{"id":13258,"date":"2011-09-15T10:00:11","date_gmt":"2011-09-15T14:00:11","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=13258"},"modified":"2011-09-15T07:00:06","modified_gmt":"2011-09-15T11:00:06","slug":"the-appearance-of-a-conflict-of-interest","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2011\/09\/15\/the-appearance-of-a-conflict-of-interest\/","title":{"rendered":"the appearance of a conflict of interest…"},"content":{"rendered":"
As long as we’re on the subject of psychiatrists working behind the scenes, I’d like to return to the topic of Dr. Patrick McGorry who is in the center of the push for early intervention in an "ultra high risk" of adolescents and young adults who go on to develop Schizophrenia at a greater rate than others [the magnitude of that rate varies from study to study and from investigator to investigator]. For review, the controvery centers around:<\/div>\n
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  1. \n
    elevating this "ultra high risk" group to a "disorder" in the DSM-5, vigorously opposed by Dr. Allen Frances and others <\/div>\n<\/li>\n
  2. \n
    using Antipsychotics to treat a group for a disease that only a minority will ever develop <\/div>\n<\/li>\n
  3. \n
    A massive expenditure for an early intervention program without solid proof of its effectiveness<\/div>\n<\/li>\n<\/ol>\n
    The mental health policy [3] of Australia is not my business. I’m not in love with the DSM-IIIs or DSM-IVs, so I doubt I’ll be enamored with the DSM-5 no matter what they do, but adding this category sure seems way premature to me [2]. I personally think giving Atypical Antipsychotics to a group who might<\/u> develop Schizophrenia borders on malpractice – first because it is exposing mostly non-psychotic people to unnecessary danger and second because there’s no real proof that early intervention with medication will even help the people long term that do become psychotic [1]. It’s "an experimental hypothesis" at best, not "a program" or even "a treatment." But that said, I think the idea of early, intensive intervention in Schizophrenia is a great concept to be worked towards.<\/div>\n

    <\/p>\n

    Since I’ve already said these things repeatedly, why am I back on the topic? First, someone sent me an editorial<\/font><\/strong><\/u><\/a> written by Dr. McGorry himself almost a decade ago that says some of what I just said in a softer way, concluding:<\/div>\n
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    Deinstitutionalization was a wonderful reform idea which in many places resulted in perverse outcomes because it was not properly evaluated or resourced. Early intervention should not make the same mistake.<\/strong><\/div>\n<\/blockquote>\n
    It’s a fine editorial, worthy of your full reading [as a matter of fact, McGorry might reread it himself].<\/div>\n

    <\/p>\n

    But the second thing is something that came my way that is in need a bit of an introduction. Looking at Dr. McGorry’s group’s work on early intervention, there were four studies of note [1. when n=a few<\/em>…<\/font><\/a><\/strong><\/u>]:<\/div>\n
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    1. \n
    2. \n
    3. \n
    4. \n
      Long-chain omega-3 fatty acids for indicated prevention of psychotic disorders:<\/font><\/strong><\/u><\/a> a randomized, placebo-controlled trial<\/font><\/a><\/strong><\/u>.<\/font><\/strong> Archives of General Psychiatry<\/font><\/strong>. 2010<\/font><\/strong> 67(2):146-54. [full text on-line<\/font><\/strong><\/u><\/a>]<\/div>\n<\/li>\n<\/ol>\n
      That last study [4] gave this rationale for the treatment:<\/div>\n