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Early intervention
- Eugene G Breen (7 August 2008)
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Paging Dr. Freud
- Hugh Mann (26 August 2008)
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Start with getting the biochemistry right
- Edmond V O`Flaherty (10 September 2008)
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Re: Start with getting the biochemistry right
- Sharif Elleithy (12 September 2008)
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Eugene G Breen, Consultant Psychiatrist 62/63 Eccles St Dublin 7
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Early intervention in psychiatry is in theory laudable. The average multidisciplinary psychiatric team is stretched with 3-400 diagnosed patients not to mind looking for possible cases. Resources and prioritising their optimum use is the bottom line. Really the evidence base for the preventative effectiveness of early intervention is not convincing. There is no cure for psychosis, there is no cholesterol test for psychiatric illness, nor is there a vaccination or screening test available. What there is though, is a network of willing, committed and very well placed personnel, that are very sensitive to incipient psychiatric symptoms and these are parents, relatives, teachers, career guides, school/club mentors, among others. These unseen carers, when knoweledgable and educated and supported, can intervene in a very natural way, and support youngsters through tough patches, and refer firstly to the general practitioner if necessary. Hard wired illness that is genetically loaded, will manifest whither or which, and prevention or illness reduction translates into optimum management of chronic illness. Psychosocially induced and driven illness eg. substance abuse [in many], abuse, bullying, neglect, to mention a few, are not inexorable but comptetely preventable, and early intervention reaps great results in this area, and it is usually far removed from psychiatry services as such. Supporting these already existing services and personnel could be truly effective early intervention. Competing interests: None declared |
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Hugh Mann, Physician Eagle Rock, MO 65641 USA
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Psychiatric intervention is reflexively synonymous with pharmacotherapy. Modern psychiatry is dominated by reductionist, mechanistic psychopharmacology, which focuses almost exclusively on synapses, neurotransmitters, and SSRIs. Unfortunately, modern psychiatry has largely dismissed the seminal work of Sigmund and Anna Freud. The former described structural theory (id, ego, and superego); topographic theory (conscious, preconscious, and unconscious); oedipus and electra complexes; and transference and countertransference. The latter described ego defense mechanisms: repression, denial, rationalization, sublimation, identification, displacement, projection, and reaction formation. In my opinion, it is difficult, if not impossible, to truly understand someone’s motivation and behavior without an appreciation of these two great pioneers. Competing interests: None declared |
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Edmond V O`Flaherty, GP Gleneagle,Greygates,Mount Merrion,Co. Dublin
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I am a GP but about one third of my work is concerned with biochemical psychiatry.While patients continue on their antipsychotics or antidepressants I try to improve the situation by working on the biochemistry.This has given me enormous satisfaction and it is by far the most useful work that I do.I do not know if early intervention with antipsychotics would help a person who appears to be heading for a first psychotic episode but I am sceptical.However because psychiatric conditions are largely genetic it appears that the breakdown occurs when antioxidant protection has become inadequate because of the build-up over many years of oxidative stress.Before they reach that state there are many things that could be done. Paranoid schizophrenics for example have high copper and low histamine-they are overmethylated.Copper is involved in the conversion of dopamine to noradrenaline and in turn much of this finishes up as adrenaline.It is no wonder that they are so anxious and can hardly sit still.Niacinamide,zinc, B12 and folic acid together with other nutrients,especially antioxidants, will help a lot. Incidentally antipsychotics themselves are almost all poweful antioxidants. Competing interests: None declared |
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Sharif Elleithy, Clinical Psychologist St George's Hospital, London
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In response to Dr O' Flattery's comment that "psychiatric conditions are largely genetic" - I am sorry but I just could not let this one go. Despite four decades of research, this statement does not hold up. The often quoted twin-studies data on schizophrenia has a number of serious flaws (1) and indeed the most recent research on large populations concluded that there is unlikely to be a significant association between any of the candidate genes with schizophrenia.(2) At the same time perhaps the most reliable predictor of schizophrenia is stress. Stress from traumatic or neglectful childhoods (3, 4). Stress from social and economic deprivations.(5) I wonder if the reason why Dr O'Flattery's patients are anxious and cannot sit still is because they are very stressed. I also wonder if the reason Dr Flattery finds his biochemical work is useful, is more to do with his patients feeling that he is taking an real interest in them aside from their diagnosis. (1)Joseph, J. (2003) The Gene Illusion: Genetic Research in Psychiatry and Psychology Under the Microscope. PCCS Books, Ross-on-Wye. (2)Sanders, R. et. al (2008) No Significant Association of 14 Candidate Genes With Schizophrenia in a Large European Ancestry Sample: Implications for Psychiatric Genetics. Am J Psychiatry 2008; 165:497-506 (3)Janssen, I., Krabbendam, L., Bak, M., et al (2004) Childhood abuse as a risk factor for psychotic experiences. Acta Psychiatrica Scandinavica, 109, 38-45 (4)Read, J., Goodman, L., Morrison, A., et al (2004) Childhood trauma, loss and stress. In Models of Madness: Psychological, Social and Biological Approaches to Schizophrenia (eds J. Read, L. Mosher & R. Bentall), pp. 223 -252. Hove: Brunner-Routledge. (5)Hudson, C.G.(2005) Socioeconomic status and mental illness. Am. J. of Orthopsychiatry, Vol. 75, No. 1, 3–18 Competing interests: None declared |
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