Category Archives: Social Psychiatry Article Review

Integrating Care for Older Adults

Minister for Care and Support Norman Lamb discusses some of the UK Department of Health’s plans to integrate care for older adults with long term health conditions. The address for a site for comments/feedback is shown at the end of the video.

Index: There are indices for the TAWOP site here and here Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

The Epidemiology of Alzheimer’s Disease

Povova and colleagues have a paper in the journal ‘Biomedical Papers’ titled ‘Epidemiology of and Risk Factors for Alzheimer’s Disease: A Review’ which is freely available here. I found the paper interesting for the coverage of two areas

1. Prevalence and incidence rates. The authors have gathered data from numerous studies. Prevalence data will vary according to the study methodology and the characteristics of the target population. The authors refer to a 2005 Delphi Study published in the Lancet with an estimated prevalence globally of 3.9% in people over 60 years of age. However the prevalence varies considerably between countries. For the incidence of Dementia, the authors look at a number of prospective studies and express the findings in 1000 person-years. From the data it is clear that the sampling method is critical for the interpretation of the results. Although two studies may calculate the incidence of Alzheimer’s Disease in people over the age of 65 the average age of the sampled population as well as many other variables are critical in generalising these findings to other populations. Nevertheless regardless of the methodology, with figures ranging from 6.3 to 86.7 per 1000 person years it is clear that there is a significant disease burden in the sampled populations.

2. Prevention. The authors look at prevention focusing on primary, secondary and tertiary prevention strategies highlighting the role that medication, diagnosis and modifiable risk factors play in prevention.

Index: There are indices for the TAWOP site here and here Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

Does Befriending Help with Depressive Symptoms?

There is an open-access article in the British Journal of Psychiatry by Mead and colleagues titled ‘Effects of befriending on depressive symptoms and distress: systematic review and meta-analysis‘. The researchers cite evidence that suggests over 500 voluntary sector organisations and charities in the UK offer befriending service. That’s a very impressive number. So what did the researchers conclude? Essentially the researchers thought that befriending benefits those with depressive symptoms in both the short and long term.

The researchers look at studies which included people over the age of 14. This was a very broad age range. The befriending needed to be provided as a free service regardless of whether the befrienders were paid or unpaid. The researchers wanted to ensure that befriending focused on the relationship and that it was emotionally supportive. They contacted authors of the included studies regarding these factors. There were various comparison groups which included treatment as usual.

The researchers considered allocation masking as one quality indicator. In other words the researchers in the included studies did not know which people would be included in which arm of the study.  This is used to avoid selection bias. The other indicator was that follow-up results were recorded in at least 80% of the participants. Short term was classed as less than 12 months and long-term more than 12 months. 24 studies were included. Befriending was delivered mainly as face-to-face contact but telephone contact was also used in some studies.

The studies included diverse populations across the lifespan which the authors also comment on. The included studies used various measures of depression including the Beck Depression Inventory and the Geriatric Depression Scale. The Funnel Plot for the change in depressive symptoms was asymmetrical and favoured a benefit for the befriending. Indeed for befriending versus usual care the standardised mean difference was -0.27 (95% CI -0.48 to -0.06). Befriending was less effective on the depressive symptom outcome measure than Cognitive Behavioural Therapy.

Five studies looked at the longer term benefit for befriending on depressive symptoms. The standardised mean difference for depressive symptoms between befriending and treatment as usual was -0.18 (95% CI -0.32 to -0.05) for the longer term.

The researchers have shown a significant difference between the groups. There were more complex results when social outcome measures were used and when different comparator groups were analysed. These results tended to be very specific to the populations being examined. In summary however the researchers have identified an overall benefit across the investigated populations. The main difficulty however is that depressive symptoms are not the same as depression. Thus its possible to score highly on depressive symptoms on an assessment tool without being depressed. Similarly an improvement in the depressive symptoms is not the same as remission. Comparing different outcome measures is also difficult but has been statistically managed through the use of the standardised mean difference.

The study does provide evidence of a benefit for befriending which fits with an understanding of the wider benefits of social networks whilst at the same time highlighting the importance of the nature of the relationships also.

Index: There are indices for the TAWOP site here and here Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

Carl Jung’s Concept of the Shadow

Richard Mansfield playing Dr Jekyll and Mr Hyde photographed by Henry Van der Weyde, circa 1895, Public Domain*

Carl Jung was a Swiss Psychiatrist and pupil of Sigmund Freud. Jung later went on to found Analytical Psychology. Jung developed a deep understanding of human nature and communicated this through his many works. In many of these works Jung wrote about the Shadow. So what was the Shadow? Jung believed that people have two parts to their psyche. A person will have their main conscious identity which consists of the values and beliefs that he or she recognises as important as well as the familiar parts of their personality. However there is another side which is concealed. This is the shadow.

In his work ‘Memories, Dreams, Reflections’ (Jung, 1961), Carl Jung writes about his childhood circa 1890. During this time he had seen the crowning of Kaiser Wilhelm I of the Germany, the ‘archetypes of Wagner’ and read the philosophy of Nietzsche. In his own words he had become

unconsciously caught up by this spirit of the age and had no methods at hand for extricating myself from it‘ (Jung, 1961, p.262)

In other words, Jung had become caught up in events which were soon to transform the world in the early 20th Century during a period of immense turbulence. These are the events which created the problem for which Jung sought a solution. He found it in Goethe’s ‘The Faust’. Goethe’s work was based on much older folklore. Jung saw Mephistopheles as the shadow of Faust and went on to write that

Most of all, it awakened in me the problem of opposites, of good and evil, of mind and matter, of light and darkness‘ (Jung, 1961, p.262)

Jung wrote that he sought what Faust had overlooked. For Jung this included a respect for man’s rights as well as the continuity of culture and this started him on a lifelong journey of discovery. Jung also wrote about analytic psychology as a method for making the shadow conscious. However this process of helping the person to see their hidden shadow had consequences

The conflict between the opposites can strain our psyche to the breaking point if we take them seriously or they take us seriously‘ (Jung, 1961, p.367)

Jung wrote that this strain could be resolved symbolically. He gave the Mandala as an example of a universal symbol representing the ‘wholeness of self’. Dr Jekyll and Mr Hyde is another example of the conflicting parts of the psyche. However it would be wrong to think of the shadow in terms of morality as Jung also writes that

‘the unconscious man, that is, his shadow, does not consist only of morally reprehensible tendencies, but also displays a number of good qualities, such as normal instincts, appropriate reaction, realistic insights, creative impulses etc‘ (Aion, Collected Works, Vol 9, Part 2, p266)

For Jung, the shadow was an integral part of self, hidden from view. Integration of the shadow into the psyche was part of the analytic process of individuation. A person may also project their shadow onto others. In other words they can see qualities in others that they do not like but which form part of their own shadow. Individuals have shadows and many people have many shadows. Jung suggested that there was an interaction between people’s shadows. Indeed at one level Jung thought of the shadow as part of the collective unconscious.

Short Video on the Shadow

Jung’s concept of the shadow can be interpreted in terms of values. If we hold certain values and recognise these consciously then the opposite values may form part of our shadow. The shadow is not just restricted to values but the example of Dr Jekyll and Mr Hyde illustrates the point well. Dr Jekyll and Mr Hyde clearly manifested different values and these were translated into differences in their behaviours. Considering value differences is perhaps a more intuitive way of understanding the shadow. Taking this further we can also see that sharing values would lead to a ‘shared’ shadow – the opposite of these values. The group would collectively hold unconscious and opposite values with the potential for projection. Jung’s concept of the shadow while incorporating this interpretation was more complex still.

Jung’s concept of the shadow is a powerful one which enables a person to reflect on their identity by using symbolism and also by considering their relationship with others.

Short Biography of Dr Carl Jung

References

Carl G Jung. Memories, Dreams, Reflections. Fontana Press. 1961 (republished 1993).

* Public Domain in all countries where the copyright is the life of the author plus 70 years

Appendix – Related Resources on This Site

Carl Jung

An index of the TAWOP site can be found here and here. The page contains links to all of the articles in the blog in chronological order. Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

Knowledge Transfer and Innovation in the NHS

The National Institute for Health Research (NIHR) have a YouTube channel here. The channel features a very interesting video of a briefing on knowledge transfer and innovation in the NHS. The NIHR is funding research in the NHS and there are some tips on this towards the end of the briefing.

An index of the TAWOP site can be found here and here. The page contains links to all of the articles in the blog in chronological order. Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

Will More Efficient Workers Help Society to Face the Aging Demographic Time Bomb?

 

Many countries are facing a demographic time bomb. Simple stated as the population ages a larger percentage of people are over working age and a smaller percentage of working age. As a result, it has been suggested that society will be less able to support the older adult population. Consequently we will lose public services such as libraries which become unaffordable and people will need to retire much later in life.  Japan is frequently used as an example of a country which is expected to face this situation much earlier than other countries. The combination of a shrinking and aging population with a smaller proportion of the population expected in the workforce means that Japan is studied in relation to these significant changes in society (see Appendix).

However the narrative is too simplistic and one significant factor that is often overlooked in these discussions is the increasing efficiency of the workforce. Many populations have been aging for a very long time and societies have been successful in meeting such trends. Changes in technology, healthcare and education mean that workers can become increasingly efficient. Bringing this into the discussion we can now ask whether a more efficient workforce can counter the economic effects of an aging and shrinking (based on fertility rate trends) population.

Answering these questions is particularly important in meeting the future social and healthcare needs of a society. Such answers may provide a new perspective for the debate. In the meantime many solutions have been suggested. The charity Carers UK has suggested that there will be new opportunities for people who have retired to continue at work. The IMF has suggested that countries will have to put aside half of their GDP to prepare for this imminent demographic timebomb. Raising the eligibility age for pensions has been yet another suggestion.

Whatever the solutions, this debate will become an increasingly important one in the 21st Century.

Appendix

Geriatric Island – Japan

 

 

Index: There are indices for the TAWOP site here and here Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

Pay It Forward Day – April 26th 2012

April 26th 2012 is ‘Pay It Forward Day‘. The international ‘Pay It Forward Day’ initiative was started by Blake Beattie in response to the book of the same name by Catherine Ryan Hyde. The Pay It Forward foundation is hoping to inspire over 3 million acts of kindness on ‘Pay It Forward Day’. In 2011, participants from 35 countries took part. The Foundation provides ideas for how people can get involved here.

Index: There are indices for the TAWOP site here and here Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.