Psychiatry in the news – 14 April 2009

The Observer front page on Sunday last ran the headline:

Four psychiatric patients dying every day in NHS care

In the safety conscious NHS culture, every time something untoward happens an incident form is filled in.  An incident form should be completed if, for instance, a patient was given  by mistake 10mg of Olanzapine rather than 5mg.  Sometimes the incident can actually be quite trivial.  I have filled in incident forms on three occasions, once when patient had a heart attack in my office, once when  patient scarpered before I’d finished assessing him and once when, on the side of a table, I ripped a brand new pair of trousers on the first day I wore them.

The National Patient Safety agency  collect details of these patient safety related incidents (my third incident wouldn’t be included in this).  These are published on their website on a trust by trust basis.  According to the Observer, The Liberal democrats have added up the number of deaths across the country 2007-08 and have come up with a figure showing that 1282 people died in patient safety incidents in mental health settings.  The Observer reports what Normal Lamb, the Liberal Democrats Health spokesman, has to say about their calculation:

These figures are shocking. It’s a scandal that four people a day are dying while under the care of the NHS, and nearly three a day are ending up seriously harmed. It’s an appalling indictment of NHS psychiatric care.

These deaths are the result of inadequate attention and resources being given to mental health, despite the patients being among the most vulnerable and needy in the whole health system

Now, I’m not about to argue that mental health care in the NHS is ideal, nor that it’s not underfunded.  However without further breakdown as to the circumstances surrounding each death or serious injury I don’t think that it’s fair to reach these conclusions.  A proportion of these deaths will be due to suicide and, although the numbers of these have reduced, they will be difficult to stop entirely.  But there will also be a large number due to natural cause.  A lot of people work within difficult mental health settings at only small personal gain; their care will not be perfect but this represents a disservice to their hard work.

Celebrity watch:

Ronny O’Sullivan who defends his world snooker championship title next week talks in the Guardian about the problems he has encountered with depression.  Seemingly an extremely intense man, he appears to have discovered that running helps him cope. 

O’Sullivan is a fanatical runner and its impact on helping him cope with depression is profound. “Running clears my mind, and gives me a reason to get out of bed in the morning. Once I’ve had a run I can hit some balls for a couple of hours and by then it’s the afternoon and I think, ‘Yeah, it’s been a positive day, really.'”

Sublimation was Freud’s name for it.

Phil Spector, 1960s pop supreme inventor of the ‘Wall of Sound’ and dubbed the ‘first tycoon of teen’ by Tom Wolfe has been convicted of the murder of B movie actress turned nightclub hostess Lana Clarkson.  Spector had a reputation for eccentricity and talked during his trial about being on psychiatric medication.  My web searches haven’t come up with anything particularly illuminating concerning his mental health, although these people claim him as bipolar with this quote from the Observer. 

I consider myself a disturbed human being, but I’m under control. I’ve been blessed with a genius, but I’ve been punished with insomnia and manic depression. I’ve fought the devil for 20 years

Psychiatry in the news – 7 April 2009

Guardian reports that Legalisation of drugs could save UK £14bn, says study but it’s hard to imagine that this will do anything to change Jacqui Smith’s position.  Transform discuss further

The Today Programme reported today that care home children whose behaviour during the 1970s/80s was controlled using large doses  of medication have subsequently given birth to children with birth defects.   The drugs in question included Haloperidol, Droleptan and Depixol.  The BBC have Professor Jeffrey Aronson, professor of clinical pharmacology at Oxford University who says that high doses of such drugs can cause genetic damage.  Presumably he’s suggesting that the drugs cause damage to unfertilized eggs – rather than being teratogenic.  These drugs can currently be given to women of child bearing age.  It’s obviously concerning that large doses of sedatives should be given to anyone without a mental health disorder (or even with…) but if they’re right (nb: it doesn’t sound like a very rigerous report and there could be other causes for what they’re suggesting has happened) this would have wide ranging implications.

14 April 2009 Update: I emailed Aronson but as yet no reply.  A very well known academic clinical pharmacologist where I work said to me that he’d never heard of antipsychotics causing oocyte damage. 

Not strictly on psychiatry, but on the subject of this Government’s ongoing project to give us all anxiety disorders, check out the latest Metropolitan Police anti-terrorist tube advert.  New Campaign to urge Londoners to report suspicious activity 

Reds under the bed all over again – reminds me of a Viz cartoon I once read where Jack Black knew that the new bearded people who’d moved into his sleepy, Daily Mail reading village were terrorists because they read the Guardian.

14 April 2009 Update: this annoyed me so much I wrote a full post about it.

The lost child


There’s an mildly interesting spat in the press at the moment and, being about drugs, is just about within my remit.  Novelist Julie Myerson has written a book The Lost Child, which weaves two stories.  The first is about Mary Yelloly, a girl who died of tuberculosis in the 1820s leaving a  album of precocious watercolours; the second about her son, whom she and her husband threw out of their house aged 18 because of his fondness for cannabis and the ensuing family disruption.

Given that young people in crisis usually do better with more, rather than less, support, can this really have  been the only appropriate course of action?  Teenagers are often pretty foolish (but not me obviously) and most of them see sense fairly quickly.  Mark Twain captures this process nicely:

When I was a boy of 14, my father was so ignorant I could hardly stand to have the old man around. But when I got to be 21, I was astonished at how much the old man had learned in seven years

Myerson said in her initial interviews that her son had consented to be written about, an assertion that he has since disputed.  It’s hard to see the justification for writing about one’s family in this way as Jake, her son, has now had his business widely aired and will have to live with the consequences, whilst someone else takes the literary acclaim.  Myerson has said that her motivation for publication was to help other people in a similar situation, but does this wash?  Or is it that Myserson has fallen for the narcissistic trap that befalls so many celebrities: the notion that they are different to the rest of us and so important that we, their people, cannot possibly not wish to know.

Why I had to write the book about my son’s drug trauma Guardian 1 March 2009
Terence Blacker: Writers should spare their families Independent 3 March 2009
How could any mother throw her son out of the house for smoking dope – and then profit by writing a book about it? The Daily Mail 5 March 2009 (I’ve included this as a link, but for some reason the tone of it makes me feel really cross)


Update: if I’d have known how big this story was going to be, I probably wouldn’t have bothered posting about it.  Today in the Guardian This is an emergency Jonathan Myerson justifies his and his wife’s decision to publish.  This now has the air of an unseemly family squabble; Myerson’s tone reminds me of Reefer Madness

If anyone else has an opinion about this, please leave a comment below

Psychiatry in the news 3 March 2009

I’m sorry I’m not writing much at the moment, I’ve got another bloody exam, but in the meantime:

Britain’s highest decorated serving soldier has criticised the provision of mental health care for UK soldiers: BBC: Veteran mental care ‘a disgrace’ and Ex-soldier’s battle for mental health 28 February 2009 / Guardian: Minister defends care given to war veterans 1 March 2009 / Independent: Soldiers rally to VC hero’s defence 2 March 2009 / Mirror: Young war veterans are three times more likely to kill themselves than civilians – exclusive / Independent: Dr Walter Busuttil: Some veterans have traumas from four conflicts 28 February 2009.  What interests me the most is that PTSD is always referenced in press and in popular discourse uncritically as if its validity were established beyond doubt, which illustrates how willing British society has become to describe our difficulties in terms of psychological disorders. 

Whilst I am on the subject, it may soon be quicker to list the things that don’t give you PTSD than the things that do.  Here the the Guardian website reports, with the help of the BMJ Strokes can give you post traumatic stress 27 February 2009

AstroZeneca is in trouble with its antipsychotic medication Quetiapine regarding when the company knew this medication increased the risk of developing diabetes.  Nine thousand US citizens are taking court action, saying that they have been harmed by the medication.  The Wall Street Journal reports that there are allegations that the company sought to suppress unflattering studies.  The Times reports on 27 February that concern about AstraZeneca’s conduct over Quetiapine has cost the company 7% of its share price.

In mid February, it was speculated that psychiatrists might recommend that Peter Sutcliffe the Yorkshire Ripper could be realised – Ripper’s fit to be released from Broadmoor – Sun February 17 2009  Since the only UK prisioner less likely to be released is Ian Brady, one wonders why they didn’t save their breath.  And so it turned out:  Yorkshire Ripper Peter Sutcliffe likely to spend rest of life in jail Times 18 February 2009

As a science/medicine blogger, it’s sometimes difficult to find something current to write about that Ben Goldacre at Bad Science and Vaughn at Mindhacks haven’t already covered better than you.  Goldacre has an acute ear for folly, and is an expert at exposing bullshit.  Vaughn at Mindhacks is a powerhouse of intellect.  It’s been phasers on kill for them both against the article Well connected?: the biological implications of social networking Riposte: “Facebook causes Cancer” – Bad Science / Facebook causes marble loss – Mind Hacks.  Also try Age Concern backs social networks but Ben Goldacres blood pressure still rising – Technology blog Guardian 25 February 2009 and Facebook: it’s not neuroscience – Guardian Comment is Free 25 February 2009

Psychiatry in the news 17 February 2009 – cannabis special

The Government this week launched an advertisement campaign aimed at teenage dabblers in cannabis.  It’s costing £2.2 million, and focuses on the unpleasant side effects of the drug. 

Watch the Ad 
Read a scathing review and some interesting comments

I don’t know who makes these things, but if teenagers today are anything like they were in my day (we didn’t have a VHS video recorder until I was fifteen, to put this in some sort of context) then being sick is actually an essential part of a recreational experience and therefore welcomed.  This advertisement will act, if anything, as a recruitment drive.

I’ve just discovered this documentary on cannabis, which looks interesting.

Riding on the back of this, TV doctor Mark Porter writes in the Times Cannabis and the risks: facts you need to know 

I wrote a post on cannabis ages ago called Cannabis and Jacqui Smith

I’m ashamed to admit that I find it difficult to understand how fearful we should be, doctors and public alike, of cannabis: does it really make otherwise healthy people psychotic? If so how many? Is it really getting stronger?  Didn’t smoking it used to be fun?  Expect a posting on this when time allows.


Financial Times has an article about Psychiatry as New York’s counter-cyclical industry.  I’ve been saying this to my friends for a lark for a while (someone making conversation: ‘how’s your job’ me: ‘great, I get paid the same and everythings cheaper’ etc.) but thought that I should stop as I was clearly going to get lynched.


Trainee psychiatrists charged £175 to query exam results (by RCPsych)
Boo!  Hiss!


The Times has an article about children with an increasing number of psychiatric classifications Children suffering multiple behaviour problems ASD and ADHD apparently children today are getting ‘alphabet diagnoses’ because of their multiple behaviour problems. 

The reasons for this appear complex, but to my mind has something to do with our willingness to view everything in the light of ‘disorders’, rather than through a lens that would reveal more straightforward processes….

Your thoughts as ever are very welcome.

Liver Transplants ‘furious row’

There’s an article in the Observer today talking about a ‘furious’ row that has broken out concerning the number of transplant livers that are being provided to alcoholics with liver disease.

According to Associated Press, figures released by UK health minister Ann Keen showed that the number of liver transplant cases involving damage caused by alcohol has risen rose 94 in 1997/98 to 151 in 2007/08 – increasing from 14% to 23% of the number treated annually over that period. Overall 1,300 people suffering from alcoholic liver disease have received new livers since 1997/98 – 18% of the total number of patients benefiting from the transplants. The Observer quotes the an outraged mother whose unfortunate daughter died and donated her organs and who said how she finds it ‘offensive that one in four of the livers donated go to alcoholics’.

Feelings about this obviously run high in some quarters. The subtext is that people with alcohol problems are deserving of their fate and that by giving a transplant liver to an alcoholic doctors are depriving a much more worthy recipient; a small child whose mother has terminal cancer perhaps. There is certainly a risk that someone who is an alcohol will knacker the second the same way as they did the first, but it’s not evident from the figures reported if non-alcoholics have lost out, or indeed the underlying reason why more transplant operations have taken place on such patients, beyond the obvious possibilities that there are more alcoholic cirrhosis patients or that surgeons are more willing to give them the benefit of the doubt.

I don’t think as a doctors we can afford to be picky or judgemental about our patients. As a profession plenty of our patients have done things that have not turned out to be in their best interests, be it smoking, drinking, a sexual oversight, or climbing up a tree. Some of these society is more tolerant of than others but most pay their taxes and have families who care about them. An alcoholic’s situation is often framed as one of a lack of self control, and subsequent disapproval follows from this ‘failure’. However many factors* have been implicated in alcohol abuse only some of which can be shoehorned into this narrow view.

Rather than get exercised about the care being given to people with alcohol problems, who some presumably think should be let rot, what we need more is a frank discussion about the way alcohol pervades our lives, the forces that drive this and the ways we all collude into making this so. But kicking your local alcoholic on the way to work is like shooting the messenger.


Check out Alcohol Action Necessary

Guardian article /Press Association / Daily Mail / Telegraph

Alcohol: the world’s favourite drug by Griffith Edwards is recommended to the interested reader


*The aetiology of alcohol dependence has biological, psychological and social factors. Birth trauma, abandonment by parents, death of parent, death of sibling, sexual or emotional abuse in childhood, broken families, genetics, personality traits of novelty seeking and impulsivity and biochemical factors have all been implicated.

Psychiatry in the news: 10 February 2009


Schizophrenia is the modern leprosy – Times 5 Feb
A man with a father and sister who suffer from schizophrenia criticizes the Time for change campaign as it considers all mental health disorders equally – commented on in letters Feb 7

What makes an arsonist? – Times Feb 10
There is a rising death toll from bush fires in Australia.  Some of the fires appear to have been started deliberately…

If we had turned away Churchill – BBC 9 February
On Newsnight last night, former spin supremo Alastair Campbell talked about his mental health problems and his contribution to the Time to Change Campaign

Woman in Mind, Vaudeville Theatre, London – FT 9 February
The FT has a review of this play by Alan Ayckbourn about a vicar’s wife and the aftermath of her head injury.  Apparently the main protagonist’s difficultly in understanding her peers once injured is illustrated to the audience by the play being in gibberish itself.  Sounds like an interesting device!

Psychiatry in the news January 16

These nice people have mentioned me on their list 101 Fascinating Brain Blogs


From the Independent, more reasons to keep teenagers at home Ketamine tops cocaine as new drug of choice. The day before they reported that coffee causes hallucinations

The great obesity myth in the Guardian Dr David Ashton argues that it is inappropriate that obese people are psychiatrically assessed before they have gastric banding surgery. He may be right, I don’t know, but the article didn’t point out that he was writing on behalf of his own weight loss company. He is thus bias with an interest in framing obesity as an addiction and anything that gets in the way of his approach (presumably anything psychological or psychosocial) as inappropriate.

And whilst I was looking into obesity, I happened upon a new condition that someone has made up. Orthorexia Nervosa which appears to apply to those people who have an anorexia type disorder and they will only eat healthy food. Sounds to me like you would need a fine pair of scales to distinguish it from common and garden variety anorexia nervosa. But what do I know?

Finally, in a week where there has been speculation about whether there will soon be a test for autism, and whether this will deprive us of the gifted. Anya Ustaszewski writes in the Guardian I don’t want to be cured of autism thanks. This one, as they say, will run and run.

Did anyone else see anything in the newspapers?


Added 21 January 2009

Read about the ‘coffee causes hallucinations’ headlines on Bad science blog

Suicides following financial collapse

In his classic examination of the 1929 Wall Street crash John Galbraith disabuses us of a widely held notion:

In the week or so following Black Thursday, the London penny press told delightedly of the scenes in downtown New York. Speculators were hurling themselves from windows; pedestrians picked their ways delicately between the bodies of fallen financiers.

In the United States the suicide wave that followed the stock market crash is part of the legend of 1929. In fact there was none. For several years before 1929 the suicide rate had been gradually rising. It continued to increase in that year, with a further and much sharper increase in 1930, 1931 and 1932 – years when there were many things besides the stock market to cause people to conclude that life was no longer worth living (chapter 8).

Galbraith goes on to say that in the two months following the crash the number of suicides in New York were actually comparatively low. There were in fact only two suicides on Wall Street, but these were undoubtedly dramatic. On Nov. 5, Hulda Borowski, a clerk who had been working at a Wall Street stock brokerage house for 28 years, leapt off a 40-story building; on November 16, three days after the market had taken another dive, G.E. Cutler, the head of a produce firm, climbed onto the ledge of his lawyer’s office and similarly plunged to this death.

Thankfully you can’t open the windows on tall buildings these days.

On the day Lehman Brothers was wound up I took a bus through the city and looked up once or twice from my book to see if there was anyone standing on any ledges. To my relief there was no one to be seen. Although vast sums of money have been lost, the crisis we are currently experiencing is nothing like as severe as the 1929 crash. Furthermore, thinking more broadly, predicting suicide is difficult; especially at the primary care level as depressive symptoms are common, but suicide rare. In 1998 Jenkins contended that in the UK every week 10% of 16-65 year olds report suicide depressive symptoms and 1% admits suicidal ideation, but set against this, only 0.01% will kill themselves. Previous attempts and self harm are risk factors for subsequent successful attempts; around a quarter of suicides are preceded by non-fatal self harm in the previous year (Owens and House 1994) and suicide incidence in those who have committed recent non fatal self harm is 1 in 100 over the next year, rising to 1 in 15 during 9 or more years.

The BBC has an interview with the grandson of a man who killed himself during the crash

There is one report of a banker taking his life.

Wall Street Suicides Slate

Time Magazine 80 days that changed the world – 1929

OECD report and Kerry Katona

In a new report – ‘OECD (2008), Growing Unequal? : Income Distribution and Poverty in OECD Countries’ – by the Organisation for Economic Co-operation and Development, the UK has been found to have income inequality and poverty which is falling faster than any other OECD country.

Why is this interesting? Some people have plotted the prevalence of emotional distress present in the populations of different nations* against the income inequalities also present and found there to be a positive correlation between the two. The USA, which is a nation that has built its prosperity upon a high tolerance for inequality, is top of the pile, with both the greatest income inequality (ratio of top 20% vs bottom 20% of incomes) and highest presence of emotional distress; a more socially democratic nation like Germany has much lower levels of both inequality and emotional distress. So, if the UK is becoming less unequal, will we see an improvement in our levels of emotional distress the next time they are measured?

Alas it’s unlikely to be that simple. The causes for emotional distress are multi-factorial; two other possibilities for a nations’ distress are a lack of social mobility and highly invasive, dissatisfaction creating, advertising cultures. Indeed this latter influence has a name: ‘The Hello! magazine effect’, whereby despite being increasingly better off, people compare themselves with celebrities and celebrities wealthy chums and feel relatively impoverished as a result.


Talking of celebrities and their chums, reality Queen Kerry Katona was on This Morning this morning and caused a stir ‘looking distracted and at times confused, slurring her words and almost unable to string a cogent sentence together ‘. You can watch her here and here. She said that she was taking Chlorpromazine and this was the reason for her slurred speech. I can’t be bothered to write a full post about this, but she actually didn’t seem too bad to me. Perhaps I’ve spent too much time hanging out with crack addicts in Hackney.

What did anyone else think?

* The measurement of this sort of thing is open to some debate of course.

Links for OCED

Guardian article Wealth gap narrows faster in UK than other developing countries 21 October 2008

OECD report Growing Unequal? : Income Distribution and Poverty in OECD Countries

This is Oliver James’ hobby horse

Hello Magazine effect discussed on Today 0709 and 0816