November 2010

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For over a decade Patrick McGorry has expirimented with or 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] (The full article can be read here: Mental health guru stumbles into public policy minefield.)

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]

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No sensible person would argue against Australian of the Year, psychiatrist Patrick McGorry’s call for early intervention to prevent psychosis; unless of course you know the detail of what Professor McGorry has advocated as early intervention. Put bluntly, Professor McGorry has advocated the use of antipsychotics, with a host of serious potential adverse side effects, on the hunch that adolescents may later become psychotic.

Specifically Professor McGorry is a leading international advocate for the inclusion of Psychosis Risk Syndrome, otherwise known as Attenuated Psychotic Symptoms Syndrome, in the next edition of the clinically dominant Statistical Manual of Mental Disorders (DSM-V) due for publication in 2013. He acknowledges that ‘the false positive rate may exceed 50-60%’ nonetheless has justified the use of pre-psychosis drugs by arguing ‘all those identified are by definition seeking help and need some form of care’.[1]

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Australian Government figures indicate that between 2007 and 2009 the number of children in Australia on Pharmaceutical Benefits Scheme subsidised ADHD drugs increased 23%, with large variations between states. In 2009 children living in New South Wales, Queensland and Tasmania were nearly twice as likely to be ‘medicated’ for ADHD than children living in South Australia, Victoria and the Northern Territory.

‘This large increase in the Australia wide child prescribing rate was caused by new drugs being subsidised via the PBS and the aggressive marketing of ADHD.’

Queensland, which allows General Practitioners to prescribe amphetamine based ADHD drugs unsupervised by either a Psychiatrist or Paediatrician, saw the highest rate of growth with a increase of 37% between 2007 and 2009.

Even Victoria which has traditionally had relatively low prescribing rates (in 2009 still 30% below the national per capita rate) saw an alarming 19% increase between 2007 and 2009.

The two states that had the highest prescribing rates in the country throughout the 1990’s, Western Australia and South Australia, are now lower than the national average (by 2% and 39% respectively).

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