{"id":12463,"date":"2011-08-25T18:00:19","date_gmt":"2011-08-25T22:00:19","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=12463"},"modified":"2011-08-25T18:00:19","modified_gmt":"2011-08-25T22:00:19","slug":"2-when-nmany","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2011\/08\/25\/2-when-nmany\/","title":{"rendered":"2. when n=many<\/em>…"},"content":{"rendered":"
Dr. Patrick McGorry had convinced the Australian government to fund a $400 M Program – Early Psychosis Prevention and Intervention Centres [EPPIC]<\/font><\/strong> which provoked a brisk reaction – a lot of it negative. One of his critics was Dr. Allen Frances, former Chairman of Psychiatry at Duke, and Chair of the DSM-IV<\/font><\/strong> committee who has been writing a blog in Psychology Today<\/font><\/strong> [DSM5 in Distress<\/font><\/strong><\/a><\/u>] criticizing the closed process of the DSM5 Committee and many of their proposed changes, including the possible addition of the Prodromal Risk Syndrome<\/font><\/strong> [Psychosis Risk Syndrome<\/font><\/strong>, Attenuated Psychosis Syndrome<\/font><\/strong>] to the manual. It was, in fact, this diagnosis that prompted Dr. Frances to speak out against the DSM-5 process in the first place [Psychosis Risk Syndrome: Just As Risky With A New Name<\/font><\/strong><\/u><\/a>]. In March 2011, Dr. Frances wrote a very critical blog post [Australia’s Reckless Experiment In Early Intervention<\/font><\/strong><\/u><\/a>] about the EPPIC<\/font><\/strong> Project and Dr. McGorry:<\/div>\n
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McGorry’s goal is certainly great. But its current achievement is simply impossible and Australia’s plans are patently premature. Early intervention to prevent psychosis requires first that there be an accurate tool to identify who will later become psychotic and who will not. Unfortunately, no such accurate tool exists. The false positive rate in selecting prepsychosis is at least about 60-70% in the very best of hands and may be as high as 90% in general practice. That’s right, folks, nine misidentified non patients for one accurately identified truly prepsychotic patient. Those are totally unacceptable odds.<\/p>\n

What are the costs? McGorry does not recommend antipsychotic medications as a routine part of his prevention regimen. But experience teaches us that they will be overused despite having no proven efficacy and posing the risk of massive weight gain [and its consequent array of serious complications].<\/font><\/strong> The false positives will also suffer unnecessary stigma and worry and will undergo unnecessary and misdirected treatment. And surely there are many more productive ways to spend $400 million doing a better job of managing the mental health needs of those who have real and treatable psychiatric disorders.<\/p>\n

Unfortunately, McGorry is a false prophet who’s visions are offered at least a few decades before their time. Australia, led astray by his impractical hopes, is about to embark on a vast and untried public health experiment that will almost surely cause more harm to its children than it prevents. Before embarking on this headlong and reckless rush, the following research steps need to be accomplished:<\/sup><\/div>\n