Sluggish Cognitive Tempo: the next big thing in diagnosis?

This blog ://www.slate.com/articles/health_and_science/medical_examiner/2014/09/sluggish_cognitive_tempo_is_it_a_disease_independent_of_adhd_and_can_drugs.single.html is very good, and recommended.
Briefly, sluggish cognitive tempo is a terribly-named new conception of children who have poor concentration, not due to the ‘fizziness’ of the ADHD brain, but due to slow processing in the absence of other learning disabilities. The slate article rejects SCT partly on the basis that it’s just an exaggeration of normality, but PMHA members will know that this argument could apply to whole swathes of the diagnostic textbook, from ADHD to hypertension.
So should we be looking at diagnosing this condition in our clinics? At present, it’s very hard to be clear, as the evidence base is tiny for usefulness of this concept, and it is likely to be mainly treated with educational intervention.
But we would be interested in your thoughts…

neurocognitive deficits in ADHD and conduct disorder. Same same

Really interesting work reported here http://www.sciencedaily.com/releases/2014/08/140812121542.htm?
Essentially, the basis of young people with ADHD, conduct disorder and substance misuse show very similar neurocognitive patterns. This might suggest some shared causation, and possible intervention targets which cut across all conditions. We shall see, but if the cognitive deficits can be targeted specifically, that would be a revolution in conical and diagnostic practice.

Autism and substance misuse: assume nothing

This excellent blog post http://blogs.psychcentral.com/science-addiction/2014/07/people-on-autism-spectrum-at-increased-risk-for-substance-abuse/ tangles with the complexity of the relationship between ASD and substance misuse. Essentially, able people with ASD seem quite prone to addictive behaviour. This may not be a surprise, but because people with ASD are often socially isolated it might be assumed that they don’t get exposed to substances socially. This work is another reminder to see the person, and not the diagnosis.
Of course the next question is how this relates to mental health problems in this population….

Can you diagnose ADHD without childhood symptoms?

http://www.medicalnewstoday.com/releases/279619.php?tw

US researchers have found that the move in Dsm 5 to increase the age of onset criteria from 7 to 12 did not significantly alter the profile of the population diagnosed, although did increase the proportion of predominantly inattentive diagnoses.
Many UK clinicians are alarmed at the explosion of ADHD diagnosis in the US, and may view this with some suspicion. Increasingly, as prevalence rates across the Atlantic exceed 10%, we are diagnosing quite distinct populations, as European clinicians diagnose a fat Mir select group. This limits the applicability of this finding to a UK context.

Is parity of esteem just an empty phrase?

In 2012 the government pledged to achieve parity of esteem between physical and mental health. Since then there have been working parties, reports and briefings, but also scandals like NHS England mandating a 20% greater cut for mental health, CAMHS services losing up to 40% of capacity in 4 years, and most recently and viscerally, people dying in scores while awaiting treatment for mental health problems.
So is parity just rhetoric, to keep a deeply disenfranchised group quiet till the next government? It doesn’t have to be…

To grasp the importance of parity, imagine if it was achieved. Not in the way we want, but by down-grading physical health services to the status of mental health in the NHS. People with the most serious problems, like heart disease, would have no guaranteed access times for treatment and hundreds would die unnecessarily. Young people presenting with sporting injuries would be made to feel they are a wasting staff time in A&E, while those suffering from leukaemia would be shunted across the country in search of a dwindling number of beds. Children with long term conditions like cystic fibrosis wouldn’t be able to get any treatment at all until they had complications, by which time outcomes would already be compromised. And health education and support in schools? We don’t talk about that sort of thing, thanks, we’ve got exams to pass.

There would be a national scandal, people marching through on the streets, resignations, the works. And yet we have all allowed people with mental health problems, some of our most vulnerable citizens, to be treated in this shoddy way. This has to stop. And the way to give this vague, arm-waving term ‘parity of esteem’ some guts, and enlist it for the fight, is to think not of equal esteem for ‘mental health’ as an abstract, but about equality of esteem for the people, mothers, fathers, workers, sons, daughters, friends, lovers, and colleagues, who suffer in this way.

So what now? Well, I’m on my way to the Labour party conference in Manchester, to the first of three events run jointly by the RCPCH, RCPSYCH and Young Minds, asking the three major parties to commit to a tangible action plan to achieve parity of esteem for people with mental health problems. We hope you can help by tweeting about our campaign #thinkagain, by visiting the young minds website and signing the petition calling for an end to CAMHS cuts, but above all by taking to colleagues, friends, and family about mental health, and making it a political issue.

Because it damn well ought to be.

Suicidal thoughts common in people with autism

Another sfari.org blog http://sfari.org/news-and-opinion/news/2014/suicidal-thoughts-alarmingly-common-in-people-with-autism discusses recent work on suicidality in ASD, especially aspergers. It’s an excellent piece, and I just wanted to add a few points:

1) as professionals we should be asking young people with ASD about thoughts of self harm and suicide whenever possible. Conventional depression scales won’t cut it.

2) this should put to bed once and for all the myth of autistic people as emotionally ‘frozen’. Their emotional life is qualitatively different to typicals, but no less intense.

3) the data suggesting an increase in suicide attempts is unpublished,  so should be treated with caution, but there are good reasons given to think there might be a greater risk. How much can be accounted for by conventional depression is unclear

4) if people with autism can be suicidal but not depressed, how on earth do we treat/ protect them? This I suspect will be a puzzler

5) this is a good example of a problem that would reward particular attention on people with aspergers.  It seems a shame to have dispensed with the term,  doesn’t it?