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Introduction:

ADHD (Attention Deficit Hyperactive Disorder) as the most hereditary disorder of humans, physical or psychological/behavioural has been perhaps the most recognized truly in the field of medicine, even among the experts and researchers. This common disorder starting in childhood, but if untreated endures across the life span, has been known in different terms from the time of antiquity. Hippocrates (460-329 BC) (1), known as the father of medicine, observed patients who demonstrated “quickened responses to sensory experiences” and went on to describe their inability to stay focused “because the soul moves on quickly to the next impression.” Interestingly this ancient Greek physician recognized the condition both as a cognitive and behavioral nature together and not separate. But it took the field about two millennia to bounce back and forth, between recognizing it as predominantly a motoric (hyperactive) condition to a cognitive (inattentive) disorder until the present day. 

George Frederick Still (2), the father of British Pediatrics, in 1902 described and published in the Lancet, the descriptions of 43 children with serious problems of sustained attention and self-regulation, but at the same time paradoxically being “bright and intelligent”. Dr. Still was perhaps the first one to recognize the problem with “self regulation” instead of the label of “Moral Defect” on these children up until 20th century and also appreciating their high intelligence, that has not been widely acknowledged even today! In contrast with the positive and intelligent observation of Still, for the rest of 20th century and even now in 21st century, these children have been mislabeled negatively with having “mild brain damage”, “minimal brain dysfunction”, “mental deficiency”, etc. (e.g. 3-4) 

The pathophysiologic or causative theory of ADHD prompted by Charles Bradley (1902-1979) in 1937, a pediatric neurologist who by accident treated these children Benzedrine sulfate, an amphetamine product with great success, so to born the theory of “dopamine deficiency” prominent to this day. (5-6) In 1952, first edition of DSM (Diagnostics and Statistical Manual) of psychiatric disorders by the APA (American Psychiatric Association) (7) did not include any mention of an ADHD like disorder. Then in 1957, after Laufer and colleagues (8), reporting inattention and hyperactivity, both as two main features of the condition, the second edition of DSM in 1968, included the disorder as a formal diagnostic classification. (9) But before that another bright physician, Keith Conners in 1963 started his first study on the effects of Ritalin (Methylphenidate) in ADHD children and a year later published the first “Conner’s Rating Scale” for the official assessment and rating of the ADHD that is still in common use today. (10) 

In recent years first DSM-IV in 1994 (11) and most recently DSM5 in 2013 (12), have classified the disorder into two subtypes of predominantly inattentive (ADHD-I) and predominantly hyperactive/impulsivity (ADHD-HI), though these they often overlap at least in research samples as “combined”! Impulsivity as a very cardinal feature of ADHD that has been recognized only in recent decades in the disorder, has been poorly defined in DSM-IV & 5 as only “ blurting out” verbally, or “having trouble waiting one’s turn”, and “interrupting or intrudes on others” again more verbally. And the only change from DSM-IV to DSM 5 after a quarter of century has been extending the age of onset from 7 to 12, so prompting some to propose wrongly the new entity of adult onset ADHD. (13) 

 In this article that is a synopsis of my initial work (“ADHD: Revisited” and “ADHD: Hyperattentive, disinhibited, intelligent and evolutionary”) (14-15) I will dissecting into the true nature of ADHD, and reveal its misconceptions, misunderstandings, the shortcomings in its research and its current wrong classification and treatment.

 ADHD: One type or subtypes?

Read the full text here:

https://medicinerevisited.com/psychiatry/adhd-attention-deficit-hyper-attentive/

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Introduction:

The idea of recommendation and prescription of second generation of antipsychotics in the treatment of depression (major unipolar depression, bipolar depression, depression in schizophrenia and even a milder depressive condition such as dysthymia) started in early 2000’s. First the experts recommended these agents that are originally synthesized to treat psychotic disorders such as schizophrenia, as augmentation to anti-depressants in the treatment of refractory depressions. (1-3) Soon such studies that are mostly sponsored by pharmaceutical corporations, suggested the use of antipsychotics not as an adjunct, or for the treatment of depression in psychotic disorders, or even bipolar disorder that could be accompanied by psychotic features, but for the treatment of pure unipolar major depression and as the first line treatment. (4) Nowadays it is not uncommon that even primary care physicians, psychiatrists and family physicians prescribe antipsychotics in the treatment of a patient who suffers from a simple depression. The pharmaceutical companies synthesize and market such antipsychotics (e.g. Quetiapine, Aripiprazole, Lorasidone, etc.) (these are these generic names that in different markets are sold under different brand names) have also been able to acquire indication for the treatment of depression for their products. The market sales continue to rise and the treatment indications of these antipsychotics are expanding beyond depression to other psychiatric disorders such as anxiety disorders, PTSD (Post-Traumatic Stress Disorder) and beyond. (5-6)

 A curious and cautious consumer may wonder why he or she should be prescribed an antipsychotic while having no psychotic disorder (delusions, hallucinations, etc.) but a simple depression! This article attempts to explore this wonder and show throughout the history of psychiatry, that the use of antipsychotics have not been limited to the recent time and the second-generation antipsychotics, but such attempt in the past failed over time. The experts might respond to this critic that the new antipsychotics possess such chemical structure that work on the neurotransmitters involved in depression (mainly serotonin and norepinephrine). But our lay patient could respond back that what about the impact of the antipsychotic component of these medications?! If the depressed patient is not psychotic and does not have any imbalance or over-sensitively in his or her dopamine neurotransmission (involved in psychosis) what would be the consequences of taking an antipsychotic that affect this neurotransmission. For example would he or she develop side-effects such as EPS (Extra-pyramidal symptoms) or simply abnormal movement disorders such as tremors and akathisia (restlessness and feet fidgeting, etc?! What about dampening the lay patient’s dopamine system in the brain that he or she needs it for all his or her cognitive faculties, etc.?! Since the poor lay patient could not keep this dialogue long enough against the experts who are masters of twisting the facts around to prove their points of intentions per pharmaceutical giants’ order, this article will strive to do so on the behalf such lay depressed patient and million others across the globe.

Digging the grave of antipsychotics:

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https://medicinerevisited.com/psychiatry/why-antipsychotics-for-depression-when-the-experts-miss-the-concept/

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Suicide and suicidal behaviors are very rare in animals and seem to be more of defensive nature unlike in humans that is not so, but intentional and against life. (1-2) Suicide in humans is a global issue that has resulted in 842,000 deaths globally in 2013, up from 712,000 deaths in 1990. (3) This makes it the 10^th leading cause of death worldwide. (4) 75% of suicides globally occur in the developing world. Rates of completed suicides are generally higher in men than in women, ranging from 1.5 times as much in the developing world to 3.5 times in the developed world. (5) There are an estimated 10 to 20 million non-fatal attempted suicides every year. (6) Non-fatal suicide attempts may lead to injury and long-term disabilities. In the Western world, attempts are more common in young people and females, and suicide is the second cause of death among adolescents after accidents. (7-8)

Factors that affect the risk of suicide include mental disorders, drug misuse, psychological states, cultural, family and social situations, and genetics. (8) Mental disorders and substance misuse frequently co-exist. (9) Other risk factors include having previously attempted suicide, the ready availability of a means to take one’s life, a family history of suicide. (7) For example, suicide rates have been found to be greater in households with firearms than those without them. (10) Socio-economic problems such as unemployment, poverty, Homelessness, and discrimination may trigger suicidal thoughts. (11) About 15–40% of people leave a suicide note. (12) Genetics appears to account for between 38% and 55% of suicidal behaviors. (13) War veterans have a higher risk of suicide due in part to higher rates of mental illness such as post traumatic stress disorder (PTSD) and physical health problems related to war. (14)

Half of all people who die by suicide may have major depressive disorder; and having a mood disorder such as depression or bipolar disorder increases the risk of suicide 20-fold. (6) Other mental disorders’ risk of suicide are Schizophrenia (14%) that leads about 5% of such patients die from suicide, borderline personality disorder, PTSD, eating disorder, and substance use disorders. (6-7, 15) Approximately 20% of suicides have had a previous attempt, and of those who have attempted suicide, 1% complete suicide within a year^, and more than 5% die by suicide within 10 years. (7) Acts of self-harm are not usually suicide attempts and most who self-harm are not at high risk of suicide. Some who self-harm, however, do still end their life by suicide, and risk for self-harm and suicide may overlap. (16)

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https://medicinerevisited.com/psychiatry/suicide-species-why-some-people-kill-themselves/

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Introduction:

Since the industrial revolution of 17 to 18^th century in Europe, humans who freed themselves from slavery, feudalism, monarchy and alike, were worried about their dependence and overcoming by their own scientific creations.(1) Perhaps the first of these fears is demonstrated in the popular story of Dr. Frankenstein in 1818, who became a victim of the torment of his own creation.(2) Later on in many stories and films such as Space odyssey 2001, this fear warned us all! Although none of the fears of human clone, machines or robots did not materialize, humans became addicted first to televisions, then video games and most recently to computers, internet, social media, cell phones and alike. This dependency and addiction has not been limited to only a small group of scientists and creators, but has become an epidemic world wide, affecting ordinary people of all ages and totally out of control and a real concern in all lands.

The free thought as expressed in philosophy for example by the popular phrase of Rene Descartes’ “I think therefore I am”, that was the foundation of humans’ modern achievements, has faded away.(3) Similarly the free will that was well expressed through existentialism, and well expressed for example by the popular phrase of Arthur Schopenhauer’s “The world is my representation.” has been totally lost. (4-5) Humans rapidly became slaves once again as in the remote past before the industrial revolution, but this time not to religion, or monarchies, landlords, or another human, but to their own byproducts. The computer that was initially created for fast computing, then as an information technology, soon was transformed to a social media and communication, brain idling and washing device. The invention of mobile devices has facilitated this addiction, dependency, obsession and loss of free thought and will globally and across the life span. In the following we will see how digital addiction has become the most common and worrisome addiction of all types, worse than addiction to gambling, and illicit drugs.

From TV to the Internet and beyond:

After the world war II, when TV invented and became a public entertainment device at home, addiction to it also started with its medical and psychiatric consequences such as reactive apathy and obesity. (6-7) Then soon came the video games such as Nintendo, and by the 80’s personal computers and by the 90’s internet. The medical concern grew so much that medical and psychological journals such as “Cyberpsychology Behaviour” for studying the medical and psychological complications of cyber-addictions were founded. (8) The obsessive and compulsive use of digital technology brought behavioural problems and symptoms similar to any addictive disorder, so the term “digital addict” and “digital addiction” were coined. (9)

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Digital Addiction: The end of free thought and will

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Introduction:

According to Oxford dictionary, “intelligence” means “The ability to acquire and apply knowledge and skills.” Webster dictionary defines “intelligence” as “the ability to learn or understand things or to deal with new or difficult situations.” Webster has another definition for “intelligence” that is related to CIA and other governmental spy agencies as “Secret information that a government collects about an enemy or possible enemy; also : a government organization that collects such information.” The medical dictionary online has this definition for intelligence: “The ability to learn and to deal with new situations and to deal effectively with tasks involving abstractions.” Wikipedia has a broader definition: “Intelligence has been defined in many different ways including one’s capacity for logic, understanding, self-awareness, learning, emotional knowledge, memory, planning, creativity, adaptive behavior, problem solving and self-control. It can be more generally described as the ability to perceive information, and retain it as knowledge to be applied towards adaptive behaviors within an environment or context.”

 Intelligence has been defined in many forms, e.g., logic, abstract thought, comprehension, self-awareness, learning, emotional, retaining, planning, invention, creation, problem solving, etc. An editorial statement by fifty-two researchers defines the intelligence as “A very general mental capability that, among other things, involves the ability to reason, plan, solve problems, think abstractly, comprehend complex ideas, learn quickly and learn from experience. It is not merely book learning, a narrow academic skill, or test-taking smarts. Rather, it reflects a broader and deeper capability for comprehending our surroundings—”catching on,” “making sense” of things, or “figuring out” what to do.” (1)

 Generally speaking of intelligence, comes of mind IQ or Intelligence Quotient that is measured by different tests including Stanford-Binet, Raven’s progressive matrices, the most currently used Wechsler intelligence scales for children and adults, the Kaufman assessment battery for children, etc. Some tests consist of a single type of task; others rely on a broad collection of tasks with different contents (visual-spatial, verbal, numerical) and asking for different cognitive processes (e.g., reasoning, memory, rapid decisions, visual comparisons, spatial imagery, reading, and retrieval of general knowledge). The psychologist Charles Spearman early in the 20th century carried out the first formal factor analysis of correlations between various test tasks. He found a trend for all such tests to correlate positively with each other, and named it g for “general intelligence factor”. He interpreted it as the core of human intelligence that, to a larger or smaller degree, influences success in all cognitive tasks and thereby creates the positive manifold. This interpretation of g as a common cause of test performance is still dominant in psychometrics. (2)

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https://medicinerevisited.com/psychiatry/intelligence-what-is-it-and-are-the-iq-tests-correct/

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“I loved music, until my music teacher got upset at one of my classmates, aggressively grabbed him by the neck, kicked him out of the class and swore at him” Sebastian in grade 5.

 Still I cannot believe what Sebastian told me and happened in his school, in “Beverly Acres Public School” in Richmond Hill, Ontario, Canada, about a maltreatment, physical and verbal abuse of a 10 years old child in front of the whole class! When I told Sebastian that I am going to write up the incident in my website and the world will know about it, he was excited to hear what others might think of the situation and condemn the abuse by their teacher!

 “Children of a lesser God” is originally a play by Medoff that in 1986 was adapted to a feature film, about a school for the deafs, their sufferings and struggles to learn. While any physical defect of a child could be considered by some or the child himself or herself as being of a lesser attention by the God to him or her, the mental defects of a child and more importantly so, the trauma, maltreatment and abuse that befall on a normal and healthy child could be taken as such.

A search in “pubmed” of the NIH (National Institute of Health) of the United States, reveals the following number of research papers: on child abuse in total:40331; child abuse by teachers:412; by clergy:115; by preiests:123! The child welfare of the US government reports that relatives, babysitters, and foster parents are the common perpetrators. The American humane association reports the following rate of common child abuse and maltreatments: neglect 62.8% as the highest type of abuse; physical abuse 16.6%; sexual abuse 7.1%; emotional and psychological abuse 7.1%; medical neglect 2% and “others” at 14.3%. Canadian child welfare agency, reports that in 2007, there were an estimated 67,000 children in out-of-home care across Canada. The Canadian Incidence Study of Reported Child Abuse and Neglect reports an increase of abuse reports from 135,261 in 1998 to 235,315 in 2003 and 235,842 in 2008. Neglect and exposure to intimate partner abuse and violence has been reported at 34% to be the highest, followed by physical abuse at 20%, emotional maltreatment at 9% and sexual abuse at 3%, different than the statistics in US, though both are similar in being western, mainly English speaking societies with multi-cultural striatum. Child issues that perhaps triggered more abuse by the perpetrators have been reported to be Academic difficulties: 23%; depression, anxiety, withdrawal: 19%; Aggression: 15%; Attachment issues: 14%;Intellectual & developmental disabilities: 11%; and ADD/ADHD: 11%. Care-givers risk factors have been reported to be the highest among the victims of domestic violence and abuse at 46%. Schools have been the most common source of abuse reports at 24%.

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Children of a lesser God: When guardians shatter the Futures

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