© 2003 The Royal College of Psychiatrists
Highlights of this issue
This month the Journal bids farewell to our Editor, Professor Greg Wilkinson. His editorial in this issue (pp. 465–466) provides a personal reflection on his experience in the Editor's chair, and outlines some of the innovative changes to the Journal during his tenure. Over the past 10 years he has been an energetic and highly valued Editor. I am sure you will join the Editorial Board in expressing our heartfelt thanks for his years of unswerving devotion to our journal.
TREATMENTS FOR DEPRESSION
Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive technique used to stimulate the human brain in vivo using very strong pulsed magnetic fields. Preliminary evidence demonstrates effects on the brain but whether these are clinically useful remains undetermined. Martin et al (pp. 480–491), in a meta-analysis based on studies comparing rTMS with a sham intervention in patients with depression, found the studies to date to be of insufficient quality to determine its clinical effectiveness. Selective serotonin reuptake. inhibitors are increasingly used to treat depression in the elderly but little work has focused on their prophylactic efficacy. Wilson et al (pp. 492–497) find that sertraline at therapeutic dosage provides insufficient protection against depressive relapse.
COMPONENTS OF SECURITY
Security at high secure hospitals should consist of three components: relational (detailed knowledge of individuals); physical (deterrents to escape); and procedural (systems of management to ensure safety). Although the distinction between these is artificial and security should be viewed as an indivisible whole, Exworthy & Gunn (pp. 469–471) warn that neglect of any one feature will result in disturbances and weakened security. The Tilt Report, an independent security review of high security hospitals, is criticised for its neglect of relational security, and Exworthy & Gunn outline the possible wide-ranging adverse consequences for the implementation of its recommendations.
BRAIN IMPAIRMENT IN SCHIZOPHRENIA
The anterior cingulate cortex is consistently implicated in the pathophysiology of schizophrenia. In a case–control study to determine the timing of such disturbances, Yucel et al (pp. 518–524) reveal morphological abnormalities of the anterior cingulate cortex to be present in young people considered to be at high risk of the disorder but find that such abnormalities do not identify individuals who subsequently make the transition to psychosis. Shergill et al (pp. 525–531) suggest that auditory hallucinations in schizophrenia may arise through impaired processing of inner speech. The impairment appears to be at the level of verbal generation rather than conscious evaluation or labelling of auditory material. It is suggested that impaired self-monitoring may also be at the core of other symptoms.
ASSESSING AND REDUCING SUICIDE RISK
Annually, approximately 1000 people with schizophrenia commit suicide in the UK. Emerging evidence suggests that clozapine may reduce suicide in schizophrenia, but its cost-effectiveness in this regard is unclear. Duggan et al (pp. 505–508) estimate that if all patients with treatment-resistant schizophrenia in the UK were to receive clozapine, approximately 53 suicides could be prevented annually. It was also estimated to be a cost-effective intervention. Hawton et al (pp. 537–542) find that the risk of suicide after deliberate self-harm remains considerably elevated in the long term, and underline the need to take into account any previous episode in assessing risk.
ADOLESCENTS MUST STOP SMOKING
Boys et al (pp. 509–517), in a large epidemiological study, determine which of three psychoactive substance types (alcohol, nicotine and cannabis) is most closely linked to psychiatric disorders in early adolescence. Having a psychiatric disorder increased the likelihood of substance use and greater involvement with one substance increased the risk of other substance use. Risk of psychiatric disorder was primarily explained by regular smoking and, to a lesser extent, by regular cannabis use. The authors stress the importance of investing in smoking prevention at an early age.
CHILDHOOD TRAUMA AND PSYCHIATRIC MORBIDITY
Morgan et al (pp. 532–536) investigate the lifetime prevalence of post-traumatic stress disorder (PTSD) in 41 survivors of the Aberfan disaster 33 years later compared with community controls. Unsurprisingly, survivors were over 3 times more likely to have lifetime PTSD. However, a considerable number suffered from current PTSD, suggesting the persistence of symptoms into adult life and indicating the importance of early detection and treatment. Hammersley et al (pp. 543–547) investigate the relationship between childhood sexual abuse and other childhood traumas and later hallucinations in people with bipolar affective disorder. Strong associations were observed between reported childhood sexual abuse and a history of hallucinations, especially auditory ones. Whether the experience of such abuse has an impact on the later symptom profile of patients with bipolar affective disorder needs further investigation.
STOPPING BENZODIAZEPINE TREATMENT
Oude Voshaar et al (pp. 498–504) evaluate the efficacy and feasibility of tapering off long-term benzodiazepine use in general practice and assess the benefit of additional group cognitive–behavioural therapy. Tapering off was found to be effective and acceptable, especially in patients using less that 12 mg diazepam equivalents. Additional group cognitive–behavioural therapy did not confer greater success.
Related articles in BJP:
- Fare thee well – the Editor's last words
- GREG WILKINSON
BJP 2003 182: 465-466.[Full Text] - Taking another tilt at high secure hospitals: The Tilt Report and its consequences for secure psychiatric services
- TIM EXWORTHY and JOHN GUNN
BJP 2003 182: 469-471.[Full Text] - Repetitive transcranial magnetic stimulation for the treatment of depression: Systematic review and meta-analysis
- JOSÉ LUIS R. MARTIN, MANUEL J. BARBANOJ, THOMAS E. SCHLAEPFER, ELINOR THOMPSON, VÍCTOR PÉREZ, and JAIME KULISEVSKY
BJP 2003 182: 480-491.[Abstract] [Full Text] - Older community residents with depression: long-term treatment with sertraline: Randomised, double-blind, placebo-controlled study
- K. C. M. WILSON, P. G. MOTTRAM, L. ASHWORTH, and M. T. ABOU-SALEH
BJP 2003 182: 492-497.[Abstract] [Full Text] - Tapering off long-term benzodiazepine use with or without group cognitive–behavioural therapy: three-condition, randomised controlled trial
- RICHARD C. OUDE VOSHAAR, WIM J. M. J. GORGELS, AUDREY J. J. MOL, ANTON J. L. M. VAN BALKOM, ELOY H. VAN DE LISDONK, MARINUS H. M. BRETELER, HENK J. M. VAN DEN HOOGEN, and FRANS G. ZITMAN
BJP 2003 182: 498-504.[Abstract] [Full Text] - Modelling the impact of clozapine on suicide in patients with treatment-resistant schizophrenia in the UK
- ANDY DUGGAN, JULIET WARNER, MARTIN KNAPP, and ROBERT KERWIN
BJP 2003 182: 505-508.[Abstract] [Full Text] - Psychiatric morbidity and substance use in young people aged 13–15 years: results from the Child and Adolescent Survey of Mental Health
- A. BOYS, M. FARRELL, C. TAYLOR, J. MARSDEN, R. GOODMAN, T. BRUGHA, P. BEBBINGTON, R. JENKINS, and H. MELTZER
BJP 2003 182: 509-517.[Abstract] [Full Text] - Morphology of the anterior cingulate cortex in young men at ultra-high risk of developing a psychotic illness
- MURAT YÜCEL, STEPHEN J. WOOD, LISA J. PHILLIPS, GEOFFREY W. STUART, DEIDRE J. SMITH, ALISON YUNG, DENNIS VELAKOULIS, PATRICK D. McGORRY, and CHRISTOS PANTELIS
BJP 2003 182: 518-524.[Abstract] [Full Text] - Engagement of brain areas implicated in processing inner speech in people with auditory hallucinations
- SUKHWINDER S. SHERGILL, MICHAEL J. BRAMMER, RIMMEI FUKUDA, STEVEN C. R. WILLIAMS, ROBIN M. MURRAY, and PHILIP K. McGUIRE
BJP 2003 182: 525-531.[Abstract] [Full Text] - The Aberfan disaster: 33-year follow-up of survivors
- LOUISE MORGAN, JANE SCOURFIELD, DAVID WILLIAMS, ANNE JASPER, and GLYN LEWIS
BJP 2003 182: 532-536.[Abstract] [Full Text] - Suicide following deliberate self-harm: long-term follow-up of patients who presented to a general hospital
- KEITH HAWTON, DANIEL ZAHL, and ROSAMUND WEATHERALL
BJP 2003 182: 537-542.[Abstract] [Full Text] - Childhood trauma and hallucinations in bipolar affective disorder: preliminary investigation
- PAUL HAMMERSLEY, ANTON DIAS, GILLIAN TODD, KIM BOWEN-JONES, BERNADETTE REILLY, and RICHARD P. BENTALL
BJP 2003 182: 543-547.[Abstract] [Full Text]
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