Over the next several months, Mad in America is publishing a serialized version of Peter Gøtzsche’s book, Critical Psychiatry Textbook. In this blog, he discusses the lack of evidence for benefit, and the evidence of harms, of psychosis drugs used for early intervention/first-episode psychosis. Each Monday, a new section of the book is published, and all chapters are archived here.
“Early intervention? Yes, but not with psychosis drugs
An argument for using psychosis drugs was that it is harmful not to intervene early, and the term “duration of untreated psychosis” (DUP) was often used. It was claimed that DUP worsens the prognosis for schizophrenia and similar disorders;16:194,17:326,18:79,18:233 19:235,20:416 that it is harmful for the brain to be psychotic;18:98,20:416 and that with early intervention, a chronic course can be prevented for many patients17:326 who can be taught to handle their vulnerability.18:80
These arguments are not correct. When a drug doesn’t work for a disease but only pacifies the patients, it cannot be important to use it early in the course of a disease. Furthermore, the research—none of which was referenced—that claims that the duration of untreated psychosis is related to the prognosis is unreliable. People who are not treated early are not comparable to those treated early and they are in a worse condition, on average, with a host of prognostic factors that bode for a poor long-term outcome, e.g. homelessness and alcoholism.
It is not possible with statistical methods to adjust reliably for such differences. As already noted, the more variables you include in a logistic regression, the further you are likely to get from the truth50 (see Chapter 2, Part Two) …”
You can read more from here.
