[costello]

CONCERNS about the overmedication of young people and rigid models of diagnosis have led the architect of early intervention in Australian psychiatry, Patrick McGorry, to abandon the idea pre-psychosis should be listed as a new psychiatric disorder.

The former Australian of the Year had previously accepted the inclusion of pre-psychosis - a concept he and colleagues developed - in the international diagnostic manual of mental disorders, or DSM, which is being updated this year.

Professor McGorry has been part of a team researching pre- and early-psychosis, and his work in the latter helped secure a massive $222.4 million Commonwealth funding injection for Early Psychosis Prevention and Intervention Centres across Australia.

They have found symptoms such as having some delusions or disorganised speech and thought can predict psychosis.

But he believes young people at risk of psychosis are already over-medicated and inclusion in the manual could worsen the problem. "I think it's a valid point to be concerned about the harms particularly in places like America," he said. "I think probably I have given a bit more weight to that argument now".

He said 27 per cent of patients in his ultra-high risk clinics had to be taken off anti-psychotic medications prescribed by GPs.

Professor McGorry has been heavily criticised for his work in early psychosis by doctors who believe it will lead to overmedication.

"I certainly didn't push for [pre-psychosis] to be included although I got panned as if that was what I was trying to do," he said. ''I just didn't want 15 years of progress to be lost".

Allen Frances, the chairman of the taskforce that created the current DSM and a critic of the proposals for the new manual, proposal to include pre-psychosis, currently called attenuated psychosis, in the manual that inspired his campaign.

"It was a very specific moment, it was in May of 2009," he said. "I realised the ark DSM5 was taking would be so far off the mark that it would be irresponsible not to say anything."

Professor McGorry said it was his focus on developing staging models in psychiatry, similar to those seen in other areas of medicine such as cancer treatment where an illness is graded from symptoms needing investigation through to stages of the disease varying in seriousness, that had led him to decide the DSM listing was not helpful.

"We need a more radical change to the diagnostic approach which allows people to get help when they really need it but also ensures risky treatments that cause harm wont get used."

Treatment centres such as Headspace, which allowed for non-drug treatments such as counselling or employment help, could provide the first step in such a system, without needing a DSM diagnosis to be attached to the people who used them.

"It's quite a legitimate debate, what the boundaries of mental illness are," he said.

"We want to provide help, but we don't want to turn everyone into a brain disease."

http://www.smh.com.au/national/healt...219-1th8a.html

[volatile]

we used to have personalities, now we have illnesses

Sometimes I feel as though I've been slaughtered, but I'm just trained to not scream.