Rob Poole

Clinical relevance of findings in trials of antipsychotics: systematic review

BACKGROUNDnThere is concern over the methods used to evaluate antipsychotic drugs.nnnAIMSnTo assess the clinical relevance of findings in the literature.nnnMETHODnA systematic review identified studies of antipsychotics that used the Brief Psychiatric Rating Scale (BPRS) and Positive and Negative Syndrome Scale (PANSS). A published method of translating these into Clinical Global Impression - Change scale (CGI-C) scores was used to measure clinical relevance.nnnRESULTSnIn total 98 data-sets were included in the BPRS analysis and 202 data-sets in the PANSS analysis. When aggregated scores were translated into notional CGI-C scores, most drugs reached minimal improvement on the BPRS, but few reached that level for PANSS. This was true of both first- and second-generation drugs, including clozapine. Amisulpride and olanzapine had better than average CGI-C scores.nnnCONCLUSIONSnOur findings show improvements of limited clinical relevance. The CGI-C scores were better for the BPRS than for the PANSS.

Praying with a patient constitutes a breach of professional boundaries in psychiatric practice

The extent to which religion and spirituality are integrated into routine psychiatric practice has been a source of increasing controversy over recent years. While taking a patients spiritual needs into account when planning their care may be less contentious, disclosure to the patient by the psychiatrist of their own religious beliefs or consulting clergy in the context of treatment are seen by some as potentially harmful and in breach of General Medical Council guidance. Here, Professor Rob Poole and Professor Christopher Cook debate whether praying with a patient constitutes a breach of professional boundaries in psychiatric practice.

The clinical implications of church attendance and suicide

Kleiman and Lui[1][1] have conducted a respectable study that suggests that people in the USA who attend church frequently are less likely to die by suicide than other people. Although the finding is interesting, it is not surprising. It is congruent with Durkheim’s 19th-century theory about the

Is alcohol consumption irrelevant to outcome in anxiety and depression

Boschloo and colleagues[1][1] report that DSM-IV alcohol abuse is not a risk factor for unfavourable outcome in depression and anxiety disorders. This finding, which ostensibly conflicts with clinical experience, could easily be misunderstood to imply that non-dependent alcohol use is irrelevant in

Severe mental illness and social factors

This chapter examines the evidence about the relationship between poverty and severe mental illness, by which we mean psychotic disorders. In Chapters 2 and 3 the nature of poverty in the UK in the twenty-first century is discussed in detail. It is important to recognise from the outset that the concept of poverty is complex. Individual income is difficult to measure, and may not be as relevant as relative income, perceived disadvantage or social exclusion. It is easy to inadvertently conflate these concepts, and this is apparent in parts of the literature. In this chapter, some work is cited that uses the concepts of social disadvantage and deprivation rather than poverty per se. The movement between discussion of different types of social adversity should not be taken to imply that the differences between them are irrelevant. On the face of it, it appears self-evident that being poor is bad for people’s health. A strong association between poverty and ill health is well established for nearly all types of disease and in all parts of the world (Black et al., 1993). The association between material deprivation and mental illness is just as strong as it is for physical illness. However, it is by no means universally accepted that this relationship is causal; that exposure to poverty leads to mental ill health. Much of the discussion in the psychiatric literature has taken social factors to have a modulating effect on more profoundly causative bio-genetic factors. It is only recently that the possibility of a strictly causal role for social factors has been seriously addressed within the mainstream psychiatric research literature. There is a body of opinion that has long preferred the view that a reverse causation applies, that mental illness causes poverty. The suggestion is that mental illness undermines people’s ability to work and to maintain their social position. Interest in non-biological factors has sharply increased in recent years with regard to schizophrenia in particular. The association between this disorder and social factors is very strong and consistent. A particular type of social factor, namely growing up in inner-city deprivation, seems to be especially powerful in conferring a heightened risk of schizophreniform disorders. For this reason we shall concentrate here on the evidence regarding schizophrenia.