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2023 Ethical Human Psychology and Psychiatry
Background: Antidepressant (AD) medications increase suicidality for some, or all, age groups. Some, or all, types of ADs, are frequently used in suicides involving overdoses. Methods: The article examines a previously unanalyzed data set summarizing 7,829 media reports of Coroners’ inquests in England and Wales that mention ADs, between 2003 and 2020. Results: The most frequently cited ADs were SSRIs (48.9%) and tricyclics (24.6%). The specific drugs cited most often were the SSRI drug citalopram (19.8%) and the tricyclic drug amitriptyline (17.5%). Of 2,329 cases of death by overdose, 933 (40.1%) were overdoses of ADs, 512 of which (54.9%) did not involve other substances. The ADs most frequently named were amitriptyline (186), and citalopram (86). A further 929 were overdoses of unnamed medicines, a proportion of which may have been ADs. Limitations: The data set, which relies primarily on archives of local newspapers, is incomplete and therefore underestimates the total numbers involved. The accuracy of coroners’ verdicts is not perfect. Conclusions: If preventing suicide is a primary reason for prescribing ADs, this data set includes several thousand people for whom the drugs clearly did not work. Furthermore, about 1,000 people used the drugs that were supposed to alleviate their depression to kill themselves. Systematic analyses of all inquests would be more informative. Meanwhile, reducing the overprescribing of these relatively ineffective and, for some, lethally dangerous substances is suggested, to reduce suicides.
2023 Ethical Human Psychology and Psychiatry
This article presents two clinical scenarios based on antidepressant-induced deaths, which make clear that there are a number of intervening processes in between the valuable data Read and colleagues 1 present and the verdicts that come out of inquests. The manner in which inquests and court cases are structured means that it is very rare for even clearly-proven prescription drug induced deaths to result in a verdict that the drug has caused the death. Instead, a growing number of drug-induced deaths fuel perceptions of a need for more and better drugs. Central to this situation is a question about how to determine causality in drug-induced injury cases. The idea that randomized controlled trials are the way to establish causality needs to be revisited. Unless there is reform, people caught in situations like the two described here would be better placed holding their own inquests, and finding ways to promulgate the resulting verdicts, rather than “trusting” in a process that is biased against them.
2023 Ethical Human Psychology and Psychiatry
Statistics indicate social workers comprise most of the mental health workforce in the United States. Social workers also abide by the profession’s code of ethics, comprising ethical principles and standards. Psychiatric disorders are predicated on the Diagnostic and Statistical Manual of Mental Disorders ( DSM-5 ). Psychiatric disorders are ubiquitous, notably in the realm of mental health to help individuals gain access to services and for insurance reimbursement purposes. However, the development of the DSM and diagnoses are not without significant controversy, forcibly placing social workers in a role of practicing in unethical ways, contributing to oppressive practices and social problems.
2023 Ethical Human Psychology and Psychiatry
Modern psychiatry is a house divided. On the one hand, the dominant concept of biological reductionism means that the great bulk of research funding and effort is directed at finding a physical cause for mental disorders. On the other hand, many practitioners are unhappy with the apparent inhumanity of looking at the mentally disturbed as “biological specimens.” They prefer an approach that allows them to integrate psychological, social, cultural, and other historical elements in their management. Unfortunately, until recently, there has been no such model available. The biocognitive model for psychiatry argues that reductionism is wrong, and offers a highly developed mentalist model in its place. The goal is to allow the integration of psychosociocultural information in a formal, scientific model of the mind.
Ophir, Yaakov; Shir-Raz, Yaffa
2023 Ethical Human Psychology and Psychiatry
Two publications by Merzon and colleagues in the Journal of Attention Disorders ( JAD ) suggest that attention-deficit hyperactivity disorder (ADHD) increases the risk of COVID-19 infections (2020) and severe outcomes (2021). Adherence to stimulant treatments was recommended to attenuate the spread of the pandemic (2020). The conclusions of these timely studies attracted considerable attention, probably due to their wide-scope implications for the public health. But how valid are they? Furthering our earlier critique published in this journal, the current article outlines seven severe gaps in these publications, including inconsistencies in the definitions and rates of ADHD, inadequate definition for ADHD medications, omissions of crucial information, unsuitable analyses, and unmet declarations regarding conflicts of interests and data availability. In fact, the latter, which constitutes a repeated avoidance of data sharing (up to this day, March 28, 2023), seems to have led the editor-in-chief of JAD to propose the write-up of the current article (which he then judged, after the peer review process, as “worthy of publication,” but also that JAD is “not the best placement” of its publication—despite its specific focus on several JAD articles). To complete the picture regarding this burning public health issue, this article also provides a glimpse into the problematic happenings that took place behind the scenes, which included a personal defamation and various stalling tactics, along with an elaborated and fully-referenced response that was sent by the authors of the current article to the reviewers and the editor-in-chief of JAD in real time ( Appendix ). Together, the discrepancies and problematic ethical conducts that are exposed in the current article suggest that the speculation regarding the link between a neurodevelopmental diagnosis (ADHD) and a respiratory virus (COVID-19) has not been subjected to adequate scientific inquiry. On the contrary, the lack of transparency, the observed gaps, and the existing extensive literature on stimulant-related cardiovascular risks, including the recently published guidelines for starting ADHD medications by one of the authors of the 2021 study, raise concerns regarding the potentially dangerous implications of stimulant use during a global epidemic.
Levinsson, Henrik; Tham, Katarina Fredriksson; Straht, Maja; Wolgast, Martin
2023 Ethical Human Psychology and Psychiatry
Background: Previous research has emphasized the high prevalence and far-reaching consequences of violations of ethical principles in patient care. Aim: To study the extent of violations perceived by healthcare professionals in Swedish adult psychiatric care. Methods: Online survey among 2,538 mental health professionals. A revised version of Transgressions of Ethical Principles in Health Care Questionnaire was used. Results: Events that could be perceived as abusive occur to a large extent. Respondents reported 96% observation and 84% self-involvement in at least one abusive event during the past 12 months and were considered unethical by 43% upon observation and by 34% upon self-involvement. Respondents who work in inpatient care report both more observations and more of their own involvement in abusive events compared to outpatient care. Conclusions: The findings indicate the importance of actively working with and preventing violations and abusive events, and could motivate healthcare professionals to talk about alternative ways of acting in certain situations.