International Journal of Psychiatry in Clinical Practice, 2010; 14: 159
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Issues of IJPCP traditionally contain a broad range of reports from around the world, and this issue is no exception, being concerned with the outcome of psychosis, the introduction of electronic medical records into routine clinical practice, the problems experienced in general hospital settings, and a series of intriguing biological investigations. To start, Wolter and colleagues (Bad Zwischenahn, Germany) describe a naturalistic prospective evaluation of the one-year outcome among 106 patients with schizophrenia, which found that whilst almost 30% were significantly improved, only 13.2% met criteria for symptomatic remission at follow-up. This rather stark finding is balanced by the report from Wolstencroft and colleagues (Wollongong, Australia), which describes the development of a structured interview schedule to assess the stage of psychological recovery from enduring mental illness: in-depth interviews with 18 users of mental health services provide some support to the arguments of those who espouse a ‘recovery’ model, emphasising the need for affected individuals to accommodate to persistent psychotic symptoms. In-depth interviews using qualitative research methods are also a feature of other reports within this issue. For example, Silver and colleagues (London, UK) used this approach to explore self-perceptions among people with the diagnosis of body dysmorphic disorder, and were able to identify shared themes such as an idealised childhood self, and the ‘duty to look good’. In addition, Boyer and colleagues (Marseille, France) used semi-structured interviews with health and social service professionals and administrative staff to explore the impact of introducing electronic medical records into a busy teaching hospital, and found that 70% of respondents spoke favourably of this change, emphasising the improved access to medical information, and greater opportunity for more effective team-working: however, there were also concerns about resulting increased work demands and the potential loss of patient confidentiality.
ISSN 1365-1501 print/ISSN 1471-1788 online © 2010 Informa Healthcare DOI: 10.3109/13651501.2010.509681
Many psychiatrists work in consultation-liaison services based in the general hospital, and two papers examine common problems in this setting. The prevalence, pattern and impact of depression on quality of life of patients who had survived a cerebrovascular accident was investigated by Gbiri and colleagues (Lagos, Nigeria), who found that incident depression following stroke significantly reduced life quality, interacting with age, available support and educational attainment. Many such patients will undergo treatment with antidepressant drugs but it is important to be more mindful of potential problems when initiating psychotropic drugs: Sinclair and colleagues (Bristol, UK) find that general hospital patients were significantly more likely than psychiatric unit inpatients to be exposed to potential drug-drug interactions and to more serious interactions. As editors, we are always keen to include reports of biological investigations, as well as evaluations of clinical outcome and the impact of change in the delivery of mental health services. This issue incorporates three such studies: the report from Koc and colleagues (Ankara, Turkey) describes an investigation of cryptic mosaic X chromosome aneuploides among schizophrenic patients and their first-degree relatives; Yoshimura and colleagues (Fukuoka, Japan) highlight the close correlation among 103 healthy volunteers between plasma and serum levels of brain-derived neurotrophic factor (BDNF); and Pae and colleagues (Bucheon, Korea) report the absence of an effect of the SLC6A3 40 base VNTR polymorphism of the dopamine transporter protein on the response of 142 patients with schizophrenia to antipsychotic drug risperidone.
David Baldwin and Siegfried Kasper Joint Editors