Australasian Psychiatry

• Vol 11, N

o 2 •

June 2003

235

CORRESPONDENCE

Psychiatrists and the pharmaceutical industry

DEAR SIR,

There have been recent reports in themedia of political actions taken bylarge USA drug companies in relationto issues that should be of majorconcern to medical practitionersgenerally and specific concern to psy-chiatrists.

First, the pharmaceutical industry haspressured the USA government in rela-tion to the proposed free trade agree-ment between Australia and the USA,namely to dismantle our Public Bene-fits Scheme (PBS). For years, the inter-national drug companies have, despitetheir public protestations, detestedthe Australian pharmaceutical bene-fits scheme. The two obvious reasonsfor this are, first, that it contains theirprofit margins in the Australian mar-ket place. More importantly, however,the prices negotiated by the Pharma-ceutical Benefits Advisory Committeeare used by other countries as a nego-tiating basis to also attempt to containdrug costs; it has widespread interna-tional ramifications and limits theiralready massive profits, profits thatremain massive even after the ‘high’deductions for new drug develop-ment. As psychiatrists, we should begreatly concerned that in the processof the free trade agreement, in noway should the PBS be undermined.Already a significant proportion of ourclientele, especially those with seriousmental illness, are greatly socially dis-advantaged and any limitation to theready availability of psychiatric drugtreatments would be unthinkable.

A second, equally concerning, issuealthough of less local impact, is thefact that despite the Bush admini-stration’s attempts to provide cheapmedication to developing countries,the USA drug industry has refusedthese proposals. No doubt the drugindustry has a socially palatableexplanation for their actions; theirlack of altruism would seem appar-ent, however.

It is to be hoped that various pressuregroups including our College, the

Australian Medical Association andother bodies are prepared to take apublic stand on these issues, and thatat an individual level it would seemappropriate that we first express ourview strongly when we see represent-atives from the drug companies, andperhaps write directly to the chiefexecutive officers of the local indus-try. Such changes to our own PBSsystem are likely to occur by stealthand ‘early intervention’ on thismatter may prove more fruitful thansitting on our hands.

Christopher Tennant

St Leonards, NSW

Obsessive–compulsive disorder and psychosis

DEAR SIR,

Prakash Gangdev is to be thankedfor raising the area between obsessive–compulsive disorder (OCD) and psy-chosis that presents conceptual, diag-nostic and treatment difficulties.

1

Hesuggests that the definition of obses-sions should drop the criteria of resis-tance, recognition of senselessnessand insight; this would allow OCD tobe diagnosed more readily, especiallyin patients with psychotic disorder.

Obsessive–compulsive disorder iscommon. Most patients are obviouslyanxious and struggle with compul-sions that can be understood to bea consequence of the ego-dystonicnature of their obsessions. Theabsence of an aversion to the recur-rent mental image or thought andthe absence of compulsions raise thepossibility that the personality struc-ture is less stable, reality testing isimpaired and thinking disordered.Fortunately, such presentations areless common. Unfortunately, theimplications of such disturbances aresometimes not appreciated, and pro-longed treatment with cognitive–behavioural approaches or serotoninre-uptake inhibitors (SSRIs) may yieldlittle improvement.

Undue striving for nosological preci-sion with patients who present with‘obsessive psychosis’ has an under-lying irony. As in other areas, severedisturbances of thought can eludecategorization relying upon rationaldescription. Pragmatic treatmentattends to both the repetitivethoughts and impaired insight.

Pharmacotherapy is often symptomfocused: SSRIs can be helpful forrepetitive thoughts without OCD;antipsychotics can be helpful for psy-chotic symptoms without schizo-phrenia. To redefine obsessions byremoving evidence of intrapsychicconflict is to change their essence. Itwould also make it difficult to rec-ognize the possible significance ofrecurrent images or thoughts whensuch conflict is absent.

REFERENCE

1.

Gangdev P. The relationship between obsessive–compulsive disorder and psychosis.

AustralasianPsychiatry

2002;

10

: 405–410.

Howard Cooper

Heidelberg, Vic.

The Black Dog Institute

DEAR SIR,

In the September 2002 issue of

Aus-tralasian Psychiatry

, The Black DogInstitute (BDI), a new State-basedinitiative addressing depressive dis-orders, was described. Readers of

Australasian Psychiatry

will be inter-ested to learn that the Institute’slogo, developed by Sydney adver-tiser, John Bevins, and designed andimplemented by Cato Purnel Part-ners, has won first place in theMobius Awards in the ‘Image Build-ing, Corporate Identity and Brand-ing’ competition in the USA. Theaward was announced in Chicago inlate January.

As described in last year’s article, thelogo acknowledges that ‘black dog’was the term Winston Churchill usedfor his own depression, with Church-ill’s victory sign enigmatically castingthe shadow of a black dog, and provid-ing a metaphor for a disorder that isconstantly lurking in the background.

Further developments of the conceptare evidenced in the BDI’s firstannual report, which will be pub-lished on the Institute’s new website(web2gover201.web2go.com.au/sites/blackdog).

Gordon ParkerDirector, Black Dog Institute

Sydney, NSW