Abstract
Should I read that? Do I need to? And more importantly, do I want to? Readers of this month’s Journal have abundant opportunity to pose these very questions. Let us start with a matter firmly tied to clinical practice: do antidepressants help where persons with a dementia also have depression? Macfarlane et al. (2012) dissect the influential study in the UK by Banerjee et al. (2011) which compared sertraline, mirtazapine and placebo, finding no significant difference. Despite its several flaws, some might conclude that antidepressants are of little use in this group. But it is not so simple: these patients often do get better, but psychosocial treatment needs to be part of the package. Draper (2012) and Snowdon (2012) both endorse the latter unequivocally. Yet there is another factor behind it all, as Alexopoulos et al. (1988) sagaciously pointed out: depressive symptoms in the dementias tend to be transient. Half a century ago, Martin Roth (1955) wrote that in patients with depression in dementia, ‘The mood change is short-lived and shallow . . . Depressive ideas are fragmentary and transient and the whole picture usually has a characteristic lability’. So need we be surprised at Banerjee et al.’s findings?
Kumarasinghe et al. (2012) give an overview of where microarray gene expression research in schizophrenia currently stands. Here, readers could profitably try to identify the strategies investigators use and the impediments encountered. So far, let us say there is promising progress on what will be a long journey. In a radically different contribution from South Korea, Ahn et al. (2012) tell us of its high rate for parricide, this in a culture where filial respect is paramount – to the extent that traditionally children should live in a mud hut near their parents’ tomb for at least 3 years after their death (Ahn et al., 2012). Most cases of parricide were by men with schizophrenia killing their mother, with whom they lived, an extreme manifestation of expressed emotion.
Gonda et al. (2012) set themselves two fundamental questions about rehabilitation in severe mental illness. Hopefully, such work may yet lead to identifying what the active elements are in programs that demonstrably bring benefit. A further contribution on psychiatric treatment finds that people with anxiety disorders can get a little better with self-administered computerised psychotherapy on the internet, plus a few brief phone calls from a non-clinical assistant (Bell et al., 2012). Because such on-line treatment is here to stay, it is all the more important to identify what we do not know about it. Lampe’s list is right on target here (Lampe, 2012), including the role of therapist contact. Whether or not there are future advances in such psychological treatment, we can be sure the e-technology it uses will leap ahead, conceivably bringing an interactive psychotherapist in hologram form to one’s own living room, at any time one elects, conferring an even greater reduction of symptoms. Carl Rogers’ contribution may still carry relevance.
Australia and New Zealand are in the forefront of reforming mental health legislation. This issue carries a collaborative paper by a barrister and psychiatrist who spell out for us where the changes are likely to be (Callaghan and Ryan, 2012). The core issue is capacity. Their paper is one to heed closely.
If stigma about mental illness is to be reduced, it would be a good idea to know what the general public think it is (Jorm and Reavley, 2012). Writing from Zürich and Denmark Hill, Rüsch et al. (2012) produce data on this, finding that the UK public see two rather separate constructs, embedded in which are the central issues of capacity and volition (Henderson, 2005). This issue offers a rich opportunity for the reader to exercise both faculties.