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Why a Critical Skills Curriculum on Psychotropic Medications?

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Why a Critical Skills Curriculum on Psychotropic Medications? June 2008 A Critical Curriculum on Psychotropic Medications • Principal Investigator: • Research Coordinator: – David Cohen, Ph.D. – Inge Sengelmann, M.S.W. • Professional Consultants: • Flash production and design: A Critical Curriculum on – David O. Antonuccio, Ph.D. – Sane Development, Inc., and (psychology) Cooper Design, Inc. Psychotropic Medications – Kia J. Bentley, Ph.D. (social • Voice narration and Flash editing: work) – Saul McClintock – R. Elliott Ingersoll, Ph.D. (counseling & psychology) – Stefan P. Kruszewski, M.D (psychiatry) – Robert E. Rosen, J.D., Ph.D. (law) www.CriticalThinkRx.org CriticalThinkRx CriticalThinkRx was made Module 1 possible by a grant from the Attorneys General Consumer and Why a Critical Skills Prescriber Grant Program, funded by the multi-state Curriculum on settlement of consumer fraud Psychotropic Medications? claims regarding the marketing of the prescription drug Neurontin® 4 Curriculum Rationale Part A Physicians write prescriptions, but other professionals often influence Curriculum Rationale, who gets prescribed and why Funding and Contents Training for these professionals is mostly haphazard and often influenced by the pharmaceutical industry 6 Module 1 www.CriticalThinkRx.org Exhibit 1, page 1 of 146 1 June 2008 Curriculum Objectives Critical thinking Help practitioners in mental involves assessing beliefs, health and child welfare arguments and claims to arrive sharpen critical thinking skills at well-reasoned judgments to deal with complex and uses standards such as clarity, evolving issues about accuracy, relevance, and psychotropic medication completeness 7 8 Critical thinking CriticalThinkRx asks “who benefits?” is sensitive to the influence of A prescription for vested interests on information critical thinking about emphasizes the ethical psychotropic implications of treatment medications decisions 9 10 Curriculum funding Funding source of CPGP • Received from the Attorneys General 2003: Attorneys General of 50 Consumer & Prescriber Education states charged Warner Lambert, a Grant Program (CPGP) subsidiary of Pfizer, Inc., with • CPGP is overseen by the Attorney conducting an unlawful marketing General offices of Florida, New York, campaign promoting the off-label Ohio, Oregon, Texas and Vermont uses of the anticonvulsant drug (plus two rotating states) Neurontin 11 12 Module 1 www.CriticalThinkRx.org Exhibit 1, page 2 of 146 2 June 2008 CPGP awards grants Neurontin settlements 2006: CPGP funded 28 2004: The company settled for $430 million applications in 19 states – CriticalThinkRx, funded at Florida —$21 million was earmarked for International University, is the only research and education aimed at project targeting non-medically health professionals trained professionals in child welfare and mental health 13 14 CPGP aims to improve prescribing CPGP requires that practices by educating health professionals about the curriculum be maintained in the public domain, freely the drug development and approval accessible by anyone process the investigators and their pharmaceutical industry marketing consultants forego funding from knowledge and skills to evaluate drug information critically the pharmaceutical industry for the duration of their grants 15 16 Selection of content Mainstream views Systematic literature searches Researchers agree that clinical were conducted in 2006-2007 on practice has far outpaced the were conducted in 2006-2007 on empirical evidence, yet… databases in medicine, – Mainstream mental health pharmacology, public health, practice subscribes to a social work, counseling, and “medical” model supporting psychology medication of children with little evidence of safety or – Materials were selected based on efficacy relevance and accuracy 17 18 Module 1 www.CriticalThinkRx.org Exhibit 1, page 3 of 146 3 June 2008 Content bias Content orientation CriticalThinkRx offers CriticalThinkRx emphasizes the alternative views based on ethical dictate: “First, do no empirical evidence to harm” stimulate critical thinking and CriticalThinkRx tries to close gaps a more balanced evaluation between research and practice to based on ethical codes of maximize opportunities to help practice clients and avoid harm 19 20 Curriculum design Principal Investigator David Cohen, Ph.D., L.C.S.W. • Professor of Social Work, Modules designed by experienced Florida International University, Miami, and a researcher/clinician with input private practitioner • Author of numerous from independent consultants in publications on psychiatric drugs, medicalization, and counseling, psychology, law and psychiatry • His latest books are Your Drug May Be Your Problem psychiatry, social work, and law (2nd rev. ed, 2007) and Critical New Perspectives on ADHD (2006) 21 22 Research Coordinator Consultant: Counseling Inge Sengelmann, M.S.W. • Professor of Counseling, College R. Elliott Ingersoll, Ph.D. of Education and Human • M.S.W. with a Services, Cleveland State background in University journalism and • A licensed psychologist and corporate clinical counselor in Ohio, he communication has authored books, book chapters, and articles on • Clinician focused on psychopharmacology, spiritual holistic approaches to approaches to counseling, and the treatment of Integral theory in mental health trauma-related mood • Author, Psychopharmacology and behavioral for Helping Professionals: An problems Integral Exploration (2006) 23 24 Module 1 www.CriticalThinkRx.org Exhibit 1, page 4 of 146 4 June 2008 Consultant: Social Work Consultant: Psychology Kia J. Bentley, Ph.D., L.C.S.W. • Professor, Department of David O. Antonuccio, Ph.D. Psychiatry, University of • Professor, Director of the Nevada School of Medicine Ph.D. Program, and Associate Dean for Strategic • Fellow, American Initiatives in Social Work at Psychological Association; Virginia Commonwealth Diplomate, clinical University, where she has psychology, American Board of taught since 1989 Professional Psychology • Author, The Social Worker & • His articles on the Psychotropic Medication comparative effects of (3rd ed., 2006) (with Joseph psychotherapy and Walsh) pharmacotherapy have received extensive national • Editor, Psychiatric coverage and are models of Medication Issues for Social careful scholarship Workers, Counselors and careful scholarship Psychologists (2003) • Has received many prestigious awards for his outstanding contributions to clinical 25 science and research 26 Consultant: Psychiatry Consultant: Law Robert E. Rosen, J.D., Ph.D. Stefan P. Kruszewski, M.D. • Harvard Medical School • Professor of Law, University of graduate and board- Miami, Coral Gables, FL certified in adolescent • Has taught courses in children psychiatry and the law, professional responsibility, and sociology • Pensylvannia-based and the law clinician and scientist • Has served as member of working with U.S. and Miami-Dade's Community-Based international judicial, Care Alliance, and is a reviewer legislative, and for Foster Care Review regulatory bodies • Holds a J.D. from Harvard Law School, and a Ph.D. in sociology • His publications appear from the University of in American Journal of California at Berkeley Psychiatry and BMJ • Former fellow, Harvard’s Program in Ethics and the Professions 27 28 Use of drug names Most prescription drugs have a Part B generic and a brand name (e.g., fluoxetine/Prozac) In this course, charts show both Case Studies names, but discussions use brand names because they are more familiar to laypersons 29 30 Module 1 www.CriticalThinkRx.org Exhibit 1, page 5 of 146 5 June 2008 Case 1: Rebecca Riley A recent tragic case (April 11, 2002 – Dec.13, 2006) raises questions What went wrong? about the use of psychiatric medications in young children © Copyright 2007 The Patriot Ledger 31 32 Some salient facts In 2002, then again in 2005-2006, Massachusetts’ DSS investigated complaints that the three Riley children might be sexually or physically abused and neglected by their parents DSS ruled complaints unfounded 33 34 By 2006, all three Riley children were Rebecca, the youngest child, was diagnosed with Bipolar I Disorder and prescribed psychotropic drug first medicated at age 2 cocktails by same child psychiatrist – By age 4, she was taking Seroquel from Tufts Medical Center (antipsychotic), Depakote – Parents were also diagnosed and (anticonvulsant), and clonidine mother received Paxil (antihypertensive) – As discussed in next modules, diagnosing children with Bipolar – She also took 2 over-the-counter Disorder I is a questionable and cold medicines controversial practice 35 36 Module 1 www.CriticalThinkRx.org Exhibit 1, page 6 of 146 6 June 2008 Dec. 13, 2006: Rebecca Riley is found Parents indicted … dead on her parents' bedroom floor Michael Riley, 34, and Carolyn – Autopsy later indicated cause of death Riley, 32, indicted in 2007 for the st as “intoxication due to the combined 1 degree murder of their daughter Rebecca (charge later effects” of clonidine, Depakote, and reduced to 2nd degree murder) two cough medications – Parents charged with giving her © Copyright 2007 – “The amount of clonidine alone in “excessive amounts” of clonidine The Patriot Ledger Rebecca’s system was fatal.” – Child’s doctor told mother Rebecca “was already on a high dose of clonidine” and a higher dose could kill the child (Commonwealth of Massachusetts, Feb. 5, 2007) 37 (Commonwealth of Massachusetts, Feb. 5, 2007) 38 Case leads to resignations… … puts careers on the line February, 2007 April, 2008 39 40 March 10, 2007 March 10, 2007 41 42 Module 1 www.CriticalThinkRx.org
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