A2 Psychopathology: Imprecise diagnosis and drug-based treatments

Right drug, wrong sample?

September/October’s (2012) edition of Scientific American Mind features an article that caught my eye entitled “Studying drugs in all the wrong people” (page 34 – 41). The author, Gabriella Rose, highlights a growing concern that due to the pressure for researchers (in the US) to recruit large numbers of patients/participants quickly for drug trials (medical and psychiatric) the “wrong” patients are being recruited.

The author highlights that this is a particular problem for Psychiatric drug trials. Testing a new drug on people that do not have the disorder it is designed to treat clearly threatens the validity of treatment studies, the safety of the participants involved and the progress of biological treatments.

Pressure on researchers for fast participant recruitment

According to the article, some participants are faking symptoms in order to be included in samples, aided by the difficulty of making accurate diagnoses, and clinicians are sometimes allocating patients whose symptoms do not quite match the requirements to fill spaces.  Why would participants and researchers do this? Perhaps because both are motivated by the financial incentives offered by pharmaceutical companies to do so. The author points out that the desire for publication also adds to the pressure felt by researchers to favour the quantity of participants over the quality of participants.

In the A level Psychology classroom

Discussing the validity of treatments: Psychopathology; A2 Psychology

A2 students are required to evaluate biological treatments “in terms of appropriateness and effectiveness for the chosen disorder as part of Unit 4’s Psychopathology in Section A (AQA A). This article provides a stimulus for discussion and ultimately scope for effective AO2 (as a coherent argument can be made and backed up) based on the issues raised.

In order for a drug to be seen as successful in a drug-trial it needs to be shown to help more patients than the placebo or existing drugs. It is however, according to this article, difficult to trust studies assessing the effectiveness of drug treatments if the research is conducted in conjunction with industry or influenced by the needs of Pharmaceutical companies. As anti-psychotic and anti-depressants are top sellers (in the US) this is a big problem for the progress of drug treatments for these disorders as the pressure to recruit from financial motives will be greater.

The main thread of the article is that drug treatments that might be beneficial to patients may be failing unnecessarily because of the sampling issues. As a consequence of the poor sampling and lack of validity, the progress of drug based treatments is potentially being held back as is the recovery of those who most need treatment.

2 Quotes for use as lesson starters

Gabriella Rose, the author of the article, sums up the issues with diagnosis and classification in this line from her article:

Psychiatric diagnosis is as much art as it is science.”

I think this would make a fitting starter for discussion of what the author means by this either at the start, end or both (revisiting the quote to see the progression in student responses) of teaching students about the issues surrounding diagnosis and classification of mental health disorders in Unit 4 (Psychopathology). This would be relevant of course to any of the chosen disorders (Depression, Schizophrenia, OCD or Phobias) in A2 Psychology.

The article also refers to the rise in placebo rates in drug studies:

For the past two decades the number of Psychiatric subjects who appear to be getting better on placebos has been increasing.”

This quote provides a useful stimulus for discussion centred on why this might be happening. The article argues that the inappropriate selection of participants may play a role in rising placebo rates. For example, a patient who is not depressed but has been scored as “depressed” for entry to the study, will inevitably show improvement even from a sugar pill over the course of the study. In reality the participants behaviour and well-being will be unchanged as they did not have the disorder in the first place. This starter/plenary/discussion would work well after studying biological treatments to raise issues involved in assessing the effectiveness and/or appropriateness of biological treatments for use as AO2.


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