Abstract
This month the Journal takes an international perspective, with authors based in Europe, Asia and Africa, as well as Australia and New Zealand. Whilst most of our readers practice in Australasia, we are very much part of a global profession and contributions from other parts of the world provide useful new ideas and novel approaches to treatment.
For example, there has been considerable local research looking at the associations between vitamin D and mental illness. Both Australia and New Zealand have adequate amounts of sun (sometimes too much in parts of Australia), but despite this abundance, vitamin D deficiency is surprisingly quite common (Daly et al., 2011). Khoraminya and colleagues (2013), from Iran, review the evidence that vitamin D deficiency might be linked to depression. They found that 95% of their patients with major depressive disorder were deficient in vitamin D, and that a vitamin D + fluoxetine combination was more effective than fluoxetine alone. This study has wider implications. Dietary vitamin D intake is usually not sufficient (Nowson et al., 2012) and some sun exposure is necessary to achieve adequate levels. There are social, cultural and individual reasons for inadequate sun exposure, and further research is needed to determine whether it would be useful to develop a public health campaign aimed at improving vitamin D levels.
Turner et al. (2013) also set out to improve the evidence base for the treatment of depression, comparing a single-session brief intervention for depression with six sessions of cognitive behavioral therapy (CBT) in depressed cardiac patients. Rather unexpectedly, more was not better, and there was no difference between the brief intervention alone and the brief intervention + CBT. This study highlights the need for properly designed studies that do not simply use an uncontrolled design to confirm the researchers’ expectations.
As eloquently described by Ben Goldacre in Bad Science (2008), research into the effects of dietary supplements often lacks scientific rigor and is confounded by placebo effects. Liu et al. (2013) discuss the difficulties of providing adequate placebos in omega-3 trials, given that omega-3 has a strong fishy smell and an oily texture. They also describe some other potential pitfalls for the inexpert researcher. On a different topic, but still with a theme of improving the quality of psychiatric research, Vella and Pai (2013) discuss the challenges of measuring burden of care in serious mental illness, and offer some recommendations.
Larsen and colleagues (2013) build on previous findings demonstrating that people with severe mental illness have very poor physical health. They explore national differences, collecting data in Denmark, Switzerland, Japan and Africa. In all populations studied, people with schizophrenia or affective disorder had much higher rates of obesity, diabetes and cardiovascular disease than the general population. The factors involved in causing these high rates of medical comorbidity therefore seem to be present in all of these countries despite differences in culture and lifestyle. This is important for Australia as our Second Australian Survey of Psychosis data show that Australians with psychosis have similar cardiometabolic disorders (Galletly et al., 2012). Also at a population level, Christiansen et al. (2013) used a very large Danish registry to identify risk factors for suicide attempts in young people; these results can then inform preventive strategies.
As always, the Journal contains articles and comments on the sociopolitical context in which psychiatrists work. Levy (2013) has written a thoughtful article about the possible biological basis for the benefits and side effects of stimulants used in the treatment of attention-deficit hyperactivity disorder (ADHD). She notes that important ethical and scientific issues regarding ADHD have become clouded by an atmosphere of moral panic rather than scientific debate. Also in the political arena, March et al. (2013) talk about the negative consequences of the absence of acquired brain injury from Australian national policy documents.
The preparation of DSM-5 has led to some very useful discussions about the boundaries between psychiatric disorders and non-disorders, and about psychiatric classification. This month the discussion focuses on eating disorders, with an article on muscle dysmorphia (a pathological need to develop excessive muscularity, most common in young men). Is this an eating disorder?, A body dysmorphic disorder?, A subtype of obsessive compulsive disorder?, Or a cultural phenomenon, that is not a disorder at all? Murray and Touyz (2013), Russell (2013) and Hay (2013) provide a smorgasboard of commentaries.