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.
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.