Open dialogue is an integrative approach to the organisation of specialist mental health services and therapeutic meetings.
This qualitative study sought to explore service users’ and clinicians’ experiences of network meetings during the implementation of open dialogue in a modified version, for a UK-based mental health service.
In total 19 participants were interviewed (8 service users and 11 clinicians) and an inductive thematic analysis of the data was conducted.
(Medscape.com) – Ketamine is a darling of combat medics and clubgoers, an anesthetic that can quiet your pain without suppressing breathing and a hallucinogenic that can get you high with little risk of a fatal overdose.
For some patients, it also has dwelled in the shadows of conventional medicine as a depression treatment — prescribed by their doctors, but not approved for that purpose by the federal agency responsible for determining which treatments are “safe and effective.”
That effectively changed in March, when the Food and Drug Administration approved a ketamine cousin called esketamine, taken as a nasal spray, for patients with intractable depression. With that, the esketamine nasal spray, under the brand name Spravato, was introduced as a miracle drug — announced in press releases, celebrated on the evening news and embraced by major health care providers like the Department of Veterans Affairs.
The problem, critics say, is that the drug’s manufacturer, Janssen, provided the FDA at best modest evidence it worked and then only in limited trials. It presented no information about the safety of Spravato for long-term use beyond 60 weeks. And three patients who received the drug died by suicide during clinical trials, compared with none in the control group, raising red flags Janssen and the FDA dismissed.Read More
(RxISK.org) – The European Medicines Agency has just concluded a review into sexual dysfunction after the discontinuation of SSRIs and SNRIs. Before we discuss their findings, it’s worth looking back over the events of the past year.Read More
In his resignation letter – which he subsequently published on his online blog – Dr Gordon criticised the College’s treatment of patients who had suffered “less than positive, and sometimes harmful, effects of psychiatric interventions including prescribed medications”.
He said the College was too close to the pharmaceutical industry, adding: “as a direct consequence informed consent and realistic psychiatry are compromised”.
Service providers throughout Europe have identified the need to define how high-quality community-based mental health care looks to organize their own services and to inform governments, commissioners and funders. In 2016, representatives of mental health care service providers, networks, umbrella organizations and knowledge institutes in Europe came together to establish the European Community Mental Health Services Provider (EUCOMS) Network. This network developed a shared vision on the principles and key elements of community mental health care in different contexts. The result is a comprehensive consensus paper, of which this position paper is an outline.
With this paper the network wants to contribute to the discussion on how to improve structures in mental healthcare, and to narrow the gap between evidence, policy and practice in Europe.
The development of the consensus paper started with an expert workshop in April 2016. An assigned writing group representing the workshop participants built upon the outcomes of this meeting and developed the consensus paper with the input from 100 European counterparts through two additional work groups, and two structured feedback rounds via email.
High quality community-based mental health care: 1) protects human rights; 2) has a public health focus; 3) supports service users in their recovery journey; 4) makes use of effective interventions based on evidence and client goals; 5) promotes a wide network of support in the community and; 6) makes use of peer expertise in service design and delivery. Each principle is illustrated with good practices from European service providers that are members of the EUCOMS Network.
Discussion among EUCOMS network members resulted in a blueprint for a regional model of integrated mental health care based upon six principles.
(Frontiers) – The prescription of antidepressants to children and adolescents is a controversial topic. With respect to depressive disorders, to date no single pediatric antidepressant trial found efficacy on the pre-specified primary outcome (Healy et al., 2019). However, when meta-analytically pooled across all trials, antidepressants appear to have a statistically significant albeit marginally small benefit over placebo (Locher et al., 2017). It also appears that antidepressants are more effective for anxiety disorders than for depressive disorders (Locher et al., 2017). On the other hand, the risk of suicidal events in antidepressant recipients is about twice that seen in placebo recipients, indicating that antidepressants increase the suicide risk in children and adolescents (Sharma et al., 2016).
Another issue related to the risk-benefit conundrum is the influence of the pharmaceutical industry on the design, conduct and publication of pediatric antidepressant trials (Leo, 2006). Systematic biases and even research misconduct have been documented in several industry-sponsored trials, and these flaws further complicate the interpretation of published findings on the usefulness of antidepressants in children and adolescents (Jureidini et al., 2004).
The aim of this Research Topic is to provide a forum to discuss these important issues. Researchers from the field of child and adolescent psychiatry, paediatrics, clinical psychology, social work, public health, sociology, epidemiology, clinical pharmacology and toxicology, and psychopathology, may submit high-quality research.Read More
(MadInAmerica.com) – In an effort to increase support for children vulnerable to “psychiatric illness,” mental health screening assessments are now recommended by a wide range of regulatory agencies for adverse childhood experiences (ACEs), depression, anxiety, suicidality, etc. However, recent years have seen an increased intensity and zeal in the application of blanket screening policies, particularly related to depression and suicide risk.
In their commentary published last week in the Journal of the American Academy of Child & Adolescent Psychiatry, researchers Schuyler Henderson, Ruth Gerson, and Blake Phillips, offer a timely, critical perspective regarding the conflicting evidence for what constitutes “high risk,” and what can (and can’t) be done in response when risks are identified.
“The Joint Commission mandates a suicide assessment for patients ‘who exhibit suicidal behavior or who have screened positive for suicidal ideation’ followed by risk stratification: after ‘this assessment, patients should be classified as high, medium or low risk of suicide,’” they write. “But is suicide risk stratification in child psychiatry ready for prime time? Are we putting the risk assessment cart before the horse?”Read More
(The Guardian) – It’s something of a relief to see before you, written down in black and white, what you have known to be true for a long time: in this case, that antidepressant withdrawal symptoms aren’t, well, all in your head. In a significant shift in position, the Royal College of Psychiatrists now accepts that it has not paid enough attention to patients suffering from severe withdrawal symptoms when coming off antidepressants.Read More
(Acta Neuropsychiatrica) – In a recent commentary with the polemic title ‘Antidepressnats; what’s the beef?’, Goodwin and Nutt argued that the benefit-risk ratio of antidepressants had been questioned inappropriately (Goodwin & Nutt, 2019). Personally I think it is a great achievement that our medical system can offer pharmacological treatments to people who suffer from serious clinical depression, and like Goodwin and Nutt I accept that antidepressants may be useful in some patients (Hengartner & Ploderl, 2018). Nevertheless, and this is where my position deviates from Goodwin and Nutt, I am also concerned about the overestimation of efficacy and the minimisation of harm (Hengartner, 2017). There are many misrepresentations in the commentary by Goodwin & Nutt, all of which systematically inflate the apparent benefits of antidepressants, and in this letter, I will discuss five of them.Read More
Antipsychotics are the first-line treatment for people with schizophrenia or psychosis. There is evidence that they can reduce the symptoms of psychosis and risk of relapse. However many people do not respond to these drugs, or experience adverse effects and stop taking them.
In the UK, clinical guidelines have stressed the need for research into psychosocial interventions without antipsychotics. This systematic review examines the effects of psychosocial interventions for people with schizophrenia or psychosis who are on no/minimal antipsychotics.
Databases were searched for empirical studies investigating a psychosocial intervention in people with a schizophrenia spectrum disorder who were not taking antipsychotics or had received an antipsychotic minimisation strategy.
We identified nine interventions tested in 17 studies (N = 2250), including eight randomised controlled trials. Outcomes were generally equal to or in a small number of cases better than the control group (antipsychotics/treatment as usual) for Cognitive Behavioural Therapy (CBT), Need Adapted Treatment and Soteria. The remaining interventions provided some encouraging, but overall inconsistent findings and were Psychosocial Outpatient Treatment, Open Dialogue, Psychosocial Inpatient Treatment, Psychoanalysis/Psychodynamic Psychotherapy, Major Role Therapy, and Milieu Treatment.
Study quality was generally low with little recent research. In conclusion, nine psychosocial interventions have been studied for patients on no/minimal antipsychotics. The majority of studies reported outcomes for the intervention which were the same as the control group, however, study quality was problematic. Given the adverse effects of antipsychotics and that many people do not want to take them, high quality trials of psychosocial treatments for people on minimal/no antipsychotics are needed.