Saturday, November 12, 2011

Another addition to the war of words over early psychosis

GP David Shiers and bipolar disorder expert Prof. Jan Scott, both from the UK, are both quoted in this report in the Weekend Australian, and they both lend support to the vision of early intervention in psychosis that has been promoted by Prof. Patrick McGorry. I have a few comments about the content of this article. Dr Shiers is quoted as claiming that new early intervention services, presumably in the UK, save money by lowering the rate of hospital readmissions. Where's the published study that demonstrates as much? There is no reference to any published study in this newspaper report, so I've got to assume that there isn't one.

Professor Scott's assertion that "...there is no medical disorder in which the outcome is better if you delay treatment" is presented in this article as a supporting argument for McGorry's early intervention program, but it fails, for two reasons. Firstly, it doesn't really address the previously expressed fears of Dr Allen Frances that McGorry's early intervention plans for a condition that is characterised as pre-psychosis will probably misdiagnose young patients who are not genuinely developing cases of psychosis. There is simply no value in intervening early with patients who are not geuninely ill. Secondly, Prof. Scott's assertion fails as a supporting argument because it simply isn't true. I can easily think of medical diseases, disorders and conditions in which the best medical practice is either watchful waiting or delaying treatment for a specified period. Some mild infections are best left untreated but with monitoring if it is not clear that antibiotics are necessary, and I know of at least one birth defect in which self-correction can happen in infancy, and therefore the best medical proctice is to delay surgery till the age at which the chances of spontaneous healing are negligible. I also believe that best medical practice for some cases of prostate cancer might be watchful waiting. Most cases of stuttering (a speech disorder) in early childhood remit spontaneously, and the last time I checked there was virtually nothing in way of credible published evidence that the treatment program used by most speech pathologists works better than no treatment, so the argument for doing nothing, at least in the early years, makes sense. When a medical doctor makes such a questionable and dogmatic statement I believe we should take that as a hint that an interventionist bias combined with an insufficient regard for all of the options and all of the evidence about outcomes could be operating, which is the last thing that we need in the vexed and heated dispute over how to treat Australian youths who may, or may not, be developing a serious mental illness.

At odds over early psychosis.
by: Sue Dunlevy
From:The Australian
November 12, 2011


  1. I would love to see how they research the topic of delayed or no treatment everyone that doesn't show up at the hospital that day ? Since I was raised as a Christian Scientist and then had no money for health insurance most of my life...I am a perfect example of someone who probably has a great natural immune system . As to the Aspergers < I think there are some advantages to not having interventions as far as trying things I would have never tried had I been told I "can't do that because of AS" . My brain may have glitches but there is no guarantee that some "experts" opinion of how my brain should be rewired is any better then how my own brain rewires itself to cope .

  2. I believe that delayed or no treatment is not that had to study, in fact the most basic requirement of any scientific study of an intervention, the randomized controlled trial, must have a control group of patients who receive no treatment or the standard treatment or a placebo treatment. For a proper study of a stuttering early intervention the obvious control group is a group of young kids who stutter who are left on a waiting list to access a speech pathologist, randomly chosen, with the treatment group randomly chosen from the same pool of waiting young patients. The only issue with this is the ethics of denying treatment, but this is no issue if there is no certainty that the treatment is of any use.