Atypical anti-psychotics more typical than not...
Well, we hate to say, "we told you so," but...we told you so.   Not long ago, pharmaceutical companies and medical professionals were touting a new breed of drugs aimed at the treatment of people diagnosed with major mental illnesses: the so-called atypical anti-psychotic drugs.  Can you remember the hype?  The drugs were heralded as a major advance--a revolution even--and accompanied by claims of increased effectiveness and tolerability.  Now a study conducted by the National Institute of Mental Health (NIMH) provides, for the first time, detailed information comparing the effectiveness and side effects of both new and older medications.  And what did they find?  Good marketing always trumps bad research.  In the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE, for those who like cute acronyms) trial, researchers directly compared an older medication (perphenazine), available since the 1950s, to four newer medications (olanzapine, quetiapine, risperidone, and ziprasidone) which cost roughly 10 times as much as the older medications. 

Taken as a whole, the newer medications showed no substantial advantage over the older medication used in this study .    Contrary to expectations (and promises by drug company detailers), movement side effects (rigidity, stiff movements, tremor, and muscle restlessness) primarily associated with the older medications, were not seen more frequently with the older drug used in the study.  Indeed, the older medication was as well tolerated as the newer drugs and was equally effective as three of the newer medications.  To be fair, one newer medications, olanzapine, performed slightly better than the other drugs in terms of relapse and tolerability.  Importantly, however, such benefits were frequently outweighed by significant weight-gain and serious metabolic changes.

So, what does this all mean?   Well, if the history of the treatment of schizophrenia is any guide, then the failure to find any difference between newer and older treatments is likely to herald an announcement of a new, more improved, extra-super-duper treatment.  If you'd like to read more about the sad history of treatment for people with schizophrenia, pcik up Robert Whitaker's book Mad in America.  You won't be able to sleep at night after reading it--we promise.

If you want to read the details of the NIMH study, click on the link below:

http://www.nih.gov/news/pr/sep2005/nimh-19.htm

Criminal Profiling: What does the Research say?

It's all the rage.  There's even a TV show about it.  Profilers.  Specially trained law enforcement personnel sift through notes, records, and crime scene photos to develop a profle of the type of person liekly to commit a particular crime.  In spite of its recent and growing popularity in pop culture, the practice of criminal profiling actually dates back to the 1880's.  At that time, two physicians used crime scene clues to make predictions about British serial killer Jack the Ripper's personality.  The question, of course, is "Does it work?"  And to answer that question, all you need to do is ask yourself, "Did the authorities ever nab Jack the Ripper?"  It is comforting to assume that trained profilers can reliably identify characteristics of various crimilar types that inform and empower law enforcement.  In reality, however, it may be that the field of profiling has more in common with James Van Praag than with science.  Says Michael Saks of Arizona State University, "profiling no doubt could benefit from some serious psychological research.  But so far most of the help it has received is just hype."  For his part, Saks was referring to an article in the APA house organ Monitor on Psychology about criminal profiling called "Psychological Sleuths."    One study cited in the Monitor article showed that profilers did have the highest number of accurate statements about the type of person most likely to commit a particular crime (i.e., a rape).  As Saks points out, however,  the profilers also made more statements than any other group they were compared to in the study (e.g., detectives, psychologists, students).  When accuracy was considered as a proportion of total statements, the students in the study actually did much better than the profilers (91% versus 82%).  Oh well. 

Winerman, L. (July/August 2004).  Does profiling really work. Monitor on Psychology, 67.
Saks, M.J. (September/October 2004).  Profiler performance.  Monitor on Psychology, 4.
Risinger, D.M., & Loop, J.L. (2002).  Three card monte, Monty Hall, modus operandi and 'offender profiling': Some lessons of modern cognitive science for the law of evidence.  Cardozo Law Review, 24, 193-285.

Sex Offender Treatment an Oxymoron?

On a similar note, what about the treatment of sex offenders.  The subject has garnered a great deal of attention of late thanks to the nationwide coverage given to the kidnapping and murder of several children.  Supporters of treatment cite data showing that newer treatment programs are better at reducing recidivism.  But doubts remain.  And when push comes to shove, the bulk of the evidence still rests on the side of those who doubt.  A recent study by R. Karl Hanson, for example, found a 22 percent recidivism rate after 12 years of treatment.  As has been historically true of every other problem treated by the talkingcure, the type of treatment the offenders received (skills training, psychodynamic, behavior, cognitive-behavioral) made no difference whatsover.  So, you may ask, what about the data in support of sex offender treatment?  Turns out, that these studies suffer from numerous methodological problems such as, comparing treated offenders with those who refused treatment, or comparing those who completed treatment with those who dropped out.  Plus, even when the programs work, the success rate is quote low.   Leaders in the field are quick to point out, of course, that more research is being done.  Until then, the best defence is vigilance. 

Cooper, G. (November/December 2004).  Is sex offender treatment effective.  Psychotherapy Networker, 24.

Not had enough of this baloney?

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