Physical Illness in Patients with Severe Psychiatric Illness

Severe Psychiatric (mental) Illness (SPI) affects about 3% of the Scottish population (163,000 people), and is associated with an average reduction in life expectancy of 15 to 20 years, largely due to preventable physical illness. England has described and implemented a comprehensive plan to address this inequality. Scotland has no comparable plan. Scotland should implement a similar plan as a matter of urgency

Lake-size dependency of wind shear and convection as controls on gas exchange

High-frequency physical observations from 40 temperate lakes were used to examine the relative contributions of wind shear (u*) and convection (w*) to turbulence in the surface mixed layer. Seasonal patterns of u* and w* were dissimilar; u* was often highest in the spring, while w * increased throughout the summer to a maximum in early fall. Convection was a larger mixed-layer turbulence source than wind shear (u */w*-1 for lakes* and w* differ in temporal pattern and magnitude across lakes, both convection and wind shear should be considered in future formulations of lake-air gas exchange, especially for small lakes. © 2012 by the American Geophysical Union.Jordan S. Read, David P. Hamilton, Ankur R. Desai, Kevin C. Rose, Sally MacIntyre, John D. Lenters, Robyn L. Smyth, Paul C. Hanson, Jonathan J. Cole, Peter A. Staehr, James A. Rusak, Donald C. Pierson, Justin D. Brookes, Alo Laas, and Chin H. W

Informing investment to reduce inequalities: a modelling approach

Background: Reducing health inequalities is an important policy objective but there is limited quantitative information about the impact of specific interventions. Objectives: To provide estimates of the impact of a range of interventions on health and health inequalities. Materials and methods: Literature reviews were conducted to identify the best evidence linking interventions to mortality and hospital admissions. We examined interventions across the determinants of health: a ‘living wage’; changes to benefits, taxation and employment; active travel; tobacco taxation; smoking cessation, alcohol brief interventions, and weight management services. A model was developed to estimate mortality and years of life lost (YLL) in intervention and comparison populations over a 20-year time period following interventions delivered only in the first year. We estimated changes in inequalities using the relative index of inequality (RII). Results: Introduction of a ‘living wage’ generated the largest beneficial health impact, with modest reductions in health inequalities. Benefits increases had modest positive impacts on health and health inequalities. Income tax increases had negative impacts on population health but reduced inequalities, while council tax increases worsened both health and health inequalities. Active travel increases had minimally positive effects on population health but widened health inequalities. Increases in employment reduced inequalities only when targeted to the most deprived groups. Tobacco taxation had modestly positive impacts on health but little impact on health inequalities. Alcohol brief interventions had modestly positive impacts on health and health inequalities only when strongly socially targeted, while smoking cessation and weight-reduction programmes had minimal impacts on health and health inequalities even when socially targeted. Conclusions: Interventions have markedly different effects on mortality, hospitalisations and inequalities. The most effective (and likely cost-effective) interventions for reducing inequalities were regulatory and tax options. Interventions focused on individual agency were much less likely to impact on inequalities, even when targeted at the most deprived communities

What do general adult psychiatry patients think we should call borderline personality disorder?:A cross-sectional study to find the most acceptable diagnostic term

Aims and Method. To determine the most acceptable term for borderline personality disorder (BPD). Cross sectional study of patients who know what it feels like to be diagnosed with a mental disorder. The main outcome measures were the proportion of participants offended by, and confused by, alternative terms for BPD. Results. N=72. Being diagnosed with a condition was more offensive than being diagnosed with a disorder (X2 = 41.18, df 1, p < 0.01). Fluxithymia offended the fewest participants (13%) but was the most confusing term (31%). Emotionally unstable personality disorder was the most offensive term (63%). After fluxithymia, emotional intensity disorder was the least offensive term, and not especially confusing (11%). Changing BPD to emotional intensity disorder would avoid an offensive event every 3.6 diagnostic announcements. Conclusion. The diagnostic term BPD should be replaced with emotional intensity disorder because this term provides a balance of clarity and inoffensiveness

Clinical characteristics and suicidal ideation as predictors of suicide:prospective study of 1000 referrals to general adult psychiatry

Aims and method Questions often follow the suicide of someone who presented to general adult psychiatry (GAP) when expressing suicidal thoughts: ‘Why were they not admitted, or managed differently, when they said they were suicidal?’ Answering these questions requires knowledge of the prevalence of suicidal ideation in patients presenting to GAP. Therefore, we determined the general clinical characteristics, including suicidal ideation, of a large sample of patients presenting to a GAP emergency assessment service or referred as non-emergencies to a GAP service. Results Suicidal ideation was very common, being present in 76.4% of emergency presentations and 33.4% of non-emergency referrals. It was very weakly associated with suicide, varied between different diagnostic categories, and previous assessment by GAP did not appear to affect it. The suicide rate during the contingent episode of care was estimated as 66 per 100000 episodes. Clinical implications This, and other evidence, shows that suicide cannot be predicted with an accuracy that is useful for clinical decision-making. This is not widely appreciated but has serious consequences for patients and healthcare resources

Determining the electronic performance limitations in top-down fabricated Si nanowires with mean widths down to 4 nm

Silicon nanowires have been patterned with mean widths down to 4 nm using top-down lithography and dry etching. Performance-limiting scattering processes have been measured directly which provide new insight into the electronic conduction mechanisms within the nanowires. Results demonstrate a transition from 3-dimensional (3D) to 2D and then 1D as the nanowire mean widths are reduced from 12 to 4 nm. The importance of high quality surface passivation is demonstrated by a lack of significant donor deactivation, resulting in neutral impurity scattering ultimately limiting the electronic performance. The results indicate the important parameters requiring optimization when fabricating nanowires with atomic dimensions

Evaluation of a brief art psychotherapy group for adults suffering from mild to moderate depression: Pilot pre, post and follow-up study

Current therapies do not offer universal solutions for the ‘global burden’ of depression. By focusing on non-verbal communication and creativity, arts therapies might present a relevant treatment option but their effectiveness remains unclear. A pilot study was undertaken to evaluate a brief art therapy group for adults suffering from depression. Adults experiencing mild to moderate depression took part in art therapy and completed questionnaires at three points in time. The intensity of depression, levels of anxiety and general wellbeing were measured. Semi-structured interviews focused on participants’ expectations and experience of therapy. A decrease in depressive symptoms was observed immediately after the therapy and at the follow-up, and a trend for improvement of subjectively perceived wellbeing was recorded. Potential benefits of therapy recognised by participants included: acceptance of depression, readiness to express emotions, sense of self and awareness of others, readiness for meaningful relationships, sense of achievement, sense of balance and new insights, growth and meaning. The statistically significant results and participants’ experience indicate that art therapy may offer a valuable treatment option for depression, and further research is recommended. Future studies should explore ways of addressing both the outcomes and the process of therapy through creative methodological designs

Art psychotherapy practice with adults who suffer from depression in the UK: Qualitative findings from a depression-specific questionnaire

The 'global burden' of depression demands more effective treatments. Evidence suggests that arts therapies are offered to individuals who suffer from depression. However, despite recent increases in research, the methods and tools used by arts therapists remain unclear. A nationwide survey of arts therapists was conducted in 2011; practitioners who work primarily with depression were identified and invited to complete an additional questionnaire that focused on specific aspects of their practices. Therapists responded by offering detailed descriptions of their work with the condition. Data analysis led to findings that greatly enrich the knowledge obtained from the main survey regarding the meaning of depression and techniques/tools used by the therapists. New insights into the work of arts therapists with individuals who suffer from depression encompass the therapeutic aims, as well as the challenges and rewards of the practice. The themes of motivation and time, as well as the paradox of isolation versus the need to relate, were identified by the respondents as crucial in the therapeutic process. The findings facilitate an understanding of the meaning and possibilities of arts therapies in the treatment of depression. This area would benefit from further in-depth research, particularly regarding the techniques used by therapists and the origins of therapeutic change. It is expected that this and future research will be of a special interest to arts therapists and other professionals who wish to gain insight into what arts therapies practice with depression entails