King's College London
Psychosis Studies
After an intercalated BSc in Psychology and Basic Medical Sciences, Professor MacCabe qualified in medicine at the University of London in 1995 and completed his basic and higher specialist training in Psychiatry at the Maudsley Hospital from 1997 to 2004. He obtained a joint MRC/Department of Health Special Training Fellowship in Health of the population research in 2004, in collaboration with the Department of Medical Epidemiology and Biostatistics at Karolinska Institute, Stockholm. He obtained an MSc in Epidemiology from the London School of Hygiene and Tropical Medicine in 2006 and a PhD in 2008. In 2009 he was awarded a Clinical Senior Lectureship by the Higher Education Funding Council for England. He was awarded a personal chair as Professor of Epidemiology and Therapeutics at King's College London in 2019. Professor MacCabe has been honorary consultant psychiatrist at the National Psychosis Unit since 2005, where he is responsible for treating inpatients with severe psychosis and conducting clinical trials. Prof MacCabe serves on the Board of Trustees of the mental health charity, SANE. Professor MacCabe's research in treatment refractory schizophrenia personalised medicine mirrors his clinical work, and is geared towards helping people whose psychosis has not responded to standard antipsychotic treatment. His research includes work on the epidemiology, genetics and neurochemistry underlying treatment refractory schizophrenia, and identifying biomarkers that may be used in personalised medicine. Much of his research is conducted in collaboration with UK and international partners.

Presenter of 1 Presentation


Fri, 05.08.2022
Session Time
18:30 - 19:30
Session Type
Lecture Time
18:30 - 18:50


Abstract Body

The Evidence Based Medicine paradigm (EBM), in which the evidence from randomised controlled clinical trials drives treatment protocols to optimise health while maximising economic efficiency, has revolutionised treatment is many fields of medicine. Treatment resistant psychosis carries a very high social and economic burden, but I will argue that EBM has failed to improve the lives of people with treatment resistant psychosis. The first problem has been the concept of treatment resistant psychosis itself. While it is a clinically recognisable syndrome, it is poorly defined and validated, and is unattractive to pharmaceutical companies as it is imbued with a sense of therapeutic pessimism. Secondly, I will argue that the model of EBM overvalues the findings of randomised clinical trials (RCTs). However, RCTs have several drawbacks which are accentuated in TRP. These include selection bias, short time horizons and outcome measures that are poorly measured, can fail to detect clinically meaningful effects and do not align with patient priorities. Thirdly, non-RCT evidence for the efficacy of clozapine in this population, while compelling, is undervalued by the EBM paradigm. After presenting these arguments, I will make suggestions as to how we can move forward with research in this field.