Friday, November 13, 2015

Mind versus Brain: The case of the low-dose anti-psychotic drugs

Are ADHD, autism, schizophrenia and other mental health disorders primarily neurological, best treated as brain diseases with drugs? Or psychological conditions that should be treated with therapy? Or both? Huge question, huge debate in mental health. The mind versus brain dilemma has been on my mind a lot lately. Well a lot of minds lately. Let me explain.

A few weeks ago I listened to the director of the National Institute of Mental Health, Tom Insel, M.D., who spoke about the future of mental health. He was being honored at a scientific symposium held by The Child Mind Institute, in fact, their fifth annual On The Shoulder of Giants lecture series. This year’s event honored achievements in neuroscience. So there was a lot of talk about brain research. 

The NIMH head honcho stressed psychiatric disorders must be viewed and studied as neurological diseases for advances in prevention and treatment. A medical doctor, he held up the great success made in reducing childhood cancer mortality over the past several decades as an example of how the psychiatric community can make similar progress. Drawing another parallel to medicine, Insel also pointed out the significant progress in cardiac treatment in the past decades. He estimated psychiatry is about where cardiology was fifty years ago. Although he's very optimistic about brain research, he also added that important contributions will come from studying the genome and providing better access and delivery of health care services. Phew. 

On the way home I couldn’t help but think about that new rather groundbreaking study out last month showing the benefits of both medical and psychological interventions in treating schizophrenia. People suffering from schizophrenia who showed the most progress received both lower than normal doses of anti-psychotic drugs plus traditional therapy aimed at helping them manage their symptoms. 

At least I this is what I thought the groundbreaking study found.

Until yesterday when I saw all the corrections in The New York Times’ coverage of the study. They reported the results wrong. Supposedly the researchers don’t know for sure if the drug doses were lower than normal in the combo care group. What they do seem to know is that people who got the combo interventions (including drugs and therapy?) earlier, closer to their first episode, fared better. 

True, the New York Times published a thoughtful op-ed from a Cornell psychiatry professor  addressing Psychiatry’s Mind-Brain Problem. But then they had to publish a correction because the author, George Makari, cited their botched schizophrenia results. This is what happens when respected news sources inaccurately cover potentially important studies. The inaccuracies get repeated. Over and over. By the way, I only knew about the corrections to the original reporting because I read the op-ed. I really could use an alert when major media messes up major details about potentially major studies. 


Now, I don’t have access to the full study so I can’t say what the heck the researchers did find (or didn’t). The journal abstract is particularly abstract in this case. The title doesn't clear up a whole lot either: Comprehensive Versus Community Care for First-Episode Psychosis. The abstract does not mention low drug doses. Other news sources mention the low dose too. Some emphasize the study showed people who had help early in their illness and those with the right measures (multi-prong, coordinated care, including therapy and I suppose drugs?) fared the best. CBS did mention the intervention involved low doses and no, hasn't corrected that info yet. Nor have others who have mentioned it. So what happened here? I assume the low dose information was in the press materials. I also wonder if one of the researchers involved or maybe an outside expert maybe misspoke, possibly overemphasizing the low dose conclusion. One of the study co-authors mentions low drug doses in discussing the results in an interview with NPR. Read the interview. The theme there is drugs, not so good, talk therapy great. 

In any event, this is yet another example of poor communication of important research. 

Also, an example of how difficult it is to figure out what a study really involved and showed, etc - even if you're motivated, it's difficult to find answers. 

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