Many years ago, we showed that even medical students can have an image of a drug that does not correspond to the known therapeutic efficacy1: 80% research considered that cotrimoxazole (rather than ampicillin) should be used to treat acute urinary tract infection, while 80% considered that ampicillin (rather than cotrimoxazole) should be used to treat surinfection Inhibitors,research,lifescience,medical of chronic bronchitis―an unwarranted distinction at that time. For the treatment of insomnia, the prevalent choice among benzodiazepines (ie, the molecules selected most often by the responders) was the following: chlordiazepoxide for a chronic alcoholic patient, nitrazepam for a healthy
young man, and oxazepam for an anxious menopausal woman. These answers were in accordance with the local image of the drug, or local belief.1 The third set of information consists of personal opinions derived from treating patients, from talking to colleagues, Inhibitors,research,lifescience,medical and sometimes from wishful thinking or idiosyncratic hypotheses. These three sets of information are used in the decision process; this means that this process has rational and irrational, and Inhibitors,research,lifescience,medical explicit and implicit
components. Psychiatric disorders can be grouped into three categories on the basis of their evolution. Several run a chronic course, with aggravation or little improvement in core symptoms. This is the case for dementias, mental Inhibitors,research,lifescience,medical deficiency syndromes, and schizophrenia. Fibromyalgia is another disorder with an evolution characterized by unremitting symptoms over years. For these types of disorders, the prognosis, in the etymological sense of “knowing the future,” can be made with facility so long as one considers aspects of the disease for which no treatment Inhibitors,research,lifescience,medical has ever been shown to influence the course. Obviously, these aspects are unlikely to change, a
situation that does not ask for competence in prediction. However, there are accompanying symptoms and comorbid disorders that can respond to treatment. For example, antidementia or other drugs can modify behavioral dyscontrol in dementia patients; agitation can be favorably managed in mental retardation patients; and fibromyalgia patients can make adaptations that improve their quality of life. It is within the framework of these improvements that the clinician should make a prediction nearly of treatment usefulness. Other psychiatric disorders tend to run a favorable course, for example, many of the acute stress reactions, when the stressor is not too intense and when the threshold of severity remains below the criteria for posttraumatic stress disorder or adjustment disorder. For these types of disorders or situations, the challenge is to identify patients whose evolution might not be spontaneously favorable.
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