Efficacy of antidepressants in adults -- Moncrieff and Kirsch 331 (7509): 155 -- BMJ

Efficacy of antidepressants in adults -- Moncrieff and Kirsch 331 (7509): 155 -- BMJ

(Recommended by Marcelo Gustavo Colominas [mgcolominas@gigared.com])
Most people with depression are initially treated with antidepressants. But how well do the data support their use, and should we reconsider our strategy?

Evidence-Based Mental Health Treatments and Services

Evidence-Based Mental Health Treatments and Services:
Anthony F. Lehman, Howard H. Goldman, Lisa B. Dixon, and Rachel Churchill
"The purpose of this report is to inform policymakers about the significance of recent advances in evaluating evidence for allocating resources to and within public mental health programs. These advances are of particular importance because the public sector is the largest payer for services to persons with chronic mental illness.
The authors' central point is that the best evidence yields both good and bad news. The good news is that 'many potentially available treatments and services' have been shown to produce 'improved symptoms and functioning' in patients with severe, persistent mental illness. The bad is that 'there are substantial gaps between what science tells us to do and what we do in actual practice, despite the significant investment of public resources.'
The research about which the authors report is increasingly useful to policymakers and clinicians. Many scientists are working collaboratively, often across national boundaries, to collect, analyze, and synthesize evidence about interventions to prevent and treat illness. A recent Milbank Report describes this international scientific advance (Ray Moynihan, Evaluating Health Services: A Reporter Covers the Science of Research Synthesis). "

Risk for schizophrenia and schizophrenia-like psychosis among patients with epilepsy: population based cohort study -- Qin et al. 331 (7507): 23 -- BMJ

Risk for schizophrenia and schizophrenia-like psychosis among patients with epilepsy: population based cohort study -- Qin et al. 331 (7507): 23 -- BMJ: "Risk for schizophrenia and schizophrenia-like psychosis among patients with epilepsy: population based cohort study
Ping Qin"
The association between epilepsy and psychosis has been researched since the nineteenth century. Several studies1-4 but not all5 6 have found a higher prevalence of schizophrenia-like psychosis in patients with epilepsy compared with the general population. Yet many questions remain unanswered and large scale studies using empirical data are scant.7 The causal mechanism underlying the association is unclear. Seizures may damage the brain, which may in turn increase the risk of schizophrenia-like psychosis, or the two conditions may share common aetiological factors. These hypotheses may be disentangled by evaluating the risk of schizophrenia-like psychosis in people with a family history of epilepsy.8 Genetic vulnerability to psychosis may facilitate the development of psychosis in the patients with epilepsy.9 10 However, there have been no published family history studies with appropriate methods.8 In addition, differences in risk of developing psychosis—for example, by type of epilepsy, age at onset, and number of admission to hospital—remain poorly understood.

In this population based cohort study we examined the risk of schizophrenia or schizophrenia-like psychosis associated with a history of epilepsy using data from Danish longitudinal registers. We also investigated how and to what extent this risk is influenced by family histories of psychosis and of epilepsy.