Blog
New Paper: Let’s get physical: improving the medical care of people with severe mental illness - Advances in Psychiatric Treatment
Thursday, May 10, 2012
Today, together with Vijay Delafon and Oliver Lord, I have a new overview of physical/mental comorbidity focussing on quality of care issues. Its published in the RCPsych journal Advances in Psychiatric Treatment.
Let’s get physical: improving the medical care of people with severe mental illness
APT May 2012 18:216-225;
http://apt.rcpsych.org/content/18/3/216.abstract
SUMMARY
There is clear evidence of increased medical comorbidity and related mortality in people with severe mental illness, despite numerous guidelines for managing medical conditions in this population. This article assesses inequalities in medical treatment and preventive healthcare received by psychiatric patients compared with the general population. It considers whether the medical care provided is adequate and whether published guidelines improve it. Mental health specialists, general practitioners and hospital specialists appear to deliver poorer than average medical care for this vulnerable population. Implementation of physical healthcare guidelines is incomplete and the guidelines must be matched with resources to address this deficit.
Reflections upon 100 Peer Reviews 2009-2011
Thursday, March 29, 2012
In 2009 I starting keeping records of the peer reviews of original manuscripts I was undertaking for various medical journals. I just discovered I have performed 115 peer reviews since 2009 mostly but not exclusively for editors of psychiatric journals. Thats about my limit, and certainly on the threshold for interfering with my own work. Why do it? I believe peer review should be performed to a high standard in an unbiased way. Its also a great way of keeping up-to-date and getting a sneek peek at what is coming soon!
That said, lets be honest the peer review system in science is at best "haphazard" and at worst "broken". Reviewers often disagree, give destructive personal comment and use their annonymous position to score political points. One reviewer of one of my best submissions to a obscure journal arrogantly offered to try and "see what can be salvaged from this terrible paper" (I subsequently withdrew this paper and submitted elsewhere) much to the surprise of the editor.
100 or so reviews later here are the lessons I learned as a reviewer. I would encourage editors to introduce a structured format for peer reviews, to always write to the reviewers personally, to avoid giving editorial opinions before the review. As a reviewer the most important thing is to take the job seriously, give constructive comments, avoid accept or rejection opinions (leave this is the editor) and avoid personal comments devoid of evidence. In short the review itself should be evidence based. Last but most important, I plead with journals to make reviewers identity known; this is the only sure way of stopping biased or discourteous reviews.
Most Accessed and Most Downloaded in Psycho-oncology (wiley)
Monday, March 19, 2012
Our team has two papers in the Top10 most accessed and Top10 most downloaded articles in Wiley's journal "Psycho-oncology" for 2011. As a reward for readers they are both available free!
The most downloaded of our papers is
"Screening for distress and depression in cancer settings: 10 lessons from 40 years of primary-care research"
http://onlinelibrary.wiley.com/doi/10.1002/pon.1943/abstract
The most cited of our papers is:
Desire for psychological support in cancer patients with depression or distress: validation of a simple help question
http://onlinelibrary.wiley.com/doi/10.1002/pon.1759/abstract
see here for more details
http://onlinelibrary.wiley.com/journal/10.1002/%28ISSN%291099-1611
Which symptoms are indicative of depression in cancer?
Tuesday, February 07, 2012
I am pleased to report that our new paper on somatic symptoms of depression is out today in J Aff Dis (http://www.sciencedirect.com/science/article/pii/S0165032711007221). We looked at both somatic and non-somatic symptoms against HADS-D and PHQ9 in 279 patients seen up to three times (558 contacts. We also had 176 contacts (31%) who were in a palliative stage. Results may be surprising to those who think somatic symptoms of depression are always "contaminated by physical illness". Only low energy was poorly discriminating and in a subset of palliative patients moving or speaking slowly were less influential but poor appetite/overeating and feeling tired or having little energy were valuable.
The bottom line is be careful about always attributing somatic symptoms of depression to cancer.
-----------------------abstract----------------
Background
There have been few studies that have attempted to examine the phenomenology of comorbid depression, in particular the diagnostic value of individual somatic and non-somatic symptoms when attempting to diagnose depression following cancer.
Methods
We approached 279 patients up to three times within 9 months of first presentation with a diagnosis of cancer, and collected data following a total of 558 contacts. 176 contacts (31%) were in a palliative stage. Symptoms were elicited by self-report PHQ9 and HADS-D scales. The prevalence of major depression was 12.7% but 29.6% had major or minor depression (any depressive disorder) according to modified DSMIV criteria.
Results
All symptoms of depression were significant more common in depressed versus non-depressed cancer patients regardless of stage. Against broadly defined any depressive disorder (ADD) the most accurate diagnostic symptoms were all somatic (namely trouble falling or staying asleep or sleeping too much; feeling tired or having little energy; poor appetite or overeating; trouble concentrating on things such as reading). Indeed the optimal symptom insomnia had good case-finding properties and screening properties used alone. A two step combination of three questions give a sensitivity of 100% and specificity of 91.6% against ADD. Against major depressive disorder (MDD) both somatic and non-somatic symptoms were valuable (including but not limited to the PHQ2 stem questions). Only low energy was poorly discriminating which may suggest that the standard ICD10 criteria may not be optimal. When considering depression as defined by the HADS-D (≥ 11), then the three most influential symptoms were psychological closely followed by somatic symptoms. When looking for MDD and HADS-D depression, no single symptom was a good proxy for depression highlighting a possible shortcoming if clinicians attempt to rely on one single question. In a subset of palliative patients feeling bad about yourself and moving or speaking slowly were less influential and outperformed by poor appetite/overeating and feeling tired or having little energy.
Conclusion
This research suggests that most somatic symptoms remain influential when diagnosing depression in the context of cancer and hence should not be omitted indiscriminately, even in palliative stages. The optimal symptoms for diagnosing depression will depend on whether a narrow concept of depression or a broad concept of depression is considered clinically important.
Metabolic abnormalities in those taking atypical antipsychotics: Update1
Sunday, January 29, 2012
An update on the blog from September 23, 2011
Our team together with Belgian specialists Marc DeHert and Davy Vancompfort have published a key paper examining metabolic abnormalities in SMI patients established on antipsychotics drugs. We have extensively reviewed almost 300 studies including about 120 looking at schizophrenia alone for rates of metabolic syndrome, diabetes, pre-diabetes, weight gain, smoking, high blood pressure and abnormal lipids. This paper is here:
Prevalence of Metabolic Syndrome and Metabolic Abnormalities in Schizophrenia and Related Disorders--A Systematic Review and Meta-Analysis.
Mitchell AJ et al Schizophr Bull. 2011 Dec 29. [Epub ahead of print]
We have finished a second related paper about rates of abnormalities in those with SMI not prescribed antipsychotics (drug naive) and will be looking for a home for it soon. A nice narrative summary is freely available here
http://ukpmc.ac.uk/articles/PMC2656262/
a new narrative review is also here
http://archpsyc.ama-assn.org/cgi/content/abstract/68/6/609