In a recent published research 44,218 and 46,089 baseline users of single typical and atypical drugs, respectively, and 186,600 matched nonusers of antipsychotic drugs were retrospectively compared for the risk of sudden cardiac death.
Current users of typical and of atypical antipsychotic drugs had a similar, dose-related increased risk of sudden cardiac death.
It was already known that typical antipsychotics increased the risk of sudden cardiac death. This study adds the important knowledge that atypical antipsychotics also carriages that risk increasing with higher dosages.
How high is the risk?
Current users of typical antipsychotic drugs had an adjusted rate of sudden cardiac death that was twice that for nonusers. A similar increased risk was seen for current users of atypical antipsychotic drugs. The 6 atypical antipsychotics did not differ significantly.
Implications?
Before you think that atypical antipsychotics are a safer alternative to typical antipsychotic, think twice. When prescribing or taking off label atypical antipsychotics think twice. Especially children and elderly with dementia.
Does this mean we can’t prescribe antipsychotics? No but before you doe be sure to do it for patients with a clear indication. Physicians should continue to be able to prescribe antipsychotic drugs when there is clear evidence of benefit, for conditions such as schizophrenia and bipolar disorders.
a small risk of rare but fatal side effects may be acceptable until new medications with a safer cardiac risk profile are developed
Should it change the way we prescribe antipsychotics?
In an Editorial a wise recommendation is made:
in our view if an antipsychotic agent is necessary, it seems reasonable to obtain an electrocardiogram before and shortly after initiation of treatment with an antipsychotic drug. This modest effort could enable each patient starting on a high-dose antipsychotic to be
screened for existing or emergent prolongation of the QT interval
One of the arguments for this recommendation is that clozapine’s risk on agranulocytosis is smaller than this adverse effect while those patients are tested frequently with close monitoring of white cell counts during the first months of treatment.
W. A. Ray, C. P. Chung, K. T. Murray, K. Hall, C. M. Stein (2009). Atypical Antipsychotic Drugs and the Risk of Sudden Cardiac Death New England Journal of Medicine, 360 (3), 225-235 DOI: 10.1056/NEJMoa0806994
S. Schneeweiss, J. Avorn (2009). Antipsychotic Agents and Sudden Cardiac Death — How Should We Manage the Risk? New England Journal of Medicine, 360 (3), 294-296 DOI: 10.1056/NEJMe0809417
I am not a firm believer of Internet Addiction. One of the main features of addiction is having complaints, suffer complications of the addiction. The main features of an addiction are social and/or emotional problems leading to doctors visit or other forms of help seeking. So what we are looking for is teenagers using the Internet as there only way to communicate, play and doing that at night. Anyone can explain to them why that isn’t healthy. Internet is mostly defined as excessive use, withdrawal, tolerance and negative consequences. If these flimsy characteristics are followed most of us suffer from all kinds of addictions such as work addiction, sports addiction, chocolate addiction well may be you can think of a few more.
Moreover, it seems that people mistake the medium for the message. When they hear that folks are “addicted to the Internet”, they blame the Internet, the medium, for the problem, whereas the Internet is simply provides a new source of behaviors for people who would have had behavioral addictions anyway. Even incorporating this new medium into our culture will be accompanied by getting used to, finding the right balance in your daily routine.
Beside the these previous mentioned objections to the new diagnosis of Internet Addiction a recent Metasynthesis of the recent quantitative research on this matter came to the following conclusion:
previous studies have utilized inconsistent criteria to define Internet addicts, applied recruiting methods that may cause serious sampling bias, and examined data using primarily exploratory rather than confirmatory data analysis techniques to investigate the degree of association rather than causal relationships among variables.
This study was done to find answers to the questions: How has Internet addiction been measured? What aspects of the Internet addiction phenomenon have been investigated by academic researchers?
The biggest problem with studies defining a new syndrome is usually that they don’t use validated diagnostic tools but mostly some severity scale. This is also the trouble with research for depression in the medical ill patients. If someone is severely ill and you use an Hamilton Depression Rating Scale they will almost all have high scores not because they are depressed but because the feel horrible due to their somatic illness.
Another big problem is that Internet Addiction is not clearly defined in the recent scientific publications and research. Some researchers have adapted substance use disorder, while others reference pathological gambling, resulting in an inconsistent definition of Internet addiction. Many researchers, due to the complex nature of the topic, do not provide a clear definition of Internet addiction.
Besides not using a clear definition researchers used different scales for measuring Internet Addiction, and these scales have not been standardized for efficient cross-study comparisons.
Most of the studies used Internet-based survey formats as well as used high school and university student samples. The different sample selection criteria across the studies have brought varying conclusions on the prevalence of Internet addiction. Studies on Internet Addiction focus on adolescents. In trying to recruit samples outside of schools most of these sample recruitment methods suffer from sampling bias. This makes generalizing the findings of the study to other populations troublesome to say the least. The sample selection criteria are still far from the randomization principle and raise questions regarding sample coverage errors.
Studies on Internet addiction have focused on “proving” the existence of Internet addiction or identify the characteristics of Internet addicts. The analysis methods employed were thus exploratory rather than confirmatory.
How was this study done?
A study was included if it used human participants and a quantitative instrument to measure Internet addiction. To ensure quality and completeness, only fulllength articles in peer-reviewed journals or conference proceedings were considered. Searches of academic databases and of Google and Yahoo! using keywords Internet addiction, Internet addicted, problematic Internet usage, and computer addiction
resulted in 120 articles spanning the period 1996–2006. If you want the whole database of articles please follow this link which downloads a excel file with all the references (120). For this review they used 61 articles from the 120.
Important they didn’t use the important criteria of a prospective design nor using a control group nor randomized attribution to two conditions. That’s the meaning of quantitative data, just counting numbers, not an experimental prospective study design.
In the end the research on this subject until now is biased. This review names the most important flaws from these publications. They offer suggestions to improve the research on this subject. To my opinion their recommendations don’t go far enough. If you want to prove the validity of a concept randomized prospective trials with clear hypothesis before hand are needed. What do you think.
In a study the majority of the patient population (96%) preferred their psychiatrist not to wear a white coat although 58% did not think it would make a difference in their relationship with their doctor.
The psychiatrists mostly (64%) agreed on this point, 14% added that in situations like geriatric psychiatry, emergency psychiatry, inpatient and consultation liaison they preferred to wear a white coat.
Both the patients and psychiatrists considered dress to be an important part of the doctor–patient relationship.
The majority of the patients (65%) preferred the male psychiatrist to be dressed in casual shirt and casual trousers. Similarly, the dress shirt with skirt/pants was the most popular dress attire for female doctors (60%). The psychiatrists dressed more formally. ‘‘Suit and tie or sports coat and dress pants and tie’’ or ‘‘Shirt, tie and dress pants’’. The female psychiatrists suggested a relatively informal dress attire of ‘‘Dress blouse/shirt and pants/skirt.’’ Male psychiatrists are more critical towards their dress compared to the patients.
The study was done in Upstate New York with a chronically ill population who were attending the outpatient clinic for many years. This limits generalizability.
These results are in contrast with a UK study (1997). They reported that the doctors dressed in suits were considered to be more competent and the white coat was related to being the most understanding. The description of smart attire consisted of wearing a long sleeved shirt with formal trousers and a tie (male) and a blouse and skirt (female). Comparable to the US study the psychiatrists usually were more critical about their attire as compared to patients themselves.
What about other doctors than psychiatrists?
In a large study from New Zealand with outpatients attending clinics that covered a range of medical and surgical specialties patients prefer a semiformal style of dress over formal suits and white coats. Casual dress styles were less popular.
In the New Zealand setting this would involve dressing in a tidy, semiformal manner in conservative clothing.
In a study done in the US, South Carolina, respondents from an internal medicine outpatient clinics overwhelmingly favor professional attire with white coats for physicians. This could be due to a more formal attitude in the south of the US.
Concluding
No psychiatrists shouldn’t wear white coats, special situations excluded. A happy face and smart attire is all that is needed.
S REHMAN, P NIETERT, D COPE, A KILPATRICK (2005). What to wear today? Effect of doctor’s attire on the trust and confidence of patients The American Journal of Medicine, 118 (11), 1279-1286 DOI: 10.1016/j.amjmed.2005.04.026 Nikhil D. Nihalani, Arun Kunwar, Jud Staller, J. Steve Lamberti (2006). How Should Psychiatrists Dress?—A Survey Community Mental Health Journal, 42 (3), 291-302 DOI: 10.1007/s10597-006-9036-9 M. M Lill (2005). Judging a book by its cover: descriptive survey of patients’ preferences for doctors’ appearance and mode of address BMJ, 331 (7531), 1524-1527 DOI: 10.1136/bmj.331.7531.1524
Both Shrink Rap and Mind Hacks report on a debate about how transparent the process for developing the upcoming DSM-V should be. This debate is published in the LA Times. Those in charge of the revision want secrecy, nobody knows why. It is suggested in the comments it could have something to do with the insurance companies?
Besides transparency of the making of the new revision of this psychiatric diagnostic bible other problems were mentioned on this blog as well as others:
Will Internet addiction be a new diagnosis in the DSM V? Medicalize problems again. In an editorial in the American Journal of Psychiatry Internet Addiction is proposed as a new diagnosis in DSM V. Now the American Journal of Psychiatry used to be a serious peer reviewed journal although some of us doubt this feature for a while now.
More than half the 28 new members of writers of the next edition of the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM) have ties to the drug industry.
Suicidal behavior as Sixth Axis in DSM VIt is suggested in an editorial of the American Journal of Psychiatry that suicidal behavior be considered a separate diagnostic category documented on a sixth axis. Ridiculous. Suicidal behavior (death and attempts) is a symptom of various psychiatric conditions. We will need a seventh axis for addiction, another item often overlooked. It is a kind of safe guard against lack of interest, lack of empathy for psychiatric patients.
There is still a long way to go. The DSM-V is due out in May 2012, and all mental illness and proposals for the classifications of new mental illness are currently under review by the DSM-V committee.
Civilians can be exposed to traumatic events. Most notably terrorist bombing attacks. In Israel, civilians are a frequent target of terrorist suicide bombers (e.g., attacks on civilians riding on public buses).
BusWorld is a simulation of a terrorist suicide bus-bombing attack designed to treat survivors for PTSD.
What is Post Traumatic Stress Disorder? Patients with PTSD commonly have persistent traumatic thoughts, memories, or nightmares about the traumatic event; typically avoid thinking about the traumatic event; feel emotionally numb; and show social avoidance (e.g., avoid riding buses). Other common symptoms include recurring flashbacks, irritability, anger and rage, hypervigilance, bodily discomforts, and trouble sleeping.
In a recent publication this form of Virtual Reality Exposure Therapy was tested on 30 healthy volunteers without PTSD.
The objective of the present study was to measure the amount of anxiety elicited in nonsymptomatic adults in response to four progressively more intense levels of the BusWorld simulation toward the eventual use with people who have witnessed and survived a terrorist bus-bombing attack and developed PTSD.
What is Virtual Reality Exposure Therapy? In Virtual Reality Exposure therapy, patients go into an immersive computer-generated environment (go back to the scene of the traumatic event) to help them gain access to their memories of the traumatic event, change unhealthy thought patterns, gradually habituate to their anxiety, and reduce the intensity of associated emotions. The therapist’s ability to manipulate the amount of anxiety experienced by the client during therapy is an important element of successful exposure therapy.
How was it done? The therapist controls the severity of the scenario in the VRE therapy via the pressing of different function keys. The VR was programmed to have 4 levels of intensity. This way the participants and future PTSD patients can be exposed to graded exposure with 4 increasing levels of distress.
Level 1. The participant views the quiet street scene in the absence of any action. The events are viewed from an urban Israeli sidewalk, near a café, across the street from a bus stop
Level 2. A bus appears and approaches the bus stop, but there is no explosion.
Level 3. The bus arrives at the bus stop and explodes; the bus is seen to be burning, there is smoke and shattered glass on the street, but there are no accompanying sound effects.
Level 4. This level is the same as Level 3, except with the addition of sounds of the bus exploding, people screaming and crying, as well as police sirens and reflections of flashing police-car lights (police car is not visible to participants) but in this level it is clear to see that there has already been some victims injured in a car accident.
In this study with healthy participants the level of distress increased with each level. This suggests that BusWorld may prove to be a valuable medium for providing graded exposure for individuals suffering from PTSD originating from suicide bus bombings.
It has already been tried with survivors of the 9/11 attack on the World Trade Center:
a graded immersive simulation of the events of September 11, 2001, at the World Trade Center in Manhattan.
This has been studied in a controlled trial with a waiting list group. The VRE was more efficacious in reducing PTSD symptoms.
PTSD, Soldiers and War In a recent article in British Medical Journal it is concluded that an association was found between deployment for more than a year in the past three years and mental health that might be explained by exposure to combat. In other words: Personnel who were deployed for 13 months or more in the past three years were more likely to fulfil the criteria for post-traumatic stress disorder, scored worse on the general health questionnaire, and have multiple physical symptoms. PTSD is frequent among soldiers exposed to combat.
Virtual Reality Exposure Therapy with PTSD in soldiers
Our group exercise sessions with our physical therapists draw on a range of rehabilitative techniques including strength & conditioning, functional movement and Pilates. Your physiotherapist will take a full history and conduct an assessment to include or exclude directional based exercises in your program. The result is an exercise program tailored to your clinical needs. Utilising a reformer and trapeze table, strengthening and lengthening can be achieved often without aggravation of the injury due to the low impact on the hips, knees and back. Our group exercise sessions are more than a generic exercise class, providing you with therapeutic intervention for your musculoskeletal condition.
This therapy has been used with Vietnam veterans with PTSD:
a helicopter hovering over a rice paddy field, which clients viewed via a head-mounted display
This has been studied in an open trial with good efficacy for PTSD.
But can Soldiers benefit from Technology-Based Approaches to Mental Health Care
A recent study utilized a survey-based approach to examine pre- and post-deployed Soldiers’ knowledge of and attitudes toward using technology to access mental health care.
This study examined 352 U.S. Soldiers’ knowledge of and attitudes toward using technology to access mental health care. Results indicated that Soldiers were quite experienced with a wide variety of technology-based tools commonly proposed to facilitate mental health care. In addition, the majority of participants stated that they would be willing to use nearly every technology-based approach for mental health care included in the survey. Notably, 33% of Soldiers who were not willing to talk to a counselor in person were willing to utilize at least one of the technologies for mental health care.
This is especially important since soldiers often face unique barriers to care, including geographic location, deployment, complex duty environments, and fear of treatment stigma, and may not access the mental health care services they need.
Naomi Josman, Ayelet Reisberg, Patrice L. Weiss, Azucena Garcia-Palacios, Hunter G. Hoffman (2008). BusWorld: An Analog Pilot Test of a Virtual Environment Designed to Treat Posttraumatic Stress Disorder Originating from a Terrorist Suicide Bomb Attack CyberPsychology & Behavior, 2147483647-3 DOI: 10.1089/cpb.2008.0048 R. J Rona, N. T Fear, L. Hull, N. Greenberg, M. Earnshaw, M. Hotopf, S. Wessely (2007). Mental health consequences of overstretch in the UK armed forces: first phase of a cohort study BMJ, 335 (7620), 603-603 DOI: 10.1136/bmj.39274.585752.BE Jaime A. B. Wilson, Kristin Onorati, Matt Mishkind, Mark A. Reger, Gregory A. Gahm (2008). Soldier Attitudes about Technology-Based Approaches to Mental Health Care CyberPsychology & Behavior, 2147483647-3 DOI: 10.1089/cpb.2008.0071
It is suggested in an editorial of the American Journal of Psychiatry that suicidal behavior be considered a separate diagnostic category documented on a sixth axis. Ridiculous. Suicidal behavior (death and attempts) is a symptom of various psychiatric conditions.
Their main concern is that during assessment, clinicians evaluate the principal diagnosis responsible for the chief complaint and use overview questions to identify comorbid conditions. They further reason that suicidality in high-risk groups can easily go unidentified.
What they overlook to my opinion is that this addition of another axis will not end. We will need a seventh axis for addiction, another item often overlooked. It is a kind of safe guard against lack of interest, lack of empathy for psychiatric patients. The lack of being able to feel the trouble these patients can have, even resulting in suicidal behavior. We should train our residents in empathy, in getting them to understand the consequences of the symptoms these patients suffer including suicidal behavior.
For that matter another editorial in the same issue hits the nail on the head:
The course asks residents to consider the fact that our sociocultural context is just as critical as basic neurobiology in shaping how we understand and intervene in our patients’ illnesses.
The authors of this editorial describe a course that focuses on the heterogeneity of mental illness
experience, and they describe outcomes in a comprehensive narrative. Texts on illness experience remind residents that they see an extremely brief slice of an individual’s life in the clinic.
In short: the person and his or her world behind the “patient”, that is what important, not another axis in DSM V.
The course consists of lectures, readings, and homework, the course engages residents in discussions about the psychiatric task. Social science is taught not as a set of abstract theories but as a set of tools to use as residents consider the responsibilities, complexities, and uncertainties of clinical work.
M. A. Oquendo, E. Baca-Garcia, J. J. Mann, J. Giner (2008). Issues for DSM-V: Suicidal Behavior as a Separate Diagnosis on a Separate Axis American Journal of Psychiatry, 165 (11), 1383-1384 DOI: 10.1176/appi.ajp.2008.08020281 E. Bromley, J. T. Braslow (2008). Teaching Critical Thinking in Psychiatric Training: A Role for the Social Sciences American Journal of Psychiatry, 165 (11), 1396-1401 DOI: 10.1176/appi.ajp.2008.08050690
In a recent systematic review it is concluded that with the limited number of studies and their methodological limitations no evidence was found supporting the notion that antidepressants can induce switching or accelerate cycling. In terms of switch risk, antidepressants seem safe when combined with a mood stabilizer. However, antidepressants given as monotherapy cannot be recommended, at least not when treating patients with bipolar disorder type 1.
However, it should be noted that stating that there is no evidence for such a risk is obviously not the same as stating that there is evidence for no such risk. Nevertheless, there is some evidence suggesting that antidepressants given in addition to a mood stabilizer are not associated with an increased rate of switch when compared with the rate associated with the mood stabilizer alone…
With switch was meant the switch of depression into hypomania⁄ mania in patients with bipolar disorder on antidepressants. In this meta analysis this question was opposed against the probability that this switch is a phenomenon attributable to the natural history of bipolar disorder itself.
Now why is that important?
Antidepressants have been poorly studied for their use in bipolar depression. The main reason for this is that, most of the evidence base in clinical psychopharmacology comes from industry-sponsored trials.
The industry couldn’t find any advantage for an antidepressant being registered for depression in bipolar disorder. They could be used for depression and they could promote antidepressants for any kind of depression.
Moreover, antidepressants are the most commonly prescribed drugs in bipolar disorder, way ahead of mood stabilizers and antipsychotics, despite the evidence base is much better for the latter.
A Psychiatric Divide?
The European point of view is that the switch is not promoted by the use of antidepressants but more probably the course of the illness while the more defensive standpoint of the view in the United States is that switches are caused mainly by antidepressant use in bipolar depressive patients especially tricyclic antidepressants.
More findings from this meta analysis
Switch rates in unipolar depressed patients were, respectively, 3.0% and 4.6%, before and after the introduction of antidepressants; in bipolar depressed patients, similar rates of around 29% were observed for the two periods.
In five trials comparing placebo with an antidepressant in bipolar depression the pooled total switch rates when on treatment with antidepressants and placebo were 3.8% and 4.7%, respectively, and not statistically significant.
When combining a mood stabilizer and an antidepressant compared to a mood stabilizer alone or placebo the switch rates between moodstabilzer alone or the combination with an antidepressant did not differ significantly.
The likelihood of switching into hypomania ⁄mania is dependent on the course of depressive symptoms: a patient who has remitted from depression seems to be at a higher risk of switching than a patient with persistent depressive symptoms. Therefore, the higher switch rates observed with TCAs might be simply a methodological artefact explained by a higher efficacy of TCAs.
Data on switching after a symptom free interval are even more limited in bipolar disorder.
Depressed patients with bipolar disorder type 2 given an antidepressant and a mood stabilizer might have a lower switch rate than patients with bipolar disorder type 1 receiving the same treatment.
Very high switch rates of up to 50% during ECT are reported; this high rate may be
linked to the high antidepressant efficacy of ECT. The advantage of ECT is that continuing the treatment treats the resulting hypomania/mania.
The association between rapid cycling and antidepressant use might be explained by the fact that included patients sought treatment for depression which has been found to be a predictor of rapid cycling. Systematic data on any causal role of antidepressants in the development of rapid cycling
are lacking.
The only solution to finding a definite answer to the question whether antidepressants can induce hypomania/mania and rapid cycling in bipolar depressed patients is doing a randomized placebo controlled trial.
Why is a placebo controlled trial not feasible?
The sample size needed to control for the natural course of the bipolar disorder would make a very large sample necessary. Moreover, the treatment groups then may not be balanced any more in terms of baseline clinical variables such as number of previous episodes or previous rapid cycling.
Even if antidepressants could be found to induce switches to a larger extent than other treatments, then it might be that the total burden of illness due to shortening of total duration of depression would be diminished.
In the same number of the Acta Psychiatrica Scandinavia results of another meta-analysis was published. Long-term antidepressant treatment in bipolar disorder: meta-analyses of benefits and risks.
In short the main conclusions were:
Available research suggests an unfavorable risk ⁄ benefit relationship for long-term antidepressant treatment in type-I bipolar disorder.
Adding an antidepressant to a mood stabilizer has yielded little gain in protection from recurrences of bipolar depression.
Antidepressant-alone, without a mood stabilizer, may diminish depressive relapse, but carries larger risks of manic or hypomania relapses.
R. W. Licht, H. Gijsman, W. A. Nolen, J. Angst (2008). Are antidepressants safe in the treatment of bipolar depression? A critical evaluation of their potential risk to induce switch into mania or cycle acceleration Acta Psychiatrica Scandinavica, 118 (5), 337-346 DOI: 10.1111/j.1600-0447.2008.01237.x
S. N. Ghaemi, A. P. Wingo, M. A. Filkowski, R. J. Baldessarini (2008). Long-term antidepressant treatment in bipolar disorder: meta-analyses of benefits and risks Acta Psychiatrica Scandinavica, 118 (5), 347-356 DOI: 10.1111/j.1600-0447.2008.01257.x
Dr Shock is not very impressed with these new antipsychotics. Most research is done with comparison to high dose haloperidol, not very honest. Anyway the most dreaded side-effect of these new antipsychotics is weight gain. And I mean really weight gain, not just a few kilo’s. Clozapine and olanzapine produce the most weight gain followed by quetiapine and risperidone. Ziprasidone and aripiprazole produce the least weight gain.
The trouble is that those antipsychotics are mostly used in patients with schizophrenia and they usually have to use it for the rest of their lives. Moreover, these patients can have other risk factors for cardiovascular disease as well. Weight gain may also adversely affect treatment adherence, is associated with reduced quality of life, social stigma, and greater morbidity and mortality.
Wouldn’t it be nice if we had effective interventions and specific treatment approaches to control this anti psychotic weight gain. And I mean non-pharmacological. Recently I wrote a post about the use of metformine during treatment with atypical antipsychotics. Metformine was combined with lifestyle intervention, this consisted of a diet,psycho education and exercise.
A recent study indicates that lifestyle intervention and metformine in combination has the greatest effect on weight loss and increases insulin sensitivity for patients taking atypical antipsychotics. These methods result in a decrease of 1.8 of the BMI, an increase in insulin resistance index of 3.6 and the waist circumference decreases with 2.0 cm.
Fortunately their is a recent health supplements which help to the actual weight loss which are the Exogenous Ketones Supplements excellent for good health and to maintain your weight, also there’s a new systematic review and meta analysis about this topic. And this is the result:
Ten trials were included in the meta-analysis. Adjunctive non-pharmacological interventions, either individual or group interventions, or cognitive–behavioural therapy as well as nutritional counselling were effective in reducing or attenuating antipsychotic-induced weight gain compared with treatment as usual, with treatment effects maintained over follow-up.
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I was interested in these interventions. Six of the included trials investigated cognitive–behavioural intervention strategies; three nutritional counselling interventions; and one combined nutritional and exercise interventions. Five used group interventions and 5 examined individual interventions. There was no statistically significant or practically important differences between therapeutic approaches, either individual compared with group interventions, or CBT compared with nutritional counselling.
Only one trial was found with a young cohort with recent-onset psychosis. Weight gain is a greater problem for these young patients, they are especially susceptible for this side-effect. My friend uses this boiled egg diet and he lost around 2 pounds in 2 weeks.Treatments offered in early stages should be more benign as well as effective to improve treatment adherence. These interventions against weight gain are especially beneficial to this young group of patients.
Overall weight loss was on average 2,6 kg. Is statistically significant also clinically relevant?
In this review, the average baseline weight was approximately 80 kg (ranging from 66.5 to 101.3 kg). Therefore, even a weight loss of 1.9–3.2 kg represents a reduction of 2.5–4.0% of initial body weight in a significant number of patients. It may be plausible, then, to expect that these reductions in body weight could result in corresponding reductions in morbidity and early mortality.
So start implementing these interventions when prescribing new antipsychotics.
M. Alvarez-Jimenez, S. E. Hetrick, C. Gonzalez-Blanch, J. F. Gleeson, P. D. McGorry (2008). Non-pharmacological management of antipsychotic-induced weight gain: systematic review and meta-analysis of randomised controlled trials The British Journal of Psychiatry, 193 (2), 101-107 DOI: 10.1192/bjp.bp.107.042853
This is the first post about mass media and psychiatry. Trends in the newspapers in the United States on reporting topics of mental illness:
Most stories in newspapers in relation to mental illness were mostly about dangerousness (39%). Not danger to others but mostly stories with text related to violent crime (25%). Thirteen percent of the stories were related to suicidal or self-injurious behavior, only 4% dealt with mental illness as a variable related to being victimized by crime. These stories were mostly on the front page increasing impact. Stories in the entertainment section did not focus on dangerousness more often than other sections
Causes mentioned in newspaper articles for developing a mental illness:
parental misbehavior (2 percent)
fewer stories blamed mentally ill persons for their illness (less than 1 percent)
Five percent of the stories discussed genetic or biological causes
Most stories dealt with environmental causes (10 percent), including trauma and job stress
Stories about genetic causes were most frequently found in the health section (14 of 160 stories, or 9 percent)
Stories about environmental causes were frequently seen in the lifestyle section (31 of 332 stories, or 9 percent) and the health section (eight of 332 stories, or 2 percent)
Twenty-six percent of stories were related to treatment and recovery. Most were about biological treatments (13 percent) and psychosocial treatments (14 percent). In terms of frequency, most stories about research and treatment were found in the health section of newspapers. Biological treatments were also prominently discussed in the front section and, interestingly, in the business section.
Stories that could support patients with mental illness were twenty percent of all articles. The single largest theme was shortage of resources; these themes were most prevalent in editorials and opinion pieces. Five percent of stories were related to poor quality of treatment. Themes on housing and homelessness were present in 6 percent of stories. Even though insurance parity is a prominent issue on the agenda for mental health advocacy, only 2 percent of articles dealt with this theme, if you are looking to get insured with this condition there are several health insurance companies who gives Best Medicare supplement plans 2020 that can help you
How? All U.S. newspapers with daily circulation greater than 250,000 were selected for our study or in states without such large editions the largest newspaper was selected. All relevant stories (N=3,353) in large U.S. newspapers were identified and coded during six week long periods in 2002.
Why is it important? The public is still being influenced with messages in newspapers about mental illness and dangerousness mostly on the front page.
However, when these numbers are considered in terms of base rates, one finds mental illness to be a poorer predictor of violence than demographic variables, such as age, gender, and race or ethnicity……Yet the public is more likely to view people with mental illness as dangerous
Instead of focusing on personal or parental blame, stories seemed to focus on biological or mostly environmental causes, while in research the brain has become the focus of recent interest and development especially neuroscience. Treatment and recovery are also an important topic in articles in newspapers. Sometime these mental issues from you or someone you know could be a liability to the public if left untreated. if you need public liability insurance, visit constructaquote.com in the event something horrible happens to you or your loved one struggling with issues.
So this is my plea, if you or someone you know (In my head I am saying this in Morgan Freeman’s voice) are suffering from depression SHOUT IT OUT! Depression and mental illness are REAL and can result in death. Mental health issues are not something to be swept under the rug or whispered about in the corner. Do I know the miracle cure for depression? No. But I do know that for many being active helps, eating healthy, sleeping regularly, being involved with community and family are all helps. I think one of the best things we can do for ourselves or our loved ones who suffer with mental illness is to get rid of the stigmas that surround it. There should be no feelings of embarrassment or shame, if you had cancer or another terminal illness would you be embarrassed?? Hell no! You would fight to stay alive. As a matter of fact there would probably be a Go Fund Me account being set up for you as I type! If your family members, loved ones or friends show signs of depression do not ignore it, do not think that it will go away on its own, do not think that because someone who has suffered with depression and is suddenly “happy” that they are “cured”. My son seemed happier in the last months leading up to his death than he had been in the past few years. Looking back now, we thought things were getting better and THAT was the BIGGEST misconception of all. He was happy because he had made piece with his decision and had a plan. He was suffering in silence like many people who have mental health issues do. Do not be silent. Silence kills. If you plan to get a Life Insurance then visit http://moneyepert.com/ for more details.
Limitations This research only used a search in large newspapers. The selection of stories was than judged with only four themes. or this article you can learn more about Terminal Mental Illness Life Cover Quotes
Nevertheless stories about mental illness and dangerousness and crime are waning compared to previous research. Focus has shifted from personal and parental blame to genetic and environmental causes which is a good thing. This kind of research has to be repeated in the near future do discover trends of stories on mental illness in mass media.
Next post in this series will be on Wednesday August 13th about A Portrait of Depression in the Mass Media, Gender Influences.
Patrick W. Corrigan, Psy.D., Amy C. Watson, Ph.D., Gabriela Gracia, B.A., B.S., Natalie Slopen, A.M., Kenneth Rasinski, Ph.D., Laura L. Hall, Ph.D. (2005). Newspaper Stories as Measures of Structural Stigma Psychiatric Services, 56 (5), 551-556 DOI: 15872163
For the first time on this blog I wrote a series, yes about patient doctor relationship. It was fun and not easy to stop. You can look at it from very different angles and I did have some more.
The most liked by the “audience” was the first piece on empathy. Now empathy is for most of us confusing. It depends on what definition you use. I discussed it from the view point of a very strict definition as mainly used in psychotherapy. From that point of view I concluded that
Empathy is a quality not every human or doctor possesses. Moreover, experience and age enhance the use of empathy. Not to say that lack of experience or being young excludes the possibility for showing empathy, there are still natural talents out there.
Another important topic is can we teach empathy in Med School?
In short: No I don’t think so. For several reasons. Empathy is a process with different steps. Especially feeling what the patients feels is a quality not every doctor has. And if they do it is not always appropriate nor possible to be sensitive enough to use it. Moreover this process not only needs the quality it is also costs energy, depends on the relationship with the patient, and needs experience.
The next post was on Self -disclosure by doctors. One of my favorites. Happily a blogger whom I greatly admire, aqua writing on Vicarious Therapy, shared with us the self disclosure of her pdoc. As can be derived from the post I am not an advocate of self-disclosure.
Sharing strong beliefs or emotions without understanding the patient’s perspective seems risky; a practitioner may unknowingly infuse the dialogue with his or her needs without carefully tying them to the patients’ needs
The neuroscience of empathy was tough.It is still in it’s infancy and like most human emotions hard to understand.
In contrast to empathy, emotional intelligence is an easier concept to handle. You van even measure emotional intelligence. There is also some evidence that higher Emotional Intelligence (EI) in doctors is important to the patient doctor relationship. Assessment of EI is now used as part of the selection process for some medical school applicants in an effort to consider an applicant’s competence in interpersonal skills. Is that a good thing or bad?
Accidentally I bumped in to a nice video and description of emotibots. Through the combination of cameras,sensors, artificial neural networks and software development ICT results are developing robots that can respond to human emotions.
The last post in that series was about Humanism and professionalism. The opinion that humanism and professionalism are one and the same carries the risk of isolating the physician from the lay public. The tension between adapting to a new professional identity and the lay position is most visible and even palpable during clerkship and residency training. To me this topic is very recognizable and new. Really an eye opener.
Well that sums it up. And yes I liked it so much that tomorrow I will start another series about mass media and psychiatry. What do they write about mental illness in newspapers and why is that important. Also gender influences on description of patients in newspapers and how is ECT portrayed in the newspapers. Can’t wait.
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