Impact News

Responding to Violence, Suicide, Psychosis and Trauma

Suicide in Mid-life Men

Disadvantaged men in mid-life have a tenfold increased risk of suicide. According to the Samaritans this is linked to loss of identity and male pride. Hopelessness is the killer, however, and loss of identity and lack of help-seeking behaviours IMHO contribute to this alongside isolation, poverty, substance misuse, poor mental health.


Filed under: Other Mental Health, Suicide, , ,

Gender Differences in Suicidal Behaviour in Adolescence

A cursory look at the statistics is enough to tell us that there are huge gender differences involved in suicidal (and self-harming) behaviour. Here’s an interesting study: #mentalhealth

Filed under: Impact Training, Other Mental Health, self-harm, Suicide, , , , ,

How self-harm is treated in A&E

People who self-harm do not generally get a good deal when they are admitted to A&E (ER). Most of the evidence is anecdotal but here is an interesting study:

Filed under: Impact Training, Other Mental Health, self-harm, Suicide, , , , ,

Difficult, Disturbing & Dangerous Behaviour

This dramatic course delivered by Dr Iain Bourne is being made available by Sitra:

20th September 2012 in London

26th September in Leeds


Filed under: Impact Training, Other Mental Health, Violence, , , , , , , ,

Different Worlds; working with hallucinations, delusions and paranoia

This dramatic course delivered by Dr Iain Bourne is being made available by Sitra

24th October 2012 in Southampton

Filed under: Impact Training, Other Mental Health, psychosis, , , , , ,

Beyond Abuse: working with high risk service users

This dramatic course delivered by Dr Iain Bourne is open for applications by Sitra:

12th September 2012 in Southampton

25th October 2012 in London

Filed under: Impact Training, Other Mental Health, Violence, , , , , , ,

NHS Trust Guilty Following Fatal Stabbing of Care Worker

Care staff are having to work with increasingly challenging service users, often inappropriately placed, without adequate training or supervision. Another tragic death …
Central Bedfordshire Council

20 July: Sentencing of former Dunstable care home owner and county NHS Trust
A county NHS Trust and the owner of a former Dunstable care home have been sentenced after being found guilty of safety failings following the fatal stabbing of a care worker at a private residential care home in Dunstable.

Kathleen Bainbridge, 58, from Luton was killed at Abacus House, on Princes Street, on 24 August 2007 by resident Stephen Flatt, then aged 55, who attacked her with a knife from a kitchen. Fellow care worker Barbara Hill, from Dunstable, was also attacked when she went to help her colleague.

A joint investigation by the Health and Safety Executive (HSE) and Central Bedfordshire Council found that Abacus House was not the correct care facility for Mr Flatt, who had been placed there by the Hertfordshire Partnership NHS Foundation Trust.

A trial at Luton Crown Court heard he had been diagnosed with bipolar disorder and that Abacus House staff had no expertise or training for dealing with people with this disorder, or for managing violent or aggressive behaviour.

Hertfordshire Partnership NHS Foundation Trust was yesterday (19 July) fined £150,000 and ordered to pay costs of £326,346 for breaching Section 3(1) of the Health and Safety at Work etc. Act 1974 for its failings in relation to the fatal incident after being prosecuted by HSE.

The council brought proceedings at the same time against the owner of Abacus House, Chelvanayagam Menna, who was fined £75,000 and ordered to pay costs of £338,996 after being found guilty of breaching Sections 2(1) and 3(1) of the same Act.

After the sentencing HSE Inspector Karl Howes said: “This was a tragic incident that left a family without a wife, mother and grandmother. No-one expects to go to work and never return home.

“Care homes have a duty not only to protect the safety of their residents but their staff as well. The NHS Trust failed to adequately assess the risks that were posed to staff and other residents from placing Mr Flatt in Abacus House.

“I hope this will make all NHS Trusts and care facilities carefully consider the procedures that they have in place during patient placement.”

Councillor Budge Wells, Deputy Executive Member for Sustainable Communities, Services at Central Bedfordshire Council said: “The legal process has been long and difficult, particularly for Mrs Bainbridge’s family but also for her former colleagues – especially Mrs Hill.

“Of course the trial of Stephen Flatt had to take initial priority and once this was concluded the police instigated a further investigation of the Trust and care home owner. However the Council and HSE cooperated closely on their investigation from the outset and were in a position to progress with proceedings as soon as the police cleared the way.

“All concerned in the case hope that the right lessons are learned from this tragedy and that nothing of a similar nature occurs in future.”

Filed under: Impact Training, Other Mental Health, psychosis, trauma, Violence, , , , , , ,

Fat Faced Men and Aggression

I am often amazed by the things that researchers get up to. The research below is, to me at least, both bizarre and intriguing.

What lies beneath the face of aggression?
Soc Cogn Affect Neurosci first published online December 23, 2011
Carré JM, Murphy KR, Hariri AR
Recent evidence indicates that a sexually dimorphic feature of humans, the facial width-to-height ratio (FWHR), is positively correlated with reactive aggression, particularly in men. Also, predictions about the aggressive tendencies of others faithfully map onto FWHR in the absence of explicit awareness of this metric. Here, we provide the first evidence that amygdala reactivity to social signals of interpersonal challenge may underlie the link between aggression and the FWHR. Specifically, amygdala reactivity to angry faces was positively correlated with aggression, but only among men with relatively large FWHRs. The patterns of association were specific to angry facial expressions and unique to men. These links may reflect the common influence of pubertal testosterone on craniofacial growth and development of neural circuitry underlying aggression. Amygdala reactivity may also represent a plausible pathway through which FWHR may have evolved to represent an honest indicator of conspecific threat, namely by reflecting the responsiveness of neural circuitry mediating aggressive behavior.
Affiliation: Department of Psychology, Wayne State University, Detroit, MI, USA, 48202.

Filed under: Impact Training, Other Mental Health, Violence

How effective are Anti-depressants?

One of the problems in assessing the efficacy of drugs is that the assumption that patients don’t know in a double-blind study if they are taking the active medicine or a placebo. However, all medicines have side-effects and placebos have none, so in fact most trialists know if they are taking sugar pills because they don’t notice any physical changes. Consequently when trials show, for example, fluoxetine to be better than placebos, they may show nothing of the kind.

In this light, the study below is even more surprising in that it suggests that anti-depressants, placebo and a talk therapy are all equally (in)effective! It would be even more alarming if they had chosen fluoxetine as the antidepressant (although recent studies have suggested that even this is only more effective than placebos for the most severe forms of depression) and CBT in place of supportive-expressive therapy.

Antidepressant, Talk Therapy Fail to Beat Placebo

By Amy Norton

NEW YORK (Reuters Health) Dec 22 – Neither antidepressants nor “talk therapy” were able to outperform placebo pills in a new clinical trial on depression treatment — although there were hints that the effects varied by gender and race, researchers report.

The findings, published November 29 in the Journal of Clinical Psychiatry, add to evidence that people receiving “real” depression treatment in studies — from antidepressants to St. John’s wort — often do no better than people given a placebo.

A recent review found that a minority of antidepressant users even fared worse than placebo users.

In this latest study, researchers randomly assigned 156 patients with major depression to either take sertraline daily for 16 weeks; take a placebo for the same period, or undergo supportive-expressive therapy twice a week for four weeks and then weekly for 12 weeks.

The three groups did similarly overall.

In the antidepressant group, 31% responded (as judged by improvements on the Hamilton Rating Scale for Depression). The same was true of about 28% of patients in the talk-therapy group, and 24% in the placebo group.

“I was surprised by the results. They weren’t what I’d expected,” said lead researcher Dr. Jacques P. Barber, dean of the Institute of Advanced Psychological Studies at Adelphi University in Garden City, New York.

Still, he stressed in an interview, the lack of benefit over placebo does not mean that depression therapies are pointless.

For one, Dr. Barber said, receiving a placebo in a clinical trial “is not the same as getting no treatment.”

Study participants in placebo groups have contact with health professionals who are asking about their symptoms and well-being, he said. And for some people, that attention can make a difference — and may help explain the placebo response seen in studies.

In addition, at least some people in placebo groups believe they are getting the real treatment – and people’s beliefs about their therapy can play a key role in whether they get better.

But apart from that, different people may respond differently to a given type of depression therapy. Dr. Barber’s team found some evidence of that.

The study had an unusually large minority population for a clinical trial on depression: Forty-five percent of the patients were African American.

The researchers found that African-American men tended to improve more quickly with talk therapy than with medication or placebo. In contrast, white men fared best on placebo, while black women showed no differences in their responses to the three treatments.

Only white women, Dr. Barber said, showed the expected pattern: a quicker response to both medication and talk therapy than to the placebo.

But all of that is based on fairly small numbers of people, and more research is needed to see if the gender and racial differences are real, according to Dr. Barber.

A psychiatrist not involved in the study agreed. “Those findings are interesting, but need to be interpreted with a grain of salt,” said Dr. David Mischoulon from Harvard Medical School.

As for the overall lack of benefit from the real treatments over placebo — in this and other studies – Dr. Mischoulon cautioned against reading that as “nothing works for depression.”

“I think it’s the opposite,” he told Reuters Health, “It’s more that, everything seems to work to some degree.”

Like Dr. Barber, Dr. Mischoulon said that the placebo condition in clinical trials is not really “no treatment.”

Instead, he said, “I try to offer as broad a menu of options as possible, because all may potentially help.” Dr. Mischoulon has also studied alternative depression remedies, like fish oil and acupuncture.

Another caveat from the current study, he noted, is that it looked only at two types of medication. (Some patients were switched to venlafaxine if they did not respond to sertraline after eight weeks). And it tested just one type of talk therapy.

Supportive-expressive therapy is a short-term form of psychoanalysis that aims to help people understand how their personal relationships are related to their symptoms.

It’s different from cognitive behavioral therapy, the best-studied form of talk therapy for depression. Both Dr. Barber and Dr. Mischoulon said it’s not clear if the current findings would extend to psychotherapies other than supportive-expressive therapy.

“This is one type of psychotherapy, and it’s two antidepressants,” Dr. Mischoulon said. “It would be wrong to conclude that psychotherapy doesn’t work, and antidepressants don’t work.”

The study was funded by the National Institutes of Health. Some of Dr. Barber’s co-researchers have received funding from the pharmaceutical industry.

Filed under: Other Mental Health, ,

Are the Clinically Depressed Just More Realistic?

It is often reported that we all tend to delude ourselves and actively distort our assessments of the probability of events occurring about us, but only one group of people are able to predict the likelihood of those events occurring better than the rest of us, the clinically depressed! A recent study seems to bear this out (J Behav Ther Exp Psychiatry. 2011 Oct 5; vol. 43(2) pp. 699-704 Confidence judgment in depression and dysphoria: The depressive realism vs. negativity hypotheses. Zu-Ting Fu T, Koutstaal W, Poon L, Cleare AJ). See the abstract below (I have edited out the methodology as if you are interested in that you would need to examine the original and full text.

BACKGROUND AND OBJECTIVES: According to the negativity hypothesis, depressed individuals are over-pessimistic due to negative self-concepts. In contrast, depressive realism suggests that depressed persons are realistic compared to their nondepressed controls. However, evidence supporting depressive realism predominantly comes from judgment comparisons between controls and nonclinical dysphoric samples when the controls showed overconfident bias. This study aimed to test the validity of the two accounts in clinical depression and dysphoria. CONCLUSION: The present study confirms depressive realism in dysphoric individuals. However, toward a more severe depressive emotional state, the findings did not support depressive realism but are in line with the prediction of the negativity hypothesis. It is not possible to determine the validity of the two hypotheses when the controls are overconfident. Dissociation between item-by-item and retrospective confidence judgments is discussed.
Copyright © 2011 Elsevier Ltd. All rights reserved.
Affiliation: Institute of Biomedical Sciences, Academia Sinica, 6F, No. 16, Alley 10, Lane 437, Pa-The Rd Sec 2, Taipei 10552, Taiwan.

Filed under: Other Mental Health, ,