Anxiety Disorders: University of London

Keen DV, Fonseca S, Wintgens A. · St George's Healthcare NHS Trust, London, UK. · Arch Dis Child. · Pubmed #18456696 No free full text.

Abstract: BACKGROUND: Selective mutism (SM) now acknowledged as an anxiety condition, tends to be a poorly understood, highly complex and vastly under-recognised clinical entity. Children with SM are a vulnerable group as the condition is not the remit of any one professional group. This inevitably leads to delay in formal diagnosis and management. There is a lack of systematic research on which to base guidelines for management. AIM: To develop, agree and validate key principles underlying the management of SM through a consensus process involving international experts, in order to create a local care pathway. METHODS: A local multi-agency consultation process developed 11 statements, which were felt to be the key principles underpinning a potential care pathway for managing SM. Thirteen recognised experts from North America, Europe and Australia participated in a modified Delphi process involving two rounds using a Likert-scale and free commentary. Both quantitative and qualitative analyses were used in the validation or revision of the statements at each stage. RESULTS: Response rates were 100% for Round 1 and 84.6% for Round 2. Despite the differing professional backgrounds and service contexts, by successive revision and/or revalidation of statements, it was possible to arrive at a consensus about key principles relating to early recognition, assessment and intervention. The agreed key principles are presented together with the resulting local care pathway. CONCLUSION: Through a Delphi process, agreement was reached by a multidisciplinary group of professionals, on key principles that underpin the timely identification, assessment and management of children with SM. These include the potential for staff in school/preschool settings to identify SM and that intervention programmes should generally be based in these settings. Children with SM should receive assessment for possible coexisting disorders, whether developmental, emotional or behavioural and additional specific intervention given for these. Agreement was reached as to what constitutes clinical progress, intervals for monitoring progress, criteria for referral onwards for multidisciplinary specialist assessment and the role of selective serotonin reuptake inhibitor (SSRI) medication. A consensus methodology has been successfully used to compensate for the lack of evidence base and harness the expertise of a relatively small number of experienced professionals in order to provide a basis for the future development of services.

Gregory AM, Lau JY, Eley TC. · Psychology Department, Goldsmiths College, University of London, London, UK. · Eur Arch Psychiatry Clin Neurosci. · Pubmed #18297422 No free full text.

Abstract: It is becoming increasingly apparent that genetic research into psychiatric disorders would benefit from consideration of the environment because these risk mechanisms are likely to interact. Despite generalised anxiety disorder (GAD) being one of the most prevalent disorders presented in primary care, there is a paucity of published studies of gene-environment interactions (G x E) for this phenotype. This article describes how our current knowledge of GAD is useful in designing studies of G x E for GAD. To increase the chances of identifying replicable G x E for GAD further information is needed with regards to: defining and measuring GAD, difficulties co-occurring with GAD, quantitative genetic estimations for GAD, specific genes associated with GAD, and specific environmental risks for GAD.

Gregory AM, Lau JY, Eley TC. · Psychology Department, Goldsmiths College, University of London, Lewisham Way, New Cross, London, UK. · Eur Arch Psychiatry Clin Neurosci. · Pubmed #18297421 No free full text.

Abstract: Phobias are common disorders causing a great deal of suffering. Studies of gene-environment interaction (G x E) have revealed much about the complex processes underlying the development of various psychiatric disorders but have told us little about phobias. This article describes what is already known about genetic and environmental influences upon phobias and suggests how this information can be used to optimise the chances of discovering G x Es for phobias. In addition to the careful conceptualisation of new studies, it is suggested that data already collected should be re-analysed in light of increased understanding of processes influencing phobias.

Soomro GM, Altman D, Rajagopal S, Oakley-Browne M. · St. George's Hospital Medical School, Department of Psychiatry, University of London, Cranmer Terrace, London, UK SW17 0RE. · Cochrane Database Syst Rev. · Pubmed #18253995 No free full text.

Abstract: BACKGROUND: Obsessive compulsive disorder is a common and disabling disorder. A significant proportion of patients manifest a chronic course. Individual randomised controlled trials (RCTs) have shown that selective serotonin re-uptake inhibitors (SSRIs) are effective in this condition. Previous systematic reviews or meta-analyses summarising the evidence are methodologically problematic or limited in the scope of their analysis. OBJECTIVES: To examine the efficacy and adverse effects of serotonin re-uptake inhibitors (SSRIs) versus placebo for obsessive compulsive disorder (OCD) in adults. SEARCH STRATEGY: CCDANCTR-Studies and CCDANCTR-References were searched on 12/11/2007. Reference lists were checked. Experts in the field were contacted. SELECTION CRITERIA: All RCTs and quasi-RCTs examining the efficacy of SSRIs compared with placebo for OCD in adults were eligible for inclusion. DATA COLLECTION AND ANALYSIS: Selection of studies and data extraction were carried out by two review authors independently, and quality assessment of studies was undertaken. Data analysis was conducted using Review Manager software. Summary measures were produced using the weighted mean difference (WMD) for continuous data and relative risk (RR) for dichotomous data, with 95% confidence intervals (CI). SSRIs were examined as an overall group of drugs, and as individual drugs. MAIN RESULTS: Seventeen studies were included in the review, involving 3097 participants. Based on all 17 studies, SSRIs as a group were more effective than placebo in reducing the symptoms of OCD between 6 and 13 weeks post-treatment, measured using the Yale-Brown Obsessive Compulsive Scale (YBOCS) (WMD -3.21, 95% CI -3.84 to -2.57). The WMD for individual SSRI drugs were similar and not statistically different. Based on 13 studies (2697 participants), SSRIs were more effective than placebo in achieving clinical response at post-treatment (RR 1.84, 95% CI 1.56 to 2.17). The pooled RR was shown to be similar between individual SSRI drugs. Although reported adverse effects data were more limited, with few exceptions, the overall and individual adverse effects for the different SSRIs were always worse than for placebo and, in the majority of cases, the difference was statistically significant. Nausea, headache and insomnia were always reported amongst the most common adverse effects in trials of each of the drugs. AUTHORS' CONCLUSIONS: SSRIs are more effective than placebo for OCD, at least in the short-term, although there are differences between the adverse effects of individual SSRI drugs. The longer term efficacy and tolerability of different SSRI drugs for OCD has yet to be established.

Hassan I, McCabe R, Priebe S. · Unit for Social and Community Psychiatry, Barts and the London School of Medicine, University of London, London, UK. · Commun Med. · Pubmed #18052814 No free full text.

Abstract: The quality of the professional-patient relationship in the treatment of mental illness predicts patient outcome. Hence, we conducted a review of recorded professional-patient communication to identify existing research, methods, and findings. Sixteen studies focused on (i) how psychiatric symptoms are manifested in patient communication; (ii) the role of therapist communication in patient improvement; (iii) the influence of sociodemographic characteristics on doctor-patient communication; and (iv) how patients and professionals jointly construct therapeutic interactions. The findings were disparate and included (a) patient nonverbal communication is impaired in depression and schizophrenia; (b) the use of specific therapeutic skills led to improvement in depression; high expressed emotion (criticism and emotional over-involvement) in treating schizophrenia was a state rather than trait characteristic of therapists; (c) patient gender, income, and education influenced communication about depression, anxiety, and medication; and (d) psychiatrists' varying institutional agendas, which sometimes competed with patients' agendas, strongly shaped their consultations. Few studies investigated two-way professional-patient communication, with most focusing on either patient or therapist communication in isolation from the other. Finally, methodological advances in linking communication processes with treatment outcomes in large-scale observational studies and trials are a challenge for research on medical communication.

Andrews B, Brewin CR, Philpott R, Stewart L. · Department of Psychology, Royal Holloway University of London, Egham, Surrey TW20 OEX, UK. · Am J Psychiatry. · Pubmed #17728415 links to  free full text

Abstract: OBJECTIVE: Since the diagnosis of delayed-onset posttraumatic stress disorder (PTSD) was introduced in DSM-III, there has been controversy over its prevalence and even its existence. The authors sought to resolve discrepant findings concerning the prevalence of delayed-onset PTSD by conducting a systematic review of the evidence. METHOD: A literature search was conducted for case reports and group studies with adequate measurement of delayed-onset PTSD according to DSM criteria. Studies that met inclusion criteria were examined for the defined length of delay for delayed-onset PTSD, presence of symptoms before full diagnostic criteria were met, length of follow-up, prevalence estimates, and other variables. Studies were also examined for differences between immediate-onset PTSD, delayed-onset PTSD, and no-PTSD cases. RESULTS: Ten case studies and 19 group studies met criteria for inclusion in the review. Studies consistently showed that delayed-onset PTSD in the absence of any prior symptoms was rare, whereas delayed onsets that represented exacerbations or reactivations of prior symptoms accounted on average for 38.2% and 15.3%, respectively, of military and civilian cases of PTSD. CONCLUSIONS: The discrepant findings in the literature concerning prevalence can be largely, but not completely, explained as being due to definitional issues. Little is known about what distinguishes the delayed-onset and immediate-onset forms of the disorder. Continuing scientific study of delayed-onset PTSD would benefit if future editions of DSM were to adopt a definition that explicitly accepts the likelihood of at least some prior symptoms.

Gregory AM, Eley TC. · Psychology Department, Goldsmiths College, University of London, Lewisham Way, New Cross, London, SE14 6NW, UK. · Clin Child Fam Psychol Rev. · Pubmed #17503180 No free full text.

Abstract: Anxiety is a common problem, typically beginning early in life. This article explores reasons for individual differences in levels of anxiety among children, by reviewing the genetic literature. The plethora of research to date has demonstrated clearly that both genes and environmental influences play important roles in explaining differences in levels of anxiety of various types among children. This has encouraged researchers to search for specific genes and environmental influences upon anxiety. Despite important progress in identifying links between anxiety and specific genes--including associations between serotonin and dopamine genes and different symptoms of anxiety--overall, progress has been slow because multiple genes of small effect size are likely to influence anxiety. This article explains how the hunt for genes involved in anxiety is likely to benefit from genetically sensitive research, which examines the co-occurrence of symptoms; includes measures of the environment; and examines endophenotypes and risk pathways.

Badenhorst W, Riches S, Turton P, Hughes P. · Department of Mental Health, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK. · J Psychosom Obstet Gynaecol. · Pubmed #17225626 No free full text.

Abstract: OBJECTIVE: To review the available evidence on the psychological effects of perinatal death on fathers. METHOD: Electronic search of CINAHL, MEDLINE and PsycINFO databases from 1966-2005. Inclusion criteria: papers describing at least one psychological outcome for fathers who had experienced stillbirth or neonatal death. Exclusion criteria: papers not in English, dissertations, reviews, books without original data, intervention studies, studies of parents without separate results for fathers, studies where perinatal loss was not distinguished from other losses, first person accounts of a single experience, studies reporting on fewer than five fathers. Seventy-seven potential papers were obtained and screened by two authors. Seventeen studies were included. Study quality was rated using a checklist and main findings were summarized. RESULTS: Quality of methodology varied. Qualitative studies described classical grief responses, but less guilt than mothers. Fathers described experiences related to their social role and potential conflict between grieving couples. Quantitative research reported symptoms of anxiety and depression, but at a lower level than mothers. Fathers may develop post-traumatic stress disorder following stillbirth. DISCUSSION: Case prevalence of psychological disorders is unknown. More good quality research is needed. The social role of fathers as carers for their partners needs recognition when planning care for bereaved families.

Montgomery SA. · Imperial College School of Medicine, University of London, PO Box 8751, W13 8WH, UK. · Expert Opin Pharmacother. · Pubmed #17020438 No free full text.

Abstract: Pregabalin is a new anxiolytic that has been recently licensed for the treatment of generalised anxiety disorder (GAD) in Europe. Short-term efficacy is based on six positive placebo-controlled studies, all of which showed a significant early separation from placebo in all of the doses used (150-600 mg) at the first week, and the efficacy at the end of the treatment was comparable with the comparators used in four of these studies. Pregabalin was effective in more or less severe GAD, on psychic and somatic symptoms of GAD, and in treating the subsyndromal depressive symptoms of GAD. Efficacy in the elderly was shown in a separate placebo-controlled study. The effect on cognitive function was minimal and notably less than that observed with benzodiazepines. The discontinuation symptoms following abrupt treatment cessation were similar to the rates with serotonin-noradrenaline re-uptake inhibitors and lower than with benzodiazepines with no signals of tolerance or dependence.

Hirsch CR, Clark DM, Mathews A. · Institute of Psychiatry, King's College, University of London, De Crespigny Park, UK. · Behav Ther. · Pubmed #16942974 No free full text.

Abstract: Cognitive-behavioral models of clinical problems typically postulate a role for the combined effects of different cognitive biases in the maintenance of a given disorder. It is striking therefore that research has tended to examine cognitive biases in isolation rather than assessing how they work together to maintain psychological dysfunction. The combined cognitive biases hypothesis presented here suggests that cognitive biases influence each another and can interact to maintain a given disorder. Furthermore, it is proposed that the combined effects of cognitive biases may have a greater impact on sustaining a given disorder than if the biases operated in isolation. The combined cognitive biases hypothesis is examined in relation to imagery and interpretation in social phobia. Individuals with social phobia experience negative images of themselves performing poorly in social situations, and they also interpret external social information in a less positive way than those without social anxiety. Evidence of a reciprocal relationship between imagery and interpretations is presented, and the mechanisms underlying the combined effects are discussed. Clinical implications and the potential utility of examining the combined influence of other cognitive biases are highlighted.

Ghodse H, Galea S. · Department of Addictive Behaviour and Psychological Medicine, St George's Hospital Medical School, London, UK. · Int Rev Psychiatry. · Pubmed #16753668 No free full text.

Abstract: The 26th December 2004 saw a disaster brought on by massive waves - the Asian Tsunami. Millions of people died or were affected to varying degrees. The mental health aftermath did not only hit the Tsunami affected areas but it also sent ripples globally. Financial and humanitarian aid was overwhelming. This review brings together the mental health consequences and the global response. It provides a systematic overview of the mental health problems both within the affected areas and globally. It considers different levels and intensities of mental health problems both in affected areas and globally and explores the effects on vulnerable groups. It describes the unprecedented response and highlights the importance of providing culturally and contextually sensitive, integrated and co-ordinated interventions, informed by qualitative and quantitative assessment of needs, urgency and resource availability. The review also provides a retrospective view on the drivers of such a response.

de Silva P. · Institute of Psychiatry, King's College, University of London, UK. · Int Rev Psychiatry. · Pubmed #16753667 No free full text.

Abstract: This paper discusses the tsunami disaster in Sri Lanka with special reference to Buddhism, which is the majority religion in the island. The role of religious beliefs and of religion in general in strengthening coping skills is well known. Buddhism, with its specific views on the human condition and its use of psychological strategies, is almost unique among world religions. The Buddhist responses to the tsunami have been discussed widely, if largely informally, in Sri Lanka, and many concepts and practices have been highlighted and focused on. This paper provides an overview of the relationship between culture and traumatic experiences, with a brief discussion of the role of religion in mental health. It then goes on to explore some relevant Buddhist concepts and practices which can be used in clinical settings.

Soomro GM. · Section of Community Psychiatry, St George's Hospital Medical School, London, UK. · Clin Evid. · Pubmed #16620454 No free full text.

This publication has no abstract.

Gavrilovic JJ, Schützwohl M, Fazel M, Priebe S. · Unit for Social and Community Psychiatry, Barts and the London School of Medicine, Queen Mary, University of London, United Kingdom. · J Trauma Stress. · Pubmed #16382432 No free full text.

Abstract: This review aimed to identify factors associated with seeking treatment from mental health services after a traumatic event. Databases of literature were searched in a systematic manner and 24 relevant articles were found. Although many of the findings are inconsistent, the most important factors associated with treatment seeking appear to be a higher level of psychopathology, the type and level of the traumatic event, and sociodemographic characteristics, in particular female gender. Even though the evidence is insufficient to guide service development, suggestions for future research are made. The methodological quality of research should be improved to establish whether the inconsistency of findings reflects methodological artefacts or true differences between different samples and contexts.

Hemsley DR. · Psychology Department, Institute of Psychiatry, King's College, University of London, London SE5 8AF, England, UK. · Neurosci Biobehav Rev. · Pubmed #15964074 No free full text.

Abstract: This review provides a historical perspective on a model for schizophrenia based on results of experiments derived from learning theory. It was developed by the author in collaboration with Jeffrey Gray and numerous colleagues, (e.g. [Gray, J.A., McNaughton, N., 2000. The Neuropsychology of Anxiety. second ed. Oxford University Press, Oxford; Hemsley, D.R., 1987a An experimental psychological model for schizophrenia. In: Hafner, H., Gattaz, W.F., Janzarik, W. (Eds.), Search for the Causes of Schizophrenia, vol. 1. Springer, New York, pp. 179-188.; Hemsley, D.R., 1993. A simple (or simplistic?) cognitive model for schizophrenia. Behaviour Research and Therapy 31, 633-646]. It contrasts with earlier cognitive formulations [e.g. Hemsley, D.R., 1975. A two stage model of attention in schizophrenia research. British Journal of Social and Clinical Psychology 14, 81-88], which emphasised a weakening of contextually elicited response biases, and lacked a link to potential neural bases of the disorder. The model emphasizes the need to demonstrate patterns of performance that are not interpretable in terms of the well established 'generalized deficit' manifest in schizophrenia. It proposes that the cognitive disturbance is a change in the way stored material is integrated with sensory input and ongoing motor programmes. In particular, spatial and temporal context fail to activate appropriate stored regularities. A number of possible pathways from the cognitive disturbance to the symptoms of schizophrenia are outlined; again the term 'context' is widely employed. Thus, it has been invoked to explain the occurrence of hallucinations, delusions, thought disorder and disruptions in the sense of personal identity. However the term 'context' is ill-defined and the review indicates the variety of ways in which it may exert its influence. These are unlikely to reflect the operation of a unitary mechanism.

Zakrzewska JM, Forssell H, Glenny AM. · Oral Medicine, St Bartholomew's and the Royal London, Queen Mary's School of Medicine and Dentistry, Turner Street, London, UK, E1 2AD. · Cochrane Database Syst Rev. · Pubmed #15674897 No free full text.

Abstract: BACKGROUND: The complaint of a burning sensation in the mouth can be said to be a symptom of other disease or a syndrome in its own right of unknown aetiology. In patients where no underlying dental or medical causes are identified and no oral signs are found, the term burning mouth syndrome (BMS) should be used. The prominent feature is the symptom of burning pain which can be localised just to the tongue and/or lips but can be more widespread and involve the whole of the oral cavity. Reported prevalence rates in general populations vary from 0.7% to 15%. Many of these patients show evidence of anxiety, depression and personality disorders. OBJECTIVES: The objectives of this review are to determine the effectiveness and safety of any intervention versus placebo for relief of symptoms and improvement in quality of life and to assess the quality of the studies. SEARCH STRATEGY: We searched the Cochrane Oral Health Group Trials Register (20 October 2004), the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 4, 2004), MEDLINE (January 1966 to October 2004), EMBASE (January 1980 to October). Clinical Evidence Issue No. 10 2004, conference proceedings and bibliographies of identified publications were searched to identify the relevant literature, irrespective of language of publication. SELECTION CRITERIA: Studies were selected if they met the following criteria: study design - randomised controlled trials (RCTs) and controlled clinical trials (CCTs) which compared a placebo against one or more treatments; participants - patients with burning mouth syndrome, that is, oral mucosal pain with no dental or medical cause for such symptoms; interventions - all treatments that were evaluated in placebo-controlled trials; primary outcome - relief of burning/discomfort. DATA COLLECTION AND ANALYSIS: Articles were screened independently by two reviewers to confirm eligibility and extract data. The reviewers were not blinded to the identity of the studies. The quality of the included trials was assessed independently by two reviewers, with particular attention given to allocation concealment, blinding and the handling of withdrawals and drop outs. Due to both clinical and statistical heterogeneity statistical pooling of the data was inappropriate. MAIN RESULTS: Nine trials were included in the review. The interventions examined were antidepressants (two trials), cognitive behavioural therapy (one trial), analgesics (one trial), hormone replacement therapy (one trial), alpha-lipoic acid (three trials) and anticonvulsants (one trial). Diagnostic criteria were not always clearly reported. Out of the nine trials included in the review, only three interventions demonstrated a reduction in BMS symptoms: alpha-lipoic acid (three trials), the anticonvulsant clonazepam (one trial) and cognitive behavioural therapy (one trial). Only two of these studies reported using blind outcome assessment. Although none of the other treatments examined in the included studies demonstrated a significant reduction in BMS symptoms, this may be due to methodological flaws in the trial design, or small sample size, rather than a true lack of effect. AUTHORS' CONCLUSIONS: Given the chronic nature of BMS, the need to identify an effective mode of treatment for sufferers is vital. However, there is little research evidence that provides clear guidance for those treating patients with BMS. Further trials, of high methodological quality, need to be undertaken in order to establish effective forms of treatment for patients suffering from BMS.

Soomro GM. · Section of Community Psychiatry, St George's Hospital Medical School, London, UK. · Clin Evid. · Pubmed #15652061 No free full text.

This publication has no abstract.

Soomro GM. · Section of Community Psychiatry, St George's Hospital Medical School, London, UK. · Clin Evid. · Pubmed #15555141 No free full text.

This publication has no abstract.

Oliver S, Dezateux C, Kavanagh J, Lempert T, Stewart R. · Social Science Research Unit, Institute of Education, University of London,, 18 Woburn Square, London, UK, WC1H 0NR. · Cochrane Database Syst Rev. · Pubmed #15495068 No free full text.

Abstract: BACKGROUND: Newborn blood spot screening programmes are designed to detect serious conditions affecting individuals, where early treatment can improve health. It is suggested that screening can improve the experience of diagnosis for parents. For example, without newborn screening, when a child with cystic fibrosis becomes symptomatic a period of uncertainty can arise prior to diagnosis. These potential advantages of screening need to be weighed against potential disadvantages of screening at individual and population levels. Some newborn screening programmes inadvertently identify newborn infants who, although not affected by the condition, carry a gene for it and can pass on that gene to their children; these are 'genetic carriers'. Knowledge of newborn carrier status can lead to: testing of parents and family members, and concern about possible affected future siblings should both parents be identified as carriers; the possibility of such testing revealing the putative father is not the biological father; concern about the child's future reproductive choices; and unjustified anxiety about the health of the carrier newborn.There is an urgent need to develop clear guidance as to how to respond, with advances in technology fuelling the expansion of newborn blood spot screening and raised expectations of informed consent and disclosing test results. Depending on the condition for which screening is offered, options include: employing tests that do not identify carrier status, if available; identifying acceptable ways of disclosing carrier status; or identifying acceptable ways of not disclosing carrier status. These options are illustrated by screening programmes for sickle cell disorders and cystic fibrosis. Currently, there are no screening tests available for sickle cell disorders that do not identify carrier status. For cystic fibrosis, the policy choice is between an extended period of testing, and a screening result that is available sooner for most newborns, but inadvertently identifies carrier babies. OBJECTIVES: The aim of this review was to assess the impact of disclosing to parents newborn carrier status inadvertently identified by routine newborn blood spot screening. SEARCH STRATEGY: We searched for reports addressing disclosing newborn carrier status to parents following newborn screening for sickle cell disorders and cystic fibrosis in: commercially available electronic databases (October 2002), specialist registers, online journals, online abstracts and conference abstracts. We also scanned the reference lists of included papers. SELECTION CRITERIA: Studies addressing the impact of disclosing carrier status using a soundly controlled trial or randomised controlled trial. DATA COLLECTION AND ANALYSIS: Two researchers independently scanned titles and abstracts for relevance using the pre-specified inclusion criteria. Full reports of selected citations were then located and screened again for relevance by two researchers independently. At each stage, results were compared and discrepancies resolved by discussion. MAIN RESULTS: We found no controlled trials about disclosing carrier status. REVIEWERS' CONCLUSIONS: There is a need to develop and evaluate the effects of interventions to support the disclosure of carrier status to parents following newborn screening.

Hofberg K, Ward MR. · South Staffordshire Healthcare NHS Trust, St George's Hospital, Stafford, UK. · Postgrad Med J. · Pubmed #13679545 links to  free full text

Abstract: Pregnancy is a major life event for all women. However, when a psychiatric disorder is added to or exacerbated by the pregnancy then the problem requires expert knowledge from more than one area of medicine. This paper looks at pregnancy and the relationship with depression, eating disorders, and pathological fear of childbirth or tokophobia. It also examines the outcome for these women and their babies. Mental illness is a serious concern. It is now recognised that death from suicide is the leading cause of maternal death overall. Research in these areas is relatively sparse but an attempt is made to collate what is known.

Ghodse H. · International Centre for Addiction Studies, Department of Addictive Behaviour and Psychological Medicine, St George's Hospital Medical School, Cranmer Terrace, London SW17 0RE, UK. · Br J Psychiatry. · Pubmed #12835238 links to  free full text

Abstract: BACKGROUND: The unavailability of psychotropic and analgesic drugs for medical purposes results in suffering that goes unrelieved. Their excessive availability results in overmedication and suffering of a different kind. Aims To highlight the discrepancies between the demand for and supply of controlled drugs for licit purposes by different communities, and to promote their rational utilisation. METHOD: Review of the United Nations, World Health Organization and other literature on the licit use of narcotic analgesics and psychotropic substances. RESULTS: There are large differences in the use of psychotropics and analgesics by different countries. The differences between industrialised and non-industrialised countries are particularly striking. There is evidence of unmet need in some countries and overutilisation in others. CONCLUSIONS: Governments, international organisations, health professionals and the pharmaceutical industry must work together to ensure an adequate supply of psychotropic and analgesic drugs for medical and scientific purposes, and to implement appropriate measures to minimise the development of misuse and dependence.

Soomro GM. · Section of Community Psychiatry, St George's Hospital Medical School, London, UK. · Clin Evid. · Pubmed #12603924 No free full text.

This publication has no abstract.

Sequeira H, Hollins S. · Department of Psychiatry of Disability, St George's Hospital Medical School, London, UK. · Br J Psychiatry. · Pubmed #12509313 links to  free full text

Abstract: BACKGROUND: There are few publications concerning the psychological reactions of people with learning disabilities to sexual abuse. Most significantly, there are no controlled studies and few which demonstrate a systematic approach to documenting the sequelae of trauma. AIMS: To critically review the published research in this field. METHOD: A literature search in peer-reviewed psychiatry, psychology, nursing and social care journals for the years 1974 to 2001 was conducted and 25 studies were reviewed. RESULTS: Several studies suggest that, following sexual abuse, people with learning disabilities may experience a range of psychopathology similar to that experienced by adults and children in the general population. However, because of methodological limitations, these results are not conclusive. CONCLUSIONS: Whether people with learning disabilities experience reactions to sexual abuse similar to the general population has yet to be explored by systematic research.

Poole K, Froggatt K. · Macmillan Practice Development Unit, Centre for Cancer and Palliative Care Studies, Institute of Cancer Research, London, UK. · Palliat Med. · Pubmed #12465697 No free full text.

Abstract: This paper aims to examine the loss of weight and loss of appetite as 'problems' experienced by patients with advanced cancer and those that care for them. It reports the results of a systematic search of the literature and presents the findings as a narrative review. Research to date has focused upon charting the prevalence and incidence of these symptoms, but little empirical work has been conducted to investigate how patients and carers experience these problems. There is some evidence to suggest that anorexia may be more distressing for those caring for the patient than the person suffering from the symptom itself. Understanding the reason for this anguish requires an appreciation of the meaning of food refusal and constitutes the first step towards informing the development of effective interventions. Such exploratory work is mandatory if health professionals wish to move beyond speculation and deliver interventions that provide meaningful benefits for the cancer patient and their family.

Soomro GM. · Section of Community Psychiatry, St George's Hospital Medical School, London, UK. · Clin Evid. · Pubmed #12230713 No free full text.

This publication has no abstract.