Archive for February, 2010

Jurors Speak Up with Hands Tied

In a break from the typical dismissive response to death by psych drugs, which is to assume everybody did their best and a bad but faultless thing happened, jurors in the Carolyn Riley case are outraged at the conduct of Dr. Kayoko Kifuji. Rightly so. Kifuji diagnosed children as mentally ill for exhibiting the defining behaviors of childhood. She Diagnosed a three year old child with pediatric bipolar disorder (which was absent from the DSM draft released the day after the conviction). She passed out cocktails of serious drugs to two year old children like they were Flintstone’s vitamins — drugs that aren’t approved for use in children and are usually used judiciously even in adults. She let the parents experiment on all of their kids with these drugs and, following their lead, prescribed per those experiments — so yes, the jury was outraged.

From the Boston Globe:

“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.’’

Another juror said that while the 12-member panel found that the 35-year-old mother was primarily responsible for Rebecca’s death, many jurors were “off the wall’’ when they heard the testimony of Dr. Kayoko Kifuji of Tufts Medical Center. She said they were struck by how quickly Kifuji diagnosed Rebecca with bipolar and hyperactivity disorders, as well as how little the doctor seemed to supervise the mother’s dispensing of medications.

“It blew me away,’’ said that juror, who asked to remain unidentified for fear of reprisals.

Rebecca’s psychiatrist was the focus of some of the most powerful reactions from the jurors after a three-week trial that left them emotionally and physically exhausted.

Not only has she not been convicted of a crime, she will go undisciplined by courts and the medical establishment even outside of the criminal trials surrounding the Rebecca Riley case which can only add to the frustrated outrage of the jurors.

Other than the nationwide publicity given to the Riley case, in which Kifuji is mentioned repeatedly, the only overt sign that Kifuji had potentially questionable conduct is on the Board of Registration of Medicine’s website…Still, when asked if the board’s investigation concluded that Kifuji acted within acceptable medical standards, spokesman Russell Aims responded by saying that the board “closed the complaint against Dr. Kifuji without discipline.’’ He said the board, however, “reserves the right to reopen a case if new information comes to light.’’

The psychiatrist will not face criminal prosecution. A grand jury last summer declined to indict her, and Kifuji testified in Carolyn Riley’s trial only after being granted immunity from prosecution.

Prosecutors contend the Rileys “duped” Kifuji into authorizing the drugs but that doesn’t say much for her as a doctor does it? “Duped” doesn’t begin to explain diagnosing toddlers as bipolar, her cavalier approach to diagnosing and prescribing in general or her indifference to the misuse of drugs like depakote and clonidine. Kifuji had access to Rebecca herself, providing ample opportunity to make her own assessments. She chose instead to go on the word of the parents in brief and drug centered visits. She admitted that she found the Rileys’ actions unsettling. Maybe they were just not unsettling enough to interfere with business. While the prosecution and Kifuji’s lawyers tried to paint her as the good and upstanding doctor who got fooled, in the end she comes out looking like the prime example of psychiatrist-as-drug-dealer — not unlike the physician in every town that addicts know to visit for his liberal dispensing of narcotics — and the Rileys were repeat business. If you’re going to hand out drugs that easily, without concern for how they’re being used and on whom, you don’t get to claim ignorance.

In a country where a gun manufacturer or salesperson can be held responsible for the crimes of someone who legally buys or even steals a handgun (which I’m against), it’s shocking that Kifuji is able to walk away from this without penalty. She is a doctor and with that paycheck and perceived authority comes an obligation to think past the drugs that keep you in business and consider the well being of the people in your care. I sincerely hope her other child patients fare better but it doesn’t seem likely. The only things that seem to have changed for Kifuji since Rebecca’s death are the amount of attention she’s received and a new sense of impunity.

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February 13, 2010 at 9:48 am 1 comment

If You Have to Ask…

Recently while sifting through the vast number of articles linking antipsychotics to metabolic symptoms and adverse effects like rapid weight gain, high blood pressure and diabetes, I stumbled upon a question posed by a doctor to Psychiatric Times. Apparently his concern over whether or not to perform basic tests to assess the health of his patients qualifies as an “ethical dilemma.”

I’m a psychiatrist in private practice and do not have a secretary or nurse. One of my patients who has bipolar II depression is undergoing psychotherapy. I have prescribed an atypical antipsychotic for this patient. The drug’s manufacturer recommends periodic checks for metabolic syndrome—which means (among other things) checking the patient’s blood pressure, weight, and BMI via measurements of his waist circumference.

I am willing to weigh patients undergoing psychotherapy and check their lab test results and blood pressure, but I am uncomfortable making physical contact to check waist circumference. Instead, I discuss with patients how to take care of themselves, and refer them to a primary care physician.

Is it appropriate to touch such patients for clinical purposes? If not, could I be blamed if a patient has an MI secondary to high blood cholesterol levels if I haven’t been monitoring these parameters?

Does touching a patient in this setting constitute a boundary violation?

Not only does he rely on the drug’s maker to inform him of the need for metabolic testing, he’s not sure whether it falls within his scope or even the boundaries of decency. On top of that, his principle concern seems to be whether he could be blamed if his neglect of physical indicators ends in a patient’s heart attack — and really, what doctor needs that kind of hassle? I get that some sensitive situations can arise when dealing with emotional well being and touch but if that’s the case, shouldn’t he already have a close working relationship with a real doctor for when the situation arises? Maintaining physical health should be mandatory for continued pharmaceutical intervention. I find it strange that he’s more comfortable prescribing high risk drugs than he is assessing their affect on his patients. He may as well just come out and ask if there’s any way he can keep prescribing but get off the hook with that whole pesky “health” thing.

Psychiatric Times doesn’t appear to have answered the question but I found it worth mentioning all the same that it was asked. There is a link instead to a podcast about the ethics of praying with patients.

February 10, 2010 at 8:20 pm 1 comment

DSM-V Draft Released

A draft of the DSM-V has been released and is open to public comment. That’s news to me. I have yet to review any of it first hand but thought I’d put this out there to for anyone with the time and interest to take a look at it. There are some big changes in the works. While it’s not without its flaws, some of the more ludicrous attempts at creating new disorders have actually not made it into the draft and other labels are being revised. I may not have a chance to check it out and weigh in today but I’m definitely concerned with the implications that psychosis risk syndrome might carry. Think of how quickly you can lose your rights over a label. Putting a label aside for risks of symptoms is going to get messy. All things considered it is just a draft and the final isn’t due until 2013 so there’s still plenty of time for the wind to blow this thing in any direction. If nothing else, it’s a glimpse into the process, showing it is very much based on opinion and deliberation not objective medical discovery.

Here is a quick overview from MedPage Today and a few thoughts on it from Philip Dawdy at Furious Seasons and a brief breakdown at Beyond Meds with links to articles of interest to people following particular issues.

February 10, 2010 at 3:00 pm 2 comments

Carolyn Riley Convicted

Well, the verdict is in. Carolyn Riley has been found guilty of second degree murder in the prescription drug induced death of her four year old daughter, Rebecca. I don’t know where to begin or what to say, really. We’re not talking about a child who had a freak reaction to a medication. Rebecca was a child abused with massive amounts of powerful drugs as a result of scheming parents and a negligent doctor and ultimately given an overdose of a sedative she never should have had. The Riley parents fabricated lists of symptoms for their children in order to get drugs to sedate them and when one of them, Rebecca, got pneumonia, they responded with more sedatives to quiet her complaints. When you have two parents who put all of their kids on heavy psych drugs at the age of two in order to control them, a doctor who sees diseases in the most basic childhood behaviors but not abuses when they are laid out in front of her and almost nobody paying attention, things turn horrible in no time at all — and that’s just the overview. The closer you look, the uglier it gets. I don’t even know how to approach some of the things that came to light during the trial but I have to wonder how many red flags have to be ignored before it all comes down to the death of a toddler diagnosed first as having attention deficit disorder, then at three, bipolar disorder — all for acting her age.

Boston Globe on the conviction: (emphasis mine)

A South Shore mother was found guilty today of second-degree murder in the death of her 4-year-old daughter who never woke up one night in December 2006 after ingesting toxic levels of psychotropic drugs…

The case had drawn national attention to the growing use of psychotropic drugs on very young children. When Rebecca died, she and her two older siblings were all on three potent psychiatric medications for bipolar and hyperactivity disorders. All of them went on those medications at age 2…

Prosecutors…depicted Carolyn Riley as an unusual type of child abuser, a woman who routinely overused sedating psychiatric pills to control her energetic toddlers and induce sleep. Prosecutors said she went to a lethal extreme in the hours before her daughter died on Dec. 13, 2006, dispensing as much as twice the girl’s daily dosage of clonidine at once as the girl was already battling a respiratory illness…

Prosecutors said the mother also had a scheme to obtain federal disablity checks through fraudulent claims that her children were mentally disabled…The state asserted that Carolyn Riley always put her husband’s needs over her children’s, and the night Rebecca received her fatal overdose, the husband was irate about the sick child’s repeated efforts to enter her parents’ bedroom, moaning, “Mommy … Mommy.”

and on the doctor: (who is still practicing and faced no charges)

Dr. Kayoko Kifuji acknowledged that when she first met Rebecca Riley, at age 2, she had initially diagnosed her with having attention-deficit hyperactivity disorder after only a one-hour meeting. She authorized the mother to give one prescription tablet of clonidine, a sedative, each night. But within a few days, Carolyn Riley acknowledged she was giving the girl two full tablets.

“Did she ask for you to authorize the double dose?” asked Plymouth First Assistant District Attorney Frank J. Middleton Jr.

“No,”

The relationship between Kifuji and Carolyn Riley was portrayed today as relatively minimal and business-like, resulting in the psychiatrist exhibiting a high degree of trust in the mother’s account of her children’s behavior, as well as a willingness to look past obvious transgressions committed by the mother in her dispensing of medication.

And what transgressions they were. While the whole situation speaks volumes about the Riley parents, Kifuji is no saint in all of this. Diagnosing toddlers as mentally ill and putting them on adult psychotropics is disturbing enough but to turn a blind eye to blatant chemical abuses against children is reprehensible. It could have all been over if she had put the brakes on then — but that’s not how she does things.

…the two met each other for the first time in April 2003 when Carolyn Riley brought her older daughter, Kaitlynne, then 2, to see Kifuji who was then practicing at a clinic a Bay State Medical Center in Springfield.

After a one-hour meeting in her office, the psychiatrist diagnosed Kaitlynne as having bipolar illness and immediately prescribed Depakote based largely on the mother’s depiction of the girl as physically aggressive to her older brother, and the girl saying she sometimes saw “monsters” and “ghosts.”

Over the next several months, as the mother reported Kaitlynne having continued problems, including sleep issues, the psychiatrist raised the possibility of adding clonidine. At that time, the mother acknowledged she had already been trying out clonidine on Kaitlynne, having taken some of these prescription pills from a bottle designated for her oldest son, Gerard.

“Did that concern you?” the prosecutor asked.

“Yes,” Kifuji replied.

While Kifuji told Carolyn Riley that a parent cannot just introduce new medications without a doctor’s approval, the psychiatrist went ahead and added clonidine to Kaitlynne’s regimen of prescription pills.

What more can I say? This child didn’t stand a chance. Her father, Michael (another saint) will be tried separately for the same charges.

February 10, 2010 at 1:10 pm 1 comment

We’ll Always Have Camden

At my show, I surprised my wife with a painting that, judging by her response, she likes very much. It is of the Schooner Olad on which we sailed — at sunset — on our tenth anniversary in the summer of 2008. It is, among other things, a reminder of a serene moment in what can often be a daunting life, to say the least. The following afternoon, a customer asked me the secret to being happily married for eleven years. Without thinking even for a second, I told her it was finding the right person from the start — and it’s true. All of the hard work and tips solicited from those who have done it can’t compensate for that.

February 8, 2010 at 10:35 am

Back to Your Irregularly Scheduled Program

With the art show and a last minute commissioned piece behind me, I will be able to resume more regular posting. As always, there is plenty to say but for now I’ll just say thanks. I had a great turnout at my show, got some good feedback and people were genuinely interested in a movement toward rights, transparency and truth in the mental health system. To anyone who bought or will buy any of my pieces, a sincere and special thank you. You’re buyers in a town of lookers and will be taking a piece of me home. I’m honored (and sometimes baffled) that you’d want to.

In addition, I will be taking up oil painting, which I haven’t attempted since my youth. There are matters of subject and mood that I don’t think I can touch with watercolor. Oils were made for the heaviness and depth that I’d like to convey in future works. This isn’t an end to watercolors for me, just a shift away for now. Having just shown eleven piece in watercolor, many of them recently completed, I’m ready to put that setup in a drawer for a while and explore other media and I’ve had a crush on oils for a long time.

While I’m happy with the outcome of my focused energies, I had no idea how little I’d be able to work on this weblog which is tough for me because, as all who know me personally know, I am almost constantly bursting at the seams with thoughts and opinions on the state of things befitting Spit, Bristle and Fury and there is no shortage of critical information that is seldom put out by other means than small (even miniscule) outlets like this. Thanks for visiting here and I hope it proves to be something of value.

February 8, 2010 at 10:20 am

Diagnosed by the Press

Apparently in the eyes of Dario McDarby of the Examiner, if you live strangely, have a troubled life and don’t step up to claim your diagnosis, you are  not only one of the great number of undiagnosed mentally ill but doing a great disservice to others suffering from mental illness by contributing to its stigma — at least if you’re a celebrity. In his gossipy, agenda laden ramblings, he refers to the late Casey Johnson as “obviously disturbed but possibly undiagnosed” and showing “the negative behaviors of a troubled person suffering from untreated neuroeccentricities.” His explanation for the connection between strange behavior and stigma to strangers:

The impact that this kind of notoriety of obviously disturbed celebrities causes trouble for people struggling to reclaim their mental well-being. It perpetuates the stigma of “mental illness” because of the obscene, grotesque, and ugly behavior of celebrities and others who can afford treatment but resist it because it somehow affects their notoriety. Most people do not have adequate access to services that can help them develop the tremendous talents that may lie undiscovered in their “disorders.”

I’ll never understand how people make the leap  from access to care or a right to care to the duty to receive care but it seems to be increasingly adopted by pro-diagnosis circles pretty consistently. Maybe it’s not one person’s “obscene, grotesque, and ugly behavior” that contributes to other people’s stigma around mental health. If anything, it’s armchair psychiatrists like McDarby trying to diagnose famous strangers through the microscope of gossip press, forcing a connection between serious mental illness and exploitable and tabloid-worthy acting out. One has little to do with the other  outside of the connection we create between them with articles like this. Psych diagnoses are stigmatizing because we try to put every socially unpopular or unacceptable behavior under the umbrella of a mental health label.

Though not diagnosed with any “mental illness,” at least to the public’s knowledge, Ms Johnson showed the negative behaviors of a troubled person suffering from untreated neuroeccentricities. In fact, she used them for notoriety in her alleged love tryst with Tila Tequila, possibly another troubled woman with undiagnosed mental health issues.

Instead, society becomes harsher toward neuroeccentrics because characters, who have the resources to reclaim their mental well-being, become pathetic actors in a tragedy written by scheming journalists and choreographed by dull-witted paparazzi. The blowback from this disgusting show greatly affects those with few resources, but who may possess even greater talents than the dead heiress and her grotesque Internet diva.

I’m not sure why any one person’s diagnosis is supposed to be the “public’s knowledge” and While McDarby appears to have some level of respect for people with mental health diagnoses, I’m puzzled by why he would write them into the stories of tabloid characters. To me, it seems a great disservice to link wild behaviors born out of celebrity to the people in this country with perceived mental illness that are leading (or trying to lead) “normal” lives, whatever that means. We are all too willing to throw life changing and stigmatizing diagnoses at people and now, having become quite comfortable trying people in the press, we are moving on to diagnosing people in the press which adds a lot to the notion that mental health is a matter of public opinion. I have to wonder how far McDarby is from the types of journalists and paparazzi he calls into question when he’s using a “dead heiress and her grotesque internet diva” to frame his argument that every one with troubles should get in line for a diagnosis.

February 6, 2010 at 10:19 am

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