© 2009 The Royal College of Psychiatrists
Highlights of this issue
Mental ill health in childhood
Three papers in the Journal this month consider issues related to measuring, understanding and treating mental ill health in childhood. Baron-Cohen et al (pp. 500–509) undertook a study to establish the prevalence of autism-spectrum conditions in Cambridgeshire using two case ascertainment methods. First, a survey of individuals on the Special Educational Needs register and second, a screening of the mainstream primary school population. Estimated prevalence was found to be approximately 1% based on either method, in keeping with previous studies. On the basis of a formula devised to combine estimates, the authors report a prevalence of 157 per 10 000, including previously undiagnosed cases. In light of an increasingly emphasised need for routine outcome monitoring to be undertaken by clinical services and the problem of assessing the benefits of interventions in the absence of a control group, Ford et al (pp. 552–558) developed an algorithm for producing a Strength and Difficulties Questionnaire (SDQ) Added Value Score. Using data from a longitudinal community study, the authors derived the algorithm and then tested it using data from the Welsh Sure Start randomised controlled trial (RCT). The SDQ Added Value Score acted as predicted when applied to the RCT data and consequently the authors conclude that their work provides preliminary support for the use of such a tool in the assessment of the outcome of interventions provided by child mental health services. Utilising data from the ALSPAC cohort, Thomas et al (pp. 521–526) found that fetal growth measures were associated with risk of psychosis-like symptoms at 12 years but measures of childhood growth were not. Controlling for IQ only partially accounted for the association between birthweight and psychosis-like symptoms.
Impact of time on recall and response to trauma
In a cross-sectional multisite military veterans study, Frueh et al (pp. 515–520) found that delayed-onset post-traumatic stress disorder (PTSD) (i.e. symptoms emerging more than 6 months after the index trauma) was uncommon. The development of PTSD symptoms more than 1 year after trauma was rare and no individuals were found to have developed PTSD more than 6 years after trauma exposure. In a study of Norwegian citizens who had experienced the 2004 South-East Asian tsunami, Heir et al (pp. 510–514) found evidence for recall amplification of the perceived threat over time. The increase in recalled threat intensity between the assessment points of 6 and 24 months following the event was also found to be associated with a lack of PTSD symptom improvement but not with either degree of exposure or immediate stress response, among other factors.
Antidepressants: induced anxiety and impact on amygdala function
In a systematic review of studies relating to the jitteriness/anxiety syndrome which can follow administration of antidepressants, Sinclair et al (pp. 483–490) found that although the syndrome appears to have a strong impact on prescribing guidelines and practices, there is an absence of robust evidence regarding key aspects of the syndrome, including knowledge of the factors associated with increased risk, the ramifications of the syndrome if it occurs, and how best it should be managed. Murphy et al (pp. 535–540) undertook a randomised placebo-controlled study of the effect of a single dose of citalopram on amygdala response to emotional faces. When assessed 3 hours after administration, those healthy volunteers who received citalopram were found to have reduced amygdala responses to fearful facial expressions. The authors conclude that the early response to administration of citalopram may indicate that antidepressants have an earlier onset of action than previously thought.
Caring for the physical health of people with mental illness
In a systematic review of the quality of medical care received by people with mental health problems compared with those without mental disorder, Mitchell et al (pp. 491–499) found that although the majority of studies found evidence of inferior quality of care received by the former in at least one domain, there was considerable variation in findings reported. There were, however, methodological problems in many of the studies identified, including inadequate provision of information regarding patient satisfaction and structural differences in care delivery. The authors also had difficulty separating information about care delivery from care uptake. Ratschen et al (pp. 547–551) contacted all English National Health Service trusts providing mental healthcare in order to investigate the implementation of smoke-free policies in in-patient settings. All responding trusts had smoke-free policies in place but the majority reported difficulties in implementing these policies. Despite the challenges identified by trusts, the overall impact of the policy was regarded by most as beneficial.
Naltrexone implants for opioid dependence
Kunøe et al (pp. 541–546) examined the safety and effectiveness of 6-month implantable naltrexone in reducing opioid use after in-patient treatment for opioid dependence. Those randomised to receive the implant were found to have reduced days of heroin use and reduced days of opioid use during the 6-month follow-up period than those randomised to usual care. Improvements were also found in levels of polydrug use, injecting behaviour and quality of life, while adverse events were no more commonly found in the treated group.
White matter abnormalities in familial bipolar disorder
Using diffusion tensor imaging techniques and whole brain voxel-based morphometry analysis, Chaddock et al (pp. 527–534) found that individuals with psychotic bipolar 1 disorder had reduced fractional anisotropy compared with controls in a number of key intra- and inter-hemispheric tracts. In addition, genetic liability was found to be associated with reduced fractional anisotropy across areas of white matter in both patients and their first-degree relatives.
Related articles in BJP:
- Antidepressant-induced jitteriness/anxiety syndrome: systematic review
- Lindsey I. Sinclair, David M. Christmas, Sean D. Hood, John P. Potokar, Andrea Robertson, Andrew Isaac, Shrikant Srivastava, David J. Nutt, and Simon J. C. Davies
BJP 2009 194: 483-490.[Abstract] [Full Text] - Quality of medical care for people with and without comorbid mental illness and substance misuse: systematic review of comparative studies
- Alex J. Mitchell, Darren Malone, and Caroline Carney Doebbeling
BJP 2009 194: 491-499.[Abstract] [Full Text] - Prevalence of autism-spectrum conditions: UK school-based population study
- Simon Baron-Cohen, Fiona J. Scott, Carrie Allison, Joanna Williams, Patrick Bolton, Fiona E. Matthews, and Carol Brayne
BJP 2009 194: 500-509.[Abstract] [Full Text] - Longitudinal changes in recalled perceived life threat after a natural disaster
- Trond Heir, Auran Piatigorsky, and Lars Weisæth
BJP 2009 194: 510-514.[Abstract] [Full Text] - Delayed-onset post-traumatic stress disorder among war veterans in primary care clinics
- B. Christopher Frueh, Anouk L. Grubaugh, Derik E. Yeager, and Kathryn M. Magruder
BJP 2009 194: 515-520.[Abstract] [Full Text] - Association of measures of fetal and childhood growth with non-clinical psychotic symptoms in 12-year-olds: the ALSPAC cohort
- K. Thomas, G. Harrison, S. Zammit, G. Lewis, J. Horwood, J. Heron, C. Hollis, D. Wolke, A. Thompson, and D. Gunnell
BJP 2009 194: 521-526.[Abstract] [Full Text] - White matter microstructural impairments and genetic liability to familial bipolar I disorder
- Christopher A. Chaddock, Gareth J. Barker, Nicolette Marshall, Katja Schulze, Mei Hua Hall, Adele Fern, Muriel Walshe, Elvira Bramon, Xavier A. Chitnis, Robin Murray, and Colm McDonald
BJP 2009 194: 527-534.[Abstract] [Full Text] - Effect of a single dose of citalopram on amygdala response to emotional faces
- Susannah E. Murphy, Raymond Norbury, Ursula O'Sullivan, Philip J. Cowen, and Catherine J. Harmer
BJP 2009 194: 535-540.[Abstract] [Full Text] - Naltrexone implants after in-patient treatment for opioid dependence: randomised controlled trial
- Nikolaj Kunøe, Philipp Lobmaier, John Kåre Vederhus, Bjørg Hjerkinn, Solfrid Hegstad, Michael Gossop, Øistein Kristensen, and Helge Waal
BJP 2009 194: 541-546.[Abstract] [Full Text] - Implementation of smoke-free policies in mental health in-patient settings in England
- Elena Ratschen, John Britton, and Ann McNeill
BJP 2009 194: 547-551.[Abstract] [Full Text] - Strengths and Difficulties Questionnaire Added Value Scores: evaluating effectiveness in child mental health interventions
- Tamsin Ford, Judy Hutchings, Tracey Bywater, Anna Goodman, and Robert Goodman
BJP 2009 194: 552-558.[Abstract] [Full Text]
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