Posts

On This Day … 02 August [2022]

Published on by Andrew MarshallLeave a comment

People (Deaths)

Paul Goodman

Paul Goodman (1911–1972) was an American writer and public intellectual best known for his 1960s works of social criticism. Goodman was prolific across numerous literary genres and non-fiction topics, including the arts, civil rights, decentralisation, democracy, education, media, politics, psychology, technology, urban planning, and war. As a humanist and man of letters, his works often addressed a common theme of the individual citizen’s duties in the larger society, and the responsibility to exercise autonomy, act creatively, and realise one’s own human nature.

Born to a Jewish family in New York City, Goodman was raised by his aunts and sister and attended City College of New York. As an aspiring writer, he wrote and published poems and fiction before receiving his doctorate from the University of Chicago. He returned to writing in New York City and took sporadic magazine writing and teaching jobs, several of which he lost for his overt bisexuality and World War II draft resistance. Goodman discovered anarchism and wrote for libertarian journals. His radicalism was rooted in psychological theory. He co-wrote the theory behind Gestalt therapy based on Wilhelm Reich’s radical Freudianism and held psychoanalytic sessions through the 1950s while continuing to write prolifically.

His 1960 book of social criticism, Growing Up Absurd, established his importance as a mainstream cultural theorist. Goodman became known as “the philosopher of the New Left” and his anarchistic disposition was influential in 1960s counterculture and the free school movement. Despite being the foremost American intellectual of non-Marxist radicalism in his time, his celebrity did not endure far beyond his life. Goodman is remembered for his utopian proposals and principled belief in human potential.

What is the Secret Society of Happy People?

Published on by Andrew Marshall1 Comment

Introduction

Secret Society of Happy People (SOHP) is an organisation that celebrates the expression of happiness.

Founded in August 1998, the society encourages thousands of members from all around the globe to recognise their happy moments and think about happiness in their daily life.

Purpose

The Secret Society of Happy People supports people who want to share their happiness despite the ones who don’t want to hear happy news. Their mottos include “Happiness Happens” and “Don’t Even Think of Raining on My Parade”.

The main purpose of the Society is to stimulate people’s right to express their happiness “as loud as they want”.

Reception

The Society was founded in August 1998 in Irving, Texas, by Pamela Gail Johnson. In December 1998, it gained international reception, when it challenged advice columnist Ann Landers for discouraging people from writing happy holiday newsletters enclosed with their holiday cards. In a letter to Landers, Johnson demanded an apology “to the millions of people you made feel bad for wanting to share their happy news.” The Society’s campaign persuaded Landers to change her advice on holiday letters, one of the rare occasions the columnist had a change of heart. Within the next few years the Society grew bigger being supported by thousands of fans from more than 34 countries.

Founder

Pamela Gail Johnson founded the Secret Society of Happy People with the main idea of creating a “safe place” where people can share their happy moments, without being discouraged by the parade rainers. Since 1998 she has been managing the Society by writing posts, writing the newsletter, updating social media information and answering fan’s questions on her blog Ask Pamela Gail: Where Happiness Meets Reality. Each blog post is formed as an answer to the member’s questions submitted through the website. The purpose is to give people advice for handling their unhappy moments and learning the lesson out of each and every one of them. The column is posted weekly. Pamela is also the author of The Secret Society of Happy People’s Thirty-One Types of Happiness Guide released in November 2012 and Don’t Even Think of Raining on My Parade: Adventures of the Secret Society of Happy People.

Events

Happiness Happens Day

In 1999 the Society declared 08 August as the “Admit You’re Happy Day”, now known as the “Happiness Happens Day”. The idea was inspired by the event that happened the previous year on the same date- the first member joined the Society. In 1998 the Society asked the governors in all 50 states for a proclamation. Nineteen of them sent proclamations.

Happiness Happens Month

Celebration of happiness was expanded in 2000, and thanks to the support of not-so-secretly-happy members from around the world, the Society declared August as Happiness Happens Month. The purpose of Happiness Happens Day and Month is to share happiness and encourage people to talk and think about happiness.

HappyThon

Every year, the Society organises an online social media event known as HappyThon, on Happiness Happens Day. The aim of this event is to send inspirational messages via social networks, emails or texts, share happy moments, philosophy, quotes, etc. HappyThon is the first online social media event that promotes happiness around the world.

Since 1998 the Society have been organising voting and announcing the Happiest Events and Moments of the Year. Before the end of the century, a vote for 100 of the Happiest Events, Inventions and Social Changes of the Century was organised. In the third week of January the Society hosted Hunt for Happiness Week. They asked the current governors for proclamation, and got it by seven of them.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Secret_Society_of_Happy_People >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

On This Day … 31 July [2022]

Published on by Andrew MarshallLeave a comment

People (Deaths)

  • 1958 – Eino Kaila, Finnish philosopher and psychologist, attendant of the Vienna circle (b. 1890).

Eino Kaila

Eino Sakari Kaila (09 August 1890 to 31 July 1958) was a Finnish philosopher, critic and teacher. He worked in numerous fields including psychology (sometimes considered to be the founder of Finnish psychology), physics and theatre, and attempted to find unifying principles behind various branches of human and natural sciences.

In the 1920s he worked in the field of literary criticism and psychology as a professor at the University of Turku and is said to have been the first to introduce gestalt psychology to Finland.

Despite being greatly influenced by the logical positivists and critical of unempirical speculation, an aspect common to all of Kaila’s work was in strive for a holistic, almost pantheistic understanding of things. He also maintained a more naturalist approach to psychology. His book Persoonallisuus (1934, Personality) was a psychological study with philosophical dimensions, in which emphasized the biological nature of psychological phenomena. During the last years of his life he attempted to construct a theory of everything in Terminalkausalität Als Die Grundlage Eines Unitarischen Naturbegriffs, but this, what was meant to be the first installment in a more extensive study, was not met with much enthusiasm outside of Finland.

Though he withdrew his support of the National Socialists before the end of the Second World War, he wrote about the differences between “western” and “eastern” thought and claimed that the homogeneity of the people was a necessity for a functioning democracy.

What is Delusional Parasitosis?

Published on by Andrew MarshallLeave a comment

Introduction

Delusional parasitosis (DP) is a mental disorder in which individuals have a persistent belief that they are infested with living or non-living pathogens such as parasites, insects, or bugs, when no such infestation is present.

They usually report tactile hallucinations known as formication, a sensation resembling insects crawling on or under the skin. Morgellons is considered to be a subtype of this condition, in which individuals have sores that they believe contain harmful fibres.

Delusional parasitosis is classified as a delusional disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM5). The cause is unknown, but is thought to be related to excess dopamine in the brain. Delusional parasitosis is diagnosed when the delusion is the only symptom of psychosis and the delusion – that cannot be better explained by another condition – has lasted a month or longer. Few individuals with the condition willingly accept treatment, because they do not recognise the illness as a delusion. Antipsychotic medications offer a cure, while cognitive behavioural therapy and antidepressants can be used to help alleviate symptoms.

The condition is rare, and is observed twice as often in women as men. The average age of people with the disorder is 57. An alternative name, Ekbom’s syndrome, refers to the neurologist Karl-Axel Ekbom, who published seminal accounts of the disease in 1937 and 1938.

Classification

Delusional infestation is classified as a delusional disorder of the somatic subtype in the Diagnostic and Statistical Manual of Mental Disorders (DSM5). The name delusional parasitosis has been the most common name since 2015, but the condition has also been called delusional infestation, delusory parasitosis, delusional ectoparasitosis, psychogenic parasitosis, Ekbom syndrome, dermatophobia, parasitophobia, formication and “cocaine bugs”.

Morgellons is a form of delusional parasitosis in which people have painful skin sensations that they believe contain fibres of various kinds; its presentation is very similar to other delusional infestations, but people with this self-diagnosed condition also believe that strings or fibres are present in their skin lesions.

Delusory cleptoparasitosis is a form of delusion of parasitosis where the person believes the infestation is in their dwelling, rather than on or in their body.

Epidemiology

While a rare disorder, delusional parasitosis is the most common of the hypochondriacal psychoses, after other types of delusions such as body odour or halitosis. It may be undetected because those who have it do not see a psychiatrist because they do not recognise the condition as a delusion. A population-based study in Olmsted County, Minnesota found a prevalence of 27 per 100,000 person-years and an incidence of almost 2 cases per 100,000 person-years. The majority of dermatologists will see at least one person with DP during their career.

It is observed twice as often in women than men. The highest incidence occurs in people in their 60s, but there is also a higher occurrence in people in their 30s, associated with substance use. It occurs most often in “socially isolated” women with an average age of 57.

Since the early 2000s, a strong internet presence has led to increasing self-diagnosis of Morgellons.

Brief History

Karl-Axel Ekbom, a Swedish neurologist, first described delusional parasitosis as “pre-senile delusion of infestation” in 1937. The common name has changed many times since then. Ekbom originally used the German word dermatozoenwahn, but other countries used the term Ekbom’s syndrome. That term fell out of favour because it also referred to restless legs syndrome. Other names that referenced “phobia” were rejected because anxiety disorder was not typical of the symptoms. The eponymous Ekbom’s disease was changed to “delusions of parasitosis” in 1946 in the English literature, when researchers J Wilson and H Miller described a series of cases, and to “delusional infestation” in 2009. The most common name since 2015 has been “delusional parasitosis”.

Ekbom’s original was translated to English in 2003; the authors hypothesized that James Harrington (1611-1677) may have been the “first recorded person to suffer from such delusions when he ‘began to imagine that his sweat turned to flies, and sometimes to bees and other insects’.”

Morgellons

Mary Leitao, the founder of the Morgellons Research Foundation, coined the name Morgellons in 2002, reviving it from a letter written by a physician in the mid-1600s. Leitao and others involved in her foundation (who self-identified as having Morgellons) successfully lobbied members of the US Congress and the US Centres for Disease Control and Prevention (CDC) to investigate the condition in 2006. The CDC published the results of its multi-year study in January 2012. The study found no underlying infectious condition and few disease organisms were present in people with Morgellons; the fibres found were likely cotton, and the condition was “similar to more commonly recognized conditions such as delusional infestation”.

An active online community has supported the notion that Morgellons is an infectious disease, and propose an association with Lyme disease. Publications “largely from a single group of investigators” describe findings of spirochetes, keratin and collagen in skin samples of a small number of individuals; these findings are contradicted by the much larger studies conducted by the CDC.

Signs and Symptoms

People with delusional parasitosis believe that “parasites, worms, mites, bacteria, fungus” or some other living organism has infected them, and reasoning or logic will not dissuade them from this belief. Details vary among those who have the condition, though it typically manifests as a crawling and pin-pricking sensation that is most commonly described as involving perceived parasites crawling upon or burrowing into the skin, sometimes accompanied by an actual physical sensation (known as formication). Affected people may injure themselves in attempts to be rid of the “parasites”; resulting skin damage includes excoriation, bruising and cuts, as well as damage caused from using chemical substances and obsessive cleansing routines.

A “preceding event such as a bug bite, travel, sharing clothes, or contact with an infected person” is often identified by individuals with DP; such events may lead the individual to misattribute symptoms because of more awareness of symptoms they were previously able to ignore. Nearly any marking upon the skin, or small object or particle found on the person or their clothing, can be interpreted as evidence for the parasitic infestation, and individuals with the condition commonly compulsively gather such “evidence” to present to medical professionals. This presentation is known as the “matchbox sign”, “Ziploc bag sign” or “specimen sign”, because the “evidence” is frequently presented in a small container, such as a matchbox. The matchbox sign is present in five to eight out of every ten people with DP. Related is a “digital specimen sign”, in which individuals bring collections of photographs to document their condition.

Similar delusions may be present in close relatives – a shared condition known as a folie à deux – that occurs in 5 to 15% of cases and is considered a shared psychotic disorder. Because the internet and the media contribute to furthering shared delusions, DP has also been called folie à Internet; when affected people are separated, their symptoms typically subside, but most still require treatment.

Approximately eight out of ten individuals with DP have co-occurring conditions – mainly depression, followed by substance abuse and anxiety; their personal and professional lives are frequently disrupted as they are extremely distressed about their symptoms.

A 2011 Mayo Clinic study of 108 patients failed to find evidence of skin infestation in skin biopsies and patient-provided specimens; the study concluded that the feeling of skin infestation was DP.

Cause

The cause of delusional parasitosis is unknown. It may be related to excess dopamine in the brain’s striatum, resulting from diminished dopamine transporter (DAT) function, which regulates dopamine reuptake in the brain. Evidence supporting the dopamine theory is that medications that inhibit dopamine reuptake (for example cocaine and amphetamines) are known to induce symptoms such as formication. Other conditions that also demonstrate reduced DAT functioning are known to cause secondary DP; these conditions include “schizophrenia, depression, traumatic brain injury, alcoholism, Parkinson’s and Huntington’s diseases, human immunodeficiency virus infection, and iron deficiency”. Further evidence is that antipsychotics improve DP symptoms, which may be because they affect dopamine transmission.

Diagnosis

Delusional parasitosis is diagnosed when the delusion is the only symptom of psychosis, the delusion has lasted a month or longer, behaviour is otherwise not markedly odd or impaired, mood disorders – if present at any time – have been comparatively brief, and the delusion cannot be better explained by another medical condition, mental disorder, or the effects of a substance. For diagnosis, the individual must attribute abnormal skin sensations to the belief that they have an infestation, and be convinced that they have an infestation even when evidence shows they do not.

The condition is recognised in two forms:

  • Primary delusional parasitosis: The delusions are the only manifestation of a psychiatric disorder.
  • Secondary delusional parasitosis: This occurs when another psychiatric condition, medical illness or substance (medical or recreational) use causes the symptoms; in these cases, the delusion is a symptom of another condition rather than the disorder itself.
    • Secondary forms of DP can be functional (due to mainly psychiatric disorders) or organic (due to other medical illness or organic disease.
    • The secondary organic form may be related to vitamin B12 deficiency, hypothyroidism, anaemia, hepatitis, diabetes, HIV/AIDS, syphilis, or abuse of cocaine.

Examination to rule out other causes is key to diagnosis. Parasitic infestations are ruled out via skin examination and laboratory analyses. Bacterial infections may be present as a result of the individual constantly manipulating their skin. Other conditions that can cause itching skin are also ruled out; this includes a review of medications that may lead to similar symptoms. Testing to rule out other conditions helps build a trusting relationship with the physician; this can include laboratory analysis such as a complete blood count, comprehensive metabolic panel, erythrocyte sedimentation rate, C-reactive protein, urinalysis for toxicology and thyroid-stimulating hormone, in addition to skin biopsies and dermatological tests to detect or rule out parasitic infestations. Depending on symptoms, tests may be done for “human immunodeficiency virus, syphilis, viral hepatitis, B12 or folate deficiency,” and allergies.

Differential Diagnosis

Delusional parasitosis must be distinguished from scabies, mites, and other psychiatric conditions that may occur along with the delusion; these include schizophrenia, dementia, anxiety disorders, obsessive-compulsive disorder, and affective or substance-induced psychoses or other conditions such as anaemia that may cause psychosis.

Pruritus and other skin conditions are most commonly caused by mites, but may also be caused by “grocer’s itch” from agricultural products, pet-induced dermatitis, caterpillar/moth dermatitis, or exposure to fiberglass. Several drugs, legal or illegal, such as amphetamines, dopamine agonists, opioids, and cocaine may also cause the skin sensations reported. Diseases that must be ruled out in differential diagnosis include hypothyroidism, and kidney or liver disease. Many of these physiological factors, as well as environmental factors such as airborne irritants, are capable of inducing a “crawling” sensation in otherwise healthy individuals; some people become fixated on the sensation and its possible meaning, and this fixation may then develop into DP.

Treatment

As of 2019, there have not been any studies that compare available treatments to placebo. The only treatment that provides a cure, and the most effective treatment, is low doses of antipsychotic medication. Cognitive behavioural therapy (CBT) can also be useful. Risperidone is the treatment of choice. For many years, the treatment of choice was pimozide, but it has a higher side effect profile than the newer antipsychotics. Aripiprazole and ziprasidone are effective but have not been well studied for delusional parasitosis. Olanzapine is also effective. All are used at the lowest possible dosage, and increased gradually until symptoms remit.

People with the condition often reject the professional medical diagnosis of delusional parasitosis, and few willingly undergo treatment, despite demonstrable efficacy, making the condition difficult to manage. Reassuring the individual with DP that there is no evidence of infestation is usually ineffective, as the patient may reject that. Because individuals with DP typically see many physicians with different specialties, and feel a sense of isolation and depression, gaining the patient’s trust, and collaborating with other physicians, are key parts of the treatment approach. Dermatologists may have more success introducing the use of medication as a way to alleviate the distress of itching. Directly confronting individuals about delusions is unhelpful because by definition, the delusions are not likely to change; confrontation of beliefs via CBT is accomplished in those who are open to psychotherapy. A five-phase approach to treatment is outlined by Heller et al. (2013) that seeks to establish rapport and trust between physician and patient.

Prognosis

The average duration of the condition is about three years. The condition leads to social isolation and affects employment. Cure may be achieved with antipsychotics or by treating underlying psychiatric conditions.

Society and Culture

Jay Traver (1894-1974), a University of Massachusetts entomologist, was known for “one of the most remarkable mistakes ever published in a scientific entomological journal”, after publishing a 1951 account of what she called a mite infestation which was later shown to be incorrect, and that has been described by others as a classic case of delusional parasitosis as evidenced by her own detailed description. Matan Shelomi argues that the historical paper should be retracted because it has misled people about their delusion. He says the paper has done “permanent and lasting damage” to people with delusional parasitosis, “who widely circulate and cite articles such as Traver’s and other pseudoscientific or false reports” via the internet, making treatment and cure more difficult.

Shelomi published another study in 2013 of what he called scientific misconduct when a 2004 article in the Journal of the New York Entomological Society included what he says is photo manipulation of a matchbox specimen to support the claim that individuals with DP are infested with collembola.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Delusional_parasitosis >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is the Epidemiology of Child Psychiatric Disorders?

Published on by Andrew MarshallLeave a comment

Introduction

The epidemiology of child psychiatric disorders is the study of the incidence, prevalence, and distribution of conditions in child and adolescent psychiatry.

Subfields of paediatric psychiatric epidemiology include developmental epidemiology, which focuses on the genetic and environmental causes of child psychiatric disorders. The field of paediatric psychiatric epidemiology finds widely varying rates of childhood psychiatric disorders, depending on study population, diagnostic method, and cultural setting.

Prevalence of Mental Illness

Epidemiological research has shown that between 3% and 18% of children have a psychiatric disorder causing significant functional impairment (reasons for these widely divergent prevalence rates are discussed below) and Costello and colleagues have proposed a median prevalence estimate of 12%. Using a different statistical method, Waddell and colleagues propose a prevalence rate for all mental disorders in children of 14.2%.

Developmental Epidemiology

Developmental epidemiology seeks to “disentangle how the trajectories of symptoms, environment, and individual development intertwine to produce psychopathology”.

Socio-Economic Influences

Mental illness in childhood and adolescence is associated with parental unemployment, low family income, being on family income assistance, lower parental educational level, and single-parent, blended or stepparent families.

Methodological Issues

Epidemiological research has produced widely divergent estimates, depending on the nature of the diagnostic method (e.g. structured clinical interview, unstructured clinical interview, self-report or parent-report questionnaire), but more recent studies using DSM-IV-based structured interviews produce more reliable estimates of clinical “caseness”. Past research has also been limited by inconsistent definitions of clinical disorders, and differing upper and lower age limits of the study population. Changing definitions over time have given rise to spurious evidence of changing prevalence of disorders. Furthermore, almost all epidemiological surveys have been carried out in Europe, North America and Australia, and the cross-cultural validity of DSM criteria have been questioned, so it is not clear to what extent the published data can be generalised to developing countries.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Epidemiology_of_child_psychiatric_disorders >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

On This Day … 27 July [2022]

Published on by Andrew MarshallLeave a comment

People (Births)

  • 1906 – Herbert Jasper, Canadian psychologist and neurologist (d. 1999).

People (Deaths)

  • 1931 – Auguste Forel, Swiss neuroanatomist and psychiatrist (b. 1848).

Herbert Jasper

Herbert Henri Jasper OC GOQ FRSC (27 July 1906 to 11 March 1999) was a Canadian psychologist, physiologist, neurologist, and epileptologist (an adult/paediatric neurologist who specialises in the treatment of epilepsy).

Born in La Grande, Oregon, he attended Reed College in Portland, Oregon and received his PhD in psychology from the University of Iowa in 1931 and earned a Doctor of Science degree from the University of Paris for research in neurobiology.

From 1946 to 1964 he was Professor of Experimental Neurology at the Montreal Neurological Institute, McGill University and then from 1965 to 1976 he was Professor of Neurophysiology, Université de Montréal. He did his most important research with Wilder Penfield at McGill University. He was a member of the American Academy of Neurology and the American Association for the Advancement of Science. He was also a member of the Canadian Neurological Society and the Royal Society of Medicine. He wrote more than 350 scientific publications.

Auguste Forel

Auguste-Henri Forel (01 September 1848 to 27 July 1931) was a Swiss myrmecologist (studies ants), neuroanatomist, psychiatrist and eugenicist, notable for his investigations into the structure of the human brain and that of ants.

For example, he is considered a co-founder of the neuron theory. Forel is also known for his early contributions to sexology and psychology. From 1978 until 2000 Forel’s image appeared on the 1000 Swiss franc banknote.

What is the Boston Graduate School of Psychoanalysis?

Published on by Andrew MarshallLeave a comment

Introduction

Boston Graduate School of Psychoanalysis is a private educational institution that focuses on training psychoanalysts, particularly in the field of modern psychoanalysis.

Founded in 1973, it only awards graduate degrees. Its main campus is in Brookline, Massachusetts.

Accreditation

The Boston Graduate School of Psychoanalysis, including its branch campus in New York, is accredited by the New England Association of Schools and Colleges, Inc. through its Commission on Institutions of Higher Education. It first received accreditation from the New England Association of Schools and Colleges (NEASC) in 1995, which opened psychoanalytic study to any qualified and engaged student irrespective of prior courses of study.

The school is the only regionally accredited school of psychoanalytic studies in the United States to grant graduate degrees.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Boston_Graduate_School_of_Psychoanalysis >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

On This Day … 26 July [2022]

Published on by Andrew MarshallLeave a comment

Events

  • 1990 – The Americans with Disabilities Act of 1990 is signed into law by President George H.W. Bush.

People (Births)

Americans with Disabilities Act of 1990

The Americans with Disabilities Act of 1990 or ADA (42 U.S.C. § 12101) is a civil rights law that prohibits discrimination based on disability.

It affords similar protections against discrimination to Americans with disabilities as the Civil Rights Act of 1964, which made discrimination based on race, religion, sex, national origin, and other characteristics illegal, and later sexual orientation and gender identity. In addition, unlike the Civil Rights Act, the ADA also requires covered employers to provide reasonable accommodations to employees with disabilities, and imposes accessibility requirements on public accommodations.

In 1986, the National Council on Disability had recommended the enactment of an Americans with Disabilities Act (ADA) and drafted the first version of the bill which was introduced in the House and Senate in 1988. The final version of the bill was signed into law on 26 July 1990, by President George H.W. Bush. It was later amended in 2008 and signed by President George W. Bush with changes effective as of 01 January 2009.

Disabilities Included

ADA disabilities include both mental and physical medical conditions. A condition does not need to be severe or permanent to be a disability. Equal Employment Opportunity Commission regulations provide a list of conditions that should easily be concluded to be disabilities:

Other mental or physical health conditions also may be disabilities, depending on what the individual’s symptoms would be in the absence of “mitigating measures” (medication, therapy, assistive devices, or other means of restoring function), during an “active episode” of the condition (if the condition is episodic).

Certain specific conditions that are widely considered anti-social, or tend to result in illegal activity, such as kleptomania, paedophilia, exhibitionism, voyeurism, etc. are excluded under the definition of “disability” in order to prevent abuse of the statute’s purpose. Additionally, gender identity or orientation is no longer considered a disorder and is also excluded under the definition of “disability”.

Carl Jung

Carl Gustav Jung (26 July 1875 to 06 June 1961) was a Swiss psychiatrist and psychoanalyst who founded analytical psychology. Jung’s work has been influential in the fields of psychiatry, anthropology, archaeology, literature, philosophy, psychology, and religious studies.

Jung worked as a research scientist at the famous Burghölzli hospital, under Eugen Bleuler. During this time, he came to the attention of Sigmund Freud, the founder of psychoanalysis. The two men conducted a lengthy correspondence and collaborated, for a while, on a joint vision of human psychology.

Freud saw the younger Jung as the heir he had been seeking to take forward his “new science” of psychoanalysis and to this end secured his appointment as president of his newly founded International Psychoanalytical Association. Jung’s research and personal vision, however, made it impossible for him to follow his older colleague’s doctrine and a schism became inevitable. This division was personally painful for Jung and resulted in the establishment of Jung’s analytical psychology as a comprehensive system separate from psychoanalysis.

Among the central concepts of analytical psychology is individuation – the lifelong psychological process of differentiation of the self out of each individual’s conscious and unconscious elements. Jung considered it to be the main task of human development. He created some of the best known psychological concepts, including synchronicity, archetypal phenomena, the collective unconscious, the psychological complex and extraversion and introversion.

Jung was also an artist, craftsman, builder and a prolific writer. Many of his works were not published until after his death and some are still awaiting publication.

Glynis Breakwell

Dame Glynis Marie Breakwell DBE DL FRSA FAcSS (born West Bromwich, 26 July 1952) is a social psychologist and an active public policy adviser and researcher specialising in leadership, identity process and risk management. In January 2014 she was listed in the Science Council’s list of ‘100 leading UK practising scientists’. Her achievements as Vice-Chancellor of the University of Bath in Bath were marred by controversy culminating in her dismissal in a dispute regarding her remuneration.

Breakwell has been a Fellow of the British Psychological Society since 1987 and an Honorary Fellow since 2006. She is a chartered health psychologist and in 2002 was elected an Academician of the Academy of Social Sciences.

Breakwell was appointed Dame Commander of the Order of the British Empire in the 2012 New Year Honours for services to higher education. She is also a Deputy Lieutenant of the County of Somerset.

What is Defined Daily Dose?

Published on by Andrew Marshall5 Comments

Introduction

The defined daily dose (DDD) is a statistical measure of drug consumption, defined by the World Health Organisation (WHO) Collaborating Centre for Drug Statistics Methodology (WHOCC).

It is defined in combination with the ATC Code drug classification system for grouping related drugs. The DDD enables comparison of drug usage between different drugs in the same group or between different health care environments, or to look at trends in drug utilisation over time. The DDD is not to be confused with the therapeutic dose or prescribed daily dose (PDD), or recorded daily dose (RDD), and will often be different to the dose actually prescribed by a physician for an individual person.

The WHO’s definition is: “The DDD is the assumed average maintenance dose per day for a drug used for its main indication in adults.” The Defined Daily Dose was first developed in the late 1970s.

Refer to Prescribed Daily Dose, Average Daily Quantity, and Maintenance Dose.

Assignment

Before a DDD is assigned by the WHOCC, it must have an ATC Code and be approved for sale in at least one country. The DDD is calculated for a 70kg adult, except if this drug is only ever used in children. The dose is based on recommendations for treatment rather than prevention, except if prevention is the main indication. Generally there is only one DDD for all formulations of a drug, however exceptions are made if some formulations are typically used in significantly different strengths (e.g. antibiotic injection in a hospital vs tablets in the community). The DDD of combination tablets (containing more than one drug) is more complex, most taking into account a “unit dose”, though combination tablets used for high blood pressure take the number of doses per day into account.

The formula for determining the dose is:

  • If there is a single recommended maintenance dose in the literature, this is preferred.
  • :If there are a range of recommended maintenance doses then
    • If the literature recommends generally increasing from initial to maximum dose provided it is tolerated, pick the maximum dose.
    • If the literature recommends only increasing from an initial dose if not sufficiently effective, pick the minimum dose.
    • If there is no guidance then pick the mid point between the dose range extremes.

The DDD of a drug is reviewed after three years. Ad hoc requests for change may be made but are discouraged and generally not permitted unless the main indication for the drug has changed or the average dose used has changed by more than 50%.

Limitations

The DDD is generally the same for all formulations of a drug, even if some (e.g. flavoured syrup) are designed with children in mind. Some types of drug are not assigned a DDD, for example: medicines applied to the skin, anaesthetics and vaccines. Because the DDD is a calculated value, it is sometimes a “dose” not actually ever prescribed (e.g. a midpoint of two prescribed tablet strengths may not be equal to or be a multiple of any available tablet). Different people may in practice be prescribed higher or lower doses than the DDD, for instance in children, people with liver or kidney impairment, patients with a combination therapy, or due to differences in drug metabolism between individuals or ethnicities (genetic polymorphism).

Although designed primarily for drug utilisation research, data using the DDD can only give a “rough estimate” compared with actually collecting statistics on drug use in practice. The DDD is often use for long term research and analysis of drug utilisation trends over time, so changes to the DDD are avoided if possible, whereas changes in the actual daily dose prescribed for a population may often occur. For example, the Recorded Daily Dose (RDD) of simvastatin in Canada in 1997 was only 8% different to the DDD, but by 2006 it was 67% different. In 2009, the DDD of several statins were updated, with simvastatin changing from 15mg to 30mg.

The DDD is based on the maintenance dose, but in practice patients in a population will be on a mix of initial and maintenance doses.

Use and Misuse

The DDD can be used as the basis for calculating various indicators of drug utilisation. The indicator DDD per 1000 inhabitants per day can suggest what portion of a population are regularly using a drug or class of drugs. The indicator DDD per 100 bed days estimates on average how many inpatients are given a drug every day in hospital. The indicator DDDs per inhabitant per year can be used for drugs normally prescribed for short treatment duration (e.g. antibiotics) to indicate the average number of days in a year a person may take that treatment. The extent to which estimates using DDD reflect actual clinical practice depends on how close the DDD is to the typical prescribed dose in that country or setting and at that point in history.

Because the primary purpose of the ATC/DDD system is drug consumption measurement, the WHO recommend caution when considering its use for cost analysis: “DDDs, if used with caution can be used to compare, for example, the costs of two formulations of the same drug.” So, the cost per DDD of an extended-release tablet taken once a day compared with a standard tablet taken twice a day, may indicate the extended-release tablet costs much more to treat the same condition.

In contrast, using DDD to compare the cost of different drugs or drug groups is “usually not valid” according to the WHO. They recommend that “DDDs are not suitable for comparing drugs for specific, detailed pricing, reimbursement and cost-containment decisions”. The DDD may not necessarily compare well with the actual PDD, and two drugs in the same ATC group may not be equally effective at their DDD.

For example, an analysis of statin use in the Ontario Drug Benefit Programme, 2006-2007. The average cost per DDD of rosuvastatin was 21% more expensive than atorvastatin ($1.14 compared to $0.94), which would suggest the shift at the time from prescribing atorvastatin to prescribing rosuvastatin would result in increased costs to the healthcare budget. Both had a DDD at that time of 10mg, but 10mg was not the only dose prescribed. For example, atorvastatin once daily at 10mg, 20mg, 40mg and 80mg was prescribed 45%, 36%, 16% and 3% of the time respectively. If one compared cost per unit (daily tablet) then rosuvastatin was instead 24% cheaper than atorvastatin ($1.44 vs $1.90), and if one compares cost per RDD (recorded daily dose) then rosuvastatin was 26% cheaper than atorvastatin ($1.43 vs $1.93). An erroneous conclusion of a healthcare budget cost increase arises in this case from using cost per DDD. At the time, the RDD of rosuvastatin was similar to its DDD (12.6 mg vs 10mg), but the RDD of atorvastatin was twice its DDD (20.6 mg vs 10mg). The DDD of atorvastatin was revised in 2009 to 20mg.

The Canadian Patented Medicine Prices Review Board analysed the use of DDD for drug utilisation and cost analysis and offered recommendations. They particularly concentrated on the problems that occur when the RDD observed in the population deviates more than minimally from the DDD. They conclude that the DDD methodology “should generally not be used to interpret Canadian drug utilisation; should generally not be applied in cost analyses; and should generally not be applied in policy decisions”. The Board recommend that provided the agreement between DDD and RDD is known and minimal, then a cost per DDD “can provide a rough idea of the treatment cost” but “caution should still be used, as misinterpretation of the results based on the DDD methodology may still occur”. If the agreement between DDD and RDD is unknown or a significant disagreement is known, then the DDD methodology “should not be used in cost analyses”. In all cases, the Board state “The DDD methodology should not be used in guiding policy decisions regarding reimbursement, therapeutic substitution and other pricing decisions”.

Example

If the DDD for a certain drug is given, the number of DDDs used by an individual patient or (more commonly) by a collective of patients is as follows.

Drug usage (in DDDs) = (Items issued x Amount of drug per item) divided by DDD.

For example, the analgesic (pain reliever) paracetamol has a DDD of 3 g, which means that an average patient who takes paracetamol for its main indication, which is pain relief, uses 3 grams per day. This is equivalent to six standard tablets of 500 mg each. If a patient consumes 24 such tablets (12 g of paracetamol in total) over a certain span of time, this equals a consumption of four DDDs.

Drug usage in DDDs = (24 (items) x 500 (mg/item)) divided by 3000 mg = 4

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Defined_daily_dose >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is the Anatomical Therapeutic Chemical Classification System?

Published on by Andrew Marshall3 Comments

Introduction

The Anatomical Therapeutic Chemical (ATC) Classification System is a drug classification system that classifies the active ingredients of drugs according to the organ or system on which they act and their therapeutic, pharmacological and chemical properties.

Its purpose is an aid to monitor drug use and for research to improve quality medication use. It does not imply drug recommendation or efficacy. It is controlled by the World Health Organisation Collaborating Centre for Drug Statistics Methodology (WHOCC), and was first published in 1976.

Brief History

The ATC system is based on the earlier Anatomical Classification System, which is intended as a tool for the pharmaceutical industry to classify pharmaceutical products (as opposed to their active ingredients). This system, confusingly also called ATC, was initiated in 1971 by the European Pharmaceutical Market Research Association (EphMRA) and is being maintained by the EphMRA and Intellus. Its codes are organised into four levels. The WHO’s system, having five levels, is an extension and modification of the EphMRA’s. It was first published in 1976.

Coding System

This pharmaceutical coding system divides drugs into different groups according to the organ or system on which they act, their therapeutic intent or nature, and the drug’s chemical characteristics. Different brands share the same code if they have the same active substance and indications. Each bottom-level ATC code stands for a pharmaceutically used substance, or a combination of substances, in a single indication (or use). This means that one drug can have more than one code, for example acetylsalicylic acid (aspirin) has A01AD05 (WHO) as a drug for local oral treatment, B01AC06 (WHO) as a platelet inhibitor, and N02BA01 (WHO) as an analgesic and antipyretic; as well as one code can represent more than one active ingredient, for example C09BB04 (WHO) is the combination of perindopril with amlodipine, two active ingredients that have their own codes (C09AA04 (WHO) and C08CA01 (WHO) respectively) when prescribed alone.

The ATC classification system is a strict hierarchy, meaning that each code necessarily has one and only one parent code, except for the 14 codes at the topmost level which have no parents. The codes are semantic identifiers, meaning they depict information by themselves beyond serving as identifiers (namely, the codes depict themselves the complete lineage of parenthood). As of 07 May 2020, there are 6,331 codes in ATC; the table below gives the count per level.

ATC LevelCodesDifferent Names/Pharmaceuticals
11414
29494
3267262
4889819
550674363

Classification

In this system, drugs are classified into groups at five different levels.

First Level

The first level of the code indicates the anatomical main group and consists of one letter. There are 14 main groups:

CodeContents
AAlimentary tract and metabolism
BBlood and blood forming organs
CCardiovascular system
DDermatologicals
GGenito-urinary system and sex hormones
HSystemic hormonal preparations, excluding se hormones and insulins
JAnti-infectives for systemic use
LAntineoplastic and immunomodulating agents
MMusculo-skeletal system
NNervous system
PAntiparasitic products, insecticides, and repellents
RRespiratory system
SSensory organs
VVarious

Second Level

The second level of the code indicates the therapeutic subgroup and consists of two digits.

  • Example: C03 Diuretics.

Third Level

The third level of the code indicates the therapeutic/pharmacological subgroup and consists of one letter.

  • Example: C03C High-ceiling diuretics.

Fourth Level

The fourth level of the code indicates the chemical/therapeutic/pharmacological subgroup and consists of one letter.

  • Example: C03CA Sulfonamides.

Fifth Level

The fifth level of the code indicates the chemical substance and consists of two digits.

  • Example: C03CA01 furosemide.

Other ATC Classification Systems

ATCvet

The Anatomical Therapeutic Chemical Classification System for veterinary medicinal products (ATCvet) is used to classify veterinary drugs. ATCvet codes can be created by placing the letter Q in front of the ATC code of most human medications.

  • For example, furosemide for veterinary use has the code QC03CA01.

Some codes are used exclusively for veterinary drugs, such as QI Immunologicals, QJ51 Antibacterials for intramammary use or QN05AX90 amperozide.

Herbal ATC (HATC)

The Herbal ATC system (HATC) is an ATC classification of herbal substances; it differs from the regular ATC system by using 4 digits instead of 2 at the 5th level group.

The herbal classification is not adopted by WHO. The Uppsala Monitoring Centre is responsible for the Herbal ATC classification, and it is part of the WHODrug Global portfolio available by subscription.

Defined Daily Dose

The ATC system also includes defined daily doses (DDDs) for many drugs. This is a measurement of drug consumption based on the usual daily dose for a given drug. According to the definition, “[t]he DDD is the assumed average maintenance dose per day for a drug used for its main indication in adults.”

Adaptations and Updates

National issues of the ATC classification, such as the German Anatomisch-therapeutisch-chemische Klassifikation mit Tagesdosen, may include additional codes and DDDs not present in the WHO version.

ATC follows guidelines in creating new codes for newly approved drugs. An application is submitted to WHO for ATC classification and DDD assignment. A preliminary or temporary code is assigned and published on the website and in the WHO Drug Information for comment or objection. New ATC/DDD codes are discussed at the semi-annual Working Group meeting. If accepted it becomes a final decision and published semi-annually on the website and WHO Drug Information and implemented in the annual print/on-line ACT/DDD Index on 01 January.

Changes to existing ATC/DDD follow a similar process to become temporary codes and if accepted become a final decision as ATC/DDD alterations. ATC and DDD alterations are only valid and implemented in the coming annual updates; the original codes must continue until the end of the year.

An updated version of the complete on-line/print ATC index with DDDs is published annually on 01 January.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Anatomical_Therapeutic_Chemical_Classification_System >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.