Saturday, June 25, 2011

Another quote to ponder

(this post has been edited a number of times for clarification)

"We're trying to say that some who have failed psycho-social therapy but are severely unwell in a pre-psychosis stage, maybe some of them do need anti-psychotics and that needs to be studied before it's ever advocated for of course," he says."

This is what I believe is a revealing quote attributed to Professor Patrick McGorry from an article in The Australian newspaper from only ten days ago. I believe this quote is revealing for a couple of reasons. Firstly, it shows that the professor is indeed prepared to consider prescribing highly problematic anti-psychotic drugs to a patient who does not meet the full diagnostic criteria for a psychotic mental illness, a situation which is just the type of scenario that professor emeritus Allen J.Frances MD from the US has repeatedly expressed much concern about.

The second thing that I find interesting about this quote is the apparently confused thinking that it betrays. If a patient is in "a pre-psychosis stage" then presumably they are not fully psychotic. Commentators have claimed that McGorry's new diagnosis of "pre-psychosis" has a huge false-positive rate, with most of the youth that it identifies as potential cases of psychosis or schizophrenia not being genuine early cases at all. So I've got to wonder how these patients can be "severely unwell". If they are "severely unwell", why don't they qualify for a full diagnosis of a psychotic mental illness?

According to what Prof. McGorry himself has said about the new psychiatric disease category of "Psychosis Risk Syndrome", which Prof. McGorry has strongly advocated for, a huge 70% of the patients who meet the criteria for this proposed new "pre-psychotic" mental illness and are given only non-drug intervention will NOT proceed to becoming genuinely psychotic:

"Six studies around the world now show 30 per cent of patients given supportive care only went on to develop psychosis but 10 per cent of those given drugs and cognitive behavioural therapy went on to psychosis, McGorry says."

If this is true, the intervention does help some people, but it also needlessly labels a large proportion of patients. Given what I've read about the large false-positive rate and the apparent lack of need for drug therapy of the majority of the people who have been given this "pre-psychosis" label, I frankly find it hard to believe that so-called "pre-psychotic" patients can be "severely unwell" due to psychosis, as Prof. McGorry claims they could be in the quote from The Australian. I'm very much tempted to consider whether, if these patients do indeed have severe problems, are their problems due to some issue or illness other than psychosis? This raises the spectre of psychiatric misdiagnosis, an issue that one can find throughout the entire history of psychiatry as a medical specialty, and a problem that has ruined many lives. The more that I read about the expensive federal government funded plans of the former Australian of the year Professor Patrick McGorry, the more concerned I feel.

Just to put into perspective the issue of incorrectly prescribing antipsychotic drugs to young people who don't really need them, I'd like to point out that these drugs, also known as neuroleptic drugs, have many serious problems as acknowledged side effects, including obesity, diabetes and a number of different forms of permanent brain damage that cause disturbing-looking facial tics. Tardive dyskinesia is one of these drug-induced tic syndromes. It is a tragic fact that the drugs themselves can mask the underlying brain damage and tics that can be caused by the use of these drugs, so that the patient and the prescribing doctor may be unaware of the damage being done by these drugs until the patient is taken off the drugs, and then the hideous tics become obvious. The patient can then look forward to a life blighted with bizarre involuntary tics that make then look crazier than they ever were before.

It appears that Professor McGorry is so obsessed about the supposedly 20% of patients who might be saved from developing full psychosis by being given drugs and therapy early that he has overlooked the majority of patients who would be identified with the proposed new diagnosis, the false-positives, who would be falsely diagnosed and permanently stigmatized as having a pre-psychosis mental illness, and who risk being given drugs that can ruin lives. It also appears that McGorry is so over-focused on potential benefits of his new vision of adolescent mental health that he doesn't realise that at least some people are going to notice the definite hazard of causing harm, and might identify this as a bigger thing than the potential pluses. I believe that I see a clinician who has no proper perspective on the issue.

Dunleavy, Sue (2011) Schism opens over ills of the mind. Australian. June 16th 2011.

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