Patrick McGorry

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McGorry in 2010

Patrick Dennistoun McGorry[1] AO (born 10 September 1952) is an Irish-born Australian psychiatrist known for his development of the early intervention services for youth.

McGorry is Professor of Youth Mental Health at the University of Melbourne.[2] He has written numerous peer reviewed articles, published in journals including The Lancet, the British Journal of Psychiatry, the American Journal of Psychiatry and the Medical Journal of Australia. He is executive director of Orygen Youth Health[3] and founding editor of Early Intervention in Psychiatry published by the International Early Psychosis Association. McGorry also advocated strongly for the establishment of the Australian government funded National Youth Mental Health Foundation, which became headspace, and is a founding board member of that organisation.[4]

McGorry and his colleagues developed an approach for young people who have symptoms of psychosis for the first time, based at the EPPIC clinic in Melbourne.[5] This EPPIC clinic has played a key part in an early psychosis treatment paradigm for psychiatry[6][7][8] and has led to significant reform of mental health services,[9] especially in the United Kingdom.[10] The EPPIC clinic is best represented by the catch phrase "A stitch in time"[11] and its development of a service for those at risk of developing psychosis.[12] Initial evaluations of EPPIC showed that it was not only effective compared to the previous traditional model of care but that it was also cost effective.[13][14][15][16] Some critics have recently disputed these findings.[17] In the past two decades more rigorous randomised evaluations in England and Denmark have shown that early intervention is effective over the first two years of care at least, but when patients return to traditional care some of the gains are lost.[18][19] Canadian data indicates that if patients remain in early intervention services for five years the gains are sustained.[20] One critic has alleged that McGorry has "systematically misled" the Australian government about the nature and implications of his evaluation study on EPPIC by misstating the description of the control group.[21] While more rigorous evaluations of early intervention services have been carried out in other countries, a systematic review of these studies concluded: "There is some support for specialised early intervention services, but further trials would be desirable, and there is a question of whether gains are maintained."[22] McGorry has claimed that early intervention services can save money,[23] but this has also been questioned by a recent review of the evidence.[24] Professor McGorry was awarded the Centenary Medal in 2003 in recognition of his work on the EPPIC programme.[25]

McGorry has advocated for early intervention with young people who are at risk of psychosis, but who are not currently psychotic, including the use of antipsychotic medication.[26] His views have been criticised by a number of people, including Allen Frances the Chair of the DSM-IV Taskforce, on the basis that most at-risk young people will not become psychotic and pre-emptive treatment may be risky.[27][28][29] McGorry and his colleagues have responded to this criticism, arguing that critics have blurred the key distinction between clinical recommendations and ethically approved research designed to build evidence to more firmly guide clinical practice.[30][31][32] A trial of the antipsychotic medication quetiapine, led by McGorry, attracted criticism on ethical grounds and was discontinued.[33][34] More recently,[when?] McGorry has begun investigating the use of lower risk treatments such as fish oil.[26]

McGorry has advocated to the Australian government to create a national network of early psychosis intervention centres, based on claims that early treatment may improve long-term outcomes.[35] Some critics have argued that he has exaggerated the evidence for early intervention and that long-term benefits and economic savings have not been established.[36][37][38][39] He has been accused of having a conflict of interest in using his position on a government advisory committee to advocate for programs that he founded.[40] McGorry has denied that he has any conflict of interest and a spokesperson for the Australian government stated that Professor McGorry was just one member of the Mental Health Expert Working Group, which was made up of experts from a range of health and non-health sectors, plus consumer and carer representatives and 'while these consultations helped to inform the development of the government’s record mental health package, decisions on the specific content...were solely a matter for the government'.[41] On 25 September 2012, Western Australian member of parliament Martin Whitely made a speech in parliament criticising the Australian Federal Government for its support of McGorry's proposals. Whitely said that McGorry had made overblown claims for his programs and that they had been accepted without proper scrutiny.[42] During the 2013 Australian Federal election, McGorry appeared in the media together with then Opposition Leader Tony Abbott at the launch of the Liberal-National Coalition's mental health policy. Abbott promised that, if elected, he would provide additional financial support for programs associated with Patrick McGorry. [43] After being elected to government, the Coalition announced in its first budget the allocation of $18M to Orygen Youth Health Research Centre for establishment of a National Centre of Excellence in Youth Mental Health and $14.9M to headspace for the expansion of its youth mental health services.[44]

In January 2010 he was named Australian of the Year for his services to youth mental health.[45][46][47] In June 2010 he was appointed an Officer of the Order of Australia.[48] In 2013 Professor McGorry was honoured with the National Alliance on Mental Illness Scientific Research Award, the first time the award has been bestowed upon a researcher outside of the United States.[49]

References[edit]

  1. ^ "University Secretar's Department Lists of Members – Professors Emeritus The University of Melbourne". www.unimelb.edu.au. Retrieved 29 January 2010. 
  2. ^ "Patrick McGorry (Australia)". International Early Psychosis Association. Retrieved 25 January 2010. 
  3. ^ Orygen Youth Health oyh.org.au, Retrieved 25 January 2010
  4. ^ headspace. "headspace Board". Retrieved 10 January 2014. 
  5. ^ McGorry PD; Edwards J; Mihalopoulos C; Harrigan SM; Jackson HJ (1996). "EPPIC: an evolving system of early detection and optimal management". Schizophrenia Bulletin 22 (2): 305–326. doi:10.1093/schbul/22.2.305. PMID 8782288. Retrieved 14 February 2009. 
  6. ^ Edwards, J. & McGorry, P.D. (2002) (eds). Implementing Early Intervention in Psychosis. A guide to establishing early psychosis services. London. Martin Dunitz.
  7. ^ McGorry PD, Killackey EJ (2002). "Early intervention in psychosis: a new evidence based paradigm". Epidemiol Psichiatr Soc 11 (4): 237–47. doi:10.1017/s1121189x00005807. PMID 12585014. 
  8. ^ McGorry PD, Killackey E, Yung A (October 2008). "Early intervention in psychosis: concepts, evidence and future directions". World Psychiatry 7 (3): 148–56. PMC 2559918. PMID 18836582. 
  9. ^ Killackey E, Yung AR, McGorry PD (2007). "Early psychosis: where we've been, where we still have to go". Epidemiol Psichiatr Soc 16 (2): 102–8. PMID 17619539. 
  10. ^ Joseph R, Birchwood M (September 2005). "The national policy reforms for mental health services and the story of early intervention services in the United Kingdom". J Psychiatry Neurosci 30 (5): 362–5. PMC 1197282. PMID 16151542. 
  11. ^ McGorry, P. D. (1998). ""A stitch in time"… the scope for preventive strategies in early psychosis". European Archives of Psychiatry and Clinical Neuroscience 248 (1): 22–31. doi:10.1007/s004060050014. PMID 9561350.  edit
  12. ^ Yung AR, McGorry PD, McFarlane CA, Jackson HJ, Patton GC, Rakkar A (1996). "Monitoring and care of young people at incipient risk of psychosis". Schizophr Bull 22 (2): 283–303. doi:10.1093/schbul/22.2.283. PMID 8782287. 
  13. ^ McGorry PD, Edwards J, Mihalopoulos C, Harrigan SM, Jackson HJ (1996). "EPPIC: an evolving system of early detection and optimal management". Schizophrenia Bulletin 22 (2): 305–26. doi:10.1093/schbul/22.2.305. PMID 8782288. 
  14. ^ Mihalopoulos C, McGorry PD, Carter RC (1999). "Is phase-specific, community-oriented treatment of early psychosis an economically viable method of improving outcome?". Acta Psychiatrica Scandinavica 100 (1): 47–55. doi:10.1111/j.1600-0447.1999.tb10913.x. PMID 10442439. 
  15. ^ Mihalopoulos C, Harris M, Henry L, Harrigan S, McGorry P (May 2011). "Is early intervention in psychosis cost-effective over the long term?". Schizophrenia Bulletin 37 (3): 651. doi:10.1093/schbul/sbp054. PMC 2728818. PMID 19509308. 
  16. ^ McCrone P, Craig TKJ, Power P, Garety PA (2010). "Cost-effectiveness of an early intervention service for people with psychosis". The British Journal of Psychiatry 195 (5): 377–82. doi:10.1192/bjp.bp.109.065896. PMID 20435964. Retrieved 14 January 2014. 
  17. ^ Raven, M. (2011). Evaluating evidence for Early Psychosis Prevention and Intervention Centres (EPPIC). The Conversation 2 November 2011. http://www.theconversation.edu.au/evaluating-evidence-for-early-psychosis-prevention-and-intervention-centres-eppic-3604
  18. ^ Craig TK, Garety P, Power P, Rahaman N, Colbert S, Fornells-Ambrojo M, Dunn, G (2004). "The Lambeth Early Onset (LEO) Team: randomised controlled trial of the effectiveness of specialised care for early psychosis". British Medical Journal 329 (7474): 1067. doi:10.1136/bmj.38246.594873.7c. PMC 526115. PMID 15485934. Retrieved 14 January 2014. 
  19. ^ Petersen L, Jeppesen P, Thorup A, Abel MB, Ohlenschlaeger J, Christensen, TO, Krarup, G, Jorgensen P, Nordentoft, M (2005). "A randomised multicentre trial of integrated versus standard treatment for patients with a first episode of psychotic illness". British Medical Journal 331 (7517): 602. doi:10.1136/bmj.38565.415000.E01. PMC 1215551. PMID 16141449. Retrieved 14 January 2014. 
  20. ^ Norman R, Manchanda R, Malla A, Windell D, Harricharan R, Northcott S (2011). "Symptom and functional outcomes for a 5-year early intervention program for psychoses". Schizophrenia Research 129 (2–3): 111–15. doi:10.1016/j.schres.2011.04.006. PMID 21549566. Retrieved 14 January 2014. 
  21. ^ Raven M. EPPIC mirage: cost-effectiveness of early psychosis intervention. Aust N Z J Psychiatry 2013; 47: 599–601.
  22. ^ Marshall M, Rathbone J. Early intervention for psychosis" Cochrane Database of Systematic Reviews 2011, Issue 6. Art. No.: CD004718. doi:10.1002/14651858.CD004718.pub3
  23. ^ Orygen Youth Health Research Centre (2011) Early Psychosis Feasibility Study. Canberra: National Advisory Council on Mental Health
  24. ^ Amos A. Assessing the cost of early intervention in psychosis: a systematic review. Aust N Z J Psychiatry. 2012 Aug;46(8) 719-34.
  25. ^ "Professor Patrick D. McGorry (AO, MD, PhD, FRCP, FRANZCP)". Our Research: Research Leaders. Orygen Youth Health. Retrieved 30 November 2013. 
  26. ^ a b McGorry, P.D. (2009). Intervention in individuals at ultra-high risk for psychosis: a review and future directions" Journal of Clinical Psychiatry 70, 1206–1212.
  27. ^ Frances. A. (2010). Psychosis risk syndrome—far too risky? Australian and New Zealand Journal of Psychiatry, 45, 803–804.
  28. ^ Dunlevy, S. (2011). US expert slams McGorry's psychosis model. The Australian, 14 June 2011. http://www.theaustralian.com.au/national-affairs/us-expert-slams-patrick-mcgorrys-psychosis-model/story-fn59niix-1226074544901
  29. ^ Jorm AF. Ethics of giving antipsychotic medication to at-risk young people. Aust N Z J Psychiatry. 2012 Sep;46(9) 908-9.
  30. ^ McGorry, P (April 2012). "Truth and reality in early intervention". Australian and New Zealand Journal of Psychiatry 46 (4): 313–316. doi:10.1177/0004867412442172. 
  31. ^ McGorry, P (March 2012). "At issue: Cochrane, early intervention, and mental health reform: analysis, paralysis, or evidence-informed progress?". Schizophrenia Bulletin 38 (2): 221–224. doi:10.1093/schbul/sbr185. PMID 22247539. 
  32. ^ McGorry, P (July 2011). "Pre-emptive intervention in psychosis: agnostic rather than diagnostic". Australian and New Zealand Journal of Psychiatry 45 (7): 515–519. doi:10.3109/00048674.2011.581648. PMID 21718121. Retrieved 13 March 2013. 
  33. ^ Stark, J. (2011). Drug trial scrapped amid outcry. The Age, 21 August 2011. http://www.theage.com.au/national/drug-trial-scrapped-amid-outcry-20110820-1j3vy.html.
  34. ^ Raven, M., Stuart, G.W. & Jureidini, J. (2012). ‘Prodromal’ diagnosis of psychosis: ethical problems in research and clinical practice. Australian and New Zealand Journal of Psychiatry, 46, 64–65.
  35. ^ Vincent, M. (2011). Budget provides mental health relief. AM, 11 May 2011. http://www.abc.net.au/am/content/2011/s3213405.htm
  36. ^ Creagh, S. (2011). Review finds limited evidence for early psychosis intervention centres. The Conversation,, 30 June 2011. http://theconversation.edu.au/review-finds-limited-evidence-for-early-intervention-in-psychosis-2091
  37. ^ Bosanac, P., Patton, G.C. & Castle, D.J. (2010). Early intervention in psychotic disorders: faith before facts?" Psychological Medicine 40, 353–358.
  38. ^ Amos, A. (2012). Assessing the cost of early intervention in psychosis: a systematic review. Australian & New Zealand Journal of Psychiatry 46, 719–734.
  39. ^ Amos, A. (2013). An axeman in the cherry orchard: Early intervention rhetoric distorts public policy. Australian & New Zealand Journal of Psychiatry, 47, 317–320
  40. ^ Stark, J. (2011). McGorry accused of conflict of interest. Sydney Morning Herald 7 August 2011. http://www.smh.com.au/national/mcgorry-accused-of-conflict-of-interest-20110806-1igxd.html
  41. ^ Thompson, J. McGorry’s mental health minefield. Medical Observer, 6 October 2011. http://www.medicalobserver.com.au/news/mcgorrys-mental-health-minefield?print=friendly
  42. ^ Dunlevy, S. (2012). Doubts cast on youth mental health program. Herald Sun 7 October 2012. http://www.heraldsun.com.au/news/national/doubts-cast-on-youth-mental-health-program/story-fndo48ca-1226489760605
  43. ^ "Mental health is largely missing from the election campaign". The Conversation. Retrieved 17 May 2013. 
  44. ^ "Budget 2014–15". Australian Government. Retrieved 17 May 2013. 
  45. ^ "Mental health expert is Australian of the Year". ABC. 25 January 2009. 
  46. ^ "Australian of the Year 2010". australianoftheyear.org.au. Retrieved 25 January 2010. 
  47. ^ Lewis, Wendy (2010). Australians of the Year. Pier 9 Press. ISBN 978-1-74196-809-5. 
  48. ^ It's an Honour: Officer of the Order of Australia
  49. ^ NAMI. "2013 Research Award". Retrieved 9 January 2014.