‘A landmark in psychiatric progress’? The role of evidence in the rise and fall of insulin coma therapy

This paper examines the evidence behind the use and decline of insulin coma therapy as a treatment for schizophrenia and how this was viewed by the psychiatric profession. The paper demonstrates that, from the time of its introduction, there was considerable debate regarding the evidence for insulin treatment, and scepticism about its purported benefits. The randomized trials conducted in the 1950s were the result, rather than the origins, of this debate. Although insulin treatment was subsequently abandoned, it was still regarded as a historic moment in the modernization of psychiatry. Then, as now, evidence does not speak for itself, and insulin continued to be incorporated into the story of psychiatric progress even after it was shown to be ineffective.

The Goldwater Rule: a bastion of a bygone era?

In tandem with the changing political landscape in recent years, interest in the Goldwater Rule has re-emerged within psychiatric discourse. Initiated in 1973, the Goldwater Rule is an ethical code specific to psychiatry created by the American Psychiatric Association in response to events surrounding the USA presidential election of 1964, in which the integrity of the psychiatric profession was challenged. Current detractors view the rule as an antiquated entity which obfuscates psychiatric pragmatism and progression. Proponents underscore its role in maintaining both respectful objectivity and diagnostic integrity within the psychiatric assessment process. This essay aims to explore the origin of the rule, and critique its applicability to modern-day psychiatric practice.

The Introduction of Medication-Free Mental Health Services in Norway: An Analysis of the Framing and Impact of Arguments From Different Standpoints

Introduction: Debates about coercive practices have challenged a traditional biomedical hegemony in mental health care. The perspectives of service user organizations have gained considerable ground, such as in the development of the Convention on the Rights of Persons with Disabilities. Such changes are often contested, and might in practice be a result of (implicit) negotiation between stakeholders with different discursive positions. To improve understanding of such processes, and how discursive positions may manifest and interact, we analyzed texts published over a 10 year period related to the introduction of medication-free inpatient services in Norway.Methods: We conducted qualitative analyses of 36 policy documents related to the introduction of medication-free services and 75 opinion pieces from a subsequent debate. We examined discursive practices in these texts as expressions of what is perceived as legitimate knowledge upon which to base mental health care from the standpoints of government, user organizations and representatives of the psychiatric profession. We paid particular attention to how standpoints were framed in different discourse surrounding mental health care, and how these interacted and changed during the study period (2008–2018).Results: The analysis shows how elements from the discourse promoted by service user organizations—most notably the legitimacy of personal experiences as a legitimate source of knowledge—entered the mainstream by being incorporated into public policy. Strong reactions to this shift, firmly based in biomedical discourse, endorsed evidence-based medicine as the authoritative source of knowledge to ensure quality care, although accepting patient involvement. Involuntary medication, and how best to help those with non-response to antipsychotic medication represented a point at which discursive positions seemed irreconcilable.Conclusion: The relative authorities of different sources of knowledge remain an area of contention, and especially in determining how best to help patients who do not benefit from antipsychotics. Future non-inferiority trials of medication-free services may go some way to break this discursive deadlock.

Psychiatry and the pharmaceutical industry

Conflicts of interest pervade the relationship between the psychiatric profession and pharmaceutical industry, threatening ethical standards of psychiatric care. They influence the quality and cost of treatment, the objectivity of research and educational activities, and the integrity of individual psychiatrists, as well as the profession in general. Various groups, apart from drug companies, bear responsibility for the prevalence of conflicts of interest, including individual practitioners and researchers, medical academe, professional organizations both within and external to psychiatry, and branches of the government. Reforming practices and policies that encourage such conflicts can only be contained by efforts aimed at educating the profession and public as to the relevant issues, as well as enlisting governmental action, in order to hold industry and the profession more accountable for potentially unethical collaborative activities.

A critical narrative analysis of psychiatrists’ engagement with psychosis as a contentious area

Background: Psychosis, characterised by altered perceptions or interpretations of reality, remains a contested area. Lately, perspectives and conceptualisations of psychosis that have traditionally been more peripheral have gained greater recognition. Both the British Psychological Society and Critical Psychiatry Network have highlighted some contentious areas in recent publications. Aims: The aim was to use critical narrative analysis to consider what facilitates and inhibits medical professionals with clinical experience of psychosis to engage with the topic of psychosis as a contentious area. Method: Semi-structured interviews were conducted with 12 medical professionals, who were at trainee or qualified level with a minimum of 6 months’ clinical experience within psychiatry, across three Trusts within the United Kingdom. This purposive sample had a diverse range of perspectives regarding psychosis. Critical narrative analysis comprising six distinct stages, informed the analysis. Results: Participants positioned themselves broadly within one of three groups: biological psychiatrists, critical psychiatrists and those more conflicted. Narrative analysis was undertaken for each participant before being integrated for this article. The research highlighted several factors which either limit or facilitate opportunities within the psychiatric profession to engage with a plurality of views regarding psychosis. These included the significance of power and hierarchy within the profession, the role of dialogue and the prevalence of reflexivity within the profession. Conclusion: A pattern was identified of psychiatrists generally associating with like-minded others and not engaging with wider evidence regarding psychosis, partly as a result of the inherent threats to the power and hierarchy of the profession. This led to new ideas being widely unknown or undervalued, potentially to the disservice of clinical practice.

TANGGUNG JAWAB APOTEKER DALAM PELAYANAN OBAT DENGAN RESEP DOKTER

ABSTRAKApoteker sebagai tenaga kesehatan profesional di bidang pelayanan kefarmasian dalam menjalankan tugasnya didasarkan kode etik sebagai penjiwaan moral pekerjaan keprofesian. Namun kode etik profesi kadang-kadang sudah tidak begitu diperhatikan lagi. Akibatnya, ciri profesi luhur bidang kefarmasian sebagai pemberian bantuan berupa pelayanan obat yang berorientasi kebutuhan masyarakat, luntur dan cenderung menjadi transaksi komersial produk kefarmasian yang berorientasi keuntungan bisnis. Metode penelitian menggunakan pendekatan yuridis normatif dengan spesifikasi penelitian bersifat deskriptif analitis. Pengumpulan data dilakukan melalui inventarisasi dan penelahaan bahan hukum primer, sekunder, dan tersier yang kemudian dianalisis secara yuridis kualitatif. Tugas dan kewenangan apoteker dalam menjalankan pekerjaan kefarmasian adalah dalam pembuatan termasuk pengendalian mutu sediaan farmasi, pengamanan, pengadaan, penyimpanan dan pendistribusian atau penyaluran obat, pengelolaan obat, pelayanan obat atas resep dokter, pelayanan informasi obat, serta pengembangan obat, bahan obat dan obat tradisional. Tanggung jawab apoteker dalam pelayanan obat yang diresepkan dokter adalah harus mengutamakan kebutuhan dan keselamatan pasien. Tanggung jawab menyeluruh apoteker dalam pelayanan obat adalah kepedulian farmasi untuk meningkatkan mutu kehidupan pasien.Kata kunci: pelayanan obat; tanggung jawab apoteker; resep dokter. ABSTRACTPharmacist as a professional health worker in the field of pharmacy services in carrying out its duties is based on the code of Ethics as a moral psychiatric profession work. But a profession code of ethics is sometimes not very much noticed. Consequently, the hallmark of the noble profession of pharmacy as a provision of assistance in the form of drug services oriented to community needs, wear off and tend to be commercial transactions of pharmaceutical products that are business-oriented. The research method uses a normative juridical approach with research specifications of the analytical descriptive. Data collection is conducted through the inventory and study of primary, secondary, and tertiary legal materials which are then analyzed in a qualitative juridical. The duty and authority of the pharmacist in carrying out the work of the pharmacy is in the manufacture including the quality control of pharmaceutical preparations, securing, procurement, storage and distribution of drugs, drug management, medical treatment of Doctor's prescription, drug information services, and the development of medicines, medicinal materials and traditional medicines. The responsibility of the pharmacist in the drug service prescribed by the Doctor is to prioritize the needs and safety of patients. The overall responsibility of pharmacists in drug service is pharmaceutical care to improve the quality of patient life.Keywords: drug services; medical prescription; pharmacist's responsibilities.

Madness in the City of Magnificent Intentions

This book is a history of the federal mental institution Saint Elizabeths Hospital and its relationship to Washington, DC’s African American community. Founded in 1855 to treat insane military personnel and the District’s civilian residents, the institution became one of the nation’s preeminent research and teaching psychiatric hospitals. From the beginning of its operation, Saint Elizabeths admitted black patients, making it one of the few American asylums to do so. The book charts the history of Saint Elizabeths from its founding to the late 1980s, when the hospital’s mission and capabilities changed as a result of deinstitutionalization and its transfer from the federal government to the District. The book makes two main arguments. First, ideas of racial difference figured prominently in how hospital officials understood the mission of the institution and subsequently designed and operated it, in how hospital officials understood mental disease and developed therapies to address it, and in how patients experienced their confinement. This history reveals the ways the American psychiatric profession engaged in an unarticulated project that conceptualized the white psyche as the norm. Second, this book argues that African Americans—both patients and nonpatients—were not powerless people acted on by large institutional forces. Black Washingtonians were active agents in their interactions with the hospital, from more overtly political and collective endeavors, such as calling for investigations of the mistreatment of black patients and advocating for the hospital’s integration, to the more individualized and quotidian attempts to manage their own or their loved one’s therapeutic experience.

“From Slave to Citizen”

This chapter covers Saint Elizabeths during the post-Reconstruction era and examines the medical professions’ changing ideas about black mental illness and black Washingtonians’ interactions with the hospital in a new era of limited citizenship. A postemancipation discourse emerged among physicians in the 1880s and 1890s that fundamentally differed from the antebellum medical consensus that insanity was rare among black people. Instead physicians began to attribute a perceived increase of black insanity to freedom itself. What the psychiatric profession—which now included individuals trained in neurology—could not agree upon was whether blacks’ new susceptibility to madness was a result of their cultural or biological underdevelopment. Despite this new consensus that associated black mental illness with freedom, this chapter argues that the increased admissions of African Americans to Saint Elizabeths in the 1890s was more the result of black families assertively using the federal institution as an important resource.