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This editorial introduces a special issue of BJPsych Advances on neuroscience in 21st-century psychiatry. It focuses on two articles in particular, which reveal the contributions of neuroscience to fully integrated biopsychosocial models of human experience.
Seasonal affective disorder (SAD) is a recurrent form of major depression, particularly occurring in the winter months with a generally spontaneous remission in spring/summer. The predictable nature of this condition provides a potentially unique opportunity to prevent recurrence in sufferers of SAD. The Cochrane Review discussed here examines the evidence for melatonin and agomelatine in preventing SAD, putting its findings into their clinical context.
Determining the optimum next-step treatment for the numerous patients with depression who do not adequately respond to an initial trial of medication remains a source of uncertainty in clinical practice. Although a number of psychological treatments are known to be effective for depression, their relative merits in the treatment-resistant group have not been ascertained. The Cochrane Collaboration has recently published a meta-analysis of the evidence available for the use of various psychotherapies as an adjunct to antidepressants compared with antidepressants alone in treatment-resistant depression. This article provides a commentary and appraisal of the clinical utility of these findings.
Cognitive health, and prevention of its decline to dementia, has risen in prominence with a corresponding exploration of modifiable risk factors to prevent a decline in cognitive health with age. This commentary discusses a new Cochrane review that examines the effect of vitamin and mineral supplementation in maintaining cognitive health in cognitively healthy adults in mid- and late-life. From a heterogeneous body of evidence, the quality of which ranged from very low to moderate, the review draws the conclusions of little or no benefit of supplements.
There is urgent need to search for a dementia treatment that can delay its progression and reduce its financial and societal burden. Despite lacking evidence, there is a large number of commercial brain-training products on the market that claim they improve cognition. The Cochrane review under consideration looks at whether cognitive training maintains or improves cognition in those with mild to moderate dementia compared with control and alternative interventions. This commentary puts its findings into clinical perspective.
Family therapy is recommended by the National Institute for Health and Care Excellence (NICE) for the management of anorexia nervosa in children and young people, but there is limited evidence to back this recommendation. The Cochrane Review under consideration evaluates the efficacy of different family therapy approaches compared with other treatments for anorexia nervosa, and this commentary puts the findings into clinical perspective.
Approaches to assessing violence in clinical practice have been influenced by developments in the field of risk assessment. As a result, there has been a focus on identifying and describing factors associated with violence. However, a factor-based approach to assessing violence in individual cases has limited clinical utility. In response, the benefits of a formulation-based approach have been promoted. This approach is enhanced by an understanding of the specific mental mechanisms that increase the likelihood of violence in the individual case. Although there is an empirical evidence base for mental mechanisms associated with violence, this literature has not been distilled and synthesised in a way that informs routine clinical practice. In this article the authors present the key mechanisms that are known to be associated with violence in a way that is relevant to the clinical assessment of violence and, in turn, can inform clinical and risk management.
In value-based healthcare (VBHC) value is defined as outcomes that matter to patients divided by the cost of achieving these outcomes. Value is measured for discrete medical conditions across the whole cycle of care. Data on the value achieved by different providers is openly shared. Providers increase value using quality improvement (QI) techniques to improve outcomes, reduce costs or both. Patients or commissioners choose the provider achieving the greatest value. Units should compete regionally or nationally. There are challenges to implementing such ideas in the mental health services in the UK. However, measuring outcomes, understanding costs and using QI to drive up value may be possible without adopting the complete model that has developed in the context of a North American and acute hospital healthcare system.