It is questionable whether clinicians can be successful arbiters of antipsychotic efficacy (53). Trained CT raters are prone to make precision and accuracy errors in measurement when assessing clinical severity in psychiatric patients (3–5), and the CATIE reports themselves undermine the assumption that practitioners can, with adequate precision and accuracy, assess and optimize patient benefits from antipsychotic drugs. Indeed, CATIE raters could find no evidence for an advantage in switching from a current to a new medication (54). Problems with measurement encountered by CT raters would be magnified for community practitioners, many of whom are not trained with and generally do not use rating scales. The difficulty of choosing the contexts in which antipsychotic treatments can be most effective with patients also complicates this CT’s utility and therefore its validity (39).
