Editorial Iunie 2017 - Prof.Dr. Aurel ROMILA


Există în limbajul comun clișeul că aparențele inșeală. Incontestabil, cu precizarea că "nu todeauna".

Aparențele formează prima treaptă a cunoașterii și furnizează ideilor o bază pentru a ajunge la adevăr. Echilibrul acestor doi factori dau realitatea și evită greșeala, falsul, înșelarea. De aceea intelectul stă sub controlul discernământului, al criticii și inteligența se opune ignoranței oligofrenului sau escrocheriei psihopatului. În delir convingerile personale sunt deplasate, iar dementa nu mai problematizează.

In relațiile intime, din pasiune orbești; cu timpul te trezești și restabilești realitatea.

Omul luptă și se apară cu "lookul "lui. Simulează grandoarea. Nu după mult timp se relevă minciuna; nu suntem decât bieți oameni supuși istoriei, presiunilor conjuncturale și doar câțiva eroi fac excepție.

Asa că toți luăm plasă, cu toată prudența și smecheria noastră. Psihologul trebuie să știe, să înțeleagă și să ierte.

Prof.Dr. Aurel ROMILA

The British Journal of Psychiatry Highlights of this issue for 1 June 2017; Vol. 210, No. 6

BJP Online -- Highlights of the Current Issue
June 2017; Vol. 210, No. 6
The complete Table of Contents for the current issue is available online at: http://bjp.rcpsych.org/content/vol210/issue6/ The following content is available online at: http://bjp.rcpsych.org/cgi/content/full/210/6/A23

Highlights of this issue

Kimberlie Dean Suicide – prediction and prevention
There is a strong focus in the BJPsych this month on the important topics of prediction and prevention of suicide. Carter et al (pp. 387–395) conducted a systematic review and meta-analysis of 39 risk scales used to predict suicidal behaviours, specifically with regard to examining the positive predictive values (PPVs) obtained from studies of these scales. The pooled PPVs for suicide, self-harm and self-harm plus suicide were all found to be too low to support the use of such risk scales as the basis of clinical intervention allocation decisions (ranging from 5.5% for suicide to 35.9% for the combined outcome). The authors propose alternatives to risk prediction stratification, recommending clinical assessment to identify modifiable risk factors and the provision of specific interventions tailored to selected self-harm subpopulations (e.g. those with borderline personality disorder) and to unselected clinical self -harm populations. In a multisite prospective cohort study of adults referred to liaison psychiatry services following self-harm, Quinlivan et al (pp. 429–436) found that the seven risk scales considered performed poorly with regard to prediction of repeat self-harm within 6 months (e.g. PPVs ranged from 13% to 47%). They found most scales performed no better than clinician or patient global ratings of risk and some actually performed worse. In a linked editorial, Owens & Kelley (pp. 384–386) comment on the mounting evidence supporting the avoidance of risk scales in clinical practice and instead recommend an individual-based 'needs assessment' approach following self-harm.
Moving from prediction of self-harm and suicide to prevention, Riblet et al (pp. 396–402) conducted a meta-analysis of randomised controlled trials (RCTs) of strategies employed to prevent death by suicide. Despite a recent increase in the number of RCTs targeting suicide, most interventions were not found to lead to a significant reduction in suicide events. Three RCTs found that the WHO brief intervention and contact (BIC) approach was associated with lower odds of death by suicide and a number of RCTs of lithium and cognitive–behavioural therapy produced positive but non-significant results. The authors comment on the small size of many trials and limited evidence for generalisability of findings across settings. In a linked editorial, Hawton & Pirkis (pp. 381–383) comment on the limitations of focusing only on the results of RCT-based evaluations of interventio ns given the likelihood that a broad range of approaches will be needed to prevent a complex problem like suicide across the range of universal, selective and indicated interventions. The authors call on researchers to complement the results of RCTs with findings from studies employing a range of methods and data from a variety of sources, as well as acknowledging that using suicide as an outcome may not be feasible for all intervention evaluations.
Ketamine and electroconvulsive therapy
In a previous systematic review and meta-analysis, increased seizure duration but a lack of efficacy was found for ketamine when used as an ECT adjunct in depression. In an updated review published in the BJPsych this month, McGirr et al (pp. 403–407) focused on RCTs examining the index course of ECT and specifically considered the role of barbiturate co-administration in limiting the efficacy of ketamine. Overall, the authors found no evidence to support using ketamine over other induction agents in ECT, with the lack of efficacy finding holding true when trials which included barbiturate anaesthetic co-administration were excluded. They also found evidence of an increase in reported confusion associated with ketamine use. In a new RCT of ketamine used as the anaesthetic agent for ECT, Fernie et al (pp. 422–428) found no significant differences between ketamin e and the control agent propofol on any outcome measure (i.e. depression severity, number of ECT treatments or memory impairment) either during, at the end or at 1 month following the course of ECT.
Treatment following a first episode of mania
Lithium and quetiapine are both considered standard maintenance agents for bipolar disorder but their comparative efficacy and roles at different stages of the illness course are insufficiently understood. In a sample of young people with first-episode mania stabilised with a combination of the two agents, Berk et al (pp. 413–421) undertook an RCT of lithium v. quetiapine during the maintenance phase of treatment and found an advantage for lithium in terms of symptom levels over 1 year. The authors comment on lithium's role as a 'gold standard' of bipolar maintenance treatment and highlight the particular role for lithium early in the course of illness, in those with severe illness and for those with a manic index polarity.

The British Journal of Psychiatry Table of Contents for June 2017; Vol. 210, No. 6

Highlights of This Issue

Highlights of this issue
Kimberlie Dean
BJP June 2017 210:A23; doi:10.1192/bjp.210.6.A23


An architect for mental health: an appreciation of Michele Tansella
Graham Thornicroft
BJP June 2017 210:379-380; doi:10.1192/bjp.bp.116.197343

Suicide is a complex problem that requires a range of prevention initiatives and methods of evaluation
Keith Hawton and Jane Pirkis
BJP June 2017 210:381-383; doi:10.1192/bjp.bp.116.197459

Predictive properties of risk assessment instruments following self-harm
David Owens and Rachael Kelley
BJP June 2017 210:384-386; doi:10.1192/bjp.bp.116.196253


Predicting suicidal behaviours using clinical instruments: systematic review and meta-analysis of positive predictive values for risk scales
Gregory Carter, Allison Milner, Katie McGill, Jane Pirkis, Nav Kapur, and Matthew J. Spittal
BJP June 2017 210:387-395; doi:10.1192/bjp.bp.116.182717

Strategies to prevent death by suicide: meta-analysis of randomised controlled trials
Natalie B. V. Riblet, Brian Shiner, Yinong Young-Xu, and Bradley V. Watts
BJP June 2017 210:396-402; doi:10.1192/bjp.bp.116.187799

Adjunctive ketamine in electroconvulsive therapy: updated systematic review and meta-analysis
Alexander McGirr, Marcelo T. Berlim, David J. Bond, Peter Y. Chan, Lakshmi N. Yatham, and Raymond W. Lam
BJP June 2017 210:403-407; doi:10.1192/bjp.bp.116.195826


Disruptive mood dysregulation disorder in offspring of parents with depression and bipolar disorder
Lukas Propper, Jill Cumby, Victoria C. Patterson, Vladislav Drobinin, Jacqueline M. Glover, Lynn E. MacKenzie, Jessica Morash-Conway, Sabina Abidi, Alexa Bagnell, David Lovas, Tomas Hajek, William Gardner, Kathleen Pajer, Martin Alda, and Rudolf Uher
BJP June 2017 210:408-412; doi:10.1192/bjp.bp.117.198754

Quetiapine v. lithium in the maintenance phase following a first episode of mania: randomised controlled trial
Michael Berk, Rothanthi Daglas, Orwa Dandash, Murat Yücel, Lisa Henry, Karen Hallam, Craig Macneil, Melissa Hasty, Christos Pantelis, Brendan P. Murphy, Linda Kader, Saji Damodaran, Michael T. H. Wong, Philippe Conus, Aswin Ratheesh, Patrick D. McGorry, and Sue M. Cotton
BJP June 2017 210:413-421; doi:10.1192/bjp.bp.116.186833

Ketamine as the anaesthetic for electroconvulsive therapy: the KANECT randomised controlled trial
Gordon Fernie, James Currie, Jennifer S. Perrin, Caroline A. Stewart, Virginica Anderson, Daniel M. Bennett, Steven Hay, and Ian C. Reid
BJP June 2017 210:422-428; doi:10.1192/bjp.bp.116.189134 OPEN ACCESS ARTICLE

Predictive accuracy of risk scales following self-harm: multicentre, prospective cohort study
Leah Quinlivan, Jayne Cooper, Declan Meehan, Damien Longson, John Potokar, Tom Hulme, Jennifer Marsden, Fiona Brand, Kezia Lange, Elena Riseborough, Lisa Page, Chris Metcalfe, Linda Davies, Rory O'Connor, Keith Hawton, David Gunnell, and Nav Kapur
BJP June 2017 210:429-436; doi:10.1192/bjp.bp.116.189993 OPEN ACCESS ARTICLE


Poor uptake of depression care in cardiology
Phillip J. Tully
BJP June 2017 210:437; doi:10.1192/bjp.210.6.437

Authors' reply
Bernd Löwe, Benjamin Gierk, and Sebastian Kohlmann
BJP June 2017 210:437-438; doi:10.1192/bjp.210.6.437a

Communication skills training for psychiatrists
Philippa Ditton-Phare, Brian Kelly, and Carmel L. Loughland
BJP June 2017 210:438; doi:10.1192/bjp.210.6.438

Authors' reply
Rose McCabe
BJP June 2017 210:438; doi:10.1192/bjp.210.6.438a


Autism Spectrum Disorder (Primer on)
Tom Berney
BJP June 2017 210:439; doi:10.1192/bjp.bp.116.197699


Derek K. Tracy, Dan W. Joyce, and Sukhwinder S. Shergill
BJP June 2017 210:441-442; doi:10.1192/bjp.210.6.441


Pina Bausch's Kontakthof – psychiatry in dance
Philippa Kaina
BJP June 2017 210:383; doi:10.1192/bjp.bp.116.195792

The Counterfeiters by André Gide – psychiatry in literature
Alistair Stewart
BJP June 2017 210:386; doi:10.1192/bjp.bp.117.198143

Me of You – poems by doctors
Qasim Ijaz
BJP June 2017 210:421; doi:10.1192/bjp.bp.117.198713


Treatment resistant mental illnesses
Kamaldeep Bhui, CBE
BJP June 2017 210:443-444; doi:10.1192/bjp.210.6.443

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