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Thursday 29 November 2012

Omega-3 fatty acid augmentation of citalopram treatment for patients with major depressive disorder.

J Clin Psychopharmacol. 2012 Feb;32(1):61-4.

Omega-3 fatty acid augmentation of citalopram treatment for patients with major depressive disorder.
California Clinical Trials Medical Group, Glendale, CA 91206, USA. lev.gertsik@cctrials.com

The objective of this study was to explore the efficacy of combination therapy with citalopram plus omega-3 fatty acids versus citalopram plus placebo (olive oil) in the initial treatment of individuals with major depressive disorder (MDD). We hypothesized that combination therapy would lead not only to greater efficacy but also to a more rapid onset of therapeutic response.

Forty-two subjects participated in this 9-week randomized, masked, placebo-controlled study of combination therapy (two 1 g capsules containing a blend of 900 mg of eicosapentaenoic acid, 200 mg of and docosahexaenoic acid, and 100 mg of other omega-3 fatty acids twice daily plus citalopram) versus monotherapy (two 1 g capsules of olive oil per day plus citalopram) treatment of MDD.

The combination therapy demonstrated significantly greater improvement in Hamilton Depression Rating scale scores over time (F = 7.32; df 1,177; P = 0.008) beginning at week 4 (t = -2.48; df 177; P = 0.014).

Combination therapy was more effective than monotherapy in decreasing signs and symptoms of MDD during the 8 weeks of active treatment; however, combination therapy did not seem to enhance the speed of the initial antidepressant response. These findings suggest that there may be an advantage to combining omega-3 fatty acids with a selective serotonin uptake inhibitor in the initial treatment of individuals with MDD. A larger definitive study is warranted.

[PubMed - indexed for MEDLINE]

Saturday 24 November 2012


Lessons Learnt – The 'Cheeky Chatty Challenge' Model –Tips for Running a Successful Psychologically Based Campaign
 in the Community.

Why did I choose this title which I feel is a good starting point for this discourse to encourage other psychologists to campaign on issues they feel strogly about?
Cheeky – is a word I regularly explain to disaffected clients as a way of reframing some of their positive social characteristics and non-verbal signals.I create a narrative that this positive endearing cluster that a lot of successful people possess is a significantly different pattern from rudeness. I describe that it will ensure that they are popular in life and will help them to succeed in any team or workplace. I believe it can also be a core feature of effective campaigning – i.e. if you cheekily target some prominent academics, influential ‘players’ or ‘movers and shakers’ either face to face or less directly with your ideas, letters or ‘posts’ then some will engage with the dialogue you are promoting and get involved making a huge difference to the level of success achieved.e.g. obtaining the signature of the highly respected Dr Dorothy Rowe (Clinical Psychologist) gave a major impetus to the petition's success.She is probably the most esteemed Humanistic Psychologist of her generation.

Chatty – I passionately believe that ‘meaningful conversations’ and social discourse are the primary vehicle for effecting community based change in a wide range of relevant issues and puts the ideas in our shared 'thought pool' out of which we freely draw contributing significantly to our 'collective psyche.' This embeds it in a way that is comfortable and effective for the people involved thus ensuring its survival. Intense and aggressive arguments do not often move opinion and can cause entrenchment but gently challenging other viewpoints using meaningful conversations can have lasting and evolving positive impacts.

A challenge – is not a threat but is professional way of asking a reasonably framed question to elicit a well thought out response from another colleague with whom you share clients. The most common response from medical colleagues whom psychologists challenge about psychotropic medication is, “ Thank you for taking the time to share your information and views.” This often leads to a review of their thinking and the medication concerned, even in some cases leading to the the complete phasing out of one or more drugs.

A Psychologically Based Campaign – is facilitated using underpinning psychological principles and theoretical  models to elicit change in individual viewpoints and ‘groupthink’ which empowers people in a positive direction, is easy to maintain and generalises well to other contexts.

Guiding star quotes and ideas.

“There is nothing more powerful than an idea whose time has arrived.”  Steve Biko.

“When deception is so common place, telling the truth is revolutionary.”  George Orwell

These quotes have provided a moral compass for the road on which the project has been heading since its inception until the present time where sometimes small but significant differences have been achieved both with individual casework, vulnerable groups of young people locally e.g. asking questions at reviews about the prescribing and monitoring of Looked After Children and at a national level in terms of policy outcomes such as the release of £400 million for psychological therapies following Pat McFadden's adjournment debate in Parliament.

The Factors and Variables that have Supported Positive Change as a consequence of the Campaign:

- -   Striving to form alliances with sympathetic individuals, groups of colleagues and professional bodies such as the Association of Educational Psychologists (Kate Fallon = General Secretary) and the Division of Educational and Child Psychology (Christopher Arnold = Chairperson) all  of whom have been very supportive.  My original inner circle of supporters were nick-named 'the Traxson 5,' and they have been a continuous source of constructive feedback and ideas that has nurtured the growth of support and helped to significantly change practice across the West Midlands. 
- - Using the power of Social Media to develop a 'community of contacts' who share the same viewpoint -   e.g. having 500+ contacts for Linkedin including many academics, 300+ followers on Twitter, 100,000 downloads on the blog and last but not least regular inputs into EPNET continuous conversations.
- -  Targeting ethical media representatives who genuinely share the same concerns for children in our society.
- -  Using national conferences to launch debate and feed in sympathetic contacts to established networks.
- - Stimulating debate at any level within the micro, meso and megasytems of our progressive society.
- -  Appearing on media programmes and asking searching questions of proponents of the medical model.
- -  Providing powerful questions to use in schools by Pastoral Care Staff and modifying them based on feedback received.
  -   Blogging daily messages, articles, opinions and video clips to ensure there is a variety and choice of stimuli.
  -  Reinforcing the comments and practice of other colleagues who share concerns about over-prescription.
--   Volunteering to contribute to national and international consultations on DSM-5 e.g.BPS Response - 'The Future of Psychiatric Diagnosis,' June 2012.
--  Challenging questionable practice by claiming the ‘Ethical Legitimacy’ afforded by the HPC Code.i.e. if the actions of another professional put a 'service user' at risk of harm then there is a 'duty of care' to take action.
--   Informing line managers, deputy directors, politicians, and Professional Bodies of actions taken and the positive outcomes.
--  Modifying the next level of response and intervention based on the effective feedback received.
--  Answering colleagues’ and parents’ questions in a matter of fact and direct manner.
- -  Challenging individual doctors and related professionals about the Adverse Drug reactions of drugs they are prescribing.e.g. the damage to sleep patterns, tremors and tardive dyskenesia.
  -  Sharing observations and conclusions about the impact of side-effects on a child’s life and wellbeing.
  -  Celebrating significant steps forward achieved at all stages of the project with interested parties.
  -  Writing articles promoting the strategies that have lead to either partial or significant success.
  -  Targeting colleagues and allies who may well be happy to share ideas and promote healthy debate.
- - Collating a free bank of resources and strategies that are evidence based and effective.
  Promoting the use of these scientifically effective alternative methodologies in a wider context.e.g. C.B.T., meditation, mindfulness, yoga and progressive relaxation training.
- -  Publishing any successes achieved by following the project's suggestions, protocols and ideas
  And last but not least - 
 START A PETITION - to send to a governmental body when a target has been achieved to influence policy.
        This can also give sympathetic colleagues a major role in recruiting signatures -
    as for the one below:

“Safeguarding Children is the Paramount Responsibility of all Workers in Childrens’ Services.” as stated by many Directors.

Join the campaign to retrict the influence of DSM-5 in the U.K. in order to Safeguard our Children and Families.


Friday 23 November 2012

YOUNGMINDS ISSUE - Five-year-olds treated for mental health problems - Courtesy of the YoungMinds Website + LISTEN TO RADIO INTERVIEWS


Five-year-olds treated for mental health problems

Carrie Dunn
30 May 2012
New figures suggest that children as young as five are being referred for drug treatment for mental health problems such as depression and anxiety.

Sarah Brennan, chief executive of YoungMinds, said to the BBC: "Intervening early with Psychological Therapies when a child or young person starts struggling to cope is proven to reduce the likelihood of that young person developing much more severe and entrenched mental health problems.
"It is vital that we invest in children and young people's mental health in order to prevent a generation of children suffering entrenched mental health problems as adults."

YoungMinds on the radio: five-year-olds with mental health problems

Carrie Dunn
30 May 2012
Listen to these BBC local radio programmes and what we've had to say about the story that children as young as five are being treated for mental health issues.
BBC Radio Berkshire - Chris Leaman features from 10mins and VIK Charlotte features from 35mins.
BBC Radio Sussex - chief executive Sarah Brennan features from 1hr 35mins.
BBC Three Counties Radio - Sarah Brennan features from 2hr 35mins.
BBC Radio London - Chris Leaman features from 1hr 20mins.
BBC Radio Oxford - Chris features from 1hr 35mins.
Keep an eye out for some media appearances later today - Chris Leaman will be on BBC Radio Solent at 5.50pm and Lucie Russell will be on the television on BBC South Today at 6.30pm.

Children and Young People’s Health Outcomes Report July 2012

Commenting on the release today of the Children and Young People’s Health Outcomes Report, Sarah Brennan Chief Executive of YoungMinds said:

“The Outcomes Report shows clear aims and aspirations for improving the mental health of children and young people. With three children in every classroom having a diagnosable mental health problem there has never been a more urgent time for authorities to act to improve the mental health of children and young people.
“The report shows the importance that everybody across the NHS, schools and colleges and local authorities has in supporting and improving the mental health of children and young people from birth through to adulthood. Early intervention, robust support mechanisms and identifying key stress points such as when transitions occur will be the key to making the report a reality.”
Sarah Brennan is a member of the Children and Youth Peoples Health Outcomes Forum and was a member of the mental health sub-group.
, ,

Bipolar disorder help - Courtesy of the YoungMinds Website


Bipolar disorder help


If you are experiencing some of these symptoms, you should speak to your GP or a school counsellor. It may not mean that you have bipolar disorder but they will be able to talk to you about how you are feeling.
If the GP thinks that you have bipolar disorder they are likely to refer you to the child and adolescent mental health service (CAMHS) or a psychiatrist who is a specialist doctor in issues such as bipolar disorder. The psychiatrist will discuss with you how you are feeling to work out if you have bipolar or another mental health problem and work out the best treatment for you.
Nice is the National Institute for Health and Clinical Excellence and it makes recommendations to healthcare professionals about different treatment. Nice says that the treatment of bipolar disorder is based primarily on psychotropic medication to reduce the severity of symptoms, stabilise mood and prevent relapse. It says that how the individual responds to the drug will determine the choice of drug for the treatment as some people may experience side effects with some of the options. Nice says patients should be involved in decisions about their treatment and care.
Treatment during manic episodes
It is likely you will be offered medication and if you have manic episodes you could be offered an anti-psychotic drug and if that doesn’t help they may offer you a drug to stabilise your mood such as lithium.
You should be closely monitored when taking this medication for possible side effects.
Treatment during depressive episodes
If you are experiencing mild depressive episodes you will be monitored closely and support put in place. If the depression is more serious, you may be offered a type of antidepressant called a Selective Serotonin Reuptake Inhibitor (SSRI). If you are under 18 this is likely to be Prozac (Fluoxetine). If you are prescribed an antidepressant you may be prescribed another drug to stabilise your mood as antidepressants can bring on a manic episode. Antidepressants can take a couple of weeks to get into your system and start working and need to be taken regularly but your doctor should explain this to you.
Once you have had treatment for mania or depression or both, you should start to feel better but the doctor is likely to monitor you closely to prevent the mood swings coming back. You may be offered talking therapy such as Cognitive Behavioural Therapy - CBT - that helps you to understand your thoughts, feelings and behaviour and helps you to think about things differently.
Your treatment is likely to be constantly under review depending on how you are feeling so it is important that you are honest with the doctor about how you are feeling so that they can help you accordingly.
The NIce guidelines are available here.
See the next section for further sources of information about bipolar disorder.

Shut up and take your pills The easy way to help hyperactive children is to give them medication - but it is often unnecessary. "Why do affluent parents use it to get 'designer children?'By Libby Purves - September 2005 - Courtesy of Timesonline


Yet sometimes I wonder whether future generations may not look back at our habits and shudder in their turn. One of them in particular grates on me: it is reported that prescriptions of the drug Methylphenidate — commonly sold as Ritalin — have risen sharply in a decade. Last year in England there were 359,000, the vast majority to children under 16. This is a mind-altering drug, described by its most bitter opponents as “ prescription crack”; in the United States 6 per cent of all children take it. Here it is less than 1 per cent, but rising fast: for this is the cure-all for the fairly newly defined condition of “ADHD” — attention deficit hyperactivity disorder.
The amphetamine-based drug is claimed by its many adherents to improve concentration and calm children’s behaviour. Parents who use it are violently defensive of their decision. The ADHD lobby has claimed, controversially, that one in twenty children today suffers such a behavioural “disorder”. Yet it is routinely prescribed to children whose age or circumstances might just as easily explain their erratic behaviour.
In the US babies have been given the drug: here, it is more likely to be administered to a nursery or school-age child who is not interested in what his teacher says and disrupts both class and home with destructive boisterousness.
I say “his” for good reason. Most children diagnosed with ADHD are boys. There is no hard clinical diagnosis or medical test for the condition; neurological theories contradict one another or fade under close examination. So it is generally diagnosed on the basis of mere behaviour — restlessness, fidgeting, outbursts of temper, unwillingness to take instructions or concentrate (which means failure to concentrate on what adults and the national curriculum want you to concentrate on). Indeed, the more descriptions of the symptoms you read the more images swim into your head: Alastair Campbell, Piers Morgan, Sir Alan Sugar, Mark Twain, Horatio Nelson, Thomas Edison . . . It is hard not to feel an uneasy suspicion that this is a conspiracy against boyish boys. In the heavily feminised, mimsy tick-box culture and educational system that now runs children’s lives, with fathers often working for long hours or absent altogether, the very nature of boyhood attracts disapproval. Or the very nature of childhood, indeed: one woman interviewed about the marvels of Ritalin complained that before it her three-year-old was always asking questions, and going on to another as soon as one was answered, which drove her mad. Well, it drives us all mad: “Why is the moon? Can sheep fly?” But if we are wise, we rejoice in it.
There are strong lobbies against Ritalin too, some of which describe it as pharmacologically similar to cocaine and brand psychiatrists as dupes of “irresponsible pseudo-science”. But calmer voices express unease, too. Professor Sir Alan Craft, president of the Royal College of Paediatrics, admits that it is “concerning”; Professor Peter Hill, a specialist in ADHD at Great Ormond Street, is quoted as admitting: “While Methylphenidate undoubtedly works for some children, clinicians are under increasing pressure from vast waiting lists to see people as quickly as possible, resulting in some medicating where it is perhaps not necessary . . .”
Incidentally, our propensity to drug children rather than meet their awkward emotional needs is also underlined by the fact that Britain has one of the world’s highest rates of prescribing antidepressants to under-16s. Thoughtful doctors go so far as to say that pharmacological solutions are popular because they offer parents an alternative explanation for bad behaviour, removing any suggestion that inadequate parenting, family breakdown or bad food are involved (an experiment in Co Durham found that if you give a daily dose of fish oil to poor children who eat junk food, it has almost as much effect as Ritalin in improving concentration and behaviour).
Without being Luddite or hysterical, we should certainly be worried. In the US there is a strident middle-class lobby for the use of the drug, with websites encouraging children to “feel good about themselves” when they take it. In Britain it is less explicit, for I have a hunch that if you took a social profile of ADHD prescriptions, a disproportionate number would go to boys from poor and ill-supported homes, without attentive fathers. Note also that when a child is diagnosed (and doctors’ definition of severe ADHD is subjective), the parents are eligible for disability benefits. So the family gets a bit more money, the child is outwardly calm, the school can function better despite its huge classes, lack of outdoor space and prescriptive learning targets. The doctor has the family off his back. The drug company doesn’t do badly, either.
Again, let us have no hysteria. There is such a thing as destructive hyperkinetic disorder. Sometimes it does go beyond normal boyish high spirits into an area of real mental illness. Sometimes, after exhaustive and responsible experiment, it is clear that the cause is not emotional neglect, bad diet or too much screen time. Sometimes Ritalin is a boon. But are there really so very many British children intrinsically disordered in their brains? So ill that they must take a psychoactive drug for 10 or 15 years of their young lives, with unknown long-term side-effects?
You would think that a country that obsesses for days about a rich adult supermodel snorting a bit of cocaine would be more worried about this.

Join the Debate
Send your e-mails via www.timesonline.co.uk/debate

Thursday 15 November 2012

Mental health: Improving access to psychological therapies (IAPT) - Courtesy of the ChiMat Website


Mental health: Improving access to psychological therapies (IAPT)

The Improving Access to Psychological Therapies (IAPT) programme supports the frontline NHS in implementing National Institute for Health and Clinical Excellence (NICE) guidelines for people suffering from depression and anxiety disorders. The Children and Young People’s IAPT project, launched in 2011, aims to improve access to treatment the evidence say works, improve outcome monitoring in order to understand what is and isn’t working, and make sure services are shaped and developed so they work for children, young people and where relevant, their families.
This key topic brings together resources relating to improving access to psychological therapies for children and young people.
o   Briefing note that summarises the way forward agreed for routine outcome monitoring in CYP IAPT.
o   CYP IAPT dataset detailing all data fields collaborating sites are required to collect.
o   A practical guide to using service user feedback and outcome tools to inform clinical practice in child and adolescent mental health.
o   Children and Young Peoples IAPT tracking outcomes: resource pack which contains a range of measures and resources for use with children, young people and parents.

Publisher: Improving Access to Psychological Therapies (IAPT) website
Published Date: 2012