The Nose Knows

I'd really like to just gloss over this topic, but I can't bring myself to do so. Have you read about "Sluggish Cognitive Tempo" (SCT)?

Check it:

...powerful figures in mental health are claiming to have identified a new disorder that could vastly expand the ranks of young people treated for attention problems. Called sluggish cognitive tempo, the condition is said to be characterized by lethargy, daydreaming and slow mental processing. By some researchers’ estimates, it is present in perhaps two million children.

Experts pushing for more research into sluggish cognitive tempo say it is gaining momentum toward recognition as a legitimate disorder — and, as such, a candidate for pharmacological treatment. Some of the condition’s researchers have helped Eli Lilly investigate how its flagship A.D.H.D. drug might treat it.

And there it is, black on white. Researchers helping Lilly market a drug. Really, "identified a new disorder"? Like what, they found a new bacteria under a microscope?

Here's Allen Frances' comment from his article, No Child Left Undiagnosed:

"'Sluggish Cognitive Tempo' may possibly be the very dumbest and most dangerous diagnostic idea I have ever encountered."

Right on Dr. Frances!

When I googled "Sluggish Cognitive Tempo", the first thing that came up was itself, followed by sluggish thyroid and sluggish bowels. I'm not sure what that implies. Anyway, SCT was the main topic in the January 2014 issue of the Journal of Abnormal Child Psychology.

According to the introductory article, SCT is characterized by "drowsiness, daydreaming, lethargy, mental confusion, and slowed thinking/behavior". Then there are a couple articles about the validity of SCT, and more discussing the relationship with ADHD.

One article I found, Symptom Properties as a function of ADHD Type: An Argument for Continued Study of Sluggish Cognitive Tempo, by McBurnett et al,  published in 2000, noted that SCT had been discarded from the inattention symptom list in the DSM IV Field Trials, due to poor negative predictive value. But then McBurnett et al decided to look at SCT again, and found that "Sluggish Tempo Items showed substantially improved utility as symptoms of Inattention, " and that a "Sluggish Tempo factor could be distinguished from an Inattention factor." It wasn't clear to me from reading the abstract why they decided to take another look at SCT.

The thing is, even if SCT is a "real thing", even if a child can "have" SCT, who says that child needs a label, or meds, or even treatment?

Note also the messy interaction between Allen Frances' opinion about SCT and his role as chair of the DSM IV task force. Maybe he does have a conflict of interest. I still think he makes more sense than this crusade to label every aspect of the human condition as pathology.

What's next, pathologic nose-picking?

1. Nose-picking at least 3 times per day, present most days, for at least 2 weeks.
    Specify:
                     a. Booger-Eating Type or      
                     b. Non-Booger-Eating Type

2. The patient is often unaware of the nose-picking behavior while it is happening (in children, the  behavior may be noted by a family member or teacher)

3. The nose-picking does not take place in the context of recent trauma to nose.

4. Nose-picking is not a culturally accepted norm for the patient.

5. The nose-picking is not better explained by another condition, such as OCD.

6. The nose-picking causes significant distress for the patient or patient's family, such as frequent    nosebleeds, teasing at school, or booger-encrusted undersides of furniture.





 

Follow Up Poll

Back in April, I posted a survey about the DSM-5: whether people planned to purchase it, what people thought the problems with it would be.

Now I'm following up. I want to know if people have purchased it, and whether they feel it's been helpful.

Click HERE to participate. It's completely anonymous, and you don't need to have participated in the first poll to join in on this one.

This survey will close 07.27.13, 12am. Thank you in advance for participating.

Free Diagnostic Coding Reference-Yay!

This is so great!

You have to check out this ICD coding reference.

These techno-angels have created a free database of ICD-9 codes, including those for 2013.

We've taken the official 2006-2013 ICD-9-CM and HCPCS coding books and added 5.3+ million hyperlinks between codes. Combine that with a Google-powered search engine, drill-down navigation system and instant coding notes  and it's easier than ever to quickly find the medical coding information you need.

They're supported by Google Adsense, so it's totally free to use. The'll even convert ICD-9 codes to ICD-10 codes. And they were happy to have me link to their site. You gotta love these guys.

What would be super-great is if they wrote some code to convert DSM-IV codes to ICD-9 codes. Maybe I'll write to them about it.

And for future reference, I've added a link to their site under "Useful Links", to the right.