CriticalThinkRXTEST

Transcript

1. A Critical Curriculum on Psychotropic Medications
2. A Critical Curriculum on Psychotropic Medications • Principal Investigators • David Cohen, Ph. D. • Jeff Lacasse, Ph. D. • Professional Consultants • David O. Antonuccio, Ph.D. • Kia J. Bentley, Ph.D. • R. Elliott Ingersoll, Ph.D. • Stefan P. Kruszewski, M.D • Robert E. Rosen, J.D., Ph.D. • Research Coordinator • Ryan Louis, MSW
3. CriticalThinkRx was made possible by a grant from the Attorneys General Consumer and Prescriber Grant Program, funded by the multi- state settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin®
4. Why a Critical Skills Curriculum on Psychotropic Medications?
5. Module 1 Curriculum Rationale
6. Curriculum Rationale • Physicians write prescriptions, but other professionals often influence who gets prescribed and why • Training for these professionals is mostly haphazard and often influenced by the pharmaceutical industry
7. Curriculum Objectives • Help practitioners in mental health and child welfare sharpen critical thinking skills to deal with complex and evolving issues about psychotropic medication
8. Critical Thinking is sensitive to the influence of vested interests on information. Critical Thinking asks “Who benefits?” Critical Thinking emphasizes the ethical implications of treatment decisions. Critical Thinking involves assessing beliefs, arguments and claims to arrive at well-reasoned judgments. Critical Thinking uses standards such as clarity, accuracy, relevance, and completeness. Critical Thinking
9. A prescription for critical thinking about psychotropic medications
10. Module 1 Curriculum Funding
11. Curriculum Funding • Received from the Attorneys General Consumer & Prescriber Education Grant Program (CPGP) • CPGP is overseen by the Attorney General offices of Florida, New York, Ohio, Oregon, Texas and Vermont (plus two rotating states)
12. Curriculum Funding • 2003: Attorneys General of 50 states charged Warner Lambert, a subsidiary of Pfizer, Inc., with conducting an unlawful marketing campaign promoting the off- label uses of the anticonvulsant drug Neurontin
13. Curriculum Funding • 2004: The company settled for $430 million • $21 million was earmarked for research and education aimed at health professionals
14. Curriculum Funding • 2006: CPGP funded 28 applications in 19 states • CriticalThinkRx, funded at Florida International University, is the only project targeting non-medically trained professionals in child welfare and mental health
15. Curriculum Funding • CPGP aims to improve prescribing practices by educating health professionals about • the drug development and approval process • pharmaceutical industry marketing • knowledge and skills to evaluate drug information critically
16. Curriculum Funding • CPGP requires that • the curriculum be maintained in the public domain, freely accessible by anyone • the investigators and their consultants forego funding from the pharmaceutical industry for the duration of their grants
17. Module 1 Curriculum Contents
18. Curriculum Contents • Systematic literature searches were conducted in 2006-2007 on databases in medicine, pharmacology, public health, social work, counseling, and psychology • In 2012, targeted literature searches were conducted to update content • Materials were selected based on relevance and accuracy
19. Mainstream view • Researchers agree that clinical practice has far outpaced the empirical evidence, yet… • Mainstream mental health practice subscribes to a “medical” model supporting medication of children with little evidence of safety or efficacy
20. Content bias • CriticalThinkRx offers alternative views based on empirical evidence to stimulate critical thinking and a more balanced evaluation based on ethical codes of practice
21. Content orientation • CriticalThinkRx emphasizes the ethical dictate: “First, do no harm” • CriticalThinkRx tries to close gaps between research and practice to maximize opportunities to help clients and avoid harm
22. Curriculum design • Modules designed by experienced researcher and clinician with input from independent consultants in counseling, psychology, psychiatry, social work, and law
23. Module 1 Principal Investigators, Coordinators, and Consultants
24. Principal Investigators, Coordinators, and Consultants Principal Investigator David Cohen, Ph.D., L.C.S.W. •Professor of Social Work, Florida International University, Miami, and a private practitioner •Author of numerous publications on psychiatric drugs, medicalization, and law and psychiatry •His latest books are Your Drug May Be Your Problem (2nd rev. ed, 2007) and Critical New Perspectives on ADHD (2006)
25. Principal Investigator Jeff Lacasse, Ph.D. •Professor of Social Work, Arizona State University, Phoenix
26. Research Coordinator Ryan Louis, MSW •Blah blah
27. Counseling Consultant R. Elliott Ingersoll, Ph.D. •Professor of Counseling, College of Education and Human Services, Cleveland State University •A licensed psychologist and clinical counselor in Ohio, he has authored books, book chapters, and articles on psychopharmacology, spiritual approaches to counseling, and Integral theory in mental health •Author, Psychopharmacology for Helping Professionals: An Integral Exploration (2006)
28. Principal Investigators, Coordinators, and Consultants Social Work Consultant Kia J. Bentley, Ph.D., L.C.S.W. •Professor, Director of the Ph.D. Program, and Associate Dean for Strategic Initiatives in Social Work at Virginia Commonwealth University, where she has taught since 1989 •Author, The Social Worker & Psychotropic Medication (3rd ed., 2006) (with Joseph Walsh) •Editor, Psychiatric Medication Issues for Social Workers, Counselors and Psychologists (2003)
29. Principal Investigators, Coordinators, and Consultants Psychology Consultant David O. Antonuccio, Ph.D. •Professor, Department of Psychiatry, University of Nevada School of Medicine •Fellow, American Psychological Association; Diplomate, clinical psychology, American Board of Professional Psychology •His articles on the comparative effects of psychotherapy and pharmacotherapy have received extensive national coverage and are models of careful scholarship •Has received many prestigious awards for his outstanding contributions to clinical science and research
30. Principal Investigators, Coordinators, and Consultants Psychiatry Consultant Stefan P. Kruszewski, M.D. •Harvard Medical School graduate and board-certified in adolescent psychiatry •Pensylvannia-based clinician and scientist working with U.S. and international judicial, legislative, and regulatory bodies •His publications appear in American Journal of Psychiatry and BMJ
31. Principal Investigators, Coordinators, and Consultants Law Consultant Robert E. Rosen, J.D., Ph.D. •Harvard Medical School graduate and board-certified in adolescent psychiatry •Pensylvannia-based clinician and scientist working with U.S. and international judicial, legislative, and regulatory bodies •His publications appear in American Journal of Psychiatry and BMJ
32. Case Studies
33. Rebecca Riley Died on December 13, 2006 from an overdose of psychiatric drugs. Girl's death stirs debate over psychiatric meds Associated Press March 23, 2007 In the final months of Rebecca Riley’s life, a school nurse said the little girl was so weak she was like a “floppy doll.” Concerns raised before of 4-year-old girl The Patriot Ledger February 06, 2007 Teachers, a social worker, a nurse and a therapist had noticed something wasn’t right about Rebecca Riley.
34. Between 2002 and 2006, Massachusetts child welfare authorities investigated the Riley family after multiple complaints of child abuse and neglect
35. These complaints were ruled unfounded
36. All three Riley children were diagnosed with Bipolar I Disorder and prescribed psychotropic drug cocktails by the same child psychiatrist at Tufts Medical Center
37. Rebecca, the youngest child, was first medicated at age 2
38. By age 4, Rebecca was taking three psychotropic medications an antipsychotic (Seroquel), an anticonvulsant (Depakote), an antihypertensive (Clonidine), as well as two over-the-counter cold medicines
39. On Dec. 13, 2006, Rebecca Riley died after her mother gave her additional Clonidine to help her daughter sleep
40. An autopsy later indicated the cause of death as “intoxication due to the combined ef fects” of Clonidine, Depakote, and two cough medications Source: Commonwealth of Massachusetts, Feb. 5, 2007
41. By Patricia Wen, Globe Staff February 10, 2010 A South Shore mother was found guilty yesterday of second-degree murder in the death of her 4- year-old daughter, Rebecca, who went to sleep one night after being given toxic levels of psychotropic drugs and never woke up. Carolyn Riley, 35, showed no visible emotion when the 12-member jury returned the verdict after 19 hours of deliberations in Plymouth Superior Court. Riley, her upper chest displaying a “Rebecca 12-13-06’’ tattoo that reflected her daughter’s date of death, was handcuffed Mother convicted in girl’s drug death Gets life sentence, possibility of parole Carolyn Riley (right) spoke with her mother, Valerie Berio, earlier this week in Plymouth County Superior Court in Brockton. (Robert E. Klein for The Globe) By Patricia Wen, Globe Staff March 26, 2010 BROCKTON – A South Shore father of three was convicted today of first-degree murder for killing his 4-year-old daughter with an overdose of a psychotropic drug that he and his wife had nicknamed "happy medicine." Michael Riley, 37, faces a mandatory sentence of life in prison without parole for the murder of his daughter Rebecca. In a separate trial in the same case, his wife, Carolyn, 35, was convicted Feb. 9 of second-degree murder. Father convicted of 1st-degree murder in death of Rebecca Riley Michael Riley (Globe file photo) DSS Chief Resigns Agency has been under fire since parents accused of killing Hull girl By KEN MAGUIRE Associated Press BOSTON - The embattled head of the state’s child welfare system is resigning five months after his agency was criticized for its action - or lack of action - in the death of a 4-year-old girl in Hull. Lewis “Harry” Spence, commissioner of the Department of Social Services since 2001, has been under fire for the agency’s handling of the Hull case in which the parents of the dead girl are charged with killing her with an overdose of prescription drugs. AP FILE PHOTO/2005 Lewis "Harry" Spence By Patricia Wen, Globe Staff February 11, 2010 BROCKTON - The jury that convicted a South Shore woman this week of killing her 4-year-old daughter with an overdose of psychotropic drugs was also outraged by the conduct of the child’s psychiatrist and hoped the doctor would be held responsible in some way for the girl’s death, according to several jurors interviewed a day after the verdict. “Every one of us was very angry,’’ said one juror, who requested anonymity to avoid retaliation for her role in Tuesday’s second-degree murder conviction of Carolyn Riley. “Dr. Kifuji should be sitting in the defendant’s chair, too.’’ Jurors outraged by psychiatrist’s conduct Felt she should share culpability in toddler’s death “Every one of us was very angry,’’ said one juror, ... “Dr. Kifuji should be sitting in the defendant’s chair, too.’’ Girl’s pill numbers disputed The prescriptions Carolyn Riley gave 4-year-old were very close to allowed amount, defense says By JULIE JETTE The Patriot Ledger HINGHAM - Lawyers for a couple accused of killing their young daughter by deliberately overdosing her with a prescription drug are questioning the math of prosecutors in an attempt to undermine the case. Lawyers for Carolyn and Michael Riley point to prescription records supplied by prosecutors and argue that those records show the Rileys did not have substantially more medication than had been prescribed for their 4-year-old “ ...prescription records ...show the Rileys did not have substantially more medication than had been prescribed for their 4-year-old daughter, Rebecca... ” By Patricia Wen, Globe Staff January 21, 2010 BROCKTON -- Five months before 4-year-old Rebecca Riley died of an alleged overdose of psychotropic drugs, a Weymouth social worker warned the girl's mother that the child seemed overmedicated and contacted the state's child-protection agency to say the family relied on an alarming amount of mood-altering medications. Social worker Angela Smith also testified today that she repeatedly suggested that the girl's mother, Carolyn Riley, obtain a second opinion on whether Rebecca and her older sister, Kaitlynne, should be on three powerful psychotropic drugs that made them seem chronically sleepy. Social worker warned that Rebecca Riley, 4, was overmedicated “Social worker Angela Smith... repeatedly suggested that the girl's mother, Carolyn Riley, obtain a second opinion on whether Rebecca and her older sister, Kaitlynne, should be on three powerful psychotropic drugs...”
42. By Scott Allen, Globe Staff June 17, 2007 No one has done more to convince Americans that even small children can suffer the dangerous mood swings of bipolar disorder than Dr. Joseph Biederman of Massachusetts General Hospital. From his perch as one of the world's most influential child psychiatrists, Biederman has spread far and wide his conviction that the emotional roller coaster of bipolar disorder can start "from the moment the child opened his eyes" at birth. Psychiatrists used to regard bipolar disorder Backlash on bipolar diagnoses in children MGH psychiatrist's work stirs debate By Lawrence Diller June 19, 2007 As a doctor, I did the nearly unthinkable at a recent conference on bipoloar disorder in children. I charged another doctor with moral responsibility in the death last December of Rebecca Riley, a 4 -year-old girl from Hull. Naming names in medicine is just not done very often -- and I knew the personal and professional risks I was taking. Yet I felt compelled to name Joseph Biederman, head of the Massachusetts General Hospital's Pediatric Psychopharmacology clinic, as morally culpable in providing the "science" that allowed Rebecca to die. Misguided standards of care “ ...I felt compelled to name Joseph Biederman, head of the Massachusetts General Hospital's Pediatric Psychopharmacology clinic, as morally culpable in providing the "science" that allowed Rebecca to die.”
43. FDA BLACK BOX WARNING IGNORED? FDA-approved Depakote black box warning label: HEPATOTOXICITY HEPATIC FAILURE RESULTING IN FATALITIES HAS OCCURRED IN PATIENTS RECEIVING VALPROIC ACID AND ITS DERIVATIVES. EXPERIENCE HAS INDICATED THAT CHILDREN UNDER THE AGE OF TWO YEARS ARE AT A CONSIDERABLY INCREASED RISK OF DEVELOPING FATAL HEPATOTOXICITY, E S P E C I A L L Y T H O S E O N M U L T I P L E ANTICONVULSANTS, THOSE WITH CONGENITAL METABOLIC DISORDERS, THOSE WITH SEVERE SEIZURE DISORDERS ACCOMPANIED BY MENTAL
44. Questions
49. This course, in the remaining modules, is intended to help you answer these questions
50. End of Module 1