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Archive for the ‘mental health’ Category

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BMJ 2006;333:1123 (25 November).
Letters
Predicting mental illness in soldiers
Pre-deployment screening for vulnerability to post- traumatic stress disorder
By: Ferhal Utku, Ken Checinski, senior lecturer in addictive behaviour

That post-traumatic stress disorder (and other mental disorders) are difficult to predict, with the implication that ex-service personnel are likely to present to civilian mental health services with such conditions.

Post-trauma debriefing is possibly harmful, so service personnel need vigilant monitoring for mental disorder after the fact.

This is particularly important when they leave the protective group environment provided by military life.

PS: I Know these are American soldiers but it illustrates very well how dangerous and stressfull life in a war zone can be.

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BMJ 2007;335:607 (22 September).

BMJ updates

Second generation antidepressants should remain an option for children and adolescents with depression or anxiety.

Are second generation antidepressants associated with suicidal ideation or suicide attempts in children and adolescents with depression or anxiety?

Answer Yes, but the risk is small and statistically non-significant. In general, the benefits of these agents outweigh the risks.

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Editorials

Physician assisted death in vulnerable populations; Claims of increased risk in these groups are not supported by evidence.

BY: Timothy E Quill, professor of medicine, psychiatry and medical humanities; BMJ 2007;335:625-626 (29 September).

Physician assisted death (both voluntary active euthanasia and physician assisted suicide) has been openly practised in the Netherlands for more than 25 years and formally legalised since 2002. The practice has been analysed in four major national studies between 1990 and 2007. A more restricted form of physician assisted death (physician assisted suicide only) was legalised in Oregon in 1997.

In Oregon, one in 50 dying patients talk to their doctors about assisted death and one in six talk to family members. There seems to be much conversation about end of life options, therefore, but relatively few cases of assisted death.

The Dutch practices of physician assisted death have also remained stable over the duration of four studies.

A study by Battin and colleagues published in this week’s Journal of Medical Ethics that analyses existing databases from Oregon and the Netherlands dispels many of these concerns. They found no increased incidence of physician assisted death in elderly people, women, people with low socioeconomic status, minors, people in racial and ethnic minorities, and people with physical disabilities or mental illness. The one exception was people with AIDS.

These findings call into question the claim that the risks associated with legalisation will fall most heavily on potentially vulnerable populations.

It raises the possibility that legalisation and regulation with safeguards may protect rather than facilitate the practice.

The most controversial cases in the Netherlands are the life ending acts that have no explicit requests (known as LAWER cases, doesn’t say why I’m afraid)(about 1000 cases each year). Most, but not all, of these patients were suffering greatly and had lost the ability to make decisions for themselves, and many had previously given consent for physician assisted death under such circumstances.

A recent study of six Western European countries—using the same format and questions as the Dutch studies—showed that four of the six countries where assisted death is illegal had a much higher incidence of LAWER cases than is seen in the Netherlands.

In fact, such cases were more common than cases of assisted death where voluntary consent was given.

If you want to find out more WHY THERE IS MORE EUTHANASIA in countries were it is NOT legalised, just CLICK HERE.

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I just had a quick look at the rapid responses to this article in a recent BMJ. As you know, I recently did a BLOG on Predicting Mental Illness in Soldiers (https://bmjjournals.wordpress.com/2007/09/21/mental-illness-in-deployed-soldiers/ ).

It is obviously very important indeed to see what can be done to avoid MENTAL Illness in general and in Soldiers in particular as we send them on missions. Now obviously the first thing in soldiers that you could do, is stop going to silly, avoidable conflicts. Something the authors didn’t mention. But we all know that there are too many conflicts and many are about what????

Furthermore, deployment is an essential ingredient of military life, is considered a valuable feature of a military career, and for many is the reason for joining up. But at some stage any human being has reached its point of no return and will break if pushed any further. You don’t need to be a psychiatrist to know that.

An interesting response was the following comment by Dr Abraham George, SpR Public Health, Manchester :

“However, we would also like to raise a number of methodological issues: · In the Methods section, the authors stated a total 10,272 personnel (4722 deployed plus 5550 non deployed personnel) followed by sample of 5547 regulars. However, the results section states “ Overall 5547 (63.9%) out of 8686 regulars who completed the questionnaire had participated in at least one deployment in the past 3 years.” A flow chart describing the recruitment process of the study participants would have helped explain the inclusion, exclusion and response rate details. · No mention was made how the authors calculated the expected sample size of the study. · Considering that only two of the outcomes measured showed a marginal association with operational tempo, could it have been possible that sample size was found to be inadequate even though the overall response rate was good? ·

Under the Discussion section, the authors state that information bias is unlikely because the outcome measurements were objective. This is incorrect because self reported responses are subjective measures.”

Now you would think that a professor etc would know this. So I would say, a very important issue to study, but too many flaws in the study itself. Unfortunately.

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Recently a German Psychiatrist who works for the German Army stated that the main predictor of soldiers getting PTSD, Post Traumatic Stress Disorder, and other mental illnesses, was not so much the lenght away from home, even though they spend a lot more time at home than British soldiers. But that it was more if the soldiers, when presented with a dangerous or horrible situation, had the feeling they had an INFLUENCE on the outcome or not.

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bmj-after-deployment.jpg The army is taking on too many jobs, resulting in too many soldiers going off sick.

http://www.bmj.com/cgi/content/extract/335/7620/571  

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