Looking at the polypharmacy arm of the project one can see that there is seldom a rationale if ever for more than two antipsychotic medications, as well as more than two antidepresants medications at the same time. There are numerous reasons why this happens, but fair to say it is not quality medical practice.

As far as the metabolic arm is concerned, this is a far more complex evaluation. Different people respond to different medications, although there has been much debate about greater efficacy of the Second generation antipsychotic medications (SGA’s) there is data to support their superiority, and many patients say they feel better on SGA’s. The fact that there is minimal to no neurological side effects (movement disorders, diminished affect)  has been under appreciated in the literature. The metabolic side effects of the SGA’s has not been fully established, there has not been any research studies showing a direct cause and effect other than weight gain  for the SGA’s. When weight gain is present it is secondary to increased appetite and suppression of the satiety center, which does lead to greater caloric intake and therefore weight gain. There is currently no data to support insulin resistance or other glucose changes with the SGA’s. Increased triglycerides has been shown but most probably due to greater fat intake.

Furthermore, switching a person with serious and persistent mental illness medication can be a risky proposition, metabolic syndrome is a serious disorder but no less serious than a manic episode or psychotic relapse.

There is an incentive for clinic programs to sign up and implement PSYCKES, they receive between seven a fifteen per cent greater reimbursement than non participating clinics. This does raise a conflict of interest, considering that one of the outcome measures is reduction in pharmaceutical costs for the state of New York.

Although the project is a quality improvement project, it reviews patients medication regimens and actually has medication changes based on guidelines established by PSYCKES. Based on the criteria established by PSYCKES, a prescriber can change the patients medications, and the data is collected and reviewed by the department of Health (DOH) and the organization of mental health (OMH). These guidelines resemble a clinical trial, there is data collected, an intervention is made and therefore  should have signed informed consent as if it was a clinical trial. We asked a key person in the design of PSYCKES and we were told that any medication changes   are ultimately between the doctor and the patient/consumer. Numerous doctors have reported that they have been pressured to make these medication switches as part of the PSYCKES agreement between their clinics and the state.