Musings of a phenomenologist

Science, psychiatry and random musings

And now for something completely different

Posted by soveda on June 7, 2010

Ok, I admit it I’m self obsessed (well I’m writing this aren’t I?) and I look at where people have clicked through to get to my blog. I had a bit of a shock yesterday when I saw someone had categorised me in their gone but not forgotten pile… Looking back I did blog a lot early on, I’ll try one a week if I can but no promises!
Having said that the following rant will take some people back to my first posts because it is about:
Comics and the movies

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Posted in film, Uncategorized | Tagged: , , , , , , , | 5 Comments »

Depression, fad or fact?

Posted by soveda on May 18, 2010

I don’t usually read the Daily Mail’s website but my attention was brought to this article by Janet Street Porter:

Depression-Its-just-new-trendy-illness

Which starts:

There’s a big black cloud hanging over parts of the UK, and it’s not going away. Not volcanic ash – but depression. This relatively new ailment appeared on my radar a couple of years ago, when I discovered that more and more women were claiming they suffered from ‘stress’

Ah yes, depression is terribly new – I believe it was first described in… Mesapotamian texts? or the Old Testament? or possibly Ancient Greece. Practically unknown until recent days as you can see.

Why did I get so annoyed with this article?

Is it because, despite the efforts of psychiatrists to reduce stigma (e.g.: Changing Minds) this sort of article appears to promote that stigma? Read the rest of this entry »

Posted in bad media, Medicine, mental health | Tagged: , , , , | 3 Comments »

Is it ethical to lie to patients?

Posted by soveda on October 8, 2009

I ask this question because a number of people have spoken to me about SPECAL care (Specialised early care in alzheimer’s… erm… care- it’s like PIN number). Back in August 2008 there was this article in the Guardian by media psychologist Oliver James. Author of this book: Contented Dementia, which discusses SPECAL and he thinks it is great.

Hang on a mo, have a look at the 4th paragraph:

“There is a desperate need for an alternative form of care. Believe it or not, my mother-in-law has discovered it. I must be the only man in Britain who would like my mother-in-law to look after me if I had dementia. She is called Penny Garner and her method enables family members or professional carers to deliver 24-hour wellbeing to people with dementias. Amazingly, we are still on good terms after spending a year producing a book that now makes her method available to everyone.”

The interesting article he wrote in August 2009 has been commented on by the mental nurse blog which is well worth a read, I have tracked down a copy of the RCN report on SPECAL so I thought I’d blog a bit on the evidence base.

Now read on:

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Posted in media, Medicine, mental health | Tagged: , , , , , , , | 4 Comments »

Suicide isn’t painless

Posted by soveda on September 4, 2009

Sorry for the punning title, I know Painless was the name of the dentist in M.A.S.H. but I couldn’t resist.
I was just pondering suicide and euthanasia, this was triggered by world suicide prevention day and the lack of coverage in the media.

Now suicide is a bad thing isn’t it?

It’s one of the targets the UK government has for mental health services – to reduce the rate of suicide and undetermined injury by 20% by 2010 (document here)

There are guidelines about reporting suicide (see here), and for good reason. When the media in Hong Kong reported a suicide by a novel and previously unknown method that method increased rapidly (see here).

Suicide is a symptom of mental disorder – however some people who complete suicide have no history of mental disorder.

The national confidential inquiry into suicide and homicide makes for interesting reading (link) The press release states:

The number of people killed by individuals suffering from mental illness in England and Wales increased between 1997 and 2005, figures released today show.  The rise occurred in people who were not under mental health care and was not found in mental health patients.

The annual report by the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness also found:

  • a fall in suicide by mental health patients overall and a continued fall in suicide by in-patients
  • suicide following absconding from the ward remains a serious problem
  • however, few serious incidents occurred following absconding from secure units

Of note “patient” means: having had contact with mental health services in the last 12 months.

So it’s clear cut …

Is it possible to wish to end your life without suffering from a mental illness? Now there’s a thorny question, if you asked most psychiatrists I suspect they would tell you that thoughts of suicide and a wish to die were not in and of themselves a sign that someone was mentally ill. Someone would likely be in some degree of distress, either mental or physical, but not necessarily mentally ill. Bit how about those individuals who wish to end their lives on their terms rather than letting a terminal illness make the decision for them (please forgive the anthropomorphising of a process), are they mentally ill?

Some would argue that they are by definition because they wish to end their lives, even if it is a rational decision.

Is that paternalism or realism?

By condoning suicide in those cases are we encouraging people to look at suicide rather than other options in managing disease. especially if you start including mental illness in the diagnoses that are “allowable” in assisted suicide. (BJPsych editorial)

Given that there is to be new guidance on assisted suicide this question will not go away. (BBC report)

For what it’s worth, physician assisted suicide/euthanasia does not sit well with me ethically. I want people to have a god quality of life and I don’t want people to feel pressurised into ending their life because they are a burden. Given the probable high numbers of people who have undiagnosed cognitive impairment/dementia who are vulnerable to this very thought process I think PAS is too risky a proposition.

Now that was the most unfocussed and self contradictory I’ve been in a while but hey, I’m human too.

Posted in mental health | Tagged: , , , | 1 Comment »

Beware the spinal trap resurected

Posted by soveda on July 30, 2009

As many other bloggers have done I am reposting a version of the Simon Singh article that has got the blogosphere in a frenzy of debunking Chiropractic.

This is the version which is altered slightly from the original. The original is out there if you search.
Here you go:

Beware the Spinal Trap by Simon Singh

Some practitioners claim it is a cure-all, but the research suggests chiropractic therapy has mixed results – and can even be lethal, says Simon Singh.

You might be surprised to know that the founder of chiropractic therapy, Daniel David Palmer, wrote that “99% of all diseases are caused by displaced vertebrae”. In the 1860s, Palmer began to develop his theory that the spine was involved in almost every illness because the spinal cord connects the brain to the rest of the body. Therefore any misalignment could cause a problem in distant parts of the body.

In fact, Palmer’s first chiropractic intervention supposedly cured a man who had been profoundly deaf for 17 years. His second treatment was equally strange, because he claimed that he treated a patient with heart trouble by correcting a displaced vertebra.

You might think that modern chiropractors restrict themselves to treating back problems, but in fact some still possess quite wacky ideas. The fundamentalists argue that they can cure anything, including helping treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying – even though there is not a jot of evidence.

I can confidently label these assertions as utter nonsense because I have co-authored a book about alternative medicine with the world’s first professor of complementary medicine, Edzard Ernst. He learned chiropractic techniques himself and used them as a doctor. This is when he began to see the need for some critical evaluation. Among other projects, he examined the evidence from 70 trials exploring the benefits of chiropractic therapy in conditions unrelated to the back. He found no evidence to suggest that chiropractors could treat any such conditions.

But what about chiropractic in the context of treating back problems? Manipulating the spine can cure some problems, but results are mixed. To be fair, conventional approaches, such as physiotherapy, also struggle to treat back problems with any consistency. Nevertheless, conventional therapy is still preferable because of the serious dangers associated with chiropractic.

In 2001, a systematic review of five studies revealed that roughly half of all chiropractic patients experience temporary adverse effects, such as pain, numbness, stiffness, dizziness and headaches. These are relatively minor effects, but the frequency is very high, and this has to be weighed against the limited benefit offered by chiropractors.

More worryingly, the hallmark technique of the chiropractor, known as high-velocity, low-amplitude thrust, carries much more significant risks. This involves pushing joints beyond their natural range of motion by applying a short, sharp force. Although this is a safe procedure for most patients, others can suffer dislocations and fractures.

Worse still, manipulation of the neck can damage the vertebral arteries, which supply blood to the brain. So-called vertebral dissection can ultimately cut off the blood supply, which in turn can lead to a stroke and even death. Because there is usually a delay between the vertebral dissection and the blockage of blood to the brain, the link between chiropractic and strokes went unnoticed for many years. Recently, however, it has been possible to identify cases where spinal manipulation has certainly been the cause of vertebral dissection.

Laurie Mathiason was a 20-year-old Canadian waitress who visited a chiropractor 21 times between 1997 and 1998 to relieve her low-back pain. On her penultimate visit she complained of stiffness in her neck. That evening she began dropping plates at the restaurant, so she returned to the chiropractor. As the chiropractor manipulated her neck, Mathiason began to cry, her eyes started to roll, she foamed at the mouth and her body began to convulse. She was rushed to hospital, slipped into a coma and died three days later. At the inquest, the coroner declared: “Laurie died of a ruptured vertebral artery, which occurred in association with a chiropractic manipulation of the neck.”

This case is not unique. In Canada alone there have been several other women who have died after receiving chiropractic therapy, and Edzard Ernst has identified about 700 cases of serious complications among the medical literature. This should be a major concern for health officials, particularly as under-reporting will mean that the actual number of cases is much higher.

If spinal manipulation were a drug with such serious adverse effects and so little demonstrable benefit, then it would almost certainly have been taken off the market.

Simon Singh is a science writer in London and the co-author, with Edzard Ernst, of Trick or Treatment? Alternative Medicine on Trial. This is an edited version of an article published in The Guardian for which Singh is being personally sued for libel by the British Chiropractic Association.

Posted in bpsdb, legal chill | Tagged: , , , , | Leave a Comment »

Chiropractic for mental health, Bogus*? Updated

Posted by soveda on May 22, 2009

[BPSDB]

*Deliberate deception not implied

In light of other bloggers looking at chiropractic treatment I thought I’d have a look from my perspective. According to the BCA chiropractic can be used to treat many conditions beyond back pain but does not appear to mention mental health symptoms specifically.

I thought I would find out if individual chiropracters did suggest they could treat depression and this is what I found:

Read the rest of this entry »

Posted in bad science, bpsdb | Tagged: , , , , , , | Leave a Comment »

I’m starting to think they do it on purpose

Posted by soveda on May 8, 2009

Here we go again, the BBC website has some more marvellous reporting of research. This time the article is : Trial drugs “reverse” Alzheimer’s
O rly…

Read the rest of this entry »

Posted in bad media, Medicine, mental health | Tagged: , , , | Leave a Comment »

The BBC being accurate again

Posted by soveda on April 25, 2009

I know I haven’t been terribly active in blogging recently but this story on the BBC website raised an eyebrow. The story in question is about a crop of daffodils being grown in Wales as a source of Galantamine crystals.
For the uninitiated, Galantamine is an Acetlycholinesterase inhibitor, one of the medications used in Alzheimer’s, more specifically it is one of the three medications that doctors in the UK are allowed to prescribe. It says it right in the NICE guidelines, not according to the BBC’s reporting though. Apparently it is only available in Scotland and then only privately…
I’ve blogged repeatedly about the quality of facts on the Beeb and I will again, hopefully by the time you read this the article will be accurate but I’m not holding my breath.

Posted in bad media, Medicine | Tagged: , , , , | Leave a Comment »

The least worst option

Posted by soveda on February 20, 2009

This post was triggered by a comment about bpsd (behavioural problems and symptoms in dementia) made by The Shrink author of the Lake Cocytus blog (follow the link and read it is a great insight into life as a consultant psychiatrist). Much of what The Shrink writes echoes with me as I have had eerily similar experiences in my practice.

I made a decision when I started blogging to focus on evidence and legislation rather than clinical cases when I started and I’m not going to change that when others do the clinical blogging better than me. Having said that one of the biggest (if not the biggest) challenges presenting to the psychiatrist working with dementia and brain injury is that of so called “behavioural disturbance” and “wanderi

Edit: the rest of post appears to have disappeared into the ether, I will reinstate it if I find my musings elsewhere!

Posted in Medicine, mental health | Tagged: , , , , , , | Leave a Comment »

When MMR attacks (or LBC and Jeni Barnett, what were you thinking?)

Posted by soveda on February 6, 2009

Just a very quick post, Ben Goldacre has been threatened by LBC’s lawyers fro infringement of copyright.

The copyright in question is to do with an episode of Jeni Barnett’s show which was frighteningly ill informed and further scare mongering about MMR. As I’ve blogged previously, the data about MMR does not show an association with autism and never has.  The events have been blogged by other already, Holford watch, jdc, Anthony Cox (Black triangle) amongst others, click on the links on this page to read their posts. You will find more links in their posts.

All this when the data shows that measles cases are increasing and therefore the risk of serious sequelae including death are also increasing. Well done LBC for stifling debate, the internet is a scary thing when geeks get riled isn’t it.

Mind you it’s all good publicity isn’t it? Well isn’t it?

Posted in bad media, bad science | 1 Comment »

 
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