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The Voice of the American Psychiatric Association and the Psychiatric Community
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Untangling Psychiatric Myths From Truths During her training, Sparsha Reddy, M.D., suspected that many of the “facts” she had learned were actually anecdotes, which, through repetition, had evolved from “rules of thumb” to “accepted truth.” To pursue this idea, she asked several distinguished experts in her future subspecialty to present their own favorite examples. Reddy is a chief resident in psychiatry at Brown University and will soon begin a fellowship in psychosomatic medicine. She led the session “Mythbusters: Untangling Psychiatric Myths From Truths” at APA’s 2012 annual meeting in Philadelphia. Philip Muskin, M.D., of Columbia University took on the myths surrounding MAOIs. For example, he discussed the purported dangers of combining MAOIs with red wine, exposed the historically inadequate techniques used to support this, and shocked the audience by revealing that it would take 30 bottles of Chianti wine to raise a person's blood pressure 30mm. He took a similarly dim view of the use of MAOIs for atypical depression, and, evoking Gumpian philosophy, he ended by saying that having more medications helps treat more patients, “and I have no more to say about that." Robert Boland, M.D., of Brown University used an odd and somewhat stretched metaphor—he compared the use of antipsychotics for treating delirium to the Trojan War: despite some kernel of truth, a closer look suggests that psychiatrists have lots of stories and very few facts. Their efficacy is likely poor, and only the lack of good alternatives reinforces the continued faith in their use. John Barnhill, M.D., examined the routine use of laboratory screening and suggested that there is no such thing as an optimal screen; the choices should always be individualized according to a good assessment. Many tests are wasteful, and some are actually misleading: Dr. Barnhill highlighted the misuse of thyroid function tests—a staple psychiatric screen—and argued that psychiatric disorders often induce falsely positive thyroid tests, resulting in the potential mistreatment of a euthyroid patient. Colin Harrington, M.D., took a similar tone in discussing the use of neuroimaging in psychiatry, finding their yield too small to support routine imaging in general psychiatric patients. He advised against ordering structural imaging unless the history or exam suggested a need: some positive indicators included advanced age, focal neurological findings, cognitive dysfunction, acute mental status changes, or an atypical course of symptoms. |
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