Monday, February 24, 2020

Comments by SamSara

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  • World Psychiatry is the number 1 ranked journal in Social Science Citation Index and has a phenomenal impact factor (a rating of how often articles are cited in a particular journal). A journal with this reputation would naturally have a low acceptance rate. Whitaker — or anyone who submits there — shouldn’t be surprised when their work is rejected. Rejection from a journal like World Psychiatry is far more likely to be a function of competition for space than some nefarious plot.

    It’s a bit premature to claim that American Journal of Psychiatry (AJP) is trying to hide anything. The Letters to the Editor on Goff, et al. have yet to appear (the article itself has only appeared in print this month) and while it’s likely that a high-profile article like this will likely generate some response we don’t yet know which (if any) will be accepted for publication. Simply because 2 letters critical of Goff, et al. were rejected doesn’t mean that all such letters have been or will be rejected. In fact, these 2 letters are rather poor and it’s easy to see why an editor would reject them outright. Murrary, et al’s, reliance on animal models to argue for supersensitivity psychosis ignores human data suggesting supersensitivity psychosis appears unlikely to occur in patients (see, e.g., Leucht, & Davis, 2017) and then goes on to belittle any potential critics by equating them with creationists. Similarly, Moncrieff et al’s critique overly simplifies (and confuses) the issue by suggesting that there isn’t enough data to provide guidance to individual patients and then inexplicably notes an NNT of 3 (such a statistic is pretty much meaningless in isolation, particularly with drugs like antipsychotics which have a wide range of potentially side effects). Both of these letters make worthy arguments but such schoolboy errors are more than enough reason for an editor to reject them outright for a high impact journal like the AJP.

    As for the broader point that the mainstream psychiatric journals have a policy of “Thou Shall Not Criticize Our Drugs,” this is demonstratively false. The Wunderink study that is so often cited (as Moncrieff et al does) against antipsychotics was published in JAMA Psychiatry (published by the American Medical Association) and the subject of this blog post, the AJP (the official journal of the American Psychiatric Association), has, for example, previously published articles on adverse side effects of antipsychotics (e.g., Allison, et al. 1999) and very recently published an article by Leucht, et al. (2017b) which suggested that “antipsychotic drug efficacy may have decreased over recent decades and that “only a minority experienced a good response” to antipsychotics. The AJP (and other mainstream psychiatric journals) routinely publish data on antipsychotic drug failure and harmful side effects. One can certainly reasonably argue that there is much that could and should be changed when it comes to mental health research and treatment but overgeneralizations and accusations of “institutional corruption” does not help patients or researchers.

    Leucht, S., & Davis, J. M. (2017a). Do antipsychotic drugs lose their efficacy for relapse prevention over time?.

    Allison, D. B., Mentore, J. L., Heo, M., Chandler, L. P., Cappelleri, J. C., Infante, M. C., & Weiden, P. J. (1999). Antipsychotic-induced weight gain: a comprehensive research synthesis. American journal of Psychiatry, 156(11), 1686-1696.

    Leucht, S., Leucht, C., Huhn, M., Chaimani, A., Mavridis, D., Helfer, B., … & Geddes, J. R. (2017). Sixty Years of Placebo-Controlled Antipsychotic Drug Trials in Acute Schizophrenia: Systematic Review, Bayesian Meta-Analysis, and Meta-Regression of Efficacy Predictors. American journal of psychiatry,