SUMMARY People with mental illness face stigma and discrimination in a variety of settings which can have an economic impact. Aim – The aim of this paper was to identify literature on the economic impact of mental illness stigma. Methods – A systematic review of the literature identified 30 papers from 27 studies by searching electronic databases and hand searching reference lists. Results – Mental illness stigma/discrimination was found to impact negatively on employment, income, public views about resource allocation and healthcare costs. Conclusions – Stigma and discrimination regarding mental health problems lead to adverse economic effects for people with these conditions. Interventions that reduce stigma may therefore also be economically beneficial. Declaration of Interest: This study was funded in relation to a National Institute for Health Research (NIHR) Applied Programme grant awarded to the South London and Maudsley NHS Foundation Trust, and in relation to the NIHR Specialist Mental Health Biomedical Research Centre at the Institute of Psychiatry, King's College London and the South London and Maudsley NHS Foundation Trust. There is no conflict of interest in connection with the submitted article.
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Abstract Individuals with schizophrenia have higher mortality rates compared to the general community. Apart from an increased risk of suicide, people with schizophrenia have an increased risk of death related to a wide range of comorbid physical conditions. There is evidence to suggest that much of this mortality is avoidable. The provision of assertive management of comorbid physical disorders has the potential to help close the differential mortality gap. While the primary data are robust, there is less empirical evidence to guide policy makers and service providers when dealing with these problems. Focused clinical programs aimed at reducing risk factors (e.g. smoking, obesity) and shared care between mental health teams and primary care providers can help reduce the burden of avoidable deaths. In light of recent evidence suggesting that the mortality gap has widened in recent decades, there is an urgent need to address the burden of avoidable deaths in those with serious mental illnesses.
Background: Impulsivity is prominent in bipolar disorder, but there is little quantitative information relating it to phase of illness. Methods: We measured impulsivity in patients with bipolar disorder who had not met episode criteria for at least 6 months, patients who were manic, and healthy control subjects. Impulsivity was measured using the Barratt Impulsiveness Scale (BIS) and performance on the computerized Immediate Memory-Remote Memory Task (IMT-DMT), based on the Continuous Performance Test, which has been shown to reflect risk of impulsivity in other populations. Results: BIS scores in euthymic and manic bipolar subjects were identical, and were significantly elevated compared to controls. Commission errors (impulsive responses) on the IMT-DMT were elevated in manic subjects but were identical to controls in euthymic subjects. Measures of impulsivity did not appear related to depressive symptoms. Limitations: The number of subjects was too small for detailed investigation of the role of comorbidities; subjects were receiving pharmacological treatments. Conclusions: Impulsivity has state- and trait-related aspects in bipolar disorder.
An extensive literature documented a mortality differential for natural causes between psychiatric patients and the general population. Less clear is the pattern for cancer diseases. Methodological problems arise when trying to explain such mortality gap: selection bias and reverse causation; time-dependent confounders that are also intermediate variables; complex relationships within a life course have to be considered. We try to explain such problems in terms of causal graphs. Excess risk for causes of death which are not attributable to higher prevalence of risk factors or treatment side-effects and higher mortality rates for avoidable causes have been also documented. These findings underline the need for research on health promotion and preventive programs targeted to psychiatric patients.
L'adesione al trattamento è stata definita come la consonanza del comportamento di una persona alle indicazioni mediche (Fawcett, 1995; Myers & Nidence, 1998). Le revisioni della letteratura orientate ad analizzare questo argomento rilevano che, nei Paesi sviluppati, solo il 50% dei pazienti affetti da patologie croniche aderisce al trattamento, mentre nei Paesi in via di sviluppo si riscontrano tassi ancora più bassi. Per esempio, negli Stati Uniti, circa 50 milioni di adulti sono affetti da ipertensione, ma solo il 50% di essi sono stati diagnosticati e trattati adeguatamente; tra i pazienti trattati soltanto il 51% aderisce al trattamento. Analogamente, in Australia, solo il 43% dei pazienti affetti da asma assume i farmaci prescritti per l 'intera durata del trattamento e solo il 27.8% usa i farmaci prescritti come preventer (World Health Organization, 2001). Sul piano della frequenza, l 'analisi della letteratura indica che tra il 20% e il 90% dei pazienti affetti da disturbi psichici abbandona il trattamento, con un 'ampia variabilità di incidenza dovuta alle differenze nella definizione di mancata adesione e alla diversità dei campioni studiati.
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AbstractTheBritish Journal of Psychiatryis an independent mainstream general psychiatric journal that competes reasonably well with others in the field. It does so by keeping a healthy balance between the demands of its readers, its contributors and the need for good science. It publishes an eclectic mix of original articles, reviews, editorials, reappraisals, comment, opinion and extras, the latter including poetry, short summaries, literature and psychiatry, and a touch of humour. These contributions are not always in keeping with the harsh requirements of the impact factor, but we judge that this makes for a better all-round journal that advances psychiatry in all its manifold aspects and is anything but dull.
Over the past ten years, the National Health Service in England has introduced home treatment teams throughout the country. Despite this, and the fact that England now has the fourth lowest number of beds per capita in Europe, no mental health service has been able to dispense with acute admission beds altogether. One unintended consequence of new investment in community alternatives to inpatient care is that the threshold for admission has risen and acute wards now accommodate a patient group that is more severe with regard to levels of disturbance and social disadvantage. This has compounded the challenge of providing high quality inpatient care and repeated national surveys suggest that acute admission wards are the weakest link in the English mental healthcare system. In response to this, the Royal College of Psychiatrists has established an accreditation scheme for acute admission wards. Only 22 of the first 132 wards to have completed the review process so far are considered to be excellent. Although 59 wards (45% of the total) failed to meet one or more essential standard, 43 of these were able to rectify the problem.
AbstractThe role of editor of a journal attracts the vision of a scholar isolated in an ivory tower selecting “la crème” of the submitted papers, with no other preoccupations that the scientific rigour. This, is of course, only one of the many roles – or, as this editorial calls them, lives – of an editor. The essential skills are many and more complex, and an editor will encounter many problems that are related to such diverse issues as anticipating scientific trends, investigating misbehaviours, settling ethical disputes, and interfacing with the lay press. It is exciting and rewarding, and never predictable.
AbstractHere we briefly summarize the most consistent structural MRI studies on hippocampus in major depression and debate the effects of clinical variables on hippocampal morphology.
Aim – We aimed at developing a prioritized set of quality indicators for schizophrenia care to be used for continuous quality monitoring. They should be evidence-based and rely on routine data. Methods – A systematic literature search was performed to identify papers on validated quality indicators published between 1990 to April 2008 in MEDLINE, the Cochrane databases, EMBASE and PsycINFO. Databases of relevant national and international organizations were searched. Indicators were described with respect to meaningfulness, feasibility and actionability. A workshop with relevant stakeholders evaluated the measures through a structured consensus process. Results – We identified 78 indicators through literature search and selected 22 quality indicators. Furthermore, 12 structural and case-mix indicators were choosen. Only five quality indicators were rated “essential indicators” (priority 1), 14 were rated “additional first choice” (priority 2), and three were rated as “additional second choice” (priority 3). Only four indicators assessed outcome quality. In the majority of indicators the evidence base supporting the indicator recommendation was weak. None of the selected indicators was validated in experimental studies. Conclusions – Evidence and validation base played only a subordinate role for indicator prioritisation by stakeholders indicating that there are discrepancies between clinical questions and requirements in schizophrenia care and scientific research. Declaration of Interest: Stefan Weinmann and Thomas Becker received an unrestricted grant from the Federal Association of Local Health Funds (AOK-BV) for the whole project. Christiane Roick is an employee of the AOK-BV. All authors declare that there are no other financing arrangements or payments that might be considered a conflict of interests related to the present paper.
Aims – The Diagnostic Interview for Psychoses (DIP) is a comprehensive interview schedule for psychotic disorders, linked to the OPCRIT diagnostic algorithm, bridging the gap between fully structured, lay-administered schedules and semistructured, psychiatrist-administered interviews. Here we describe the validity, reliability and applications of the Italian version of the DIP. Methods – The interview was translated into Italian and its content validity tested by back translation. Sixty patients, drawn from among those who contacted the South-Verona Community Mental Health Service, were included in the study. Each patient was first assessed independently by two raters, one of whom conducted the interview, while the other assumed the role of observer. Subsequently (median: 89 days), 44 of these patients were re-interviewed by a third rater, who made an independent assessment. Diagnostic validity was assessed in 18 cases, interviewed with the DIP and using the SCAN as ‘gold standard. Results – The mean duration of the interview was 37 minutes for the inter-rater interviews and 39 minutes for the retest interviews. Good to excellent inter-rater reliability was demonstrated for both ICD-10 and DSM-IV diagnoses, while in the test-retest reliability pairwise agreement was high for half of the items. Diagnostic validity was good, with twelve out of the 18 DIP-OPCRIT diagnoses (67%) matching the SCAN diagnosis. Conclusions – Overall, the results support the reliability and validity of the Italian translation of the DIP. The Italian version will be useful both in routine practice to establish standard reference diagnoses of psychosis and in the research field, where it can be used by academic researchers in clinical trials and epidemiological studies.
Abstract Although the anatomy of the parietal lobe has been under-investigated in schizophrenia, some magnetic resonance imaging studies have shown decreased volumes, suggesting its possible implication for the pathophysiology of the disease.
I got in touch with Leon Eisenberg at the very end of his long and fulfilling professional life, or, to be precise, he got in touch with me. On December 12th, 2006 I received a sharp and hilarious comment on a paper I had written on the change of the name “mental retardation” to “intellectual disability” and its relation to stigma. In a friendly tone, it distilled joy of life and “bonheur”. The author recalled an old editorial at the American Journal of Psychiatry which explained that soldiers with neuropsychiatric problems were classified under a code known as ‘Section 8’ during the Second World War. “In no time at all, this classification number spread throughout the military community and became a term of derision. If you were thought to be a bit odd, you were called a ‘Section 8. Army psychiatrists concerned about the stigma changed the terminology from “Section 8” to “Simple Adult Maladjustment”. Not long after the change was made, the author of the editorial was in a base camp watching a film starring Jerry Lewis. He was astonished to hear members of the audience call out ‘Look at the ‘Sammy. After a moment he realized that “Sammy” stemmed from the initial letters “S.A.M.” of “Simple Adult Maladjustment”.
