This weeks blog ( http://speedupsitstill.com/ ) welcomes Patrick McGorry’s change of heart in abadoning his advocacy of pre-psychosis drugging and calls on the Australian of the Year to oppose the inclusion of Psychosis Risk Syndrome in the handbook of psychiatry the DSM.
For over a decade Patrick McGorry had advocated the prescription of antipsychotics to adolescents on the hunch that they may later become psychotic. However, in response to last week’s blog ( http://speedupsitstill.com/patrick-mcgorry%e2%80%99s-call-early-intervention-psychosis-stitch-time-stitch-up ) a spokesperson for Professor McGorry told the West Australian Professor McGorry no longer supports pre-psychosis drugging.
To the best of my knowledge this is the first time Professor McGorry has publicly declared that he has abandoned his support for the use of antipsychotics to prevent psychosis. His change of position is welcome. However, history tells it will not be enough to prevent a tide of pre-emptive drugging if Psychosis Risk Syndrome is included in DSMV, the next edition of the American Psychiatric Associations handbook of psychiatry.
If this happens over-confident clinicians influenced by drug company hype (and possibly inducements) will prescribe adolescents antipsychotics as ‘bit of extra insurance’ just in case they later become psychotic. It won’t be the majority of potential prescribers who create a problem, but as we learned from the manufactured ADHD epidemic a handful of rogue prescribers can do enormous damage whilst the majority of their colleagues silently look on.
Officially recognising Psychosis Risk Syndrome in the DSMV would give a false legitimacy to the use of anti-psychotics for the treatment of the “disorder”. It would also give legitimacy to the “disorder” itself. Given that the vast majority (60%-90%) of those diagnosed with Psychosis Risk Disorder would be misdiagnosed ‘false positives’ it is legitimacy it does not deserve.
It is encouraging that Professor McGorry now acknowledges that it is reasonable to hold contrary views on the merit of including ‘Psychosis Risk Syndrome’ in DSMV. This is a significant change from his recent rhetoric of 21st Century proven solutions. Hopefully it indicates an increasing willingness to base clinical practice on evidence rather than hypothesis.
I suspect that this softening of Professor Mcgorry’s position is in large part due to the 180 degree reversal of support for Psychosis Risk Syndrome by his long term research partner at Orygen Youth Health psychiatrist Dr Alison Yung. In 2009 Dr Yung said; ‘So why the need for a specific risk syndrome diagnosis? Is the agenda really to use antipsychotics?
Dr Yung’s change is significant, but as Australian of the Year and a former president and current treasurer of the International Early Psychosis Association, it is Professor McGorry who has both the ear of government and the international psychiatric profession.
Changing his view on the validity of Psychosis Risk Syndrome being included in DSMV would not be an admission of failure but an act of a truly deserving Australian of the Year. More importantly according to Dr Allen Frances, the American Psychiatrist who led the 1994 revision of the current edition of the DSM (DSM-IV), it would help avoid ‘an iatrogenic [adverse
effects resulting from treatment] public health disaster’
The full content of the blog is included below or available at http://speedupsitstill.com/
Barring unexpected devlopments next weeks blog (Monday December 5) will examines the question; One year on and what action has the Gillard Government taken on the discredited National ADHD Guidelines?
Martin Whitely MLA
Author Speed Up and Sit Still
Past Blogs
Monday November 15 2010 – ADHD child prescribing rates increase sharply; with Sydney, Brisbane and Hobart vying for the dubious honour of being Australia’s Child Drugging Capital. http://speedupsitstill.com/sydney-brisbane-hobart-vie-dubious-honour-australia%e2%80%99s-adhd-child-drugging-capital
Monday November 22 2010 – Australian of the Year patrick McGorry’s call for early interventionto prevent psychosis: a Stitch in Time or a Step too Far. http://speedupsitstill.com/patrick-mcgorry%e2%80%99s-call-early-intervention-psychosis-stitch-time-stitch-up
Coming Blogs at http://speedupsitstill.com/news
Monday December 5- One year on and what action has the Gillard Government taken on the discredited National ADHD Guidelines?
Monday December 12- New Research; beating boredom a key to keeping kids ADHD drug free (by guest blogger Dr Nigel Williams).
Monday December 19- The ADHD Birthday Lottery; how a childs birthday effects their chances of being diagnosed.
Patrick McGorry stops advocating ‘pre-psychosis drugging’ and should now abandon his support for the inclusion of ‘Psychosis Risk Syndrome’ in DSMV
For over a decade Patrick McGorry had advocated the prescription of antipsychotics to adolescents on the hunch that they may later become psychotic. However, in response to last week’s blog a spokesperson for Professor McGorry told the West Australian he does “not recommend this (pre-psychosis drugging) as a standard treatment for clinical care because there are other treatments that are safer, like cognitive behavioural therapy and fish oil….there has been a substantial amount of research and we do change according to the research.”[1]
To the best of my knowledge this is the first time Professor McGorry has publicly declared that he has abandoned his support for the use of antipsychotics to prevent psychosis. His change of position is welcome. However, history tells it will not be enough to prevent a tide of pre-emptive drugging if Psychosis Risk Syndrome is included in DSMV, the next edition of the American Psychiatric Associations handbook of psychiatry.[2]
Unfortunately it is common practice for psychiatric drugs to be used ‘off label’ for non-approved purposes, without supporting research on the ‘hunch’ of the prescribing clinician. For example across the globe hundreds of thousands of pre-schoolers have been prescribed Ritalin for ADHD despite the fact that the manufacturers warning ‘there is not enough information to recommend its use in children under 6 years old.’[3]
This is exactly what will happen with anti-psychotics if Psychosis Risk Syndrome is included in DSMV. Over-confident clinicians influenced by drug company hype (and possibly inducements) will prescribe adolescents antipsychotics as ‘bit of extra insurance’ just in case they later become psychotic. It won’t be the majority of potential prescribers who create a problem, but as we learned from the manufactured ADHD epidemic a handful of rogue prescribers can do enormous damage whilst the majority of their colleagues silently look on.
Officially recognising Psychosis Risk Syndrome in the DSMV would give a false legitimacy to the use of anti-psychotics for the treatment of the “disorder”. It would also give legitimacy to the “disorder” itself. Given that the vast majority (60%-90%) of those diagnosed with Psychosis Risk Disorder would be misdiagnosed ‘false positives’ it is legitimacy it does not deserve.[4]
But most importantly it is completely unnecessary to include Psychosis Risk Syndrome in the DSMV. Professor McGorry and fellow psychiatrists do not need a new “disorder” to allow his now preferred treatments, cognitive behaviour therapy and fish oil, to be used for troubled adolescents.
On the positive side, in addition to reversing his support for the use of anti-psyhotics before any psychotic episode, Professor McGorry’s policy advisor, Matthew Hamilton, has also acknowledged that Professor McGorry is now open to considering these non-pharmaceutical treatments as the first line of treatment for adolescents who have experienced a first psychotic episode.
This is more good news. It may encourage clinicians to identify and deal with the causes of first psychosis free from the ‘mist of medication’ and will not prevent the later use of antipsychotics if less chemically invasive treatments are ineffective.
It is also encouraging that Professor McGorry now acknowledges that it is reasonable to hold contrary views on the merit of including ‘Psychosis Risk Syndrome’ in DSMV. This is a significant change from his recent rhetoric of 21st Century proven solutions. Hopefully it indicates an increasing willingness to base clinical practice on evidence rather than hypothesis.
I suspect that this softening of Professor Mcgorry’s position is in large part due to the 180 degree reversal of support for Psychosis Risk Syndrome by his long term research partner at Orygen Youth Health psychiatrist Dr Alison Yung. In 2009 Dr Yung said; ‘So why the need for a specific risk syndrome diagnosis? Is the agenda really to use antipsychotics?…I think there are concerns about validity, especially predictive validity, and this relates to potentially stigmatizing and unjustified treatment for some individuals as well as all the negative social effects of diagnosis. I think including the risk syndrome in the DSM-V is premature.’[5]
Dr Yung’s change is significant, but as Australian of the Year and a former president and current treasurer of the International Early Psychosis Association, it is Professor McGorry who has both the ear of government and the international psychiatric profession.
Changing his view on the validity of Psychosis Risk Syndrome being included in DSMV would not be an admission of failure but an act of a truly deserving Australian of the Year. More importantly according to Dr Allen Frances, the American Psychiatrist who led the 1994 revision of the current edition of the DSM (DSM-IV), it would help avoid ‘an iatrogenic [adverse
effects resulting from treatment] public health disaster’.[6]
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November 30, 2010
tony serve
Existing posts and pages can be found and linked to using dynamic search.
When you’re in your dashboard and you click to the Posts section (or Pages, Media, any screen with one of those listing tables), do you ever wish you could click a column header to change the display, like to sort things by date, alphabetically, by author, or other criteria? I know I wish for it all the time. And now we have it! This feature is a product of a successful Google Summer of Code student project, proof that the program is a great way to get involved with WordPress development. The little arrow next to the column heading (in my example screenshot, the Date column) shows you which column is determining the sort order, and if it’s ascending or descending. Just click on the column header to sort by that column, or to reverse the order.
If you have a lot of content, you may have run into a mildly annoying experience at some point when paging through screens in the dashboard that list your posts, media files, etc. Clicking forward and back is easy enough, as is skipping to the first or last couple of screens, but what about the middle? Say you had 23 screens worth of post listings, you’re on screen #6, and based on the dates, you think the one you’re looking for might be around page 15 or so. You would have had to click several times to advance a few screens at a time until you reached the screen you wanted. No more! With our new pagination style, those quick forward/back and first/last links are still there, but now you can jump right to any screen by just changing the editable number shown in the pagination area (and hitting enter). Sweet!
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