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There are many structural problems facing the UK at present, from a weakened National Health Service to deeply ingrained inequality. These challenges extend through society to clinical practice and have an impact on current mental health research, which was in a perilous state even before the coronavirus pandemic hit. In this editorial, a group of psychiatric researchers who currently sit on the Academic Faculty of the Royal College of Psychiatrists and represent the breadth of research in mental health from across the UK discuss the challenges faced in academic mental health research. They reflect on the need for additional investment in the specialty and ask whether this is a turning point for the future of mental health research.
The Royal College of Psychiatrists Neuroscience Project was established to promote greater integration of modern neuroscience into psychiatric training and practice. Regional “Neuronets” are being established to develop local learning opportunities. As the Southwest Neuronet, we sought to establish a high quality and sustainable regional educational event promoting modern neuroscience in psychiatry.
We developed and ran two events in collaboration with the Neuroscience Project, a whole day in-person event in September 2019 and a half day online event in January 2021. Attendees were invited from the Southwest with the latter event being shared more widely through other “Neuronets”. Both featured talks by leading experts in the neuroscience of psychiatry. The first was themed around “Neuroscience from the lab to the clinic”, building on basic research methodologies to their applications in clinical psychiatry. Our pandemic era online event, “Neuroscience of psychosis”, was structured around an evolving clinical case. Both featured interactive elements using audience polling technology to gather views and collate questions. Feedback was gathered through an online survey with individual session ratings and event ratings.
154 people attended the in-person event from across the South West Division. This included psychiatry trainees, consultants and a small number of other mental health professionals. 382 people signed up to our online event with 262 attending live and others watching recorded sessions. Feedback response rates were 42% and 33% respectively. Feedback on the practical arrangements was highly positive, particularly highlighting pre-event communication. Attendees valued the high calibre of speakers and particularly rated topics of psychiatric genetics, novel antidepressants, and autoimmune psychosis. Environmental sustainability was a prominent theme in our first event with support for our paperless approach but highlighted further potential to reduce waste associated with catering. Overall, attendees valued the opportunity to build on knowledge of basic research techniques but also wished to see greater focus on clinical applications of neuroscience, which we had responded to with the inclusion of a clinical case to frame our online event.
These events provide a prototype for low-cost regional neuroscience in psychiatry education events, in-person or online. Sustainability in terms of cost, human resources for organisation, and environmental impact are all important considerations for such events. We plan to continue to run these annually, forming part of the legacy of the Neuroscience Project. In line with feedback received, we seek to maximise the clinical relevance but also share novel research techniques encountered in the literature.
Each of the components of the biopsychosocial model of mental illness is important for understanding mental illness. Biological and genetic abnormalities have been demonstrated in major mental illnesses. These are leading to changes in our understanding of these conditions, as well as our understanding of the link between life events and mental illness.
The extent to which coffee agroforestry systems provide ecosystem services depends on local context and management practices. There is a paucity of information about how and why farmers manage their coffee farms in the way that they do and the local knowledge that underpins this. The present research documents local agro-ecological knowledge from a coffee growing region within the vicinity of the Aberdare Forest Reserve in Central Kenya. Knowledge was acquired from over 60 coffee farmers in a purposive sample, using a knowledge-based systems approach, and tested with a stratified random sample of 125 farmers using an attribute ranking survey. Farmers had varying degrees of explanatory knowledge about how trees affected provisioning and regulating ecosystem services. Trees were described as suitable or unsuitable for growing with coffee according to tree attributes such as crown density and spread, root depth and spread, growth rate and their economic benefit. Farmers were concerned that too high a level of shade and competition for water and nutrients would decrease coffee yields, but they were also interested in diversifying production from their coffee farms to include fruits, timber, firewood and other tree products as a response to fluctuating coffee prices. A range of trees were maintained in coffee plots and along their boundaries but most were at very low abundances. Promoting tree diversity rather than focussing on one or two high value exotic species represents a change of approach for extension systems, the coffee industry and farmers alike, but is important if the coffee dominated landscapes of the region are to retain their tree species richness and the resilience this confers.
Early worsening of anxiety, agitation and irritability are thought to be
common among people commencing antidepressants, especially for anxiety
disorders. This phenomenon, which may be termed jitteriness/anxiety
syndrome, is cited as an explanation for early treatment failure and
caution in using selective serotonin reuptake inhibitors (SSRIs).
However, we believe that it is inconsistently defined and that robust
evidence to support the phenomenon is lacking.
To review systematically all evidence relating to jitteriness/ anxiety
syndrome to identify: constituent symptoms; medications implicated;
disorders in which it was reported; incidence; time course; management
strategies; relationship of this syndrome to therapeutic response;
distinction between syndrome and akathisia; relationship between syndrome
and suicide; and genetic predispositions.
A systematic search identified articles and these were included in the
review if they addressed one of the above aspects of jitteriness/anxiety
Of 245 articles identified, 107 articles were included for review. No
validated rating scales for jitteriness/anxiety syndrome were identified.
There was no robust evidence that the incidence differed between SSRIs
and tricyclic antidepressants, or that there was a higher incidence in
anxiety disorders. Published incidence rates varied widely from 4 to 65%
of people commencing antidepressant treatment. Common treatment
strategies for this syndrome included a slower titration of
antidepressant and the addition of benzodiazepines. Conclusive evidence
for the efficacy of these strategies is lacking. There was conflicting
and inconclusive evidence as to whether the emergence of this syndrome
had a predictive value on the response to treatment. It appears to be a
separate syndrome from akathisia, but evidence for this assertion was
limited. The effect of jitteriness/anxiety syndrome on suicide rates has
not been evaluated. Three studies examined genetic variations and
side-effects from treatment, but none was specifically designed to assess
Jitteriness/anxiety syndrome remains poorly characterised. Despite this,
clinicians' perception of this syndrome influences prescribing and it is
cited to support postulated mechanisms of drug action. We recommend
systematised evaluation of side-effects at earlier time points in
antidepressant trials to further elucidate this clinically important