Influential Psychiatrist Expands Unexplained Illnesses to Include Food Allergy, Endometriosis, Chronic Lyme, Sick Bldg. Synd., Repetitive strain injury, many others

May 7, 2009

Influential Psychiatrist Expands Unexplained Illnesses to Include

Food Allergy, Endometriosis, Chronic Lyme, Sick Bldg. Synd.,

Repetitive Strain Injury, many others

Dr. J.I. Escobar is director of the MUPS ( " Medically Unexplained

Physical Symptoms " ) Center at the University of Medicine and

Dentistry Wood Medical School (UMDNJ-RWJMS),

which has been funded with $4M over 8 years by the U.S. NIH NIMH.

Dr. Escobar's studies what he terms " Functional Somatic

Syndromes " (FSS), which he believes are psychiatric somatoform

disorders. He defines these syndromes to include:

Irritable bowel syndrome, Chronic fatigue syndrome, Fibromyalgia,

Multiple chemical sensitivity, Nonspecific chest pain, Premenstrual

disorder, Non-ulcer dyspepsia, Repetitive strain injury, Tension

headache, Temporomandibular joint disorder, Atypical facial pain,

Hyperventilation syndrome, Globus syndrome, Sick building syndrome,

Chronic pelvic pain, Chronic whiplash syndrome, Chronic Lyme disease,

Silicone breast implant effects, Candidiasis hypersensivity, Food

allergy, Gulf War syndrome, Mitral valve prolapse, Hypoglycemia,

Chronic low back pain, Dizziness, Interstitial cystitis, Tinnitus,

Pseudoseizures, Insomnia, Systemic yeast infection, & Total allergy

syndrome. (See: Unexplained Physical Symptoms: What's a Psychiatrist

to Do? Humberto Marin, MD and I. Escobar, MD, Psychiatric

Times. Vol. 25 No. 9, August 1, 2008

http://www.psychiatrictimes.com/dsm-v/article/10168/1171223?pageNumber=1# )

Dr. Escobar's opinion is significant because he is a member

of the American Psychiatric Association (APA) Diagnostic and

Statistical Manual Fifth Edition (DSM-V) Task Force (TF),

which is now updating " The Bible " of psychiatry. In particular,

the APA DSM-V " Somatic Distress Disorders " Work Group

is now in the process of re-writing the taxonomy of psychiatric

somatoform disorders, effectively re-drawing the line between

psychiatry and medicine.

Notably, Dr. Escobar was previously a member of the private

U.S./U.K CISSD (Conceptual Issues in Somatoform and Similar

Disorders) Project, which studied how to re-write the DSM and

ICD taxonomy of somatoform disorders.

The new DSM-V, with its new taxonomy of somatoform disorders,

will then be " harmonized " with the World Health Organization (WHO)

International Classification of Diseases Eleventh Edition (ICD-11),

and thus will redefine boundary between psychiatry and medicine

worldwide.

Notably, Dr. Escobar has been an advisor to the WHO, and

co-director of the North American WHO Collaborating Center.

__

>Psychiatry Research Comes of Age at UMDNJ

>the budget of the National Institute of Mental Health (NIMH)

reached the one billion dollar mark in FY 2000, and continues to

increase at a fast pace (about 10% yearly).

>Private foundations such as the Wood Foundation

continue to invest heavily in the area of behavioral disorders. The

pharmaceutical industry is hard at work developing new drugs that

look more specific and are better tolerated than the old ones. All

these major investments have placed psychiatric departments among the

top research departments in academic institutions nationally.

__

>Studies of Medically Unexplained Physical Symptoms and Mental

Health Disparities

>We have developed strategies to recognize, recruit and retrain

patients with mental disorders presenting with multiple unexplained

symptoms at primary care clinics. An effective treatment strategy

specifically developed to manage these patients is being currently

tested, thanks to a large grant from the National Institute of Mental

Health (NIMH). Preliminary results appear to be highly satisfactory.

>A general conception in psychiatry and psychology that has held for

more than a century is that multiple unexplained somatic complaints

(somatization) represent the expression of psychological distress in

the form of unpleasant somatic sensations interpreted as signs of

disease. Exact mechanisms mediating somatization are unknown.

Nonetheless, the subjective experience of having a physical illness

is a compelling reality for the patient, which tends to persist

despite reassurance from physicians that there is nothing physically wrong.

>These patients have frequent medical visits, and often it appears

as if medical care becomes a social support network for them.

Paradoxically, they often display chronic dissatisfaction with the

care received, and may even seek financial compensation for their

disability and alleged treatment errors.

>This latter factor, when added to excessive service use, makes

somatization one of the most expensive entities in medicine.

>Throughout my psychiatric practice, I have been baffled by the

refractoriness and chronicity of somatization syndromes, and have

examined this problem both clinically and epidemiologically. As

co-principal investigator of the Epidemiological Catchment Area study

(ECA), a national survey of major mental disorders in the U.S.

general population, I described a sub-threshold cluster of

unexplained symptoms known as " Escobar's abridged somatization. "

>Dr. Escobar received his medical degree at the University of

Antioquia Medical School.

http://en.wikipedia.org/wiki/University_of_Antioquia

>After postgraduate training at the Complutense University in

Madrid, he came to the U.S. in 1969.

http://en.wikipedia.org/wiki/Complutense_University_of_Madrid

>He is currently a member of NIMH's National Advisory Mental Health

Council. In addition he has been an advisor to the World Health

Organization (WHO) and co-director of the North American WHO

Collaborating Center.

__

For photos of Dr. Escobar and his staff, see original at:

http://www.umdnj.edu/research/publications/summer_02.pdf

============

PSYCHIATRY RESEARCH COMES OF AGE AT UMDNJ

http://www.umdnj.edu/research/publications/summer_02.pdf

by I. Escobar

Volume 4, Number 7, Fall 2002, Page 1, 3

JAVIER I. ESCOBAR, MD, MS, PROFESSOR AND CHAIR, DEPARTMENT OF PSYCHIATRY,

UMDNJ - ROBERT WOOD JOHNSON MEDICAL SCHOOL

___

Sidebar / Page 2:

The University of Medicine and Dentistry of New Jersey is a statewide

network of eight schools on five campuses in Camden, New

Brunswick/Piscataway, Newark, Scotch Plains and Stratford. The

schools include New Jersey Medical School, Wood

Medical School, School of Osteopathic Medicine, New Jersey Dental

School, Graduate School of Biomedical Sciences, School of Health

Related Professions, School of Nursing and School of Public Health.

The University has more than 4,500 students in 38 degree and

certificate programs, 11,000 employees, including 2,075 faculty

members, 17,000 alumni and more than 200 education and healthcare

affiliates throughout New Jersey.

The University is dedicated to pursuing excellence in the education

of health professionals and scientists, conducting research,

delivering health care, and serving the community. UMDNJ is ranked

among the 100 top research universities in the country.

Please visit our website at http://www.umdnj.edu . E-mail us at

research@... to comment on this publication or to add someone

to the mailing list.

.... UMDNJ Research is published by the Department of Government and

Public Affairs, University of Medicine and Dentistry of New Jersey,

Publications Office, Stanley Bergen Building, 65 Bergen Street, Room

1328, Newark, N.J. 07107-3000. For permission to reprint an article,

contact the editor. For

___

The 1990s were called the decade of the brain in North America,

stimulating significant research on basic and clinical neuroscience.

During this period, psychiatry, one of the clinical neurosciences,

witnessed the development of powerful tools for the study of

brain-behavior relationships, saw the emergence of safe and effective

drugs for treating depression, anxiety and schizophrenia, and

confirmed the positive impact of traditional treatments such as

psychotherapy, via the controlled clinical trial. The fact that

biology affects behavior, and conversely, that " stress " and other

psychological influences affect biology, results in new and exciting paradigms.

Other important highlights of this decade were:

=> The " Global Burden of Disease, " an international study coordinated

by the World Health Organization, confirmed that mental disorders

such as major depression are amongst the most prevalent and disabling

health conditions worldwide.

=> " Healthy People 2000, " an initiative of the U.S. Department of

Health and Human Services, included several mental health outcomes

among the leading health indicators.

=> " Mental Health: A Report of the Surgeon General " documented the

disabling nature of mental illnesses and showcased the strong basic

science behind effective treatments, while emphasizing the importance

of recognizing and treating mental disorders. The supplement that

followed, " Mental Health, Culture and Ethnicity, " documented

unfortunate ethnic disparities, particularly regarding access to and

quality of treatment.

Entering the 21st century, psychiatric research looks very vigorous,

thanks to a decline in stigma of psychiatric illness, significant

lobbying by patient advocates and a net increase in available

research funds. For example, the budget of the National Institute of

Mental Health (NIMH) reached the one billion dollar mark in FY 2000,

and continues to increase at a fast pace (about 10% yearly). Other

NIH institutes relevant to psychiatric research, such as NIDA and

NIAAA, have followed pace. Major research priorities at these NIH

institutes include:

=> Studies on the brain, behavior and genetics.

=> Rapid translation of basic discoveries into research on mental disorders.

=> Investigations impacting the treatment of individuals with mental disorders.

=> Clinical trials, and treatment and prevention interventions

conducted in " real world " settings.

=> Childhood mental disorders.

=> Suicide.

=> Health disparities.

Private foundations such as the Wood Foundation

continue to invest heavily in the area of behavioral disorders. The

pharmaceutical industry is hard at work developing new drugs that

look more specific and are better tolerated than the old ones. All

these major investments have placed psychiatric departments among the

top research departments in academic institutions nationally. In

fact, our two departments of psychiatry at UMDNJ Wood

Medical School (RWJMS) and New Jersey Medical School (NJMS) are now

among the top 50 nationally.

In this issue of UMDNJ Research, we present a " sampler " of research

taking place in the departments of psychiatry at RWJMS and NJMS.

While the research highlighted includes faculty members from both

medical school departments, we need to acknowledge the outstanding

contribution of University Behavioral HealthCare (UBHC), our main

clinical partner. Under the leadership of Kosseff, UBHC

has become the main clinical research site for both departments. In

this issue we present ongoing investigations in our two departments

ranging from the cell to the societal level.

=> Addiction (Drs. Ziedonis, Merrill, Atdjian, ).

=> Psychosomatics, including psychological medicine, primary care

psychiatry, neurophysiology and psychoimmunology (Drs. Escobar,

Schleifer, Lehrer).

=> Psychopharmacology and psychoneuroendocrinology (Drs. Menza and Joffe).

=> The consequences of psychological trauma (Dr. Widom).

=> Epidemiology, services research and special populations (Drs.Vega

and Escobar).

=> Basic neuroscience (Drs. Cowen, Manowitz).

=> Geriatrics (Dr. Aupperle).

=> Children (Dr. Cartwright).

=> Special treatments such as ECT (Dr. Kellner).

=====

Studies of Medically Unexplained Physical Symptoms

and Mental Health Disparities

http://www.umdnj.edu/research/publications/summer_02.pdf

by I. Escobar

Volume 4, Number 7, Fall 2002, Page 6-8

LEFT TO RIGHT: ANGELICA DIAZ-MARTINEZ, PsyD; LESLEY ALLEN, PhD;

JAVIER I. ESCOBAR, MD, MS, PROFESSOR AND CHAIR, PSYCHIATRY,

UMDNJ-ROBERT WOOD JOHNSON MEDICAL SCHOOL; CONNIE HOYOS-NERVI, PsyD;

MELISSA WARMAN, PhD; AND MICHAEL GARA, PhD

" A GENERAL CONCEPTION IN PSYCHIATRY AND PSYCHOLOGY THAT HAS HELD FOR

MORE THAN A CENTURY IS THAT MULTIPLE UNEXPLAINED SOMATIC COMPLAINTS

(SOMATIZATION) REPRESENT THE EXPRESSION OF PSYCHOLOGICAL DISTRESS IN

THE FORM OF UNPLEASANT SOMATIC SENSATIONS INTERPRETED AS SIGNS OF DISEASE. "

" AN INTERESTING PARADOX IS THAT RECENT LATINO IMMIGRANTS ARE MUCH

HEALTHIER THAN THEIR U.S.-BORN COUNTERPARTS, BUT THESE ADVANTAGES

SEEM TO DISSIPATE WHEN THEY CONTINUE TO RESIDE IN THE U.S. AFTER A DECADE. "

We have developed strategies to recognize, recruit and retain

patients with mental disorders presenting with multiple unexplained

symptoms at primary care clinics. An effective treatment strategy

specifically developed to manage these patients is being currently

tested, thanks to a large grant from the National Institute of Mental

Health (NIMH). Preliminary results appear to be highly satisfactory.

In efforts to further understand health isparities, we are looking at

the prevalence of major mental disorders and quality of services

offered to Latino populations both inside and outside New Jersey.

These studies are also funded by NIMH.

Somatization Patients presenting with physical symptoms that cannot

be satisfactorily explained by repeated physical and laboratory

assessments are common in primary and specialty care. It is estimated

that as many as one-third of patients presenting to a primary care

provider cannot be diagnosed with a physical illness.

A general conception in psychiatry and psychology that has held for

more than a century is that multiple unexplained somatic complaints

(somatization) represent the expression of psychological distress in

the form of unpleasant somatic sensations interpreted as signs of

disease. Exact mechanisms ediating somatization are unknown.

Nonetheless, the subjective experience of having a physical illness

is a compelling reality for the patient, which tends to persist

despite reassurance from physicians that there is nothing physically

wrong. Typically, these patients resist any efforts to reframe their

distress as a consequence of a psychiatric disorder, such as

depression or anxiety.

These patients have frequent medical visits, and often it appears as

if medical care becomes a social support network for them.

Paradoxically, they often display chronic dissatisfaction with the

care received, and may even seek financial compensation for their

disability and alleged treatment errors.

This latter factor, when added to excessive service use, makes

somatization one of the most expensive entities in medicine.

While the problem of somatization has been variously labeled as

hysteria, ennui, hypochondria or neurasthenia, efforts at scientific

inquiry have begun only recently. In modern diagnostic systems, these

disorders are classified among the " somatoform " disorders in

psychiatry, while the other specialties in medicine use labels that

incorporate their own jargon. This has led to a proliferation of

ambiguous terms such as atypical chronic fatigue and

fibromyalgia, irritable bowel, atypical chest pain, pelvic pain,

pseudoseizures, atypical Lyme disease, and many others.

What makes this situation more confusing is that worldwide, a

physical symptom is the most common presentation for mental

disorders. That is, unexplained physical symptoms, particularly when

appearing in clusters,

presage an underlying depression or anxiety problem. What is most

intriguing, however, is that once the patient firmly endorses these

symptoms, the virulence of the underlying syndrome worsens and

traditional treatments lose punch.

Throughout my psychiatric practice, I have been baffled by the

refractoriness and chronicity of somatization syndromes, and have

examined this problem both clinically and epidemiologically. As

co-principal investigator of the Epidemiological Catchment Area study

(ECA), a national survey of major mental disorders in the U.S.

general population, I described a sub-threshold cluster of

unexplained symptoms known as " Escobar's abridged somatization. "

After coming to RWJMS as chair of psychiatry, I assembled a team of

investigators, thus creating the infrastructure of an institute for

the study of unexplained symptoms. It includes Gara, PhD, an

experimental social psychologist, Woolfolk, PhD, a professor

of clinical psychology at Rutgers University, and Lesley , PhD,

who led a pilot study of a promising new intervention called

Cognitive Behavioral Therapy (CBT).

Encouraged by positive observations in several patients as well as

reports supporting the efficacy of CBT on such functional syndromes

as fibromyalgia, and chronic fatigue and irritable bowel syndromes,

we applied for and received a four-year, $ 1.5 million grant to

compare the efficacy of CBT vs. " usual care " on 240 primary care

patients with high levels of medically unexplained symptoms.

I am principal investigator and Dr. Gara is the co-principal

investigator of the study. Co-investigators include Drs. Woolfolk,

and Lehrer. Other key personnel are Drs. Constanza

Hoyos-Nervi, -ez and Warman.

Co-investigators from the Department of Family Medicine include Drs.

Swee, department chair, Beatrix Hamm and Levin, and

Jahn from Chandler/General Internal Medicine. In just over one year,

the study has recruited more than 50 patients, and thus far,

observations have been very positive.

Researching mental health disparities According to the Census,

Latinos are the largest U.S. minority. Unfortunately, besides being

quite disadvantaged in terms of income, education and insurance

coverage, minority groups such as Latinos are also affected by

significant health disparities. An interesting paradox is that recent

Latino immigrants are much healthier than their U.S.-born

counterparts, but these advantages seem to dissipate when they

continue to reside in the U.S. after a decade. Major health

disparities affecting U.S. minority groups are not related to higher

prevalence of certain diagnoses as is the case with other medical

specialties (e.g., hypertension, diabetes), but unfortunately, to the

type and quality of the services they receive. This was clearly

documented in the recent supplement to the Surgeon General's Report.

Thus, disparities in diagnosis have been documented that may result

from a physician's bias as well as linguistic and cultural misunderstandings.

Because most Latinos with mental disorders do not use specialty

mental health care, efforts have to be made to study them in primary

care settings.

Unfortunately, the absence of solid clinical and epidemiological

information on minority populations is a major problem. Our group,

which includes Vega, Constanza Hoyos-Nervi,

-ez, Miskimen, Humberto Marin, Escobar and

Rueda, in coordination with the federally funded Latino

Research Program Project (LRPP), has initiated studies of Latinos

presenting to primary care. We are testing a number of diagnostic

instruments, assessing patients' mental health status and examining

their response to various therapeutic interventions. This represents

an active collaboration with Drs. and Jahn at the

Chandler Health Center in New Brunswick.

Finally, in terms of epidemiology, as part of the National

Comorbidity Study, which examines the distribution of major mental

disorders in the U.S. population, there has been a recent emphasis on

including representative samples of Latinos, African-Americans and

Asian-Americans. Dr. Vega and I are co-investigators in the

study. We will direct the analyses of data on Mexican-Americans, by

far the largest Hispanic group in the country.

Dr. Escobar received his medical degree at the University of

Antioquia Medical School. After postgraduate training at the

Complutense University in Madrid, he came to the U.S. in 1969. He

completed a psychiatry residency and research fellowship on

psychiatric genetics and received a Masters degree in

psychiatry/medical genetics at the University of Minnesota. In 1994,

Dr. Escobar became professor and chair of psychiatry at RWJMS. He is

currently a member of NIMH's National Advisory Mental Health Council.

In addition he has been an advisor to the World Health Organization

(WHO) and co-director of the North American WHO Collaborating Center.

His research focuses on epidemiology, diagnosis, clinical

psychopharmacology and cross-cultural medicine and psychiatry.

__

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May 8, 2009

Simply go to: www.cchr.org and get educated about the truth behind

" psychiatry " !! This will absolutely disgust you!!!!

~Dana

--- In , " Lawrence A. Plumlee " <laplumlee@...>

wrote:

>

> Influential Psychiatrist Expands Unexplained Illnesses to Include

> Food Allergy, Endometriosis, Chronic Lyme, Sick Bldg. Synd.,

> Repetitive Strain Injury, many others

>

> Dr. J.I. Escobar is director of the MUPS ( " Medically Unexplained

> Physical Symptoms " ) Center at the University of Medicine and

> Dentistry Wood Medical School (UMDNJ-RWJMS),

> which has been funded with $4M over 8 years by the U.S. NIH NIMH.

>

> Dr. Escobar's studies what he terms " Functional Somatic

> Syndromes " (FSS), which he believes are psychiatric somatoform

> disorders. He defines these syndromes to include:

>

> Irritable bowel syndrome, Chronic fatigue syndrome, Fibromyalgia,

> Multiple chemical sensitivity, Nonspecific chest pain, Premenstrual

> disorder, Non-ulcer dyspepsia, Repetitive strain injury, Tension

> headache, Temporomandibular joint disorder, Atypical facial pain,

> Hyperventilation syndrome, Globus syndrome, Sick building syndrome,

> Chronic pelvic pain, Chronic whiplash syndrome, Chronic Lyme disease,

> Silicone breast implant effects, Candidiasis hypersensivity, Food

> allergy, Gulf War syndrome, Mitral valve prolapse, Hypoglycemia,

> Chronic low back pain, Dizziness, Interstitial cystitis, Tinnitus,

> Pseudoseizures, Insomnia, Systemic yeast infection, & Total allergy

> syndrome. (See: Unexplained Physical Symptoms: What's a Psychiatrist

> to Do? Humberto Marin, MD and I. Escobar, MD, Psychiatric

> Times. Vol. 25 No. 9, August 1, 2008

> http://www.psychiatrictimes.com/dsm-v/article/10168/1171223?pageNumber=1# )

>

> Dr. Escobar's opinion is significant because he is a member

> of the American Psychiatric Association (APA) Diagnostic and

> Statistical Manual Fifth Edition (DSM-V) Task Force (TF),

> which is now updating " The Bible " of psychiatry. In particular,

> the APA DSM-V " Somatic Distress Disorders " Work Group

> is now in the process of re-writing the taxonomy of psychiatric

> somatoform disorders, effectively re-drawing the line between

> psychiatry and medicine.

>

> Notably, Dr. Escobar was previously a member of the private

> U.S./U.K CISSD (Conceptual Issues in Somatoform and Similar

> Disorders) Project, which studied how to re-write the DSM and

> ICD taxonomy of somatoform disorders.

>

> The new DSM-V, with its new taxonomy of somatoform disorders,

> will then be " harmonized " with the World Health Organization (WHO)

> International Classification of Diseases Eleventh Edition (ICD-11),

> and thus will redefine boundary between psychiatry and medicine

> worldwide.

>

> Notably, Dr. Escobar has been an advisor to the WHO, and

> co-director of the North American WHO Collaborating Center.

>

> __

> >Psychiatry Research Comes of Age at UMDNJ

>

> >the budget of the National Institute of Mental Health (NIMH)

> reached the one billion dollar mark in FY 2000, and continues to

> increase at a fast pace (about 10% yearly).

>

> >Private foundations such as the Wood Foundation

> continue to invest heavily in the area of behavioral disorders. The

> pharmaceutical industry is hard at work developing new drugs that

> look more specific and are better tolerated than the old ones. All

> these major investments have placed psychiatric departments among the

> top research departments in academic institutions nationally.

>

> __

> >Studies of Medically Unexplained Physical Symptoms and Mental

> Health Disparities

>

> >We have developed strategies to recognize, recruit and retrain

> patients with mental disorders presenting with multiple unexplained

> symptoms at primary care clinics. An effective treatment strategy

> specifically developed to manage these patients is being currently

> tested, thanks to a large grant from the National Institute of Mental

> Health (NIMH). Preliminary results appear to be highly satisfactory.

>

> >A general conception in psychiatry and psychology that has held for

> more than a century is that multiple unexplained somatic complaints

> (somatization) represent the expression of psychological distress in

> the form of unpleasant somatic sensations interpreted as signs of

> disease. Exact mechanisms mediating somatization are unknown.

> Nonetheless, the subjective experience of having a physical illness

> is a compelling reality for the patient, which tends to persist

> despite reassurance from physicians that there is nothing physically wrong.

>

> >These patients have frequent medical visits, and often it appears

> as if medical care becomes a social support network for them.

> Paradoxically, they often display chronic dissatisfaction with the

> care received, and may even seek financial compensation for their

> disability and alleged treatment errors.

> >This latter factor, when added to excessive service use, makes

> somatization one of the most expensive entities in medicine.

>

> >Throughout my psychiatric practice, I have been baffled by the

> refractoriness and chronicity of somatization syndromes, and have

> examined this problem both clinically and epidemiologically. As

> co-principal investigator of the Epidemiological Catchment Area study

> (ECA), a national survey of major mental disorders in the U.S.

> general population, I described a sub-threshold cluster of

> unexplained symptoms known as " Escobar's abridged somatization. "

>

> >Dr. Escobar received his medical degree at the University of

> Antioquia Medical School.

> http://en.wikipedia.org/wiki/University_of_Antioquia

>

> >After postgraduate training at the Complutense University in

> Madrid, he came to the U.S. in 1969.

> http://en.wikipedia.org/wiki/Complutense_University_of_Madrid

>

> >He is currently a member of NIMH's National Advisory Mental Health

> Council. In addition he has been an advisor to the World Health

> Organization (WHO) and co-director of the North American WHO

> Collaborating Center.

>

> __

> For photos of Dr. Escobar and his staff, see original at:

> http://www.umdnj.edu/research/publications/summer_02.pdf

>

> ============

> PSYCHIATRY RESEARCH COMES OF AGE AT UMDNJ

> http://www.umdnj.edu/research/publications/summer_02.pdf

> by I. Escobar

> Volume 4, Number 7, Fall 2002, Page 1, 3

>

> JAVIER I. ESCOBAR, MD, MS, PROFESSOR AND CHAIR, DEPARTMENT OF PSYCHIATRY,

> UMDNJ - ROBERT WOOD JOHNSON MEDICAL SCHOOL

>

> ___

> Sidebar / Page 2:

>

> The University of Medicine and Dentistry of New Jersey is a statewide

> network of eight schools on five campuses in Camden, New

> Brunswick/Piscataway, Newark, Scotch Plains and Stratford. The

> schools include New Jersey Medical School, Wood

> Medical School, School of Osteopathic Medicine, New Jersey Dental

> School, Graduate School of Biomedical Sciences, School of Health

> Related Professions, School of Nursing and School of Public Health.

> The University has more than 4,500 students in 38 degree and

> certificate programs, 11,000 employees, including 2,075 faculty

> members, 17,000 alumni and more than 200 education and healthcare

> affiliates throughout New Jersey.

>

> The University is dedicated to pursuing excellence in the education

> of health professionals and scientists, conducting research,

> delivering health care, and serving the community. UMDNJ is ranked

> among the 100 top research universities in the country.

>

> Please visit our website at http://www.umdnj.edu . E-mail us at

> research@... to comment on this publication or to add someone

> to the mailing list.

>

> ... UMDNJ Research is published by the Department of Government and

> Public Affairs, University of Medicine and Dentistry of New Jersey,

> Publications Office, Stanley Bergen Building, 65 Bergen Street, Room

> 1328, Newark, N.J. 07107-3000. For permission to reprint an article,

> contact the editor. For

>

> ___

> The 1990s were called the decade of the brain in North America,

> stimulating significant research on basic and clinical neuroscience.

> During this period, psychiatry, one of the clinical neurosciences,

> witnessed the development of powerful tools for the study of

> brain-behavior relationships, saw the emergence of safe and effective

> drugs for treating depression, anxiety and schizophrenia, and

> confirmed the positive impact of traditional treatments such as

> psychotherapy, via the controlled clinical trial. The fact that

> biology affects behavior, and conversely, that " stress " and other

> psychological influences affect biology, results in new and exciting

paradigms.

>

> Other important highlights of this decade were:

>

> => The " Global Burden of Disease, " an international study coordinated

> by the World Health Organization, confirmed that mental disorders

> such as major depression are amongst the most prevalent and disabling

> health conditions worldwide.

>

> => " Healthy People 2000, " an initiative of the U.S. Department of

> Health and Human Services, included several mental health outcomes

> among the leading health indicators.

>

> => " Mental Health: A Report of the Surgeon General " documented the

> disabling nature of mental illnesses and showcased the strong basic

> science behind effective treatments, while emphasizing the importance

> of recognizing and treating mental disorders. The supplement that

> followed, " Mental Health, Culture and Ethnicity, " documented

> unfortunate ethnic disparities, particularly regarding access to and

> quality of treatment.

>

> Entering the 21st century, psychiatric research looks very vigorous,

> thanks to a decline in stigma of psychiatric illness, significant

> lobbying by patient advocates and a net increase in available

> research funds. For example, the budget of the National Institute of

> Mental Health (NIMH) reached the one billion dollar mark in FY 2000,

> and continues to increase at a fast pace (about 10% yearly). Other

> NIH institutes relevant to psychiatric research, such as NIDA and

> NIAAA, have followed pace. Major research priorities at these NIH

> institutes include:

>

> => Studies on the brain, behavior and genetics.

>

> => Rapid translation of basic discoveries into research on mental disorders.

>

> => Investigations impacting the treatment of individuals with mental

disorders.

>

> => Clinical trials, and treatment and prevention interventions

> conducted in " real world " settings.

>

> => Childhood mental disorders.

>

> => Suicide.

>

> => Health disparities.

>

> Private foundations such as the Wood Foundation

> continue to invest heavily in the area of behavioral disorders. The

> pharmaceutical industry is hard at work developing new drugs that

> look more specific and are better tolerated than the old ones. All

> these major investments have placed psychiatric departments among the

> top research departments in academic institutions nationally. In

> fact, our two departments of psychiatry at UMDNJ Wood

> Medical School (RWJMS) and New Jersey Medical School (NJMS) are now

> among the top 50 nationally.

>

> In this issue of UMDNJ Research, we present a " sampler " of research

> taking place in the departments of psychiatry at RWJMS and NJMS.

> While the research highlighted includes faculty members from both

> medical school departments, we need to acknowledge the outstanding

> contribution of University Behavioral HealthCare (UBHC), our main

> clinical partner. Under the leadership of Kosseff, UBHC

> has become the main clinical research site for both departments. In

> this issue we present ongoing investigations in our two departments

> ranging from the cell to the societal level.

>

> => Addiction (Drs. Ziedonis, Merrill, Atdjian, ).

>

> => Psychosomatics, including psychological medicine, primary care

> psychiatry, neurophysiology and psychoimmunology (Drs. Escobar,

> Schleifer, Lehrer).

>

> => Psychopharmacology and psychoneuroendocrinology (Drs. Menza and Joffe).

>

> => The consequences of psychological trauma (Dr. Widom).

>

> => Epidemiology, services research and special populations (Drs.Vega

> and Escobar).

>

> => Basic neuroscience (Drs. Cowen, Manowitz).

>

> => Geriatrics (Dr. Aupperle).

>

> => Children (Dr. Cartwright).

>

> => Special treatments such as ECT (Dr. Kellner).

>

> =====

> Studies of Medically Unexplained Physical Symptoms

> and Mental Health Disparities

> http://www.umdnj.edu/research/publications/summer_02.pdf

> by I. Escobar

> Volume 4, Number 7, Fall 2002, Page 6-8

>

> LEFT TO RIGHT: ANGELICA DIAZ-MARTINEZ, PsyD; LESLEY ALLEN, PhD;

> JAVIER I. ESCOBAR, MD, MS, PROFESSOR AND CHAIR, PSYCHIATRY,

> UMDNJ-ROBERT WOOD JOHNSON MEDICAL SCHOOL; CONNIE HOYOS-NERVI, PsyD;

> MELISSA WARMAN, PhD; AND MICHAEL GARA, PhD

>

> " A GENERAL CONCEPTION IN PSYCHIATRY AND PSYCHOLOGY THAT HAS HELD FOR

> MORE THAN A CENTURY IS THAT MULTIPLE UNEXPLAINED SOMATIC COMPLAINTS

> (SOMATIZATION) REPRESENT THE EXPRESSION OF PSYCHOLOGICAL DISTRESS IN

> THE FORM OF UNPLEASANT SOMATIC SENSATIONS INTERPRETED AS SIGNS OF DISEASE. "

>

> " AN INTERESTING PARADOX IS THAT RECENT LATINO IMMIGRANTS ARE MUCH

> HEALTHIER THAN THEIR U.S.-BORN COUNTERPARTS, BUT THESE ADVANTAGES

> SEEM TO DISSIPATE WHEN THEY CONTINUE TO RESIDE IN THE U.S. AFTER A DECADE. "

>

> We have developed strategies to recognize, recruit and retain

> patients with mental disorders presenting with multiple unexplained

> symptoms at primary care clinics. An effective treatment strategy

> specifically developed to manage these patients is being currently

> tested, thanks to a large grant from the National Institute of Mental

> Health (NIMH). Preliminary results appear to be highly satisfactory.

>

> In efforts to further understand health isparities, we are looking at

> the prevalence of major mental disorders and quality of services

> offered to Latino populations both inside and outside New Jersey.

> These studies are also funded by NIMH.

>

> Somatization Patients presenting with physical symptoms that cannot

> be satisfactorily explained by repeated physical and laboratory

> assessments are common in primary and specialty care. It is estimated

> that as many as one-third of patients presenting to a primary care

> provider cannot be diagnosed with a physical illness.

>

> A general conception in psychiatry and psychology that has held for

> more than a century is that multiple unexplained somatic complaints

> (somatization) represent the expression of psychological distress in

> the form of unpleasant somatic sensations interpreted as signs of

> disease. Exact mechanisms ediating somatization are unknown.

> Nonetheless, the subjective experience of having a physical illness

> is a compelling reality for the patient, which tends to persist

> despite reassurance from physicians that there is nothing physically

> wrong. Typically, these patients resist any efforts to reframe their

> distress as a consequence of a psychiatric disorder, such as

> depression or anxiety.

>

> These patients have frequent medical visits, and often it appears as

> if medical care becomes a social support network for them.

> Paradoxically, they often display chronic dissatisfaction with the

> care received, and may even seek financial compensation for their

> disability and alleged treatment errors.

>

> This latter factor, when added to excessive service use, makes

> somatization one of the most expensive entities in medicine.

>

> While the problem of somatization has been variously labeled as

> hysteria, ennui, hypochondria or neurasthenia, efforts at scientific

> inquiry have begun only recently. In modern diagnostic systems, these

> disorders are classified among the " somatoform " disorders in

> psychiatry, while the other specialties in medicine use labels that

> incorporate their own jargon. This has led to a proliferation of

> ambiguous terms such as atypical chronic fatigue and

> fibromyalgia, irritable bowel, atypical chest pain, pelvic pain,

> pseudoseizures, atypical Lyme disease, and many others.

>

> What makes this situation more confusing is that worldwide, a

> physical symptom is the most common presentation for mental

> disorders. That is, unexplained physical symptoms, particularly when

> appearing in clusters,

> presage an underlying depression or anxiety problem. What is most

> intriguing, however, is that once the patient firmly endorses these

> symptoms, the virulence of the underlying syndrome worsens and

> traditional treatments lose punch.

>

> Throughout my psychiatric practice, I have been baffled by the

> refractoriness and chronicity of somatization syndromes, and have

> examined this problem both clinically and epidemiologically. As

> co-principal investigator of the Epidemiological Catchment Area study

> (ECA), a national survey of major mental disorders in the U.S.

> general population, I described a sub-threshold cluster of

> unexplained symptoms known as " Escobar's abridged somatization. "

>

> After coming to RWJMS as chair of psychiatry, I assembled a team of

> investigators, thus creating the infrastructure of an institute for

> the study of unexplained symptoms. It includes Gara, PhD, an

> experimental social psychologist, Woolfolk, PhD, a professor

> of clinical psychology at Rutgers University, and Lesley , PhD,

> who led a pilot study of a promising new intervention called

> Cognitive Behavioral Therapy (CBT).

>

> Encouraged by positive observations in several patients as well as

> reports supporting the efficacy of CBT on such functional syndromes

> as fibromyalgia, and chronic fatigue and irritable bowel syndromes,

> we applied for and received a four-year, $ 1.5 million grant to

> compare the efficacy of CBT vs. " usual care " on 240 primary care

> patients with high levels of medically unexplained symptoms.

>

> I am principal investigator and Dr. Gara is the co-principal

> investigator of the study. Co-investigators include Drs. Woolfolk,

> and Lehrer. Other key personnel are Drs. Constanza

> Hoyos-Nervi, -ez and Warman.

> Co-investigators from the Department of Family Medicine include Drs.

> Swee, department chair, Beatrix Hamm and Levin, and

> Jahn from Chandler/General Internal Medicine. In just over one year,

> the study has recruited more than 50 patients, and thus far,

> observations have been very positive.

>

> Researching mental health disparities According to the Census,

> Latinos are the largest U.S. minority. Unfortunately, besides being

> quite disadvantaged in terms of income, education and insurance

> coverage, minority groups such as Latinos are also affected by

> significant health disparities. An interesting paradox is that recent

> Latino immigrants are much healthier than their U.S.-born

> counterparts, but these advantages seem to dissipate when they

> continue to reside in the U.S. after a decade. Major health

> disparities affecting U.S. minority groups are not related to higher

> prevalence of certain diagnoses as is the case with other medical

> specialties (e.g., hypertension, diabetes), but unfortunately, to the

> type and quality of the services they receive. This was clearly

> documented in the recent supplement to the Surgeon General's Report.

>

> Thus, disparities in diagnosis have been documented that may result

> from a physician's bias as well as linguistic and cultural misunderstandings.

> Because most Latinos with mental disorders do not use specialty

> mental health care, efforts have to be made to study them in primary

> care settings.

>

> Unfortunately, the absence of solid clinical and epidemiological

> information on minority populations is a major problem. Our group,

> which includes Vega, Constanza Hoyos-Nervi,

> -ez, Miskimen, Humberto Marin, Escobar and

> Rueda, in coordination with the federally funded Latino

> Research Program Project (LRPP), has initiated studies of Latinos

> presenting to primary care. We are testing a number of diagnostic

> instruments, assessing patients' mental health status and examining

> their response to various therapeutic interventions. This represents

> an active collaboration with Drs. and Jahn at the

> Chandler Health Center in New Brunswick.

>

> Finally, in terms of epidemiology, as part of the National

> Comorbidity Study, which examines the distribution of major mental

> disorders in the U.S. population, there has been a recent emphasis on

> including representative samples of Latinos, African-Americans and

> Asian-Americans. Dr. Vega and I are co-investigators in the

> study. We will direct the analyses of data on Mexican-Americans, by

> far the largest Hispanic group in the country.

>

> Dr. Escobar received his medical degree at the University of

> Antioquia Medical School. After postgraduate training at the

> Complutense University in Madrid, he came to the U.S. in 1969. He

> completed a psychiatry residency and research fellowship on

> psychiatric genetics and received a Masters degree in

> psychiatry/medical genetics at the University of Minnesota. In 1994,

> Dr. Escobar became professor and chair of psychiatry at RWJMS. He is

> currently a member of NIMH's National Advisory Mental Health Council.

> In addition he has been an advisor to the World Health Organization

> (WHO) and co-director of the North American WHO Collaborating Center.

> His research focuses on epidemiology, diagnosis, clinical

> psychopharmacology and cross-cultural medicine and psychiatry.

> __

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>

May 8, 2009

For years there was denial about fibromyalgia and now...they are using Lyrica®

to treat a condition which supposedly is all in your head.

They are very foolish to think that no one is watching them. If they developed

medication for treatment after proper competent diagnosis, there would probably

be little objection but to deny an illness and then FIND a treatment is counter

intuitive...

>

> Simply go to: www.cchr.org and get educated about the truth behind

" psychiatry " !! This will absolutely disgust you!!!!

>

> ~Dana

May 8, 2009

Thanks for the link to www.cchr.org. I went to their website, found their

contact information and sent them a message about this ridiculous report by Dr.

Escobar.

________________________________

From: gsgrl2000 <gsgrl2000@...>

Sent: Friday, May 8, 2009 2:15:24 PM

Subject: [] Re: Influential Psychiatrist Expands Unexplained

Illnesses to Include Food Allergy, Endometriosis, Chronic Lyme, Sick Bldg.

Synd., Repetitive strain injury, many others

Simply go to: www.cchr.org and get educated about the truth behind " psychiatry "

!! This will absolutely disgust you!!!!

~Dana

--- In , " Lawrence A. Plumlee " <laplumlee@. ..>

wrote:

>

> Influential Psychiatrist Expands Unexplained Illnesses to Include

> Food Allergy, Endometriosis, Chronic Lyme, Sick Bldg. Synd.,

> Repetitive Strain Injury, many others

>

> Dr. J.I. Escobar is director of the MUPS ( " Medically Unexplained

> Physical Symptoms " ) Center at the University of Medicine and

> Dentistry Wood Medical School (UMDNJ-RWJMS) ,