tag:blogger.com,1999:blog-21605329.post8715739547050784788..comments2024-03-22T00:30:09.536-07:00Comments on The Neurocritic: Drug Trials in 'At Risk' YouthThe Neurocritichttp://www.blogger.com/profile/08010555869208208621noreply@blogger.comBlogger8125tag:blogger.com,1999:blog-21605329.post-32252673332878293672014-05-30T04:26:40.739-07:002014-05-30T04:26:40.739-07:00And it can be hard to know whether the act of iden...And it can be hard to know whether the act of identifying and treating at risk individuals changes the proportion of people who become psychotic- it is an unavoidable confound.Anonymoushttps://www.blogger.com/profile/01637831377675746694noreply@blogger.comtag:blogger.com,1999:blog-21605329.post-36731315814274106162011-09-03T00:16:51.914-07:002011-09-03T00:16:51.914-07:00The idea that in real cases there appears to be a ...The idea that in real cases there appears to be a lot of overlap in symptoms between mental illnesses like schizophrenia and depression and bipolar is not a new idea. Years ago I read a book about schizophrenia which had this in it.Lili Marlenehttps://www.blogger.com/profile/09303890038396510279noreply@blogger.comtag:blogger.com,1999:blog-21605329.post-90711084033071859822011-09-02T16:40:49.542-07:002011-09-02T16:40:49.542-07:00Anonymous #1 here... I can give you some other rea...Anonymous #1 here... I can give you some other reading ideas if you'd like I just have to round up a list. Sorry my comment turned out to be so long! (that second anonymous wasn't me).<br /><br />You're totally right, the issue with diagnosis is really tough in this case. It's hard enough in full on adult patients, when you have things like schizophrenia, schizoaffective disorder, schizophreniform disorder, bipolar with psychotic features, depression with psychotic features, etc. And in an adolescent who is newly diagnosed, it's that much harder. But, it seems like there is more overlap, genetically and in terms of mechanisms and phenotypes, between these things than previously thought- particularly between schizophrenia spectrum disorders and bipolar with psychotic features. So, in some ways, in line with the new spectrum based direction of the DSM, "psychosis" isn't a bad way to go, even though it sounds kind of vague initially.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-21605329.post-3321838170506038472011-08-31T08:27:58.366-07:002011-08-31T08:27:58.366-07:00What is your e-mail address? I won't publish i...What is your e-mail address? I won't publish it...The Neurocritichttps://www.blogger.com/profile/08010555869208208621noreply@blogger.comtag:blogger.com,1999:blog-21605329.post-78221401684728372422011-08-30T23:01:52.915-07:002011-08-30T23:01:52.915-07:00how can I get in touch with you via email?how can I get in touch with you via email?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-21605329.post-27035998226612073482011-08-29T19:37:49.494-07:002011-08-29T19:37:49.494-07:00Anonymous - Thanks for your comment. The post isn&...Anonymous - Thanks for your comment. The post isn't meant to be a comprehensive overview of MRI studies of risk prediction for psychosis. I just chose the two most recent papers that included McGorry as an author. I <i><b>am</b></i> a neuroscientist and do believe there must be a brain basis for psychotic disorders. But I'm not an expert in the field, so I was struck by the contradictory findings in these particular papers. <br /><br />I also realize that longitudinal studies of this magnitude are difficult and expensive to conduct, and that patient selection, diagnosis, and retention are very challenging issues. In fact, one of the differences between the two papers (other than multi-site vs. Australia only) was the ultimate diagnosis the UHR group would convert to: "psychosis" in Mechelli et al. (n=48) vs. schizophrenia (n=19), bipolar disorder with psychotic features (n=2), or major depression with psychotic features (n=5) with the latter two collapsed to form a small group with affective psychosis in Dazzan et al. Which brain changes should you be looking for if you can't predict the diagnosis in advance? The ones seen in generic psychosis? Or the ones in schizophrenia and the various affective psychoses? All of them?<br /><br />Any suggestions for further reading would be helpful...<br /><br /><br />John M. Nardo MD - Yes, it seems that taking Seroquel if you don't really need it isn't such a great idea!The Neurocritichttps://www.blogger.com/profile/08010555869208208621noreply@blogger.comtag:blogger.com,1999:blog-21605329.post-74270536657933830872011-08-29T13:36:10.372-07:002011-08-29T13:36:10.372-07:00Thanks! An excellent summary. Running on his chari...Thanks! An excellent summary. Running on his charisma and enthusiasm, McGorry is trying to outrun his science...John M. Nardo MDhttp://www.1boringoldman.comnoreply@blogger.comtag:blogger.com,1999:blog-21605329.post-47502466171580671272011-08-29T12:21:52.844-07:002011-08-29T12:21:52.844-07:00This is a pretty limited summary of the much large...This is a pretty limited summary of the much larger field of risk prediction for psychosis. There are a number of papers showing that there are different developmental trajectories in high risk individuals who go on to develop psychosis- there have been a number of structural MRI studies in addition to diffusion tensor imaging. <br /><br />An ONGOING goal of the field is to use these findings to be able to predict who will and will not transition to psychosis. This is not trivial- part of the difficulty is that in almost all studies involving this population, the patients are receiving some kind of treatments- family therapy, individual therapy, often they are on whatever combination of antidepressants/anxiolytics/etc that their own Dr. recommends (because to deprive them of those things would be unethical). And it can be hard to know whether the act of identifying and treating at risk individuals changes the proportion of people who become psychotic- it is an unavoidable confound. The other difficulty is that often follow up periods are for 2-3 years, and that means there are people in the "unconverted" groups who may ultimately also get psychosis after the study is complete. The only real way around this is with very very large sample sizes, such that the sample size of individuals who convert becomes big enough to make conclusions about. To this end, the field has now moved towards very large multi-site consortiums, most of which are still gathering data. <br /><br />It is premature to damn this field based on a limited reading of the literature... no one doing this work thinks it is "done", and no one would use the current MRI findings to target treatment approaches... but that doesn't mean that we won't get there eventually. Have patience!Anonymousnoreply@blogger.com