OtisRSB

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I have read through the articles link on the stickies but I am interested to know if anyone has a grasp on what the really "landmark" or major trials i should be familiar with such as catie and star*d in regard to treatment guidelines.
thanks!
 

whopper

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My opinion
Step-BD
STAR*D
CATIE

The paper where people were hired to fake symptoms & wouldn't be allowed to leave a psyche unit--forgot the name of that one. While its old, and several legal safeguards have been put into place to prevent this type of thing from happening again, I think its still something every psychiatrist should have read. Nuts, haven't read it in years & forgot the name.
 

swanny

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That would be "On Being Sane in Insane Places" by DL Rosenhan, Science 1973.

I would also include the MTA studies on ADHD in children...
 

erg923

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I have read Rosenhan (1973) too in the past and there seems to be alot of conflicting info and even rumor about the study. I am still unclear about exactly what symptoms the "patients" described to the admitting psychiastrist. If I remember correctly, they reported anxiety, vague psychotic like symptoms, and atypical auditory hallucinations. Even If this is the case, if someone is presenting with distress, vague or atypical symptoms are no reason to refuse psychiatric treatment initially. There is not alot of time during the inpatient intake for assessment for malingering, or psychometric testing to look for atypical symptom patterns/presentation. Those suspicions usually gets explored as treatment continues. Sloppy diagnoses, maybe? I'm not really sure. The only thing that really troubled me was the length of the stays..up to 54 days of showing no symptoms before they were discharged. I can understand a week, maybe even 2 at that time to monitor for symptoms and medication, but not 54 days!! No doubt influenced by the Fundamental Attribution Error and our tendency to pathologize what can be relatively benign behaviors.
 

BabyPsychDoc

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I have read Rosenhan (1973) too in the past and there seems to be alot of conflicting info and even rumor about the study. I am still unclear about exactly what symptoms the "patients" described to the admitting psychiastrist. If I remember correctly, they reported anxiety, vague psychotic like symptoms, and atypical auditory hallucinations.
For those that do not remember the paper, or have never read it, the full text paper is available on the psych books sticky :). It was posted there recently following requests from members not being able to get it from the Stanford Uni website anymore.
 

whopper

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While the paper could be debated, I have seen patients get shuffled around in the system who were not properly diagnosed. The study clarifies a point in that we psychiatrists need to take seriously. The lack of lab evidence to back up a diagnosis further instills the need for careful clinical examination & proper documentation that backs DSM guidelines. It also reminds us that we must allow patients to have representation & allow for other evaluators to offer counter evaluations.

There are good & bad doctors in every field. However the subjectivity in our own field IMHO should lower our tolerance for the lazy among our own.

No doubt influenced by the Fundamental Attribution Error and our tendency to pathologize what can be relatively benign behaviors.
My understanding is that in the 70s, people were in psyche units much longer than they are today, and it was much more common for a doctor to not allow psyche patients to get observed by another clinician. I'm wondering some of it may have been a doctor & staff just willing to keep with the current diagnosis.

While I hate saying it, I have to say it. Some docs for whatever reason: laziness, too much work, etc will brand a quick diagnosis without enough evidence. I've seen it in every field. When for example a surgeon does a bum job during a surgery-the patient can die. If a psychiatrist does it--we can unfairly commit someone, i.e. violating their constitutional rights.

Every so often, the nurse manager at the inpatient unit where I work theorizes that a patient coming in may be an actor paid by the state or a newspaper to make sure the inpatient unit is following the rules. From what I understand, these things still happen, in fact our former governor in his earlier days did this and exposed major abuses going on in a psychiatric hospital.

Her attitude? "Let them come. We're following the rules, we have nothing to fear".
 
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OtisRSB

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is there an actual STAR*D trial paper or is it a conglomeration of studies?
 

OldPsychDoc

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is there an actual STAR*D trial paper or is it a conglomeration of studies?

The data from the STAR*D trial has been rolling out in a number of papers.
 

Still Kickin

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I want to read the CATIE, STEP-BD & STAR*D trials.

So far, I just went looking for the CATIE trial. I did an Ovid Medline search for title-word "CATIE" and got tons of hits. (But lots of them have titles like "Practice in the Post-CATIE Era" or "What did we learn from CATIE", etc., so I know those aren't the actual study.)

I decided to look at the oldest articles that came up on my search thinking they might be the ones all the others were referring to. The two articles I found that looked like they might be the actual CATIE article [based on title] were more like a description of the METHODS of the CATIE trial. (I haven't finished reading them yet, but it looks like there are few, if any results presented in these papers.) So I'm thinking even these are not the "CATIE" paper.

If anyone knows the actual literature citation for these articles, please post them, I think it would make it much easier for me to find them that way. (Or - if you don't know the citation but can suggest a better search strategy, that would also be welcome...)

I am guessing I'm going to run into this looking for STEP-BD & STAR*D, too, so if anyone has the citations for THOSE (or can suggest a good search strategy), please post that, also.

THANKS!
-Still Kickin
 

BabyPsychDoc

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I want to read the CATIE, STEP-BD & STAR*D trials.

So far, I just went looking for the CATIE trial. I did an Ovid Medline search for title-word "CATIE" and got tons of hits. (But lots of them have titles like "Practice in the Post-CATIE Era" or "What did we learn from CATIE", etc., so I know those aren't the actual study.)

I decided to look at the oldest articles that came up on my search thinking they might be the ones all the others were referring to. The two articles I found that looked like they might be the actual CATIE article [based on title] were more like a description of the METHODS of the CATIE trial. (I haven't finished reading them yet, but it looks like there are few, if any results presented in these papers.) So I'm thinking even these are not the "CATIE" paper.

If anyone knows the actual literature citation for these articles, please post them, I think it would make it much easier for me to find them that way. (Or - if you don't know the citation but can suggest a better search strategy, that would also be welcome...)

I am guessing I'm going to run into this looking for STEP-BD & STAR*D, too, so if anyone has the citations for THOSE (or can suggest a good search strategy), please post that, also.

THANKS!
-Still Kickin
If I remember correctly, the NAMI website has links to the trial reports (CATIE I remember for sure).
 

blabbyblab

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The Epidemiological Catchment Area Project is where a lot of the statistics in psychiatry originated, like 1/100 people are schizophrenic.