Arthur Westover

The ACGME is soliciting input on how adult psychiatrists will be trained in the future. We NEED a requirement that adult psychiatrists learn to treat autistic and IDD adults. Colleagues, please request that this training be added! #psychiatry #autism editor.ne16.com/vo/?FileID=6de…

non-broken link as of today: gq.com/story/suicide-…

GQ 2010: The Suicide Catcher. Man stands vigil on Chinese bridge to rescue would-be jumpers. gq.com/news-politics/… thisamericanlife.org/radio-archives…

@QuantPsychiatry @taperclinic He won’t engage with your post.

I mean we still don't have good evidence that the therapeutic mechanism of antidepressant action is either numbing or energizing. The studies that have actually used questionnaires like the OQuESA (now the ODQ) to measure emotional blunting from antidepressants formally have not actually found that the change in emotional blunting over time is anticorrelated with depression severity (i.e., as people get more blunted, the depression gets better, which is what you would actually expect if the meds were doing what you say they are). In fact, the opposite happens, and as people get less depressed, the ones who are blunted still *are improving less* than the ones who are not blunted (shockingly, emotional blunting doesn't actually seem to be a mechanism whereby one's depression tends to improve). See this paper for actual empirical data on this: ("Greater change in ODQ scores was seen in patients who responded “No” to the screening question on emotional blunting after 8 weeks of vortioxetine treatment than in those who responded “Yes” at this time" - doi.org/10.1016/j.jad.…). You're welcome to find some counterexamples, but vibes and anecdote don't exactly cut it.

Establishment psych will make up any bullshit rather than just admit they temporarily numb or energize people—until the effect inevitably wears off leaving the person worse off

@QuantPsychiatry @BadreNicolas We have seen wide variances in the approach of judges (in other words, elections have consequences). I have probably said too much already, but in some cases it has been felt to significantly harm patient care.

And this standard is obviously very reasonable. It ends up in one of those weird theory-practice gaps where the actual ecosystem of judge-hospital relationships completely dictates whether or not there's a genuine trial or a perfunctory one (tbh, I often see the latter in TN, especially when reviewing involuntary commitment orders [though I would agree the vast majority of these orders were completely justified, the system for challenging them should still be better if people want to have any chance at actually fighting abuses of power]).

Legal standard on involuntary meds in the US Doctors argue that they "should be responsible for making treatment decisions for involuntarily committed patients, whether competent or not. We do not agree." 1983, Rogers v. Commissioner. In the US, involuntary medication requires an additional finding beyond involuntary commitment. In 1983, Rogers v. Commissioner set this standard. Ms. Rogers, involuntarily committed to a state hospital, argued that this should not permit involuntary medication without further competency assessment. The court agreed. Since Rogers v. Commissioner, involuntarily medications are based on one needs of the following: (1) incompetent to make decisions regarding meds, which must be approved by a judge or (2) emergency, . Here are some quotes from the ruling: • Involuntary treatment ≠ involuntary meds "Incompetence must be determined by a judge in accordance with the statutory provisions." • Judge needed "Incompetence must be determined by a judge" • Emergency "only if a patient poses an imminent threat of harm to himself or others, and only if there is no less intrusive alternative to antipsychotic drugs • Need a court order if not an emergency "In a nonemergency situation, no State interest is sufficiently compelling to overcome a patient's decision to refuse" • Misuse of meds - used for "the convenience of the staff and for punishment" • Misuse of meds #2 - used for "for purposes of behavior control and staff convenience, rather than for legitimate treatment needs"

Excellent reporting on autism research funding by @RobinRespaut at Reuters, article featuring @HelenTager and NCSA's @JillEscher. Autism research funding down by 26%. reuters.com/business/healt…

@katiewr31413491 If your IQ>50, and you can speak more than single words or fixed phrases, then you won't qualify for profound autism. There are many people who can speak in simple sentences, but can't converse, and need 24/7 care.

@ArthurWestover How is that possible ? If u need 24/7 care u have profound #3 autism

There are a lot of people that are currently diagnosed with level three autism, but won't meet profound autism criteria. In other words they need 24 hour care in many cases (some with challenging behaviors), but won’t meet criteria for profound autism. "Level 3, not PA."

@flcro @Autismville Probably true. That's why we need better medical education related to treatment and care of autism/IDD. Sorely lacking currently, for a number of reasons.

@ArthurWestover @Autismville Most non-specialists aren’t interested in anything other than socially acceptable autism, if they even know it exists. Most doctors other than specialists know very little about it either. Asperger’s IS “autism” for most people.

@PaulWhiteleyPhD I missed that era.

@ArthurWestover You only need to see the amount of media that used to come from the conference compared to recent to see the difference. Other meetings offer more science.

"But to encompass the breadth of the autism spectrum, we need to make space for the medical model too." (Simon Baron-Cohen, 2019). So at #INSAR2025, an autism research conference, how much of it was devoted to the medical model? I have a new friend who has been to INSAR (cont.)

@DrHannahBelcher True. But there is less of a chance that they are on SSI, live in a group home with 24/7 supervised care, have elopement concerns, and so forth.

@DrHannahBelcher I can't disagree. But I wonder if what used to be Asperger's is not spun off into its own diagnosis or category, what does it mean for level 3 (but not profound) to be lumped in with level 1 Asperger's in terms of research implications and funding.

I have concerns about how this group will be treated in the new future diagnostic paradigm re: research and care/resources.

@BigBadBee I certainly believe there is a wide range of aims that can be funded. But to answer your 1st question, for example, I have an autistic patient who has a rare genetic disorder, where avg lifespan is mid-20s. He's in his 20s. Genetic treatment trials, starting, may save his life.

@ArthurWestover So the debate should be… Why the expensive genetics? Why the expensive mris? Why not the inexpensive anthropologies of care settings? Why not gentle participation in knowledge creation? Not the haggling over definitions that seem to be about insurance codes (sorry UK here).

Okay, I’ve stepped out of #INSAR2025 to have a bit of a think about why this ‘profound autism’ debate is really bothering me. I get that scientific research moves in ebbs and flows. Sometimes one group or set of needs comes to the fore, and at other times it’s another.

@BigBadBee What priorities get their fair share of resources has been the basis of the entire debate, and explains the emergence of "profound autism" as a concept/subgroup. Do the profoundly autistic get the resources they need in balance w/ competing needs?

@ArthurWestover That is an easier question to have a go at… research (like some I do) with autistic folk with high(er) support needs doesn’t get the funding. The little funding available seems to be sucked up by research with shiny machines rather than by researchers listening to people.

I understand that recordings will be available later. The audience was much too small. More people need to see & hear this.

The "Understanding heterogeneity" panel Sat. 2pm at #INSAR2025 w/ Courchesne, Pierce, Bertelsen, and Radecki was important. Getting to the biology of subgroups in autism. And an impassioned plea by Dr. Courchesne for autism science to get back to science, and NIH to support it.

@haitham_amal it was a very interesting session

Excited to announce our session at #INSAR2025 in Seattle!
I’ll be chairing and speaking about the latest advancements in developing a drug for #autism.
We have an incredible lineup of speakers: Stuart Lipton, Michelle Jacob, Lidia Gabis, and Haitham Amal.

The need to address the heterogeneity of the autism diagnosis was the most important theme of #INSAR2025. Not for political reasons, but for real research reasons, to help ALL AUTISTIC PEOPLE. Now the challenge is to find biologically based ways to do this. 🙏@AutismScienceFd