In the Australian on 16 June 2011 ( http://www.theaustralian.com.au/news/features/schism-opens-over-ills-of-the-mind/story-e6frg6z6-1226075910650 ) Professor Patrick McGorry responded to his critics by withdrawing his support for the inclusion of Psychosis Risk Syndrome in the ‘Bible of Psychiatry’ DSM5. In addition he has stated that he now opposes the use of antipsychotics to prevent first break psychosis stating it ‘needs to be studied before it’s ever advocated’.
This represents significant progress as in 2010 Professor McGorry wrote, ‘The proposal to consider including the concept of the risk syndrome in the forthcoming revision of the DSM classification is innovative and timely.’ He even argued for the recognition of General Distress Syndrome, for those with even less acute, ill-defined symptoms. It is encouraging that he is now ‘ambivalent’ about including Psychosis Risk Syndrome in DSM5. Although I believe it would be much better if he joined his close colleague Professor Alison Yung and his critic Dr Allen Frances in opposing its inclusion.
Of even greater significance is his current position on the use of antipsychotics as a means of preventing first break psychosis. In an email to me received today (16 June 2011) he stated that the use of antipsychotics in those who have never been psychotic should only occur in ‘ethically approved research studies, not in clinical practice’. And he assured me that ‘patients must always be in control of the decisions’ and pointed out that evidence ’can only come from research’.
I welcome these statements as my key issues have always been; 1- prematurely inventing a new psychiatric disorder (Psychosis Risk Syndrome) and 2- the ‘off label’ use of antipsychotics in young people who have never been psychotic and who by Professor McGorry’s own admission probably never will be (70% to 90% false positive). Professor McGorry and my position are now much closer than they were when our debate began in November 2010. I look forward to meeting him later this month and hopefully finding more common ground.
For more information see http://speedupsitstill.com/extra-eppic-headspace-funding-federal-budget-quick-fix-political-problem-evidence
0r for more on the ongoing debate see http://theconversation.edu.au/early-intervention-for-psychosis-not-just-popping-pills-1859
Update (22/7/2011) – I had a constructive meeting with Professor McGorry in late June. He confirmed the positions outlined above. We are working cooperatively on many of the unresolved issues I have identified in previous blogs. These include 1- the off label prescribing of SSRI Antidepressants to young people at Headspace, EPPIC and Orygen and 2- mechanisms for ensuring clinical consistencyacross all these services and 3- the merits of continued experimentation with antipsychotics as a means of preventing psychosis.
This sounds like a tremendous step in the right direction. I particularly welcome his statement “…that the use of antipsychotics in those who have never been psychotic should only occur in ‘ethically approved research studies, not in clinical practice’”, and his assurance that ‘patients must always be in control of the decisions.’
Now I think he needs to get that message out there loudly and clearly to early intervention practitioners, and make sure that there is no deviation from this in practice at any of the existing early psychosis services to be scaled up, or the 16 new EPPIC services to be established with the unprecedented Government funding he has received.It would be nice if one could believe what he was saying and for him to put that into practice. An article earlier this year that said that was responded to by him saying that “limiting the use of antipsychotics to those that are psychotic is denying help to a significant percentage of people who urgently need help and it should not be denied to them.
Headspace prescibes antipsychotics to young people who are not psychotic, as has McGorry himself. That fact that he is now under pressure from the media seems to have changed his stance, but I doubt it has changed his opinion.
If patients should always be in control of these decisions then why does he want forced treatment laws extended and not reduced.
The reality is that there is NO evidence that these drugs have ANY antipsychotic properties in them. You can hardly design a pill when you have no idea of what you are wanting it to do. What they do is to tranquilise people to the point that they can barely move, think, feel, etc. Just becuase someone stops saying they are psychotic does not mean that they are, anymore than a psychiatrist saying that they are.
Any mental illness is simply a figment of some persons imagination. Sure people can be in acute distress, but the fact is the number of people who are misdagnosed beggers belief. People find in a person what they want to find.
As for really helping people, the healing homes in Sweden and Open Dialouge Therapy in Western Lapland in Finland are the best examples of what can be done. We also know from The Soteria House research that people can totally recover withou the use of any medication or therapy at all – they just need time, space and support. But imagine thinking that we do not need medication for something, that is just way too scary a concept.
Further there is NO research that says that people need to be kept on medication for life and yet I know of many people who have been told that by McGorry himself. Again I am yet to see any research that supports that, as all the good quality research that I have seen shows that people do best when they wean themselves OFF medication. The world health organisation has TWICE done research that has shown that people who do not take medication have a much better chance of recovery.
Medication is not wrong, what is wong is people being told they have broken brains without any research and being told that these medications can cure some brain adnormality, and that they need to take them for life. It is also wrong and always will be wrong to force anyone to take any medication against their will and to offer them nothing but medication.
Headspace offers a maximum of 12 counselling sessions for a young person and that will change to 6 next year, and they actively discourage over 6 sessions at the moment. Young people as young as 12 are being told that if they are not fixed in 6 sessions they will need to take medication for life and that is just total and utter crap.
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