Volume 1, Issue 1, Summer and Autumn 2018
2018, Volume 1, Issue 1, Pages 1-2
Scientifi c publishing is a cornerstone of clinical practice. Credible content is critical, and sources of such content
equally so. A major challenge confronting researchers is publishing their data. Whilst publications are available in
abudance, the process of seeing completed research appear in print is more likely the exception and not the rule. Some might argue that the possibility of bad science in print needs to be contained given this attitude. A valid point, assuming all that is published is good science. We have no way of knowing how much good data does not fi nd its way into the scientifi c literature, but we certainly know that not all data that does is indeed good.
Th ere are numerous reasons why research does not get published, not least of which is that notwithstanding
the plethora of available titles in which to publish – it is competitive. Each journal has a specifi c focus, target market and requirements. Th ere is seemingly a fi nite capacity, and one cannot, of course, ignore cost. Th en come the publishing costs. Th e publishing industry is for profi t, and if not profi table at the very least costs must be covered by the publication if they are not owned by one of any number of publishing houses (where cross subsidization may be possible). Costs and budget have implications for frequency of issues, number of pages per issue, publication format, distribution and so on. Someone has to pay, not only to cover costs of publication
but also access to the publication where costs are not covered up front by authors. Certainly the publishing landscape has evolved and will no doubt continue to do so. Th e issue of access is germane as it speaks to many factors that impact on researchers, both in the so called developed world and most certainly in the developing world (whose countries fi nd themselves known as Low and Middle Income Countries, i.e. LAMIC). With an emphasis on LAMIC, the World Psychiatric Association (WPA) has had an important role to play in recent times. Various operational committees and task teams under the guidance of various secretaries for scientifi c
publications have engaged in activities to address some of the experienced diffi culties encountered by LAMIC member societies. Th ese include access to skills, access to credible publishing platforms, and accessing content, to name a few. To this end, various WPA–facilitated developmental agendas have been implemented. Th ese have included WPA hosted workshops aimed at improving quality of local publications (Szabo et al. 2010). Th e aim has been indexation in credible scientifi c databases (Mari et al. 2011). Local policy should ideally be informed
by local content. Local content should be available in credible publications that serve not only a local audience. Sharing of credible data cannot simply be a one–way stream from developed to developing world countries as if the developing world has little to off er by way of science. Developed world researchers certainly frequent developing world countries to access clinical material, which invariably is published in journals not necessarily accessible to the population of psychiatrists whose patients comprise the sample. Th e WPA, through World Psychiatry, might consider having special issues for cross–cultural studies and those that have been conducted in LAMIC.
For local data to be available in credible local publications that serve an international audience, these publications need to be indexed in certain databases. Inclusion in these databases is generally problematic for local publications insofar asthey struggle to meet the minimum standards required for inclusion. Hence the aforementioned WPA workshops are conducted. To this end, the WPA has through their website – in the past triennium - initiated the development of a database that seeks to include all member society open access publications, i.e. the provision of a platform for dissemination that in effect by passes existing databases to which access can be limited.
Finally, LAMIC researchers struggle to publish in the major publications that inform the discipline. Scientific writing and how to get published is certainly an area where the WPA, in the interests of world psychiatry, has played a role through hosting of targeted workshops with interactive sessions at WPA congresses over the past triennium for junior researchers and so called early career psychiatrists. The aim has been to provide both helpful information as well mentorship, where local mentorship in their home countries is lacking. This could be developed further, e.g. through inclusion of recorded clips on the WPA website by established and previous editors of major journals with tips on choosing the right journal, pitching an article to the right source, giving examples of well written and
not so well written articles and how editors think. If the WPA is to serve the world, it needs to pursue a
developmental agenda that is truly global in scope, recognizing the need to close the gap between developed and developing.
Specific initiatives have demonstrated a commitment to such an agenda (Szabo et al. 2012). The next triennium of office bearers recently elected at the WPA Congress in Berlin (October 2017) will hopefully continue with such work.
2018, Volume 1, Issue 1, Pages 3-6
Many books and other published recommendations provide a large, sometimes excessive amount of information to be included, and of mistakes to be avoided in research papers for academic journals. However, there is a lack of simple and clear recommendations on how to write such scientific articles. To make life easier for new authors, we propose a simple hypothesis-based approach, which consistently follows the study hypothesis, section by section throughout the manuscript: The introduction section should develop the study hypothesis, by introducing and explaining the relevant concepts, connecting these concepts and by stating the study hypotheses to be tested at the end. The material and methods section must describe the sample or material, the tools, instruments, procedures and analyses used to test the study hypothesis. The results section must describe the study sample, the data collected and the data analyses that lead to the confirmation or rejection of the hypothesis. The discussion must state if the study hypothesis has been confirmed or rejected, if the study result is comparable to, and compatible with other research. It should evaluate the reliability and validity of the study outcome, clarify the limitations of the study and explore the relevance of the supported or rejected hypothesis for clinical practice and future research. If needed, an abstract at the beginning of the manuscript, usually structured in objectives, material and methods, results and conclusions, should provide summaries in two to three sentences for each section. Acknowledgements, declarations of ethical approval, of informed consent by study subjects, of interests by authors and a reference list will be needed in most scientific journals.
A systematic review on the effect of Ramadan on mental health: minor effects and no harm in general, but increased risk of relapse in schizophrenia and bipolar disorder
2018, Volume 1, Issue 1, Pages 7-16
Globally, Moslems are the second largest religious group. During the month of Ramadan from dawn to sundown, healthy Moslems are required to refrain from eating, drinking, smoking, sexual activity and harmful behaviour towards others and themselves. Thus Ramadan may change individual physical states and social interactions. Both might affect mental health within society. Consequently, this systematic review looks at the various effects of Ramadan on mental health.
A literature search on Ramadan and mental health initially identified 294 papers. We finally selected all 22 relevant papers covering Ramadan and mental health from which study data were extracted.
Relevant papers focussed on the general population and healthy volunteers, on subjects practising sports, on subjects with severe physical disorders, on subjects at risk of eating disorders and on subjects with mental health disorders. The effects of Ramadan on mental well-being were mixed. Positive and negative effects were usually minor, except in subjects with schizophrenia and metabolic syndrome, and in subjects with bipolar disorder who suffered a substantial increase of relapses.
Ramadan fasting is safe in most conditions and disorders, but caution is required in subjects with schizophrenia and bipolar disorder. The research on mental health and Ramadan would profit from larger studies with more representative samples to help understand the intra-individual and social factors that affect the mental health and well-being in patients and in society. The scientific potential of such studies may have been overlooked in the psychiatric community.
Antidepressant drugs for older patients on polypharmacy: a systematic review reveals best evidence for sertraline
2018, Volume 1, Issue 1, Pages 17-24
There is almost no data on antidepressant prescribing in older adults treated with polypharmacy, although this population represents approximately 50% of older patients. These patients are frequently excluded from double-blind randomized controlled trials, meta-analyses and existing treatment guidelines. The main aim of this paper was to identify data on antidepressant prescribing in depressed older adults on polypharmacy using a systematic review.
Randomized controlled clinical trials (RCTs) and other clinical trials in Medline/PubMed without language limitation (-2017) were searched to identify those with older depressed patients on polypharmacy. Only elderly patients (>65 years as mean) were included. Only approved antidepressants were included.
The systematic search identified 26 different clinical trials, although only one clinical open label trial with sertraline met the final inclusion criteria. This sertraline trial indicated the absence of clinically important drug-drug interactions and confirmed the effectiveness and safety of sertraline in routine clinical practice. Heterogeneity in this trial was high in almost all the categories except attrition and reporting bias.
Sertraline has the highest evidence level in older adults with depression on polypharmacy. According to the results of this review and due to a low number of appropriate trials, a basic understanding of psychopharmacology is the possible approach to avoid serious problematic drug combinations in these patients. Newer RCTs are also urgently needed. This is the first systematic review including patients treated with polypharmacy, and therefore, its results are important in the field of evidence-based medicine.
Football does not improve mental health: a systematic review on football and mental health disorders
2018, Volume 1, Issue 1, Pages 25-38
Both football (also called association football or soccer) and mental health disorders have a global impact on the lives of billions of people. Football has been used to approach and support subjects with or at risk of mental health disorders. However, it is not clear if football itself has any beneficial effect on the mental health of players, fans or spectators. Consequently, the aim of the current systematic review was to examine if playing or watching football impacts on the frequency of mental health problems in people who are involved in playing or watching the game.
We performed a systematic review on the relationship between football and mental health disorders. A total of 662 abstracts were screened initially. We identified 17 relevant papers assessing the prevalence of mental health disorders in current and previous football players, referees or spectators.
The prevalence and 12 months incidence of mental health problems in active and retired professional players and referees were similar to or higher than those found in the general population, possibly as response to osteoarthritis, severe injuries, career dissatisfaction, low social support and poor employment status after retirement. Studies in adolescent amateurs and spectators indicate that playing and watching football games may negatively affect subjective mental health, even though qualitative studies indicate mental health benefits of playing or watching football.
Players, referees and spectators are unlikely to present with fewer mental health problems than other members of society as a result of their involvement with football. It appears that some of the infrastructure that supports resilience in mental health such as a sense of inclusion, shared purpose and positive peer identification might be developed by playing in or supporting a team. Strategies that may use the assumed positive aspects of football need to be validated before implementation of large projects.