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Does N-acetylcysteine decrease irritability in autism? (Håvard Bentsen, 18 November 2013)

N-acetylcysteine (NAC) is a very promising psychotropic agent (Dean O et al, J Psychiatry Neurosci 2011). Nevertheless, the conclusion about its efficacy in autism, reported from a RCT by Ghanizadeh A & Moghimi-Sarani E in BMC Psychiatry 2013;13(196), does not seem to be warranted. The authors used a repeated measures ANOVA (Last Observation Carried Forward) approach to test the effect of NAC on the irritability subscale of the ABC inventory. They stated that the effect of groups was significant (p=0.035), but that the time*group effect was not (without showing the F- and p-values). They interpreted this as NAC reducing the irritability score more than placebo. However, as can been seen from Figure 2, it is the mean level of scores during the study... read full comment

Comment on: Ghanizadeh et al. BMC Psychiatry, 13:196

Psychiatric disorders of patients seeking obesity treatment - an earlier Asian study findings (Maniam Thambu, 14 November 2013)

I read the interesting and informative paper by Lin H.Y. et al [doi:10.1186/1471-244X-13-1] on the rate of psychiatric disorders among patients seeking treatment for obesity in Taiwan. The authors state that, to their knowledge, there has been no similar Asian study. I would like to draw the authors' attention to an earlier Malaysian study that we conducted on patients who sought treatment in a dietitian clinic for their obesity (Loo et al Psychiatric Morbidity, Personality Profile and Saliva Cortisol Levels in Overweight and Obese Patients Referred to Dietician Clinics in UKMMC. Malaysian Journal of Psychiatry 2011; 20: 4-15 []. Readers may note the similarities in terms of the setting (a university teaching hospital) and... read full comment

Comment on: Lin et al. BMC Psychiatry, 13:1

No evidence for a specific link between malingering and delayed-onset PTSD (Geert E Smid, 19 July 2013)

In their abstract, Ahmadi et al. [1] note that malingering is prevalent, especially in delayed-onset PTSD. The propensity of PTSD to occur with delayed onset has been formally recognized since its inclusion in the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980. Delayed PTSD was included in the initial definition of PTSD to accommodate the syndrome encountered in Vietnam veterans [2]. The inclusion of PTSD in DSM-III led to its acceptance as a potentially compensable disorder by the U.S. Veterans Administration. Subsequently, a rise in benefit claims by US veterans for the disorder was noted [3]. This historical situation has led to a persistent association between malingering and delayed-onset PTSD in the... read full comment

Comment on: Ahmadi et al. BMC Psychiatry, 13:154

Display of formulas 1 and 2 in the on-line version of the paper. (Scott Patten, 10 March 2013)

Equation 1 and 2 are jumbled in the on-line version.
I've sent a note to BMC asking them to fix it, but in the meanwhile it seems that deselecting the MathJax display tick box in the header of the paper corrects the problem. The pdf version is OK as well.

Scott Patten read full comment

Comment on: Patten BMC Psychiatry, 13:19

Exposure or Tolerance to Exposure?. (Eric Harris, 25 October 2012)

I applaud the authors' investigation of predictors for development of mental disorders, but think that the title (and similar language in the article) might cause the reader to misunderstand their finding. That is, subjects were classified as "exposed" only if they reported being ¿bothered a lot¿ by exposure to one of several potential stressors. Therefore, it is likely the subjects' reaction to or copiing with the event that is the predictor rather than the mere exposure to such events. read full comment

Comment on: Herzig et al. BMC Psychiatry, 12:120

Comments: Systematic review of beliefs, behaviours and influencing factors associated with disclosure of a mental health problem in the workplace (Rajshekhar Bipeta, 25 October 2012)

This is a very good manuscript. Well written. Of clinical interest. I never thought this could be a topic one can write on. I would like to replicate the study in my country (India).
Psychiatrist read full comment

Comment on: Brohan et al. BMC Psychiatry, 12:11

Numerical error (Virpi Kauko, 28 June 2012)

"Austria had 86 filicide victims and Finland had 66... read full comment

Comment on: Putkonen et al. BMC Psychiatry, 9:74

Tool clarification : Scale for Assessment of Somatic Symptoms (Geetha Desai, 27 March 2012)

The article ¿the relaxation exercise and social support trial resst: study protocol for a randomized Community based trial¿ published by Kobessi et al in 2011 is a very interesting intervention study from a developing country with limited resources. The authors have assessed the common mental disorders using Hopkins checklist for anxiety and Depression. They have used Scale for Assessment of Somatic symptoms (SASS) for assessing Somatization as mentioned in the article. The authors have mentioned the scale as Patel somatisation scale... read full comment

Comment on: Kobeissi et al. BMC Psychiatry, 11:142

Clinicians' views are important: this study adds to understanding - but the measure of their attitudes should be correctly named. (Mark Haddad, 26 November 2011)

Demyttenaere and colleagues' study of the views of GPs and psychiatrists about depression addresses an important topic, and extends our understanding of the elements of outcome that are considered important by clinicians as well as the relationships between their attitudes and aspects of clinical practice.

This paper rightly seeks to unravel some of the complexity of what comprises depression and what is important in defining recovery from this condition.

The authors appropriately recognise that the patient's perspective is a most important aspect of such enquiry - which is missing from this study. They correctly identify other potential weaknesses in their study; but although they note some of the inconsistencies in the results of previous factor analyses of... read full comment

Comment on: Demyttenaere et al. BMC Psychiatry, 11:169

Remembering Kraepelin (Mahesh Rajasuriya, 19 September 2011)

I read this article with interest. And it made me think about the contribution, if any, it made to psychiatry. And then I couldn’t help thinking about the original descriptions of Kraepelin on manic-depressive psychosis. The single most important contribution Kraepelin made to psychiatry was towards defining psychiatric syndromes by way of analysis of large clinical samples to describe psychopathology and illness-course, along with efforts to define psychobiologically coherent and clinically differentiable entities1.

In this article Hanwella and de Silva try to fine tune the definitions of phenomenology of mania, treading, though in a largely smaller scale, the same pathway Kraeplin did over a century ago. And they have been able to utilise modern... read full comment

Comment on: Hanwella et al. BMC Psychiatry, 11:137

Inflammation might underlie both asthma and ADD (Carr Smith, 09 September 2011)

Recently (BMC Psychiatry 2011, 11:128), Fasmer and colleagues reported that "Adult attention deficit hyperactivity disorder is associated with asthma." These findings are consistent with a growing body of literature that reports evidence of systemic inflammation in patients experiencing mental disorders. Previously, Masopust et al. (2011) showed that markers of thrombogenesis are activated in unmedicated patients with acute psychosis. Similarly, Drexhage et al. (2011) recently described a monocyte pro-inflammatory state in patients with bipolar disorder. The findings of these and other authors raise a very important question, "Is the pro-inflammatory state seen in mental disorders part of the pathogenesis and therefore a potential therapeutic target, or is the inflammation an association... read full comment

Comment on: Fasmer et al. BMC Psychiatry, 11:128

Common sense: Benzo-free MMTP (Donald McDonald, 19 August 2011)

it puts patients at higher risk of life-threatening multiple drug overdoses.

----Ours is a benzo-free clinic. We will outpatient taper the client from BZD's while together we pursue FDA approved options for anxiety relief. If the client remains in non-compliance we will taper him off methadone and release him from the program.

47% of the respondents had a history of BZD use, and 39.8% used BZD without a prescription. Half of the BZD users (54%) started using BZD after entering the methadone program, and 61% of previous BZD users reported increased or resumed use after entering methadone program

---Because they ARE addicts, not EX-addicts. They no longer feel the same euphoria and escape of their drug of choice, so they turn to... read full comment

Comment on: Chen et al. BMC Psychiatry, 11:90

Can findings be explained on the basis of brevity of inpatient hospitalizations? (James Dillon, 17 August 2011)

The circumstances described in this excellent and straightforward article mirror less rigorously formed impressions on this side of the Atlantic. In Michigan (USA) medical directors in the community (outpatient-based) mental health sector ascribe high rates of antipsychotic polypharmacy to hospitalization per se, as much as to treatment resistance or case complexity, though the latter may be contributing factors.

One view (I will call it the "brevity of hospitalization" hypothesis) is that very short inpatient hospitalizations, typically a week or less in duration, encourage polypharmacy. Cross-titration of drugs, adequate treatment trials, testing of adherence as a source of treatment failure, etc., cannot be accomplished in just a few days. Typically a patient arrives in a... read full comment

Comment on: Bolstad et al. BMC Psychiatry, 11:126

Further approaches to evaluating brief contact interventions for suicidal behaviour (Jayne Cooper, 01 April 2011)

We read the protocol by Vaiva and colleagues with interest. (1) We have reviewed contact-type interventions for suicidal behaviour and found that they had equivocal results. (2) Further work in this area is clearly necessary and studies like Professor Vaiva’s are to be welcomed. Rather than attempt to replicate existing work, we adopted an alternative approach, using qualitative methodologies to investigate the views of service users and staff regarding contact-based interventions (for example letters, telephone calls or crisis cards) following self-harm (3). We interviewed self-harm patients recently discharged from an emergency department, and clinical and voluntary staff from relevant service areas who took part in a focus group and individual interviews. Analytic themes using... read full comment

Comment on: Vaiva et al. BMC Psychiatry, 11:1

Addressing thrombotic potential in acutely psychotic patients (Carr Smith, 15 March 2011)

To the Editor: Masopust et al.'s recent demonstration of potentially increased risk of thrombosis in unmedicated acutely psychotic patients is both consistent with the limited literature (Akhondzadeh et al., 2007; Muller et al., 2010) and raises an important question, i.e., "What if anything should be done about the increased risk of thrombosis in acutely psychotic patients both medicated and unmedicated?" Given the current state of limited knowledge regarding whether systemic inflammation and brain inflammation in mental patients is entirely a harmful phenomenon (Wee Yong, 2010), maybe an interim middle course, e.g., administration of high-dose omega-3 fish oil as one example, could be considered as it might reduce the risk of thrombogenesis with minimal gastrointestinal risk. Several... read full comment

Comment on: Masopust et al. BMC Psychiatry, 11:2

The relationship between sales of SSRI with Suisidal Rate (kithsiri senanayake, 12 January 2011)

The suicidal rate in Sri Lanka had been very high, and it was the highest rate in the world. However the incidence is drastically declined past few years and the reason for this decline is multifactorial. There are no data as to say whether the sales of SSRI increased in Sri Lanka but apparently the use of SSRI is increased among the population. It is very difficult to correlates the suicidal risk to the SSRI sales in general population because of following reasons.

1. SSRI became popular due to its low side effects profile

2. SSRI are used not only as an antidepressant but also as anxiolitic, for the personality disorders, and as a treatment for insomnia etc.

3. The magnitude of benefit of antidepressant medication compared with placebo increases with... read full comment

Comment on: Zahl et al. BMC Psychiatry, 10:62

Reply to Aage Tverdal: Sales of SSRI and suicide rates (Per-Henrik Zahl, 23 December 2010)

Tverdal et al. [1] have previously published that there was a negative association between increasing sales of selective serotonin re-uptake inhibitors (SSRIs) and declining suicides rates in the early 1990’s in Norway. He suggested that the rapid swift from using SSRI to using tricyclic antidepressiva (which are potentially more toxic than SSRI) could explain why suicide rates fell early in the 1990 but not later. We published that if we aggregate all Nordic countries, there is no statistical association [2].

Tverdal writes that “Heterogeneity between the countries is more prominent than a null effect”. First, we did not say there was no effect in all countries. We argued that the association varied between countries and that the average effect was null... read full comment

Comment on: Zahl et al. BMC Psychiatry, 10:62

Sales of SSRI and suicide rates (Aage Tverdal, 15 October 2010)

Zahl and collegues have done an ecologic study and found no evidence of any inverse relationship between the increase in sales of SSRIs and the declining suicide rates in four Nordic countries.
Data were analysed by Fisher's exact test and Pearson's correlation coefficient, according to the abstract.
I suspect that country has not been taken into account in the analyses. Table 1 gives the data on which the analyses are made. The overall Pearson correlation coeffcient between annual changes in suicide rates and annual changes in sales figures of SSRIs is 0.06 (p=0.76). Country specific correlations are -0.54 (p=0.17), 0.78 (p=0.02), 0.25 (p=0.55) and -0.98 (p=0.02) for Norway, Sweden, Finland and Denmark, respectively. Heterogeneity between the countries is more prominent than a... read full comment

Comment on: Zahl et al. BMC Psychiatry, 10:62

breakaway training. Evidence it works (nick cox, 09 July 2010)

The other side to argue about the effectivness of breakaway training is how often the training is undertaken. Currently most healthcare institutions only insist on it being undertaken on a yearly basis. Should this be increased to a 6 monthly system then i would predict a rise in abilities. Could we possibly expect a person to remember a technique they learnt a year ago when also faced with many other factors. Having coached breakaway training for many years now i have always strongly argued that a six monthly refresher should be undertaken. Another point which could be viewed is the techniques themselves, a person would have a higher chance of remembering a technique which is based on their cognitive response rather than a technique which may not be based around their natural response.... read full comment

Comment on: Ghroum et al. BMC Psychiatry, 7:S88

Genetic Marker for Wishful Thinking? (James Dillon, 24 June 2010)

In this study of methylphenidate treatment of ADHD the authors found a genotype by treatment interaction leading them to conclude that the "...5-HTTLPR polymorphism of the SLC6A4 gene in children with ADHD... appears to modulate the behavioral response to methylphenidate in children with ADHD as assessed in the home environment by parents." Figure one and the article's narrative suggest that this difference is attributable almost entirely to a robust placebo response among children of the s's' genotype. On its face, then, this tells us very little about response to methylphenidate. But why would a placebo-response occur in a sub-group of subjects? One possibility is that a particular species of ADHD characterized by this genotype is predisposed to greater variablity, though this seems... read full comment

Comment on: Thakur et al. BMC Psychiatry, 10:50

Smoking restrictions could be detrimental for Acute Psychiatric Services (simmi sehgal, 12 May 2010)

Imposing smoking restrictions in psychiatric inpatient units could prove not being in the best interests of the patients. Firstly it has been shown by research studies that due to this restriction, the contact of crisis services by psychotic patients has been reduced. Also the rate of violent incidents towards members of staff has increased.
There could also be a possibility of the psychotic symptoms getting worse due to the use of nicotine replacement patches read full comment

Comment on: Viala et al. BMC Psychiatry, 7:P1

Too many errors for a reputable journal (Ellen Goudsmit, 12 May 2010)

Allergic encephalomyelitis? Surely they mean myalgic encephalomyelitis. Alas, it was just the first of a number of oddities and highly uncritical statements. 'Discomfort post effort' as a minor criterion? Isn't it post-exertional fatigue? That's vague enough. Why make things worse? CFS affects 2.5% of the population? I think the research reported 2.6% using the CDC criteria 1994 and including patients with comorbid psychiatric disorders. Where's pacing, rated consistently as one of the three most helpful strategies for CFS. Safer than graded exercise and not counter-intuitative (if minor activity triggers symptoms, why should increasing minor exertion decrease it? Isn't it like suggesting to a smoker with lung cancer that smoking a few more every few days might help improve their condition?... read full comment

Comment on: Avellaneda Fernández et al. BMC Psychiatry, 9:S1

Psychotherapy with Primary Health Care and the role of GPs (Aditya Mungee, 05 August 2009)

In times when Psychiatrists lament the decline of Psychotherapy as part of the identity, skill set, and training of psychiatrists in developed countries [1] it is heartening to see a positive attitude for Psychotherapy in this study conducted among the general public of Karachi.

Only 300 Psychiatrists for a country which is estimated to have a population of 220 million by 2020 [2] implies that a large proportion of the population is dependent on the General Practitioner for Psychiatric health care.The finding that GPs are a close second preference for initial consultation in case of symptoms suggestive of psychiatric disorder in this study goes on to emphasize the need to train GPs in diagnosing and managing common psychiatric disorders.Though previous results of such training... read full comment

Comment on: Zafar et al. BMC Psychiatry, 9:37

Counting Problem? Typo (Franz Gstättner, 01 July 2009)

There are total 413 patients (Table 4, page 28). But when i sum "reasons given for the client seeking help" (236 + 59 + 45 + 28 + 15 + 14 + 9 + 8) there are 414. ? And the % are 101. read full comment

Comment on: Bartlett et al. BMC Psychiatry, 9:11

Behavioral therapy (tpain hunk, 19 January 2009)

Combination treatment of behavior therapy and medication significantly reduces obsessive-compulsive symptoms in people who have responded to pharmacological drug treatment. Behavior therapy is beneficial for patients who have responded to drug treatment. The motivational therapy is the combination of the humanistic treatment with high ethics and the cognitive behavioral strategies. read full comment

Comment on: Kornør et al. BMC Psychiatry, 8:81