Data collection and analysis Three review authors (TW, JI, and NP) independently assessed RCTs for inclusion in the review, collated trial data, and assessed trial quality. We contacted investigators to obtain missing data. We stratified summary statistics by medication class, and by medication agent for all medications. We calculated dichotomous and continuous measures using a random-effects model, and assessed heterogeneity.
{"title":"Pharmacotherapy for post traumatic stress disorder (PTSD), a Cochrane Review","authors":"T. Williams, N. Phillips, D. Stein, J. Ipser","doi":"10.1192/bja.2023.17","DOIUrl":"https://doi.org/10.1192/bja.2023.17","url":null,"abstract":"Data collection and analysis Three review authors (TW, JI, and NP) independently assessed RCTs for inclusion in the review, collated trial data, and assessed trial quality. We contacted investigators to obtain missing data. We stratified summary statistics by medication class, and by medication agent for all medications. We calculated dichotomous and continuous measures using a random-effects model, and assessed heterogeneity.","PeriodicalId":9336,"journal":{"name":"BJPsych Advances","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76132558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
SUMMARY Post-traumatic stress disorder is a disabling condition resulting from a range of traumas and affecting many people worldwide. This month's Cochrane Corner review systematically searched and reported findings from 66 randomised controlled trials of pharmacotherapy for PTSD, 54 of which were included in a meta-analysis. Evidence was shown for the benefit of selective serotonin reuptake inhibitors, mirtazapine and amitriptyline in treatment response. This Round the Corner commentary critically appraises the review's findings, concluding that the summative evidence was of poor quality owing to the low number of studies, the high risk of bias and significant heterogeneity.
创伤后应激障碍是一种由一系列创伤引起的致残状况，影响着全世界许多人。本月的Cochrane Corner综述系统地检索并报告了66项PTSD药物治疗随机对照试验的结果，其中54项纳入了荟萃分析。有证据表明选择性血清素再摄取抑制剂、米氮平和阿米替林在治疗反应中有益。这篇Round the Corner评论批判性地评价了综述的发现，得出结论认为，由于研究数量少、偏倚风险高和显著的异质性，总结性证据的质量较差。
{"title":"Medication choice in post-traumatic stress disorder","authors":"Heidi Cooper","doi":"10.1192/bja.2023.16","DOIUrl":"https://doi.org/10.1192/bja.2023.16","url":null,"abstract":"SUMMARY Post-traumatic stress disorder is a disabling condition resulting from a range of traumas and affecting many people worldwide. This month's Cochrane Corner review systematically searched and reported findings from 66 randomised controlled trials of pharmacotherapy for PTSD, 54 of which were included in a meta-analysis. Evidence was shown for the benefit of selective serotonin reuptake inhibitors, mirtazapine and amitriptyline in treatment response. This Round the Corner commentary critically appraises the review's findings, concluding that the summative evidence was of poor quality owing to the low number of studies, the high risk of bias and significant heterogeneity.","PeriodicalId":9336,"journal":{"name":"BJPsych Advances","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90978108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The emergence of the COVID-19 pandemic has had a substantial negative psychosocial impact due to both the outbreak and the global response to it. As we know from previous health crises, front-line workers are among the risk groups for developing serious mental health problems. As a result of the continuous exposure to highly stressful circumstances, directly in their jobs and indirectly through media consumption and related societal pressures, healthcare professionals are at increased risk for distress, compassion fatigue, burnout and emotional disorders. Recent studies have been revealing specific stressors faced by healthcare workers during the COVID-19 outbreak, such as limited resources, work overload, fear of infecting significant others and isolation/loneliness. However, research has shown heterogeneity in adaptation to adversities, with many individuals being able to bounce back. Based on this growing evidence, this article provides a clinical working framework to empower healthcare professionals, by critically discussing resilience-promoting strategies along the intra- and interpersonal dimensions of control, coherence and connectedness.
{"title":"Fostering resilience in healthcare professionals during and in the aftermath of the COVID-19 pandemic","authors":"C. Vitorino, M. C. Canavarro, C. Carona","doi":"10.1192/bja.2023.12","DOIUrl":"https://doi.org/10.1192/bja.2023.12","url":null,"abstract":"\u0000 The emergence of the COVID-19 pandemic has had a substantial negative psychosocial impact due to both the outbreak and the global response to it. As we know from previous health crises, front-line workers are among the risk groups for developing serious mental health problems. As a result of the continuous exposure to highly stressful circumstances, directly in their jobs and indirectly through media consumption and related societal pressures, healthcare professionals are at increased risk for distress, compassion fatigue, burnout and emotional disorders. Recent studies have been revealing specific stressors faced by healthcare workers during the COVID-19 outbreak, such as limited resources, work overload, fear of infecting significant others and isolation/loneliness. However, research has shown heterogeneity in adaptation to adversities, with many individuals being able to bounce back. Based on this growing evidence, this article provides a clinical working framework to empower healthcare professionals, by critically discussing resilience-promoting strategies along the intra- and interpersonal dimensions of control, coherence and connectedness.","PeriodicalId":9336,"journal":{"name":"BJPsych Advances","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86701720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Neurosurgery for mental disorder is performed in the UK for treatment-refractory obsessive–compulsive disorder and depression. In this commentary, the procedures used are considered alongside other surgical interventions for psychiatric conditions. Given the evidence for efficacy, this commentary agrees with Whitehead & Barrera's assessment that such procedures be considered more widely in treatment-refractory illness and concurs that the advent of minimally invasive radiosurgery is an exciting prospect for patients who have not responded to other treatments.
{"title":"Neurosurgical interventions for psychiatric illness – an underutilised option in treatment?","authors":"Nigel I. Kennedy","doi":"10.1192/bja.2023.4","DOIUrl":"https://doi.org/10.1192/bja.2023.4","url":null,"abstract":"\u0000 Neurosurgery for mental disorder is performed in the UK for treatment-refractory obsessive–compulsive disorder and depression. In this commentary, the procedures used are considered alongside other surgical interventions for psychiatric conditions. Given the evidence for efficacy, this commentary agrees with Whitehead & Barrera's assessment that such procedures be considered more widely in treatment-refractory illness and concurs that the advent of minimally invasive radiosurgery is an exciting prospect for patients who have not responded to other treatments.","PeriodicalId":9336,"journal":{"name":"BJPsych Advances","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81651005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This article aims to provide psychiatrists with an overview of early release of serving prisoners and parole, using the example of the Parole Board for England and Wales. The centrality of risk assessment and management and its clinical implications for release are reviewed. Offenders who come before a parole board and require a psychiatrist to be a member of the panel and who need evidence from psychiatrists on their disorder are often characterised by the complexity of their mental disorder. Offenders with complex mental disorder have difficulty assessing effective treatment and aftercare pathways, which can result in not being released. Offenders remitted back to prison following hospital transfer for treatment experience particular problems in being released. Three roles for psychiatrists in parole hearings are identified and guidance for effective participation in hearings is discussed. Commissioning implications of the difficulty assessing the need for community aftercare are noted.
{"title":"Parole, where psychiatry meets public protection","authors":"J. O'Grady, Huw Stone, K. Murray","doi":"10.1192/bja.2022.89","DOIUrl":"https://doi.org/10.1192/bja.2022.89","url":null,"abstract":"\u0000 This article aims to provide psychiatrists with an overview of early release of serving prisoners and parole, using the example of the Parole Board for England and Wales. The centrality of risk assessment and management and its clinical implications for release are reviewed. Offenders who come before a parole board and require a psychiatrist to be a member of the panel and who need evidence from psychiatrists on their disorder are often characterised by the complexity of their mental disorder. Offenders with complex mental disorder have difficulty assessing effective treatment and aftercare pathways, which can result in not being released. Offenders remitted back to prison following hospital transfer for treatment experience particular problems in being released. Three roles for psychiatrists in parole hearings are identified and guidance for effective participation in hearings is discussed. Commissioning implications of the difficulty assessing the need for community aftercare are noted.","PeriodicalId":9336,"journal":{"name":"BJPsych Advances","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84200848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This article brings together the psychiatric and psychoanalytic views of mental illness to deepen the understanding of mental disorder. The intention is to bring to the fore the importance of loss and mourning in clinical practice. Looking for the loss event that underpins the disorder helps determine therapeutic treatment options and increases the chance of authentic therapeutic engagement and recovery. The article summarises theory about the mourning process and discusses the relationship of loss and pathological mourning to mental illness. Fictitious case vignettes developed from years in psychiatric practice are used to illustrate how this relates to clinical practice and formulation.
{"title":"The mourning process and its importance in mental illness: a psychoanalytic understanding of psychiatric diagnosis and classification","authors":"R. Gibbons","doi":"10.1192/bja.2023.8","DOIUrl":"https://doi.org/10.1192/bja.2023.8","url":null,"abstract":"\u0000 This article brings together the psychiatric and psychoanalytic views of mental illness to deepen the understanding of mental disorder. The intention is to bring to the fore the importance of loss and mourning in clinical practice. Looking for the loss event that underpins the disorder helps determine therapeutic treatment options and increases the chance of authentic therapeutic engagement and recovery. The article summarises theory about the mourning process and discusses the relationship of loss and pathological mourning to mental illness. Fictitious case vignettes developed from years in psychiatric practice are used to illustrate how this relates to clinical practice and formulation.","PeriodicalId":9336,"journal":{"name":"BJPsych Advances","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73739185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
SUMMARY Children with intellectual disability are often prescribed psychotropic medication to manage behaviours that challenge. Unfortunately, many receive medication with potentially serious long-term side-effects that has been prescribed inappropriately or for longer than is necessary. NHS England launched STOMP (stopping the over-medication of people with intellectual disability, autism or both with psychotropic medicines) in 2016 to reduce the inappropriate prescribing in adults. This was broadened to include children in 2018 by the addition of STAMP (supporting treatment and appropriate medication in paediatrics). In this article we review the rationale for STOMP–STAMP, highlight the Royal College of Psychiatrists’ position statement on STOMP–STAMP and give clinical advice for psychiatrists who treat children with intellectual disability, autism and/or attention-deficit hyperactivity disorder (ADHD). Importantly, it is essential to consider that ADHD may have been missed and that by diagnosing and treating it, the need for inappropriate antipsychotic medication may be reduced.
{"title":"Stopping inappropriate medication of children with intellectual disability, autism or both: the STOMP–STAMP initiative","authors":"Annie Swanepoel, M. Lovell","doi":"10.1192/bja.2023.14","DOIUrl":"https://doi.org/10.1192/bja.2023.14","url":null,"abstract":"SUMMARY Children with intellectual disability are often prescribed psychotropic medication to manage behaviours that challenge. Unfortunately, many receive medication with potentially serious long-term side-effects that has been prescribed inappropriately or for longer than is necessary. NHS England launched STOMP (stopping the over-medication of people with intellectual disability, autism or both with psychotropic medicines) in 2016 to reduce the inappropriate prescribing in adults. This was broadened to include children in 2018 by the addition of STAMP (supporting treatment and appropriate medication in paediatrics). In this article we review the rationale for STOMP–STAMP, highlight the Royal College of Psychiatrists’ position statement on STOMP–STAMP and give clinical advice for psychiatrists who treat children with intellectual disability, autism and/or attention-deficit hyperactivity disorder (ADHD). Importantly, it is essential to consider that ADHD may have been missed and that by diagnosing and treating it, the need for inappropriate antipsychotic medication may be reduced.","PeriodicalId":9336,"journal":{"name":"BJPsych Advances","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76266050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Beale, James Lee-Davey, Tennyson Lee, Alex Ruck Keene
This article is the second of two looking at assessment of mental capacity in clinical practice. In it, we explore capacity assessments in the context of suicidal thoughts and acts. The laws governing doctors’ responsibility to suicidal patients in England and Wales are poorly understood, with tensions at the interface between the Mental Health Act 1983 (MHA) and the Mental Capacity Act 2005 (MCA). Dynamics of the clinical encounter (including the countertransference) further exacerbate uncertainty about how clinicians should balance patients’ autonomy with protection of life. We use a case example of a patient presenting with suicidality to describe good practice, based on a balance of legal and clinical principles and up-to-date case law. We discuss the difficulty in applying the MCA in relation to patients who appear to lack a consistent and coherent sense of self and others and consider whether the MCA is fit for purpose in determining whether someone with a personality disorder diagnosis should be permitted to end their own life.
{"title":"Mental capacity in practice part 2: capacity and the suicidal patient","authors":"C. Beale, James Lee-Davey, Tennyson Lee, Alex Ruck Keene","doi":"10.1192/bja.2022.82","DOIUrl":"https://doi.org/10.1192/bja.2022.82","url":null,"abstract":"\u0000 This article is the second of two looking at assessment of mental capacity in clinical practice. In it, we explore capacity assessments in the context of suicidal thoughts and acts. The laws governing doctors’ responsibility to suicidal patients in England and Wales are poorly understood, with tensions at the interface between the Mental Health Act 1983 (MHA) and the Mental Capacity Act 2005 (MCA). Dynamics of the clinical encounter (including the countertransference) further exacerbate uncertainty about how clinicians should balance patients’ autonomy with protection of life. We use a case example of a patient presenting with suicidality to describe good practice, based on a balance of legal and clinical principles and up-to-date case law. We discuss the difficulty in applying the MCA in relation to patients who appear to lack a consistent and coherent sense of self and others and consider whether the MCA is fit for purpose in determining whether someone with a personality disorder diagnosis should be permitted to end their own life.","PeriodicalId":9336,"journal":{"name":"BJPsych Advances","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77684022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Beale, James Lee-Davey, Tennyson Lee, Alex Ruck Keene
Significant problems exist in understanding and implementing the Mental Capacity Act 2005 (MCA) despite it having been in place in England and Wales for more than 15 years. Although many guidelines exist on the assessment of capacity, it is difficult to apply such guidance in practice, given the complexity of actual situations. We may know the stages of the test for capacity, but do we really understand what they mean and how to assess them? In this, the first of two articles examining the MCA and challenges in its application, we add to existing legal guidance to explore capacity assessment in detail using a clinical scenario, and use case law and case studies to illustrate the subtleties and difficulties that may arise.
{"title":"Mental capacity in practice part 1: how do we really assess capacity?","authors":"C. Beale, James Lee-Davey, Tennyson Lee, Alex Ruck Keene","doi":"10.1192/bja.2022.81","DOIUrl":"https://doi.org/10.1192/bja.2022.81","url":null,"abstract":"\u0000 Significant problems exist in understanding and implementing the Mental Capacity Act 2005 (MCA) despite it having been in place in England and Wales for more than 15 years. Although many guidelines exist on the assessment of capacity, it is difficult to apply such guidance in practice, given the complexity of actual situations. We may know the stages of the test for capacity, but do we really understand what they mean and how to assess them? In this, the first of two articles examining the MCA and challenges in its application, we add to existing legal guidance to explore capacity assessment in detail using a clinical scenario, and use case law and case studies to illustrate the subtleties and difficulties that may arise.","PeriodicalId":9336,"journal":{"name":"BJPsych Advances","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89029438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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