ANZJP Weltanschauung

In this issue of the journal, Looi and Liberg provide enthusiastic yet realistic advice to young clinician researchers. To be fair to mature age trainees or junior consultants, I think ‘young’ equates to ‘early career’. Looi and Liberg (this issue) highlight the need for excellence in critical thinking and scientific enquiry and encourage aspiring researchers to develop their own weltanschauung. Having googled weltanschauung, the young researcher realises their need for a concept of the world and the place of humanity within this world, along with an intellectual construct that provides for analysis of the problems of existence.

Inspired, the young researcher recognises that good clinical research has a solid theoretical foundation, pursues a worthwhile goal and hopefully brings direct benefit to people with psychiatric disorders. Stopping people dying from preventable conditions is certainly worthwhile, and three papers in this edition of the Australian & New Zealand Journal of Psychiatry (ANZJP) begin by talking about premature mortality in people with mental illness. Two of these papers look at whether evaluations of cardiovascular risk and advice about lifestyle modifications undertaken in the general community are applicable to people with psychotic disorders. In the general population, the relative contribution of factors such as obesity and hypertension to cardiovascular risk has been established. Risk calculators that identify and weight the various risk factors have been developed and are widely used. Foley et al. (this issue) have undertaken a careful examination of the correlations between risk factors in people with psychosis compared to the general population. They found that the correlations were much lower in the psychosis population, indicating that traditional risk equations used in the general population might not be applicable to people with psychosis. Foley et al. (this issue) consider that this finding may relate to the effects of antipsychotic medication, differences in lifestyle due to symptoms or biological factors related to the illness itself. Vancampfort et al. (this issue) also look at whether recommendations designed for the general population are applicable to people with chronic psychiatric disorders. They argue that guidelines about the nature and duration of physical activity currently promoted as a public health measure may not be appropriate for those with a severe mental illness.

Bartlem et al. (this issue) asked people attending a community mental health centre about modifiable health risk behaviours and found that poor diet, smoking, physical inactivity and risky use of alcohol were the most common. As reported in previous studies, patients were keen to change these behaviours. However, helping them to achieve these changes is proving difficult, and there are many more studies describing the scope and nature of the problem than providing solutions. Much more work developing and evaluating interventions, such as the physical health strategies proposed by Vancampfort et al. (this issue), is needed. This would be a good starting point for a young researcher, as there are plenty of potential participants and the interventions are generally low cost.

The cardiometabolic effects of psychotropic medications contribute to the poor physical health of people with severe mental illness. These medications may have other risks; Amerio et al. (this issue) provide a very comprehensive summary of carcinogenicity in animal studies of psychotropic drugs. This is an example of pulling together information that is already available in a review or meta-analysis and can be a worthwhile exercise for the novice researcher. Amerio et al. (this issue) propose that this information might be used in the informed consent process, although it is quite hard to see how this would translate to clinical practice. There are elevated risks in mice and rats, but concordance between species is less than 100%, so these risks may not translate to humans. The doses used are very high, for example, rats are given up to 24 mg/kg/day of citalopram, which for a 70-kg person would be a daily dose of 1680 mg, and mice are given up to 10 times this dose. Furthermore, the rats and mice are presumably not depressed (although on these doses they probably do not feel great). Amerio et al. (this issue) note that counter to the increased cancer risk in animal studies, it is proven that some antidepressants have beneficial immunological effects in depressed humans, which would be expected to reduce the risk of cancer. However, the lifestyle factors mentioned above (Foley et al., Vancampfort et al., Bartlem et al.), which are more prevalent in people with psychiatric disorders, are associated with an increase in cancer risk. Foley et al. (this issue) talk about an inverse comorbidity with cancer in people with schizophrenia and other central nervous system (CNS) disorders. The associations between psychiatric disorders, medications, lifestyle and cancer are clearly complex, and teasing this out could provide a very satisfying challenge for an aspiring researcher.

There are two papers about psychological responses to major disasters in our region, the Christchurch earthquakes and the Black Saturday bushfires. Looi and Liberg (this issue) talk about using routinely collected data for research, and as an example of this, Beaglehole et al. (2015) have drawn on dispensing data for Canterbury before, during and after the earthquakes. They show that there was a spike in the dispensing of anxiolytics and sedatives after the biggest earthquake, but otherwise no change in the use of psychotropic drugs. This is a surprising finding, and they discuss possible reasons for this. Forbes et al. (this issue) demonstrate that anger and ongoing life stressors are the two factors most associated with mental health problems after the Black Thursday fires. They describe how this information can be used to improve management of psychological trauma after a natural disaster.

Critical assessment of the same data, or findings, by different researchers can produce quite different conclusions. This is well illustrated by the three papers on eating disorders. Gammelmark et al. (this issue) describe changes in the prevalence of treated eating disorders in Denmark over several decades. Mond (this issue) has written two critical evaluations of this study, drawing attention to different aspects of these findings and the various confounds that impact the interpretation of these results.

This journal covers a range of other topics ranging from suicide and the internet to stigma among physicians. Young researchers often venture into print for the first time with a letter to the ANZJP. It would be difficult to find a cohort of people with stuttering priapism associated with seroquel, so this would not be a suitable topic for a research project, but Koloth and Panickaher (this issue) have published their single case as a case report.

This edition of the journal demonstrates the capacity of researchers to take a question or hypothesis and pursue it, sometimes to unexpected conclusions. There is an emphasis on translation of research findings into clinical care, but pure research is also valued. Perhaps these are some of the components of the weltanschauung of the ANZJP.