1/ The problem with mood/affect is that if you trace the history of how the terms have been used, there's been considerable inconsistency and contradiction.

(see Ketai 1975, Owens et al 1979, Berner 1988, and Alpert et al. 1990 for the "semantic confusion" around the topic)

https://twitter.com/psychunseen/status/1820604898024870369

2/ Many have distinguished the terms based on duration/chronicity (e.g., mood is pervasive/enduring while affect is moment-to-moment) and subjective (mood)/objective(affect), but depending on the source, opposite claims have also been made about each.

pubmed.ncbi.nlm.nih.gov/2246381/

1/ Practicing medicine involves a relationship between physician and patient. Psychiatry even moreso due to the focus on symptoms and internal experiences as opposed to objective/external signs which ironically is a frequent criticism of the field from a diagnostic standpoint.

https://twitter.com/eliotmuir/status/1811061913586893172

2/ The perspectives of doctors, patients, and families are distinct. One is not necessarily more "deep" than another and each contributes something, reminiscent of the parable of the blind men and the elephant.

1/ C’mon people… put down your cognitive bias and motivated reasoning!

This new DOE report on the LaB Leak hypothesis doesn’t disclose ANY evidence and proves absolutely NOTHING.

Read what WSJ article actually says...

wsj.com/articles/covid… 2/ Not clear why the Dept of Energy is looking into this anyway, but theirs is a minority opinion among the 6 other intelligence agencies who have opined on the subject.

Most others say Lab Leak unlikely.

1/ Oh boy... So @MSN is legitimizing this @dcexaminer piece claiming that masks don't work to spread COVID as if it's news. It's not news!

It's an OP-ED piece written by a conservative columnist.

msn.com/en-us/health/m… 2/ The op-ed author cites a new @CochraneLibrary meta-analysis of 78 randomized controlled trials (RCTs)—describing it as a "massive mega-study"—to claim that masks don't stop the spread of COVID-19.

But the analysis only included 6 RCTs that involved COVID-19! Not massive!

1/ I'm a firm believer in the heterogeneity of "mental disorders." While DSM constructs have clinical utility, most DSM disorders are not "one thing" and don't claim to be.

https://twitter.com/DBDouble/status/1620452479556292610

2/ Like Bleuler's "group of schizophrenias," mental disorders are wastebasket categories that likely represent many different biopsychosocial pathways to a given constellation of symptoms.

pubmed.ncbi.nlm.nih.gov/21505113/

1/ Here are FDA approved medications for bipolar disorder as of 2022.

(thanks @eturnermd1 & @ScottMyers20 for inspiring me to update the list)

A few thoughts to bear in mind... 2/ Note that some of the oldest & most commonly used meds (e.g. divalproex) don't have FDA approval for maintenance Rx much less BP depression.

That doesn't always mean they aren't effective; sometimes it means they weren't extensively studied prior to (or after) going generic.

1/ Like many stories in medicine, antidepressant effects were first discovered inadvertently. When people suffering from major depression improved after taking them, scientists then tried to figure out why.

pubmed.ncbi.nlm.nih.gov/19442174/

https://twitter.com/doctorid/status/1553650128795451392

2/ And so, the monoamine theory was born out of the observed efficacy of MAOIs and TCAs. Prozac was developed more deliberately as a serotonergic drug, but this was done more to reduce the side effect burden of ADs than based on any premise of a serotonergic theory of depression.

1/ This isn't new, but anti-science and anti-psychiatry conspiracy theories are being increasingly embraced by the Right.

rollingstone.com/culture/cultur… 2/ For at least the past few years, the Right has been trying to shift the mass shooting conversation away from guns and on to psychiatric medications.

psychologytoday.com/au/blog/psych-…

1/ In 1911, Eugen Bleuler, the German psychiatrist that coined the term "schizophrenia," referred to the "group of schizophrenias," believing it to be an umbrella term for a variety of different disease processes giving rise to a similar phenotype.

ncbi.nlm.nih.gov/pmc/articles/P… 2/ Now a new @Slate article rehashes the tired claim that because it's a dimensional construct, "schizophrenia doesn't exist," an argument that can be made about almost any categorical definition of a continuous phenomenon.

slate.com/technology/202…

1/

As I head to San Francisco for the second half of my career, I'm curious to learn more about what's going on with mental health, drug addiction, & homelessness in the city.

This piece by @NellieBowles seems like a good starting point for discussion:

theatlantic.com/ideas/archive/… 2/

It seems to echo this similar, but more finger-pointing provocation that blames progressive policies offered in the book SanFransicko by @ShellenbergerMD:

harpercollins.com/products/san-f…

1/ Does cannabis cause psychosis?

Here's the evidence for a causal relationship as of 2022:

1. Studies like this one show that IV infusion of THC in healthy adults can produce psychotic symptoms:

pubmed.ncbi.nlm.nih.gov/15173844/ 2/

Symptoms reported in IV infusion studies include paranoia, disorganization, ideas of reference, and hallucinations

So, can THC cause psychosis acutely? Yes!

mdpi.com/2076-3425/9/4/…

Involuntary psychiatric treatment is a necessity in a just and ethical society. That said, there's plenty to discuss around this topic and to improve upon in clinical practice.

For example, how to maintain dignity with involuntary care.

sciencedirect.com/science/articl…

1/

I see people are still tweeting (which of course means "arguing" in the Twittersphere) about the "chemical imbalance theory" of psychiatry, so I thought I'd put in my 2 cents.

Let's start with something that I wrote with @jonathanstea and @tylerblack32: 2/

Here's something else I wrote about it:

THREAD

1/

The other day, I tweeted about a recent study that adds to a growing body of evidence demonstrating the effectiveness of masks in preventing the spread of COVID-19...

https://twitter.com/psychunseen/status/1471858981740158979?s=20

2/

Here it is again--note that it's not a naturalistic or epidemiologic study, but a modeling study based on known information about the penetration of SARS-CoV-2 sized particles through N95/KN95 masks.

pnas.org/content/118/49…

1/ THREAD

This story of COVID disinformation grift deserves much wider coverage.

Back in July 2020, #AmericasFrontlineDoctors stood on the SCOTUS steps and gave a press conference spreading misinformation about #COVID19

cnn.com/2020/07/28/tec… 2/ They claimed COVID was less deadly than the flu. WRONG!

They said masks don't help prevent COVID spread. NOPE!

They endorsed conspiracy that studies showing hydroxychloroquine was ineffective were "fake science" by "fake pharma companies." NOT TRUE!

rev.com/blog/transcrip…

1/

Was just thinking there were few mass shootings during the pandemic.

Unfortunately, it looks like we're getting "back to normal" now.

This thread has some of my thoughts on mass shootings, #guns , & #GunReform through the years:

#Boulder #Atlanta

aeon.co/essays/does-a-… 2/

psychologytoday.com/us/blog/psych-…

"Guns make gun owners feel safer"

THREAD 1/

Do antipsychotics shrink the brain? No!

At long last, we have RCT data in 1st episode psychosis to disentangle effects of meds vs. disease.

nature.com/articles/s4138… 2/

Here are the striking findings.

At 3 months:

- no grey matter volume change in controls
- volume *loss* w/ placebo/psychosocial tx
- volume *increase* w/ meds

THREAD 1/

Harrow et al. have published another study demonstrating an association between antipsychotic treatment and poorer outcomes compared to non-antipsychotic treatment, this time for both schizophrenia and affective psychosis. 2/

To date, no RCT (no, not even Wunderink) exists to address potential causality or more precisely *direction* of causality. The million $$ question is whether antipsychotic discontinuation leads to recovery or whether recovery leads to discontinuation.

psychologytoday.com/us/blog/psych-…

THREAD 1/

This article on "addiction as a brain disease" is a must-read update on an age-old debate.

IMO, much of it equally applies to "addiction" as other mental disorders.

(thanks to @zivacooper for sending). 2/

A few points worth discussing. First, addiction as disease is a counter-narrative in response to the:

"prevailing nonscientific, moralizing, and stigmatizing attitudes to addiction [that framed it as a] moral failing or weakness of character, rather than a 'real' disease.

THREAD 1/

Finally got around to reading and really enjoyed this new paper by @JasperFeyaerts et al. that offers a critical view of traditional conceptualizations of delusions and the (mis)assumption of a delusional continuum.

pubmed.ncbi.nlm.nih.gov/33485408/ 2/

It affirms my view that firmly distinguishing between delusions and delusion-like (and shared) beliefs is ultimately doomed, because we do not have coherent existing definitions of "delusions" nor for that matter "beliefs"

Here are my favorite quotations from this paper:

THREAD 1/10

I've been enjoying a moment of political apathy, resting on the laurels of a @JoeBiden @KamalaHarris victory, while doing my best to ignore Trump's bluster which can't hide the reality that he's been deflated & will be put to rest like so many Halloween decorations. 2/10

Last night @StephenAtHome compared Trump to herpes, suggesting that we'll likely see him "blossom" and reactivate from time to time like an annoying cold sore outbreak.

And yeah, maybe he will actually run for re-election in 2024.

thehill.com/blogs/in-the-k…