In the February 2025 edition of Magnify – the Journal Club blog from BJPsych – Dr Angharad de Cates and Dr Merryn Anderson chair a journal club in collaboration with Cornwall Partnership Trust, discussing ‘Associations between multimorbidity and neuropathology in dementia: consideration of functional cognitive disorders, psychiatric illness and dementia mimics’. They are joined by a group of early career psychiatrists who presented an appraisal of the paper, and who have written a blog post discussing their reflections on the process. An expert panel, including the senior author of the paper, also joined the discussions.

Jessica Nicholls-Mindlin

Presenting at the British Journal of Psychiatry Journal Club was a fantastic experience. It was an opportunity to do a deep dive into a scientific paper, and then hear opinions of the authors and other eminent researchers in the field.

I don’t know the literature around older age psychiatry and multiple conditions, so it was great to gain some insight into this area. Initially, I was concerned that reviewing a paper in a field I am not familiar with would make it harder to critically appraise. However, I found that an outside view in some ways made it easier, as I was not so focussed on the relevance of the findings to my own work, and instead could hone in on the methods.

Research into the effect of multi-morbidity on dementia pathology is challenging because it is by nature observational – you can’t do a randomised trial where you give participants multiple illnesses! Because of this, it can be hard to disentangle whether the multiple conditions are causing changes, are early signs of dementia itself, or are associated with another factor that is also associated with the outcome. This gave us lots to think about in the appraisal, considering how we can glean evidence of a true link between the two from observational work.

Joe is a senior registrar in older age psychiatry so he is knowledgeable in this area, which was helpful in interpreting it in context. We met initially to discuss the paper and plan our appraisal. We then split up the presentation preparation: Joe looked at the aims, introduction and methods, and I looked at the results, discussion and conclusions. We both had to go through the whole paper thoroughly to understand our sections in context, but it was helpful to have a specific area to focus on. Before the event, we had a practice run through with Angharad and Tiago. This was great opportunity to talk through some of the specifics of the appraisal and check the presentation was coming across clearly in a supportive environment.  

Reflecting on my critical appraisal after hearing the views of the authors and expert panel, I think the discussion gave me a broader view of the significance of the paper in context. It is easy to get caught up in the minutiae when you are critically appraising a paper, but the discussion reminded me of the importance of asking the bigger questions. Is this a relevant area? What does multi-morbidity really mean? How does the premise of the study – that individuals needed to be dead to be included so their brains could be pathologically examined – affect who is included?

Overall, the BJPsych JC experience was an exciting event to be part of, and I will take forward learning from this to future reading and research. 

Joseph Thorne

Presenting at the British Journal of Psychiatry Journal Club was an really rewarding experience. It offered a chance to thoroughly engage with a scientific paper, critically evaluate its methodology, and gain valuable insights directly from the authors and other leading researchers in the field. Working within a research-focused service, this experience helped me further develop my critical analysis skills while expanding my knowledge of older age psychiatry and its intersection with multi-morbidity. This perspective deepened my appreciation for the complexities involved in studying the impact of multi-morbidity on dementia pathology, particularly given the inherent challenges of observational research. The difficulty of untangling causation, early signs of dementia, and confounding factors sparked thought-provoking discussions about extracting meaningful evidence from non-experimental studies.

I collaborated on the presentation with Jess, an academic trainee with a strong grasp of the methodological aspects of the paper. Collaborating with her provided an excellent opportunity to exchange ideas and refine our approach to the appraisal. One of the session’s highlights was the participation of the paper’s authors in the discussion. Their contributions clarified the finer points of their methodology and provided a broader context for the significance of their work.

Overall, the BJPsych Journal Club was a highly educational and engaging experience. It underscored the value of collaborative learning and critical thinking while offering new insights into the challenges and importance of observational research in psychiatry. The skills and perspectives I gained from this experience will undoubtedly enhance my approach to future research and appraisals.

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