My Perspective

I was reading the NICE guidelines on "Consensus statement on high-dose antipsychotic medication", latest (2014) version. In the section on 'Potential gender and ethnicity factors and high-dose strategies' it says: Genetic polymorphisms at both the metabolic level and site of action are likely to contribute to the overall response to a particular drug. Some Asian patients might have a lower dose threshold for a variety of Extrapyramidal side-effects.

Here are some limitations of using Randomized Control Trials (RCT) for Mental Health (MH) research. In the selection of people to RCTs, one needs to include subjects of a single condition or diagnostic category. However, in psychiatry the diagnosis can be unstable, changing, apart from secondary conditions, undiagnosed comorbid conditions. This also implies that the external validity of the RCT results are limited for MH.