disturbing the comfortable

Over the years I’ve become extremely cynical about the psychiatric industry. They’re dealing with people who are even more variable than the run of the population. People who are “sick” but all of them are sick in slightly different ways. The shrinks want to be scientists: they like the white lab coats and want to find concrete evidence. Many of them are in the pay of the drug industry. A recent story mentioned the numbers of psychiatrists who worked on the DSM-IV who had taken money from the big pharms.

And now this: an extremely controversial program, pre-emptive medicating of possible schizophrenics—young ones at that—has fallen on it’s face. Any time we hear the word “pre-emptive,” we should think of Iraq and run like hell in the other direction.

The New York Times

May 1, 2006
Mixed Result in Treating Schizophrenia Pre-Diagnosis
By BENEDICT CAREY
http://www.nytimes.com/2006/05/01/health/01psych.html?_r=1&th=&oref=slogin&emc=th&pagewanted=print
In recent years, psychiatric researchers have been experimenting with a bold and controversial treatment strategy: they are prescribing drugs to young people at risk for schizophrenia who have not yet developed the full-blown disorder.

The hope is that while exposing some to drugs unnecessarily, preemptive treatment may help others ward off or even prevent psychosis, sparing them the agonizing flights of paranoia and confusion that torment the three million American who suffer schizophrenia.

Yet the findings from the first long-term trial of early drug treatment, appearing today in The American Journal of Psychiatry, suggest that this preventive approach is more difficult to put into effect — and more treacherous — than scientists had hoped.

Daily doses of the antipsychotic drug Zyprexa, from Eli Lilly, blunted symptoms in many patients and lowered their risk of experiencing a psychotic episode in the first year of treatment, the study found. But the drug also caused significant weight gain, and so many participants dropped out of the study that investigators could not draw firm conclusions about drug benefits, if any.

The long-awaited study, which was financed by Eli Lilly and the National Institute of Mental Health, raised more questions than it answered, experts said.

"The positive result was only marginally significant, and the negative result was clear," said Dr. Thomas McGlashan, a professor of psychiatry at Yale and the study's lead author. "This might discourage people, and legitimately so, from using this drug for prevention because of the weight gain, but hopefully it won't discourage study" of other drugs.

Critics have charged that treating people for a disorder that has not yet been diagnosed is not only premature but stigmatizing, especially for adolescents. The new study was intended in part to clarify the trade-off between the risks and the potential benefits of preemptive treatment.

***