{"id":22105,"date":"2012-04-13T23:01:19","date_gmt":"2012-04-14T03:01:19","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=22105"},"modified":"2012-04-13T23:06:59","modified_gmt":"2012-04-14T03:06:59","slug":"an-old-n1-type","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2012\/04\/13\/an-old-n1-type\/","title":{"rendered":"an old n=1 type&#8230;"},"content":{"rendered":"\n<p align=\"justify\">Here are the references for the two groups studying the &quot;ultra high risk&quot; patients&#8230;      <\/p>\n<table cellspacing=\"0\" cellpadding=\"5\" border=\"0\" align=\"center\">\n<tr>\n<td>\n<div align=\"center\"><a target=\"_blank\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/12365879\"><u><strong><font color=\"#200020\">Randomized   controlled trial of interventions designed to reduce the risk of   progression to first-episode psychosis in a clinical sample with   subthreshold symptoms<\/font><\/strong><\/u><\/a>.<br \/>                                   <sup>by McGorry PD, Yung AR, Phillips LJ, Yuen HP, Francey S, Cosgrave EM, Germano D, Bravin J, McDonald T, Blair A, Adlard S, and Jackson H.<\/sup><br \/>                                   <strong><font color=\"#200020\">Arch Gen Psychiatry<\/font><\/strong>. <strong><font color=\"#990000\">2002<\/font><\/strong> 59(10):921-8.<\/div>\n<div align=\"center\">[<a target=\"_blank\" href=\"http:\/\/archpsyc.ama-assn.org\/cgi\/content\/full\/59\/10\/921\"><u><strong><font color=\"#200020\">full text on-line<\/font><\/strong><\/u><\/a>]                <\/div>\n<\/td>\n<\/tr>\n<tr>\n<td>\n<div align=\"center\"><a target=\"_blank\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19670055\"><u><strong><font color=\"#200020\">Randomized  controlled trial of interventions for young people at ultra-high risk  of psychosis: study design and baseline characteristics. .<\/font><\/strong><\/u><\/a><br \/>                                             <sup>by  Phillips LJ, Nelson B, Yuen HP, Francey SM, Simmons M, Stanford C, Ross  M, Kelly D, Baker K, Conus P, Amminger P, Trumpler F, Yun Y, Lim M,  McNab C, Yung AR, McGorry PD.<\/sup><br \/>                                             <strong><font color=\"#200020\">Aust N Z J Psychiatry<\/font><\/strong>. <strong><font color=\"#990000\">2009<\/font><\/strong> 43(9):818-29.                <\/div>\n<\/td>\n<\/tr>\n<tr>\n<td>\n<div align=\"center\"><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20124114\" target=\"_blank\"><u><strong><font color=\"#200020\">Long-chain omega-3 fatty acids for indicated prevention of psychotic disorders:<\/font><\/strong><\/u><\/a><\/div>\n<div align=\"center\"><u><strong><font color=\"#200020\"><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20124114\" target=\"_blank\"> a randomized, placebo-controlled trial<\/a>.<\/font><\/strong><\/u><br \/>                                <sup>by Amminger GP, Sch&auml;fer MR, Papageorgiou K, Klier CM, Cotton SM, Harrigan SM, Mackinnon A, McGorry PD, and Berger GE.<\/sup><br \/>                                <strong><font color=\"#200020\">Archives of General Psychiatry<\/font><\/strong>. <strong><font color=\"#990000\">2010<\/font><\/strong> 67(2):146-54.<\/div>\n<div align=\"center\">[<u><strong><font color=\"#200020\">full text on-line<\/font><\/strong><\/u>]<\/div>\n<\/td>\n<\/tr>\n<tr>\n<td>\n<div align=\"center\"><a target=\"_blank\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21034687#\"><u><strong><font color=\"#200020\">Randomized controlled trial of interventions for young people at ultra high risk for psychosis: 6-month analysis.<\/font><\/strong><\/u><\/a><br \/>                                             <sup>by  Yung AR, Phillips LJ, Nelson B, Francey SM, PanYuen H, Simmons MB, Ross  ML, Kelly D, Baker K, Amminger GP, Berger G, Thompson AD, Thampi A, and  McGorry PD.<\/sup><br \/>                                             <strong><font color=\"#200020\">Journal of Clinical Psychiatry<\/font><\/strong>. <strong><font color=\"#990000\">2011<\/font><\/strong> 72(4):430-40.               <\/div>\n<\/td>\n<\/tr>\n<tr>                     <\/tr>\n<\/table>\n<p>                  <\/p>\n<table cellspacing=\"0\" cellpadding=\"5\" border=\"0\" align=\"center\">\n<tr>\n<td>\n<div align=\"center\"><u><strong><a target=\"_blank\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/12271805\"><font color=\"#200020\">Randomised   controlled trial of early detection and cognitive therapy for   preventing transition to psychosis in high-risk individuals. Study   design and interim analysis of transition rate and psychological risk   factors.<\/font><\/a><\/strong><\/u><br \/>                                      <sup>by Morrison AP, Bentall RP, French P, Walford L, Kilcommons A, Knight A, Kreutz M, and Lewis SW.<\/sup><br \/>                                      <strong><font color=\"#200020\">British Journal of Psychiatry<\/font><\/strong> Supplement <strong><font color=\"#990000\">2002<\/font><\/strong> 43:s78-84.<\/div>\n<p>              <\/td>\n<\/tr>\n<tr>\n<td>\n<div align=\"center\"><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15458988\" target=\"_blank\"><u><strong><font color=\"#200020\">Cognitive therapy for the prevention of psychosis in people at ultra-high risk: randomised controlled trial.<\/font><\/strong><\/u><\/a><br \/>                                     <sup>by Morrison AP, French P, Walford L, Lewis SW, Kilcommons A, Green J, Parker S, and Bentall RP.<\/sup><br \/>                                     <strong><font color=\"#200020\">British Journal of Psychiatry<\/font><\/strong> . <strong><font color=\"#990000\">2004<\/font><\/strong> 185:291-7.<\/div>\n<div align=\"center\">[<a target=\"_blank\" href=\"http:\/\/bjp.rcpsych.org\/content\/185\/4\/291.long\"><u><strong><font color=\"#200020\">full text online<\/font><\/strong><\/u><\/a>]<\/div>\n<p>              <\/td>\n<\/tr>\n<tr>\n<td>\n<div align=\"center\"><a target=\"_blank\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16973786\"><u><strong><font color=\"#200020\">Three-year   follow-up of a randomized controlled trial of cognitive therapy for  the  prevention of psychosis in people at ultrahigh risk<\/font><\/strong><\/u><\/a>.<br \/>                                   <sup>by Morrison AP, French P, Parker S, Roberts M, Stevens H, Bentall RP, and Lewis SW.<\/sup><br \/>                                   <strong><font color=\"#200020\">Schizophrenia Bulletin<\/font><\/strong>. <strong><font color=\"#990000\">2007<\/font><\/strong> 33(3):682-7.<\/div>\n<div align=\"center\">[<a target=\"_blank\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2526150\/?tool=pubmed\"><u><strong><font color=\"#200020\">full text online<\/font><\/strong><\/u><\/a>]<\/div>\n<p>              <\/td>\n<\/tr>\n<tr>\n<td>\n<div align=\"center\"><a target=\"_blank\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18055943\"><u><strong><font color=\"#200020\">Effects  of cognitive therapy on the longitudinal development of psychotic  experiences in people at high risk of developing psychosis.<\/font><\/strong><\/u><\/a><br \/>                                 <sup>by French P, Shryane N, Bentall RP, Lewis SW, and Morrison AP.<\/sup><br \/>                                  <strong><font color=\"#200020\">British Journal of Psychiatry<\/font><\/strong> Supplement&nbsp; <strong><font color=\"#990000\">2007<\/font><\/strong> 51:s82-7.<\/div>\n<p>              <\/td>\n<\/tr>\n<tr>\n<td>\n<div align=\"center\"><a href=\"http:\/\/www.bmj.com\/highwire\/filestream\/577609\/field_highwire_article_pdf\/0.pdf\" target=\"_blank\"><u><strong><font color=\"#200020\"> Early detection and intervention evaluation for peopleat risk of psychosis: multisite randomised controlled trial.<\/font><\/strong><\/u><\/a><br \/>                     <sup>by  Morrison AP, French P, Stewart SL, Birchwood M, Fowler D, Gumley AI,  Jones PB, Bentall RP, Lewis SW, Murray GK, Patterson P, Brunet K, Conroy  J, Parker S, Reilly T, Byrne R, Davies LM, Dunn G.<\/sup><br \/>                     <strong><font color=\"#200020\">British Medical Journal<\/font><\/strong>. <strong><font color=\"#990000\">2012<\/font><\/strong> Apr 5;344 <br \/>                     [<strong><a href=\"http:\/\/www.bmj.com\/highwire\/filestream\/577609\/field_highwire_article_pdf\/0.pdf\" target=\"_blank\"><u><font color=\"#200020\">full text on-line<\/font><\/u><\/a><\/strong>]<\/div>\n<\/td>\n<\/tr>\n<\/table>\n<p>    <\/p>\n<div align=\"justify\">I have no credentials to say this, but I think they&#8217;re well meaning and hard-working, but on the wrong track. This is one version of their <a href=\"https:\/\/www.mja.com.au\/journal\/2007\/187\/7\/pace-specialised-service-young-people-risk-psychotic-disorders\" target=\"_blank\"><u><strong><font color=\"#200020\">criteria<\/font><\/strong><\/u><\/a> for selection of pre-psychotic patients:<\/div>\n<ul>\n<div align=\"justify\"><sup>&bull; Attenuated psychotic symptoms group:  patients have experienced subthreshold, attenuated positive psychotic  symptoms during the past year;<\/sup><\/div>\n<div align=\"justify\"><sup>&bull; Brief limited intermittent psychotic  symptoms group: patients  have experienced episodes of frank psychotic  symptoms that have not  lasted longer than a week and have spontaneously  abated; or<\/sup><\/div>\n<div align=\"justify\"><sup>&bull; Trait and state risk factor group: patients   have schizotypal personality disorder or have a first-degree relative   with a psychotic disorder and have experienced a significant decrease in   functioning during the previous year.<\/sup><\/div>\n<\/ul>\n<div align=\"justify\">One of the obvious criticisms of people like me who talk about single cases is that they&#8217;re generalizing from a single instance &#8211; a perfectly valid criticism. But there&#8217;s a reason to at least consider n=1 cases, because they&#8217;re known in depth. An example is Auguste Deter, the case of Alois Alzheimer and colleague, Emil Kraepelin, that lead them to a really dramatic discovery &#8211; now called Alzheimer&#8217;s disease.<\/div>\n<div align=\"center\"><img loading=\"lazy\" decoding=\"async\" height=\"148\" border=\"0\" width=\"319\" vspace=\"5\" src=\"http:\/\/1boringoldman.com\/images\/alois.gif\" \/><\/div>\n<div align=\"justify\">I described a case [<u><strong><a href=\"http:\/\/1boringoldman.com\/index.php\/2011\/08\/22\/1-from-n-equals-one\" target=\"_blank\"><font color=\"#200020\">1. <em>from n equals one<\/em>&hellip;<\/font><\/a><\/strong><\/u>, <u><strong><a href=\"http:\/\/1boringoldman.com\/index.php\/2011\/08\/22\/2-from-n-equals-one\" target=\"_blank\"><font color=\"#200020\">2. <em>from n equals one<\/em>&hellip;<\/font><\/a><\/strong><\/u>, <u><strong><a href=\"http:\/\/1boringoldman.com\/index.php\/2011\/08\/23\/3-from-n-equals-one\" target=\"_blank\"><font color=\"#200020\">3. <em>from n equals one<\/em>&hellip;<\/font><\/a><\/strong><\/u>] who definitely developed Schizophrenia, and those of us who followed her sort of knew that was what was coming. Her brother, a doctor who referred her said &quot;she might be Schizophrenic&quot; when he first mentioned her. Her parents joined a support group for parents of psychotic&nbsp; people before her break. The doctor who was taking care of her called me because he &quot;didn&#8217;t know what [she] had.&quot; And yet she met none of those criteria listed up above. They are going for <em>sort-of<\/em> psychotic symptoms to pick their cases, and it&#8217;s &quot;<em>sort of<\/em>&quot; successful. Even in failure, they&#8217;re hitting at 7% or 8% and up to 30%-40% in some studies. That&#8217;s too low to use, but it&#8217;s certainly not close to the rate in the general or even psychiatric population.   <\/div>\n<p align=\"justify\">In my case, the symptoms were more like a pervasive identity diffusion that interfered with each developmental stage growing up; a chameleon-like quality of copying the path or styles of others to figure out how to be; a pattern of being able to complete tasks and projects, but not being able to pick which ones to pursue; and secretive, shameful, pleasure seeking [eating, pilfering, spending] that didn&#8217;t bring pleasure and became compulsive. There was a <em>not-knowing-how-to-be-ness<\/em> that characterized her whole story. I don&#8217;t exactly know how one would screen for this kind of deficit in self-definition, but I think if they are going to pursue this research, they would do well to consider working on their selection criteria. It&#8217;s what bothers me about even their term Attenuated Psychosis Syndrome. Frankly, they were better off with Psychosis Risk Syndrome. But the DSM-5 criteria themselves are even less useful:               <\/p>\n<table cellspacing=\"0\" cellpadding=\"0\" border=\"0\" width=\"95%\" align=\"center\">\n<tr>\n<td align=\"center\" colspan=\"3\"><a href=\"http:\/\/www.dsm5.org\/ProposedRevision\/Pages\/proposedrevision.aspx?rid=412#\" target=\"_blank\"><u><strong><font color=\"#200020\">Attenuated Psychosis Syndrome: Proposed Revision<\/font><\/strong><\/u><\/a>     <\/p>\n<hr size=\"1\" \/><\/td>\n<\/tr>\n<tr>\n<td align=\"justify\" colspan=\"3\"><em>The  work group is recommending that  this be included in DSM-5 but is still  examining the evidence as to  whether inclusion is merited in the main  manual or in an Appendix for  Further Research. As such, the work group strongly encourages feedback  regarding this disorder.<\/em>     <\/p>\n<hr size=\"1\" \/><\/td>\n<\/tr>\n<tr>\n<td align=\"justify\" colspan=\"3\">All six of the following:<\/td>\n<\/tr>\n<tr>\n<td width=\"30\" rowspan=\"9\">&nbsp;<\/td>\n<td align=\"justify\" colspan=\"2\">[a] Characteristic  symptoms: at least  one of the following in attenuated form with intact  reality testing,  but of sufficient severity and\/or frequency that it is  not discounted  or ignored;<\/td>\n<\/tr>\n<tr>\n<td width=\"30\" rowspan=\"3\">&nbsp;<\/td>\n<td align=\"justify\">[i] delusions<\/td>\n<\/tr>\n<tr>\n<td align=\"justify\">[ii] hallucinations<\/td>\n<\/tr>\n<tr>\n<td align=\"justify\">[iii] disorganized speech<\/td>\n<\/tr>\n<tr>\n<td align=\"justify\" colspan=\"2\">[b] Frequency\/Currency:  symptoms  meeting criterion A must be present in the past month and  occur at an  average frequency of at least once per week in past month<\/td>\n<\/tr>\n<tr>\n<td align=\"justify\" colspan=\"2\">[c] Progression: symptoms meeting criterion A must have begun in or significantly worsened in the past year;<\/td>\n<\/tr>\n<tr>\n<td align=\"justify\" colspan=\"2\">[d] Distress\/Disability\/Treatment   Seeking: symptoms meeting criterion A are sufficiently distressing and   disabling to the patient and\/or parent\/guardian to lead them to seek   help<\/td>\n<\/tr>\n<tr>\n<td align=\"justify\" colspan=\"2\">[e] Symptoms meeting criterion A are not better explained by any DSM-5 diagnosis, including substance-related disorder<\/td>\n<\/tr>\n<tr>\n<td align=\"justify\" colspan=\"2\">[f] Clinical criteria for any DSM-V psychotic disorder have never been met<\/td>\n<\/tr>\n<\/table>\n<p align=\"justify\">They might as well say, &quot;sort of Schizophrenic.&quot; That&#8217;s not how Schizophrenia works. There&#8217;s a period of confusion and agita that may go on for a while, but the patients are not psychotic. The &quot;psychotic&quot; symptoms usually arrive in a storm &#8211; all of a sudden instead of scattered around like either one of these criteria sets suggest.<\/p>\n<div align=\"justify\">Just the thoughts of an old n=1 guy&#8230;<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Here are the references for the two groups studying the &quot;ultra high risk&quot; patients&#8230; Randomized controlled trial of interventions designed to reduce the risk of progression to first-episode psychosis in a clinical sample with subthreshold symptoms. by McGorry PD, Yung AR, Phillips LJ, Yuen HP, Francey S, Cosgrave EM, Germano D, Bravin J, McDonald T, [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[2],"tags":[],"class_list":["post-22105","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/22105","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=22105"}],"version-history":[{"count":13,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/22105\/revisions"}],"predecessor-version":[{"id":22118,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/22105\/revisions\/22118"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=22105"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=22105"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=22105"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}