In a study published in ‘The Psychiatrist’ (Perecherla et al, 2011), a research team looked at a person’s understanding of their medication in a group of older adult inpatients on a psychiatry ward (n=86). They thought that people might have a better understanding of the medication for their medical illnesses rather than the mental illnesses. However they found that people had a roughly equivalent understanding of the drugs for their medical and mental illnesses. Although they used a screening tool to exclude those with cognitive impairment, this still appeared to play a role in a person’s understanding of their medication in some of the people.
Research in Psychosis
People developing a first-episode psychosis after misuse of substances were followed up over a 2-year period (Komuravelli et al, 2011). The researchers found that of the 78 people retained in the study, 46 were retained in follow-up in the services and of these 36 (i.e 78%) had been given a diagnosis of psychosis and this is supported by other similar research in this area.
Research in Dementia
Research has provided evidence that Amyloid Plaques grow in the brain at around 2-3% year. These Plaques are thought to be critical to the development of Alzheimer’s Disease according to the Amyloid Hypothesis. The original press release from the Society for Nuclear Medicine (SNM) can be found here and in the report based on papers presented at the 2011 SNM meeting the researchers noted that plaques were present in
‘12 percent of those in their 60s, 30 percent of those in their 70s and 55 percent in those over the age of 80‘
The press release also mentions other research which is investigating imaging techniques to visualise the plaques. There is the potential for such investigations to transform clinical practice if the technology becomes widely available and economically viable.
In the Amyloid Hypothesis as well as Amyloid Plaques, Tau proteins found within cells are thought to play an important role in the disease process. In a recent study, Professor Feinstein who has been researching Tau proteins for 30 years and his team discovered that when Amyloid was added to neurons it led to the disintegration of the Tau structure inside the neurons instead of the expected Tau Phosphorylation. Furthermore this was associated with the rapid demise of the neurons suggesting to the researchers that the Tau proteins role in forming the cytoskeletal infrastructure of the cell was being compromised. It will be very interesting to see further replication of these results.
Researchers have used a technique known as ‘Functional Electrical Impedance Tomography by Evoked Response’ fEITER to investigate ‘consciousness’ in people undergoing anaesthesia. Crudely speaking, as the consciousness levels were found to decrease there were corresponding changes in actvitiy in defined anatomical regions. Although this preliminary report is a little vague, the research team are still analysing the data but the combination of the effectiveness of the new technology and the correlation of activity with levels of consciousness will be very exciting results if this holds up to further analysis.
There is an interesting reappraisal of the diagnosis of Dangerous and Severe Personality Disorder by Dr Duggan in the British Journal of Psychiatry. He argues that there have been both advantages and disadvantages to the programme which have included additional funding and research in this area although there have been difficulties in using the diagnostic criteria as prognostic indicators. Duggan also writes that there is a move to ‘phase out’ the DPSD programme.
Recruitment into Psychiatry
The Royal College of Psychiatrists has started up a YouTube Channel here. The first two videos on the channel by a group of psychiatric trainees are very interesting. In the UK there has been a shortage of doctors going into psychiatry recently. There has been a lot of discussion about how to solve this recruitment problem. I think these two videos could signal a new and profound development in the relationship between psychiatrists and society. In the first video, a group of trainee psychiatrists tell us why they like what they’re doing.
During the course of the video we get to see the ‘human side’ of the trainees. They are a group of young people who share with us a passion for what they are doing. They are relaxed and friendly in their manner and challenge some of the stereotypes that have been developed over the years. Indeed there are very strong stereotypes that have to be challenged. It’s difficult to know where these stereotypes have come from but certainly in the cinema psychiatrists have a very useful role in plot devices leading to well publicised caricatures. This has been well explored in the literature and the interested reader is directed to several resources (see here, here, here and here). Trainee psychiatrists have been engaging with society in other media (see reviews here and here). However the important development here is for the psychiatrist to be shown not as an agent observing and influencing society from the outside but as part of society. In other words people who just happen to be psychiatrists. In this way people will not need to overcome stereotypic assumptions in the simple act of relating to someone who is a psychiatrist. This in turn might contribute to career choices (although research is needed in ths area).
In the second video Dr Kamran Ahmed does a brilliant job of tackling these issues. Ahmed enlists some talented people to work on the animation and sound producing a trendy video that readily connects with the audience. However the most important part of the video is that Ahmed reveals his own thoughts and feelings about his experiences as a psychiatrist. To do this requires a lot of courage but it is an important part of engaging with society because this is exactly what other people are doing regardless of their profession as part of the conversation that is happening in society. There is one point about the video made by commentators and that is the scene with the psychologist. One of the most important aspects of psychiatry is working within the multidisciplinary team. The work of the nurses, occupational therapists, physiotherapists, psychologists, psychotherapists, pharmacists, social workers, support workers and speech and language therapists is essential in getting people better and each of those roles is critically important in this work. However the video is geared towards challenging some of the assumptions that people, particularly doctors have about psychiatrists and so this video necessarily focuses on the experiences of the psychiatrist. There is a very significant exchange between psychologists and psychiatrists and both fields have become enriched because of this exchange. Again though it is a little difficult to easily discuss the differences between a Clinical Psychology Doctorate and a Medical Doctorate in the context of a short video which is fast-paced and geared towards generating wider debate. I hope that this develops into a wider movement with psychiatrists increasingly using social media to engage with society and joining with members of the other professions to do so. I think these videos are a promising and inspiring start for the profession.
Komuravelli A et al. Stability of the diagnosis of first-episode drug-induced psychosis. The Psychiatrist. 2011. 35. 224-227.
Perecherla et al. Older Psychiatric inpatients knowledge about psychotropic and non-psychotropic medications. The Psychiatrist. 2011. 35. 220-224.
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