Sunday, 17 April 2011

The relevance for the disorder versus patient-based measures used in psychosis research

The measures in trials of antipsychotics are not good measures. PANSS is
a commonly used one however it is designed to be sensitive to the effect
of medication. It's not surprising psychological therapies don't work if
they're measured with measures which advantage the effects of medication.

Another scale is BPRS. BPRS and PANSS each have 2 or 3 of the 15 (it's
debateable whether bizarre behaviour is a patient measure or a
psychiatric/judging person's measure) and 2 of 6 respectively which are
measures of the delusions and hallucinations which have typified
schizophrenia and psychosis in the public and patient understanding.

A patient accepts antipsychotics because a doctor tells them it will
cure their illness. If the patient probes any further the doctor will
probably have to answer the question: will it reduce the delusions and
hallucinations. Many patients have found the drugs don't do this. Many
have found they do but there has been no placebo controlled comparison
on this specific measure.

Regardless of the problems of truth and science there is an important
thing which a review of data could discover: which of the drugs actually
do reduce the delusions and hallucinations best. This is what patients
want. Frankly I think if they solved this they could extinguish the
schizophrenic phenotype if they found a 100% chemical solution to the
'problem'. The argument that schizophrenics must exist because they're
part of the human race is often something people who're going through
psychosis or the negative outcomes of schizophrenia is about as useful
as a chocolate teapot. But giving patients and the public what they want
from drugs called "antipsychotics" should be supported by the evidence
and potentially there's the hope that treatments which change the part
of the 'illness' which patients wants can be discovered within the
typical and atypical antipsychotics. It may be discovered that drugs
like clozapine aren't as good as patients expect on patient measures
(only the reduction of delusions and hallucinations) and other drugs are
truly antipsychosis.

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We It comes in part from an appreciation that no one can truly sign their own work. Everything is many influences coming together to the one moment where a work exists. The other is a begrudging acceptance that my work was never my own. There is another consciousness or non-corporeal entity that helps and harms me in everything I do. I am not I because of this force or entity. I am "we"