Mental illness prognosis relies on clinical judgment rather than scientific prediction methods, as there is no objective way to predict future course or remediability; this creates significant uncertainty where psychiatrists often disagree on outcomes, and guidance documents like the CPA rely on retrospective data rather than prospective criteria, potentially leading to premature life-ending decisions for individuals who could have recovered.
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[music] >> Given that there is no specific scientific way to predict the future course of mental illness, so in given that would be fair to say that any prediction would amount to a clinical hunch?
I I would say clinical judgment is where we are are basing any kind of prediction at this current time and as I said before there are there's research underway for several years to try to explore indicators to help us prognosticate better but we are not we're a long way away. And it would be fair to say that it's quite common for psychiatrists to disagree amongst one another on the future course of mental illnesses. Is that fair?
I would say so and even the diagnosis itself as others have highlighted as well that there are studies showing differences including from the initial field studies of the DSM-5 for example that there are differences in diagnosis and that they change over time. And so given the difficulty in predicting your remediability, the fact that there is no scientific objective way, would it be fair to say that if this expansion were to move ahead there would be a high rate of error in which persons who could get better, who could go on to lead a healthy and happy life would have their lives prematurely ended as Dr. Sanjeev Gained said it would be akin to flipping a coin. Would you agree?
Yeah I would say we would be using clinical judgment and there would be if we were to go forward that there would be times where there may have been a chance to provide treatments that people may not have had access to or not been aware of and that there may be times where people's illness may have improved that but we wouldn't we may have predicted incorrectly.
And you spoke about the CPA guidance and you noted that it fails to provide any scientific criteria with respect to predicting your remediability likely because there aren't no such criteria.
The CPA guidance does use the practice standard from Health Canada but that looks in a back on a retrospective basis.
You would I take it agree that that's insufficient.
That is insufficient and and again the CPA, you know, I applaud CPA for trying to come up with guidance but we're limited by the literature and the evidence and the evidence is based on retrospective >> [clears throat] >> data and it's a process document as opposed to criteria or an objective assessment.
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