity.  What happens in this diad and how it influences each and every aspect of our society, even when we are not completely aware of this, will be the topic of Dr Kostic’s talk.

Dr Kostic is a psychiatrist from Serbia, Head of the Day Hospital at the Institute of Mental Health in Belgrade. He completed his PhD in molecular medicine, with a focus on genetics and imaging in depression, but has in the meantime refocused his work on social and psychological aspects of diagnosis, overtreatment and overdiagnosis. Milutin is currently at the University of Massachusetts Boston on a Fulbright scholarship working with Prof. Cosgrove.

The talk will be followed by a Q&A session with members of the audience and proceedings will conclude by 9 am EDT/2 pm GMT.

Guest speaker presentation: Mental illness and identity, Dr Milutin Kostic – 24 april 2024 Read More »

Dainius PŪras VISITS la trobe university, australia – april 2024

On 11 April, Prof Dainius Pūras, the former United Nations Special Rapporteur on the right to the highest attainable physical and mental health, joined a panel discussion at the La Trobe Law School and the Care Economy Research Institute, Australia. The panel discussed the Transformation of Mental Health Policy, Practice, and Law in Victoria and beyond. Dainius was joined on the panel by Mary O’Hagan, Executive Director Lived Experience in the Mental Health and Wellbeing Division at the Department of Health, Victoria, and Professor Lisa Brophy, Social Work and Social Policy at La Trobe University. The panel was chaired by Associate Professor Piers Gooding from the La Trobe Law School, and guests were welcomed by Professor Irene Blackberry, Director of the Care Economy Research Institute.

Photo: L-R – A/Prof Piers Gooding, Prof Dainius  Pūras, Prof Lisa Brophy, Prof Irene Blackberry

While in Australia, Dainius also met with contacts at Deakin University to discuss mental health and deafness and he also presented at the University of Melbourne on mental health policy.

Dainius PŪras VISITS la trobe university, australia – april 2024 Read More »

PAnel Members for New Psychiatric ‘bible’ received over $14m from industry

Study finds six in 10 US physician contributors had financial ties to industry. Findings raise questions about editorial independence

A study from the Centre’s co-Founder, Lisa Cosgrove, reported that sixty percent of US physicians serving as panel and task force members for the American Psychiatric Association’s official manual of psychiatric disorders received payments from industry totalling $14.24m, finds a study published by The BMJ.

Because of the enormous influence of diagnostic and treatment guidelines, the researchers say their findings “raise questions about the editorial independence of this diagnostic manual.”

Often referred to as the ‘bible’ of psychiatric disorders, the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, text revision (DSM-5-TR) is the latest edition of the guide that doctors use to diagnose and treat patients. It is thus critical that authors of this psychiatric taxonomy should be free of industry ties.

But until the development of Open Payments (a database of financial relationships between companies and physicians), it wasn’t possible to determine the amount of monies received by authors of diagnostic and clinical practice guidelines.
To address this, researchers used data from Open Payments to assess the extent and types of financial ties to industry of panel and task force members of the DSM-5-TR.

Their analysis included 92 physicians based in the US who served as members of either a panel (86) or task force (6) on the DSM-5-TR from 2016-19, the time during which work was initiated and completed for the 2022 text revision.
Of these 92 individuals, 55 (60%) received payments from industry. Collectively, these panel members received a total of $14.24m (£11.21m; €12.96m). Only two of the six task force members had any payments reported in Open Payments, totaling $196.02 and $792.67 for 2016-19.

The most common types of payment were for food and beverages (91%), followed by travel (69%) and consulting (69%).

The greatest proportion of compensation by category of payment was for research funding (70%) which the authors point out was excluded from the American Psychiatric Association’s disclosure policy for the previous edition (DSM-5).

They highlight some study limitations, such as not including payments to physicians based outside the US or non-physician prescribers and acknowledge that amounts listed in the database may be imprecise.

Nevertheless, they say this study “provides novel data about the appreciable conflicts of interest in the DSM-5-TR and extends past research on this topic.”

To ensure unbiased, evidence based mental health practice, there should be a rebuttable presumption of prohibiting financial conflicts of interest among the panel and task force members of the Diagnostic and Statistical Manual of Mental Disorders, they write.

When no independent individuals with the requisite expertise are available, they suggest that those with associations to industry could consult to the panels, but they would not have decision making authority on revisions or inclusion of new disorders.

“As researchers, clinicians, policy makers, and leaders in evidence based medicine have argued, guideline writers should be free of financial relationships with industry, especially those writers who are responsible for such an influential manual on psychiatric taxonomy,” they conclude.

The full article can be found here.

PAnel Members for New Psychiatric ‘bible’ received over $14m from industry Read More »

Industry Influence on Mental Health Research: Depression as a Case Example

Cosgrove L, Patterson EH, Bursztajn HJ, Front Med (Lausanne). 2024 Jan 23;10:1320304 DOI: 10.3389/fmed.2023.1320304

Abstract:

Emotional distress has been rising since before the COVID-19 pandemic and the public is told that depression is a major public health problem. For example, in 2017 depressive disorders were ranked as the third leading cause of “years lost to disability” and the World Health Organization now ranks depression as the single largest contributor to global disability. Although critical appraisals of the epidemiological data raise questions about the accuracy of population-based depression estimates, the dominance of the medical model and the marketing of psychotropics as “magic bullets,” have contributed to a dramatic rise in the prescription of psychiatric drugs. Unfortunately, the pharmaceutical industry’s influence on psychiatric research and practice has resulted in over-estimates of the effectiveness of psychotropic medications and an under-reporting of harms. This is because the principles that govern commercial entities are incongruent with the principles that guide public health research and interventions. In order to conduct mental health research and develop interventions that are in the public’s best interest, we need non-reductionist epistemological and empirical approaches that incorporate a biopsychosocial perspective. Taking depression as a case example, we argue that the socio-political factors associated with emotional distress must be identified and addressed. We describe the harms of industry influence on mental health research and show how the emphasis on “scaling up” the diagnosis and treatment of depression is an insufficient response from a public health perspective. Solutions for reform are offered. Read more …


Industry Influence on Mental Health Research: Depression as a Case Example Read More »

Conflicts of Interest Should be Prohibited Among the Diagnostic and Statistical Manual of Mental Disorders Panel and Task Force Members

L Cosgrove, BMJ 2024;384:q36

Abstract:
When the DSM-5 text revision was published in 2022, we identified the amount and type of payments received by DSM panel members—a task made possible by the development of the Open Payments database. We hoped that there would be a decrease in financial conflicts of interest. As with DSM-IV and DSM-5, however, conflicts of interest among the panel members for the DSM-5 text revision were prevalent. Of the 92 panel members who met inclusion criteria, 55 (60%) received payments from industry. Collectively, these panel members received $14.2m. Read more …

Conflicts of Interest Should be Prohibited Among the Diagnostic and Statistical Manual of Mental Disorders Panel and Task Force Members Read More »

Undisclosed Financial Conflicts of Interest in DSM-5-TR: cross sectional analysis

Davis L C, Diianni A T, Drumheller S R, Elansary N N, DAmbrozio G N, Herrawi F, Piper,J, Cosgrove, L
BMJ 2024; 384 :e076902 doi:10.1136/bmj-2023-076902

Abstract:

Conflicts of interest among panel members of DSM-5-TR were prevalent. Because of the enormous influence of diagnostic and treatment guidelines, the standards for participation on a guideline development panel should be high. A rebuttable presumption should exist for the Diagnostic and Statistical Manual of Mental Disorders to prohibit conflicts of interest among its panel and task force members. When no independent individuals with the requisite expertise are available, individuals with associations to industry could consult to the panels, but they should not have decision making authority on revisions or the inclusion of new disorders. Read more …


Undisclosed Financial Conflicts of Interest in DSM-5-TR: cross sectional analysis Read More »

Dainius pŪras Promotes mental heaLTH LEGISLATION IN CHILE – November 2023

On 30 November 2023 Dainius Pūras, Professor at Vilnius University and former UN Special Rapporteur on the Right to Health, gave a keynote address at an International Seminar on ‘‘Mental Health and Legislation in Chile: Global lessons and Experiences’. The seminar took place at the University of Chile and was organised by the Ministry of Health of Chile and Inter-American Development Bank.

Photo of Dainius Pũras, speaking at International Seminar on 'Mental Health and Legislation in Chile', University of Chile
Photo: Dainius Pūras, University of Chile

The convening focused on facilitating a space for discussion, reflection and learning about experiences in mental health legislative processes, together with nationally and internationally renowned experts in the field.

Welcome speeches were given by Minister of Health, Dr Ximena Aguilera and María Florencia Attademo-Hirt, IDB Representative in Chile.

Dainius’s keynote address considered the importance of comprehensive mental health legislation to improving public mental healthcare in Chile and called for the collaboration of the various stakeholders in this process, including organized civil society, experiential experts, formally trained experts, and parliamentarians to promote the progress of the legislation.

Other speakers included an address by the Undersecretary of Public Health, Andrea Albagli, Dévora Kestel of WHO and panellists from international mental health organisations and representatives from Chile’s executive, legislative and judicial branches of government.

During Dainius’s time in Chile, he also met with officials from the Ministry of Health, contacts from the School of Public Health, University of Chile and the Movement for Rights in Mental Health to discuss progress towards the introduction of mental health legislation.

Dainius pŪras Promotes mental heaLTH LEGISLATION IN CHILE – November 2023 Read More »

Global Burden of Disease 2017 Estimates for Major Depressive Disorder: A critical appraisal of the epidemiological evidence

Lyus R, Buamah C, Pollock AM, Cosgrove L, Brhlikova P. Journal of the Royal Society of Medicine Open. 2023;14(9). doi:10.1177/20542704231197594

Abstract:

.This study aims to critically appraise the quality of the epidemiological studies underpinning the GBD 2017 estimates for MDD with respect to i) the four GBD 2017 inclusion criteria and ii) the population coverage of the studies by country and WHO region. The WHO’s ranking of depression as the single largest contributor to global disability (20) is being used to advocate for scaling up depression treatment, particularly in the global south where resources are limited. However, GBD 2017 estimates are based on incomplete country and population coverage and unclear methodologies. Extrapolation of single study estimates, the inclusion of studies with non-representative populations, and lack of specific data on MDD, undermines the reliability of many country and regional estimates. The critical flaws in the data underpinning the GBD 2017 estimates mean that policymakers should interpret these with caution. Read more …


Global Burden of Disease 2017 Estimates for Major Depressive Disorder: A critical appraisal of the epidemiological evidence Read More »

Becoming a Phronimos: Evidence-Based Medicine, Clinical Decision Making, and the Role of Practical Wisdom in Primary Care

Cosgrove, L. & Shaughnessy, A. (2023), Journal of the American Board of Family Medicine. doi: 10.3122/jabfm.2023.230034R1

Abstract:

There has been much discussion about the overmedicalization of human experience and the problems incurred by overzealous action-oriented medical care. In this paper we describe the Aristotelean virtue of phronesis, or practical wisdom, and discuss how it can be developed by interested clinicians. We argue that becoming a phronimos requires conscious attention to one’s practice by using feedback to continually improve. But there must also be judicious adherence to clinical practice guidelines and advocacy for people-as-patients at individual, community, and national levels. Read more …


Becoming a Phronimos: Evidence-Based Medicine, Clinical Decision Making, and the Role of Practical Wisdom in Primary Care Read More »

Why Psychiatry Needs an Honest Dose of Gentle Medicine

Cosgrove L, D’Ambrozio G, Herrawi F, Freeman M and Shaughnessy A (2023), Front. Psychiatry 14:1167910. doi:10.3389/fpsyt.2023.1167910

Abstract:

The pharmaceutical industry’s influence on psychiatric research and practice has been profound and has resulted in exaggerated claims of the effectiveness of psychotropic medications and an under-reporting of harms. After the regulatory approval of fluoxetine, the pharmaceutical industry began promoting (and continues to promote) a chemical imbalance theory of emotional distress. In the last decade, there has been an increased awareness about the limits of this theory and the risks of psychotropic medications. Nonetheless, the medicalization of distress, the sedimented belief in “magic bullets,” and the push to “scale up” mental health treatment have contributed to the meteoric rise in the prescription of psychiatric drugs and of polypharmacy. A major premise of this paper is that the conceptual framework of medical nihilism can help researchers and clinicians understand and address the harms incurred by inflated claims of the efficacy of psychotropic medications. We propose that psychiatry, and the mental health field more generally, adopt a model of ‘gentle medicine’ with regard to both the diagnosis of and treatment for mental health conditions and focus greater attention on the upstream causes of distress. Read more …


Why Psychiatry Needs an Honest Dose of Gentle Medicine Read More »

New Treatments for Mental Disorders Should Routinely be Compared to Psychotherapy in Trials Conducted for Regulatory Purposes

Criste, I. Halvorsen, I. Cosgrove, L.  Naudet, F. (2022). Lancet Psychiatry, Volume 9, ISSUE 12, P934-936, December 2022, DOI:https://doi.org/10.1016/S2215-0366(22)00340-6

Abstract:

Treatments for mental disorders stem from various intervention classes, such as pharmacological, psychosocial, and physical. However, whereas drugs, biologics, and devices are formally regulated by public agencies, such as the US Food and Drug Administration or the European Medicines Agency, psychotherapies are largely unregulated. We are concerned that regulatory trials for the treatment of mental disorders exclude or do not evaluate psychotherapies, even when one is ostensibly a constituent of the combination therapy submitted for approval. In trials conducted for the regulatory approval of drug-assisted psychotherapies, such as 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for post-traumatic stress disorder (PTSD) and psilocybin-assisted therapy for treatment-resistant depression, there were no specific requirements for or an evaluation of the psychotherapy component. In the MDMA trial, both the treatment and the comparator groups received a bespoke psychological intervention, not previously tested in independently conducted randomised trials, instead of one of several evidence-based alternatives. Read more …


New Treatments for Mental Disorders Should Routinely be Compared to Psychotherapy in Trials Conducted for Regulatory Purposes Read More »

Harm Reduction, Humanistic Psychology, and the CRPD

D’Ambrozio, G., Cosgrove, L., Lilly, S., & McCarthy, T. (2022), Journal of Humanistic Psychology, 0(0). https://doi.org/10.1177/00221678221136240

Abstract:

Harm reduction, which was initially developed as a public health response to illicit drug use, has relevance to the prescription of psychotropic medication. Indeed, focusing on the agency of people who use drugs—licit or illicit— facilitates a more authentic engagement with treatment. In this paper, we show how the framework of harm reduction is congruent with the guiding principles of both humanistic psychology and the Convention on the Rights of Persons with Disabilities (CRPD). Moreover, applying a harm reduction model to psychotropic drug use raises awareness that there are risks to taking these medications, risks which are frequently glossed over because of the emphasis on medication adherence and compliance. We provide case examples of organizations that take a person-centered (vs. medication- centered) approach to people experiencing mental health crises. In their unique ways, these organizations embody the principles of harm reduction and the humanistic impulse that informs the CRPD. Read more …


Harm Reduction, Humanistic Psychology, and the CRPD Read More »

Industry Effects on Evidence: A case study of long-acting injectable antipsychotics. 

Cosgrove, L., Mintzes, B.,  D’Ambrozio, G., Bursztajn, J., Shaughnessy, A. S. (2022).
Accountability in Research.  10.1080/08989621.2022.2082289 

Abstract:

A vigorously debated issue in the psychiatric literature is whether long-acting injectable antipsychotics (LAIs) show clinical benefit over antipsychotics taken orally. In addressing this question, it is critical that systematic reviews incorporate risk of bias assessments of trial data in a robust way and are free of undue industry influence. In this paper, we present a case analysis in which we identify some of the design problems in a recent systematic review on LAIs vs oral formulations. This case illustrates how evidence syntheses that are shaped by commercial interests may undermine patient-centered models of recovery and care. We offer recommendations that address both the bioethical and research design issues that arise in the systematic review process when researchers have financial conflicts of interest. Read more …

Industry Effects on Evidence: A case study of long-acting injectable antipsychotics.  Read More »

Where Clinical Practice Guidelines Go Wrong

Barry, H., Cosgrove, L. Slawson, D (2022), American Family Physician. PMID: 35426634.

Abstract:

Clinical practice guidelines, essential tools for evidence-based practice, have proliferated over the past few decades but remain controversial for several reasons, including discordance among guidelines, the influence of intellectual and financial conflicts of interest, and a lack of adherence to standards for developing trustworthy guidelines. In this editorial, we will use recent hypertension guidelines to illustrate guideline discordance and then propose how to identify trustworthy guidelines. Read more …


Where Clinical Practice Guidelines Go Wrong Read More »

Financial Conflicts of Interest in Psychopharmacology Textbooks

Cosgrove, L. Herrawi, F. Shaughnessy, A. (2021) Community Mental Health Journal. doi:10.1007/s10597-021-00906-6

Abstract:

While most medical journals require disclosures of industry payments to authors and editors, there is no requirement for textbooks. In this study we evaluated nine well-known psychopharmacology textbooks to identify payments to their writers and editors. Two-thirds of the textbooks had at least one editor or author who received personal payments from one or more pharmaceutical companies, for a total of 11,021,409 USD paid to 11 of 21 editors/authors over a seven-year period. Much of this money was paid to a single author but 24% of the writers received over 75,000 USD each over this time period. There are several psychopharmacology textbooks authored by writers without apparent financial conflicts of interest. Just as with medical journals, medical textbooks should be transparent about payments made to their authors and editors. Read more …

Financial Conflicts of Interest in Psychopharmacology Textbooks Read More »

Drivers of and Solutions for the Over-Use of Antidepressant Medication in Pediatric Populations

Cosgrove, L. Morrill, Z., Yusif, M., Vaswani, A., Cathcart, S., Troeger, R., and Karter,
J.M. (2020) Front. Psychiatry, 13 February 2020, Sec. Child and Adolescent Psychiatry, Volume 11 – 2020

Abstract:

Children in the United States and internationally are increasingly being diagnosed with depression and related psychiatric conditions and a recent study found that antidepressant (ADM) use in children and adolescents rose substantially in youth cohorts in five Western countries from 2005 to 2012. However, there has been ongoing controversy over the effectiveness and safety of ADM use in children, including concerns about ADM increasing suicidality and self-harm. In addition to the increase in the diagnosis of depression, commercially driven off-label prescriptions have been cited as a significant reason for high rates of pediatric ADM prescribing. In this commentary, we discuss two drivers of the overuse of ADM, both of which are products of an increasingly medicalized approach to mental health: 1) the demand for mental health and depression screening in youth, despite the lack of evidence to support it, and 2) the renewed momentum of the Global Mental Health Movement and concomitant calls to “scale up” the diagnosis and treatment of mental illness. Using the lens of institutional corruption, we identify the ways in which both guild and financial conflicts of interest create obstacles to rational prescribing practices in pediatric populations and offer suggestions for reform. Read more …

Drivers of and Solutions for the Over-Use of Antidepressant Medication in Pediatric Populations Read More »