From the Editor

Recently during a family meeting, a patient’s father leaned forward, looked me directly in the eye, and asked: “what would be the best for my son?”

As clinicians, we draw from many sources: personal experience, clinical guidelines, expert opinion, studies. For the latter, randomized clinical trials are considered to be the gold standard. But do such trials capture well the complexity of the patient sitting in front of you?

In the first selection, Heidi Taipale (of the University of Eastern Finland) and her co-authors offer new data to answer that question. Drawing on impressive databases (over 25 000 people diagnosed with schizophrenia spectrum disorders), they consider patients with schizophrenia in RCTs against real-world populations in a JAMA Psychiatry paper. They find: “In this study, we applied typical inclusion and exclusion criteria of RCTs to the real-world populations of individuals with schizophrenia in Finnish and Swedish national registries. We found that almost 80% of individuals with schizophrenia would be ineligible to participate in typical RCTs and are therefore not represented in them.”

Finland: Big Northern Lights and big databases

In this week’s other selection, we also consider schizophrenia but with a different perspective. What could we do better to support patients and their families? Susan Inman writes: “Mothers, like me, who provide caregiving for adult children with schizophrenia do not have much of a voice.” In a thoughtful essay for, she speaks about problems that hinder an effective mental health system, including a lack of mental health literacy campaigns.


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