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Are specialised affective disorder services useful?

  • Debra J. Shepherd (a1), Lisa M. Insole (a1), R. Hamish McAllister-Williams (a1) and I. Nicol Ferrier (a1)

Abstract

Across the UK there are a number of tertiary level affective disorder services, usually based in academic centres, that provide support for the management of patients with complex and treatment-resistant conditions. Such services play a potentially important role in instilling hope into patients, carers and healthcare teams in situations where therapeutic nihilism has often developed. They also provide a valuable reservoir of expertise on the use of medications outside of licensed usage, and new and emerging treatments. To date there is relatively little data regarding patient outcomes after referral to such services; however, what there is does suggest important benefits for both patients and healthcare economies. As ever, more research is needed.

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Are specialised affective disorder services useful?

  • Debra J. Shepherd (a1), Lisa M. Insole (a1), R. Hamish McAllister-Williams (a1) and I. Nicol Ferrier (a1)
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eLetters

Response to: Are specialised affective disorder services useful?

Muhanad Sawa, Specialty Registrar 5 in General Adult Psychiatry
10 June 2009

Corresponding author:Muhanad M Sawa MRCPsych,Specialty Registrar 5 in General Adult PsychiatryMersey Care NHS Trust,Windsor House,40 Upper Parliament Street,Liverpool,L8 7LFTel: 01512505324,Fax: 0150 709 7608

Fiona Craig MRCPsych,Consultant General Adult Psychiatrist,Mersey Care NHS Trust,Windsor House,40 Upper Parliament Street,Liverpool,L8 7LF

Dear Editor,

We would like to thank the authors of the Editorial article publishedin the Psychiatric Bulletin last February (Debra et al, 2009), which provided a welcome insight into specialist mood disorder services, with the possibility of bringing hope to those with chronic depression.

We would like to make a specific reference to the mention of hope andhow it is related to the prognosis of depression. Turner et al (2001) suggested that staff should be holders of hope and the significance of hope inspiring relationships between staff and workers was stressed in Pepper et al (2003). Hope is also gaining importance especially within thecontext of recovery. Schrank et al (2008) conducted a comprehensive review looking at different definitions of hope and current assessment tools. This increase in attention to the concept of hope serves to take usbeyond comments that it is simply a common sense notion.

The impression that was developed while reading the article is that the interventions of importance are mainly medical or even surgical. Apartfrom “instilling hope” due to the mere presence of such specialist services, there was little reference by the authors to the psychological or social interventions provided by these centres. For those less inspired by the medical model in terms of understanding their depression, this approach might run the risk of disillusionment as a result of misplaced hope.

Depression’s aetiology is multi-factorial with psychological traumas in early childhood playing an important role in developing depression in later life. Psychological interventions for severe cases of depression arewell established therapeutic options. National Institute for Health and Clinical Excellence (NICE) guidance on treatment of depression recommends CBT based therapies, Interpersonal Therapy, Couple-focused therapy and Psychodynamic psychotherapy. These options should be considered and provided if patient’s choice favours this (NICE, 2007). Some of our patients are not medically minded and would rather choose a psychotherapeutic intervention, or require social interventions or change to bring about any lasting improvement. Specialist services no doubt can and do bring hope and recovery to many; but significant investment in the medical models described might risk disempowerment and ultimate loss of hope.

Declaration of interest: nil

References

Great Britain. National Institute for Health and Clinical Excellence (2007) Management of Depression in Primary and Secondary Care. London: National Institute for Health and Clinical Excellence.

Repper, J. and Perkins, R. (2003) Social Inclusion and Recovery: A Model for Mental Health Practice. London: Bailliere Tindall.

Shepherd, D. J., Insole, L. M., Mc-Allister-Williams, R. H. and Ferrier, I. N. (2009) Are specialised affective disorder services useful? Psychiatric Bulletin, 33, 41-43.

Shrank, B., Stanghellini, G. and Slade, M. (2008) Hope in psychiatry:a review of the literature. Acta Psychiatrica Scandinavica, 118(6), 421 – 433.

Turner, D. & Frak, D. (2001) Wild Geese: Recovery in National Schizophrenia Fellowship. Wales: Green Gauge Consultancy and N.S.F Wales, Powys.
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Conflict of interest: None Declared

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