Friday, 10 October 2014

A model approach to psychotic illness?


Researchers from the University of Adelaide in Australia have developed a model that could help to predict the trajectory of a psychiatric patient's illness, thereby enabling more effective treatment.

Professor Bernhard Baune, Head of Psychiatry, says that the new model takes account of ten years of research in the field, and was formulated by reviewing and reinterpreting retrospective data.

It encompasses the wide range of variables known to impact upon disease progression, including sociodemographic, clinical, psychological and biological factors, slotting them into 'the equation' in order to model the expected path of an individual patient's illness. Of note is the fact that disease trajectory can be modelled from the first psychotic episode, which would have significant implications for the course of treatment subsequently pursued.

"Being able to predict the trajectory of psychotic illness is a kind of 'holy grail' in psychiatric medicine" says Professor Baune, who will present this work at the European Congress of Neuropharmacology in Berlin, towards the end of this month.

He observes that the application of such a model raises a number of ethical questions; for example, should a patient be offered treatment early in a disease trajectory which, heretofore, would have been reserved for many years down the track? Or, should certain treatments be withheld if modelling suggests the expected course of illness to be mild?

Top of the list of target conditions is schizophrenia, claimed by the UK Mental Health Foundation to affect 26 million people worldwide, 50% of whom, they report, cannot access adequate treatment. The Baune model is also applicable to other kinds of mental illness.

Though we must be open to any new treatment solutions for psychotic illness, one wonders at the application of such a model - or any model - to actual, lived human experience. Is the individual course of psychotic disease - or any disease - ever so predictable? Can such treatment determinism ever be the most effective approach?

Perhaps the answer is 'yes', but before embarking decisively in such a direction in behooves us to delve a little deeper into the 'reviewing and reinterpreting of retrospective data' upon which Professor Baune and his team appear to have based their new model.

There is, necessarily, a difference between a model formulated on the basis of new evidence and a model based on a 'reinterpreting' of the same set of facts. The latter type of model (of the kind proposed here) is what amounts to a second opinion. Translating opinions (or theories) into models has a habit of enshrining them as truth. In the case of psychotic illness, such 'truths' may be convenient, but they may have a negative impact on real lives.

What are your thoughts? Is it possible to accurately map the course of mental illness? As ever, your thoughts would be welcomed.

Written by Jacqui Hogan


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