CBT doesn't really work much and science in mental health

Lynch, D, 2010, Cognitive behavioural therapy for major psychiatricdisorder: does it really work? A meta-analytical review of well-controlled trials, Psychological Medicine
http://journals.cambridge.org/download.php?file=/PSM/PSM40_01/S003329170900590Xa.pdf&code=b62ffa4b898268608a9e7b504bdd5319

Cognitive behavioural therapy - changing the way people think and behave by using talking techniques from therapists - doesn't really work according to this high quality review.The review uses a different inclusion criteria to the 'mega-analysis' which is often used to show that CBT really does work.
Butler, A. et al. 2006, The empirical status of cognitive-behavioral therapy: A review of meta-analyses, Clinical Psychology Review
http://www.sciencedirect.com/science/article/pii/S0272735805001005

So which one is true? The massive review (the 2006 one) which includes loads of papers but has a weaker inclusion criteria and, if I remember right, doesn't include a funnel plot or the smaller review of higher quality trials (the 2009 one at the top of the page)?

I'm afraid it's the one of controlled trials. At least based on the current paradigm of evidence based medicine. Blindness is so important.

The double blind randomised controlled trial gained success when it showed insulin shock or insulin coma therapy to be as effective as other treatments at the toime for...think it was schizophrenia. At the time
the insulin treatment was considered best practice around the world but the introduction of random assignment to the control or active treatment group showed that, in fact, it wasn't the best treatment.

Time and again it's the reviews that select the highest quality trials which show treatments thought to work suddenly don't. The recent noteable example is electro-convulsive therapy or ECT. This barbaric
treatment is what I hope is the last in the line of psychiatric treatments which induce seizures. The history of inducing seizures to treat mental disorder can be traced back to the work of Hippocrates who
notices paitents who had malaria seizures also had behavioural changes. The recent Bentall and Read review on ECT picked high quality trials with long term follow. This treatment of last resort was shown to be as
effective on follow up as sham ECT (where no electricity is used to shock a person into a seizure) and slightly more effective during treatment.
http://www.mindfreedom.org/kb/mental-health-abuse/electroshock/ect-review-2010-read-bentall.pdf/view
(Link to paper at the bottom of the page.)

Many, many people have died because of this treatment. Some people who've had it done are major advocates of the treatment. This presentation on TED is an example.
http://www.ted.com/talks/sherwin_nuland_on_electroshock_therapy.html

The speaker may have gotten the same benefit from sham ECT and less damage to his brain.

And so back to CBT. The controls in the trials are as effective as this new dogma of treatment for all but depression where the evidence for it's effect is small. The effect size is far below what got the Improve
Access to Psychological Therapies scheme approved.then factoring in publication bias...that demon of good
research....which is the effect of trials with negative results being hidden...well it knows off about a third of the effect size of CBT studies.
http://bjp.rcpsych.org/content/196/3/173.full

In a sense it's saddening that there's few effective cures for mental disorder. Perhaps it's all the hedonic treadmill.
http://en.wikipedia.org/wiki/Hedonic_treadmill

Or perhaps it's the operational cluster of symptoms approach doesn't provide a good way to assign treatment to diagnosis?

This is some fucking interesting shit man

http://www.plosgenetics.org/article/info%3Adoi%2F10.1371%2Fjournal.pgen.0010042
Genetic correlations with professional dancers. I

t's interesting for so many reasons even while I'm drunk. Of course my critical mind is nipping away at the ...oooooh ..we have a result based on 20% of people have gene X (to do with musicians with perfect pitch)..that says sod all. It shows  a vague correlation but there may be more significant factors...oooooo....look at the tiny sample size...ooooo......look at how the experiment is so limited - just professional dancers and athletes, why not religious folk, drug users and ravers.

But I'm just like. wow. This is some fucking interesting shit.

The book where the original 1 in 4 figure comes from

Mental illness in the community: the pathway to psychiatric care By David P. Goldberg, Peter Huxley
http://books.google.co.uk/books?hl=en&lr=&id=yU0OAAAAQAAJ&oi=fnd&pg=PR7&dq=undiagnosed+rate+incidence+mental+disorder&ots=9-mcNMuHgA&sig=xW8t5NkRDylS_GDS8vb6jGuJOPc#v=onepage&q&f=false


It's somewhere in here they estimate a 250 in 1000 incidence figure from a 180 in 1000 prevalence figure. I think the sample period was a month for the prevalence figure.

However definitions of mental illness are important. I haven't read the book thoroughly to see which measure was used to calculate the prevalence figure. The calculation that goes between the prevalence and incidence was noted to be incorrect in the authors second book published in the nineties.

The medical profession are researching alternatives to clozapine

http://jop.sagepub.com/content/21/6/657.abstract
Review: Combination therapy with non-clozapine atypical antipsychotic medication: a review of current evidence
Jenifer Chan et al.
2007


There's a DARE record as well though it seems they've been less critical of this paper than others. I can only read the abstract of the paper.


<sarcasm>
I'm so glad to see this is a research priority. It's great to see the NHS are pushing forward these sorts of papers. It's even bettter to see the amount of funding, the high quality researchers involved and the huge number of psychiatrists and experienced research professionals involved in the effort for medicine to stop killing people with antipsychotics. It makes me thing that doctors really care about their patients and the NHS really focuses on important research, rather than a million and one trials of treatments for smoking cessation which are left for years before reviewers get round to adding to the DARE database.


The NHS clearly has the deaths it causes through the use of clozapine and other antipsychotics high on the agenda.
</sarcasm>


Now that I've disengaged from using the lowest form of wit let me remember my project management training. A lot of modern project management theory came from NASA because they had the unenviable task of getting to the moon. The Apollo programme is was one of the most ambitious of mankind's endeavours (and it was mankind because women would have been smart enough to know that it was just men compensating for the size of their phalluses and they wouldn't have bothered).


I got some of my training around the time of my first major breakdown so my memory of it isn't fantastic. There are variables. Time. Quality. Resources. If you want something done well then you need lots of resources or lots of time. If you have little resources then it'll take a long time or it'll be crap quality. You get the picture.


Every day that someone doesn't do something about the clozapine deaths is another person killed by psychiatry's solution to treatment resistant schizophrenia. Clearly that's not a priority. The authors of this paper published in 2007 may be the best researchers in the world however it seems the psychopharmacy isn't their specialist area. The main author works at an eating disorders clinic. Her other papers are not on psychiatric medication.


I do not point this out to slate their research. I point this out to slate the medical profession and the NHS's attitude to the development of an alternative to clozapine even if it's still pharmcotherapy.


This paper was in the latest NHS Evidence email that came out today though it was published 3 years ago. Even the NHS Evidence team can't be arsed with clozapine research. It gets stuck at the bottom of the pile. Smokers like me who knowingly self-inflict a reduced life expectancy (and who pay for their treatment on the NHS through all the tax revenue) are more important than the lives of those people that psychiatrists knowingly reduce their life expectancy. There's regular evidence about smoking cessation treatments in the NHS evidence email.


In project management if time is of the essence and quality is important then what's needed is resources. This isn't just money. It's organisations such as the Royal College of Psychiatry getting their heads out of their arses and making research into alternatives to clozapine a priority. It's getting research psychiatry on the case rather than a couple of inexperienced researchers.


At least that's what I understand from my project management training. Back in the day some totally irrationally and potentially mentally ill President of America said that they'd put a man on the moon, gave NASA an unlimited budget and told them to get on with it. To John F Kennedy it was important to reach the moon.


Around that time was the real boom period of psychopharmacy. Psychiatry moved away from psychoanalytic methods of care which required time and patience. Instead they found the convenience of pills like an 18 year old clubber at their first rave. This convenience factor, the biomedical model of schizophrenia and psychiatrist attitudes to anything that isn't of their establishment means they'd rather keep on researching new ways to use clozapine rather than ways to stop using clozapine.


How many dead schizophrenics does it take? Wasn't the Thalidomide disaster enough?

Image via Wikipedia

Going back way back into prehistoric psychiatry there were great men like Pinel who removed the shackles from the men in the Bicêtre Insane Asylum. 200 years on he would piss in the face of psychiatry for it's continued use of the new chemical shackles.

An ace article on the placebo effect

I've been meaning to get round to reading this for a while.
http://jdc325.wordpress.com/2009/11/13/the-powerful-placebo/

I totally admit I know nothing about the placebo effect after reading this post.

Image via Wikipedia

This is why I love science in a way. It's always proving me wrong. It may not do much for my self-esteem or credibility but I like finding out I'm wrong in spectacular ways like this. This blogger totally slams everything I knew.

The amount of time the blogger has spent on that article is amazing and makes my work a total mockery of good science journalism, but then it isn't good science journalism. This is just my notepad. Stuff and Nonsense is a proper blog.

The author's even read a 451 page Cochrane Systematic Review on the placebo effect. I'm going to be lazy and just read the New England Journal of Medicine article by the same author.

A URL research trick

In the previous post I came across two articles by the same author. Here's one of the URLs.

http://www.bgmi.us/web/bdavey/Psychosis.htm

I came across the article while searching for something else and as usual took a little time out to read something that was interesting. It was well worth it as well. These branches out into other information can be lead to new ideas and concepts.

I like what the authors written so I could Google his name however a simple technique using the web address could lead to a gold mine of the authors work. By deleting the file name I can get to the directory of files (this only works on some web pages). In this case it becomes

http://www.bgmi.us/web/bdavey/

And there I uncover

A STRATEGY FOR LOSERS

HELPING THE LAST TO COME FIRST IN THE ECOLOGICAL TRANSFORMATION OF SOCIETY

This only works on older sites with static pages however there are many such URL tricks that can be used to find information beyond the power of a search engine. There's nothing illegal about this and hackers would use far more sophisticated techniques if they wanted to get hold of information. This is purely something that's an advantage for researchers who have a small knowledge of IT.

It works because many websites are really just like looking at text files in directories on a computer hard drive. All that has happened is by deleting the file name the web server has returned the index.html page and if that's not there then most web servers either give a directory listing of the files or don't allow access to any of the files within the directory.

We can go to another directory by deleting another bit of the web address so it becomes

http://www.bgmi.us/web/

And there's a standard page listing the files and directories because no one has written an index.html file. It's possible to click into directories where the user has set read access. In this case there seems to be some sort of encyclopedia.

http://www.bgmi.us/web/cyclopedia/

There's a very long list of the web files there. There's no index.html (or index.htm) but there's a few files that look like index files.

There are lots more tricks like this that experienced online researchers can use to find nuggets of information that wouldn't be found using standard search engine-only techniques.

Funniest joke in the world

It may be surprising to learn that there's such a thing. Someone did a bit of research and managed not to win an IG Noble Prize.

http://en.wikipedia.org/wiki/World's_funniest_joke

(There's more information in the Google search and on the official site.)

I'm sad to say the winning joke is not that funny. I think there may have been a lot of German participants (seriously - that's not just acceptable racism coming out).

"

Two hunters are out in the woods when one of them collapses. He doesn't seem to be breathing and his eyes are glazed. The other guy whips out his phone and calls the emergency services. He gasps, "My friend is dead! What can I do?". The operator says "Calm down. I can help. First, let's make sure he's dead." There is a silence, then a shot is heard. Back on the phone, the guy says "OK, now what?

"

And here's the funniest joke in the UK according to the same research. It's the sort of joke you might not laugh at because it's not cool to laugh at that sort of thing.

"

A woman gets on a bus with her baby. The bus driver says: "That's the ugliest baby that I've ever seen. Ugh!" The woman goes to the rear of the bus and sits down, fuming. She says to a man next to her: "The driver just insulted me!" The man says: "You go right up there and tell him off – go ahead, I'll hold your monkey for you."

"

Here's the sort of joke that people don't laugh at because it's cruel yet there's a part of them that does want to laugh which makes it all the funnier. It is a brutal joke that's not funny for the humour, i.e. the unexpected punchline and the uneasiness it causes which is expressed with laughter. It's funny because it's brutal and sick though otherwise is as funny as What's brown and stick? A stick.

What's better than winning gold in the paraplegic Olympics? Walking.

It divides people's opinions more than I do and doesn't make me popular with the disablist fraternity/sorority. It's one of those jokes that can only be researched in the pub because people's attitudes in lab settings are totally different. I feel it is one that would show high levels of gender differences in the appreciation of the humour and these differences would be strongly biological as well as based on gender personality-type.

The important thing to remember is that different people have a different sense of humour.

http://www.bangedup.net/news/index.php wasn't the site I was looking for but it's relatively clean and I know there may be some faint hearted people reading this. That one's fairly clean but that's according to my disgusting standards.

www.bangedup.com was the site I was looking for to extend this ramble on humour into even darker territory. This is one of the sickest (and not sick in the good slang sense) sites I've ever seen, and I've been using the internet for over 15 years. I first came across it when it had just come out and I worked in a call centre. It very quickly viralled. Within weeks of it's release it was down and a notice up saying the site had too many hits so it was moved to another server. One day a few years later I was flicking through the list of the top 100 UK sites and there it was.

I haven't checked the site tonight and I don't particularly want to. If you know me and my sense of humour and cuntishness then consider that more of a warning than the "you have to be over 18 to view this". I remember being there at the call centre when people were laughing watching a video of a guy on a bike being hit by a car.

Of course I admit that I'm a sicko and I'm honest about what I find funny though have learned to repress my inner feelings that aren't acceptable to some people (who are, in general, of the female biological type). Perhaps you might want to see what kind of sicko you are by checking out www.bangedup.com.

Untreated depression seen through my self-harm scars

There's a really big scar from one of my self-harm attempts while I was going through hellish psychosis. It's a really big one that's described in an earlier blog post.

The scar is huge because it was untreated. I didn't know how to stitch it myself. I could have worked it out and done it but I'm not Rambo. I didn't think to take a needle and thread and DIY it.

There's an old study that shows that 85% of people recover from depression in a year without treatment. The study didn't really say enough about the actual outcomes.

Has my lack of treatment created a huge scar that will heal but leaves a big and permanent gash on my psyche and life? Yeah. Probably. C'est la vie.

Lunacy is a myth

http://www.gjpsy.uni-goettingen.de/gjp-article-owens.pdf
Owens, M. et al., Madness and the Moon: The Lunar Cycle and Psychopathology, German Journal of Psychiatry

Lunacy is a synonym of madness and comes from the same root as the word "lunar" though from the best modern science this simply isn't true. Several trials have looked at data and today there is no link between the moon and madness or what is known as the Transylvannian effect,
though there is a possible link between lunar cycles and physical disease.

In a review of 11 studies only 1 showed any correlation. In a very large study that look at all suicides over 10 years in the US there was no result. Hospitalisations don't increase and neither does violence in modern studys. One small, lower quality study showed no effect on
affective disorders but a strong effect on quality of life for people with psychotic disorders; its a fascinating result from the only piece of research mentioned in this paper however like swallows in spring it doesn't mean much.

The study is short and worth a peruse.

A surprising result on love

I'd expected a search of articles in Google Scholar with "love" in the title to give a tiny number of studies compared to the number with "depression" in. In fact there are barely twice as many academic sources on depression as there are on love.

http://scholar.google.co.uk/scholar?as_q=love&num=100&btnG=Search+Scholar&as_epq=&as_oq=&as_eq=&as_occt=title&as_sauthors=&as_publication=&as_ylo=&as_yhi=&as_sdt=1.&as_sdtp=on&as_sdts=5&hl=en

http://scholar.google.co.uk/scholar?sourceid=chrome&q=allintitle:%20depression&um=1&ie=UTF-8&sa=N&hl=en&tab=ws

However since 2000 there are just over three times as many on depression as on love.

http://scholar.google.co.uk/scholar?hl=en&q=allintitle:+love&as_sdt=2000&as_ylo=2000&as_vis=0

http://scholar.google.co.uk/scholar?hl=en&q=allintitle:+depression&as_sdt=2000&as_ylo=2000&as_vis=0

And drops back to around 2 times looking at sources from 2009.

There still significant. If I included "depressive", "melancholia" and other broad synonyms for intense unhappiness there may be a bigger effect.

The point I was going to make is that unhappiness is thoroughly medicalised however love doesn't seem to be. There'd be an interesting pub debate on whether is should be medicalised. In a way excessive love is - stalking may be considered a form of mental illness though I'm not sure under what diagnosis. I think there's a diagnosis in DSM-IV related to women who can't achieve orgasm. Liking sex too much is also in the American diagnostic criteria.

There certainly isn't a diagnosis for lack of love or avoidance of falling in love as far as I am aware. Living without that essential part of human life is something that many people live with, even people in relationships. The sadness of that makes me want to medicalise their sorrow, even if they don't recognise that they're missing out on a beautiful part of life.

The point I was hoping to make but I don't have the evidence to support it is that depression is medicalised because it affects people's work capability. A lack of love may cause depression but that is of little concern to medicine. It certainly offers no treatments. There are therapists who might advocate love as a treatment however they get struck off.

Would there ever be a society that could have "love leave" where a person needs to take time off because they've fallen in love and they want to enjoy that feeling and for it to blossom. I doubt I'd see that in my lifetime. It will be many decades before the shackles of Victorian conservatism and prudishness are overcome by progress towards the truer nature of humankind. The pub banter of "bet that person would chill out if they just had a shag" is where the wisdom remains.

I'm not sure if the barrier to a prescription of love (or sex in the jokey pub quote) becoming a regular treatment option is the prudish morality or the fact that the mental health care is becoming a system to keep people employed rather than anything to do with genuinely making life better for anyone. Certainly in the UK the people are seen as meat for the machine of society and improvements in mental healthcare are mainly in behavioural modification to get them back into whatever mindnumbing, soul crushing drivel that most people have to spend most of their adult lives doing.

Another post I have yet to write or perhaps I've written already is what I consider the next mental health system to be: unending, unconditional love for everyone by everyone. Its an insane idea but it comes from an understanding of why the second major mental health system (psychiatry) developed. Unconditional love for all means there would never have been the outcasts that were created as society changed during the Industrial Revolution/Age of reason. Homosexuality wouldn't have been treated as an illness. Psychosis would be an experience manageable in the community. Schizophrenia wouldn't exist.

I might as well as for heaven on earth....