Issue 2 www.wolfson.qmul.ac.uk/psychiatry

INS IDE

THIS

ISSUE.. .

Showing the way to treating Chronic Fatigue Syndromeby Peter White

Old age psychiatrist reports from the Frontlineby Sandra Evans

Conference Report:Cultures of the Internet | Identity, Community and Mental Health

by Kamaldeep Bhui

Latest News in Environmental, Cultural and Health Systems Research

C E N T R E F O RNewsletter

Spring 2011

P S Y C H I AT RY

Join PSI - a new interest GroupGain a new perspective on life in the streets of London

by Ania Korszun

IT’S BEEN A LONG WINTER

At last it’s time to welcome you to the Spring Edition of our Centre for Psychiatry Newsletter. NHS cuts, an economic crisis, a research excel lence f ramework review on the horizon. Yet we still have ambitions to maximize high quality undergraduate and postgraduate teaching, and maximise research income, whilst ensuring we retain our place as a lead in environmental, cultural, health systems research.

We have been very productive in CfP and there are some exciting developments.

Firstly, many congratulations to Peter White on publication of the groundbreaking research study on the effective treatment of Chronic Fatigue Syndrome (CFS).

The PACE trial is the culmination of Peter’s many years working on the frontline treating patients with CFS. The general area of medically unexplained symptoms continues to be a neglected one and CFS is a condition around which there is much controversy about effective treatments. In their recent Lancet paper, Peter White reports the first clear evidence that adaptive pacing therapy (planning activity to avoid fatigue) is little better than basic medical advice; and that cognitive behavioural therapy (changing how people think and act) and, graded exercise therapy (gradually increasing the amount of exercise) are both more effective treatments for CFS.

Another long neglected area is Dementia and care of the elderly. It is estimated that by 2025 over one million people in the UK will be living with have dementia. The costs to the economy are twice that of cancer, yet dementia research receives a fraction of the research funding allocated to cancer. Our own local elderly population pose unique healthcare challenges; Sandra Evans is the lead for old age

psychiatry in ELF; she tells us what it is like working on this frontline.

From her account of the diversity and r ichness of our pat ient population, you can see that we are very wel l p laced to run the increasingly successful MSc in transcultural mental health care and MSc Psychological Therapies; both courses are oversubscribed, and receive positive regard from students, teachers, policy makers, and international academic networks. Nasir Warfa and Lesley Nott give an update on these innovative courses.

Recruitment into psychiatry and academia in general is an important issue for all of us and this year we have launched our Psychiatry Student Interest Group open to all students; this also offers a mentorship programme for students expressing an interest in careers in psychiatry.

In 2012, we are hosting the 3rd world congress of cultural psychiatry; you are invited to review the programme and submit symposia, and take advantage of the early bird deadline for registration (1st July; see www.wacp2012.org)

Enjoy the newsletter and, as ever, we welcome your comments and contributions. If you wish to submit an article or letter, or promote your course or congress, please send us materials at least 8 weeks ahead of the next issue.

Ania Korszun Kamaldeep Bhui

CONTENT

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FROM THE EDITOR’S DESK

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From the Central Lead’s Desk by Stephen Stansfield

Finding the right pace for treating Chronic Fatigue Syndromeby Peter White

Report from the Frontlineby Sandra Evans

Msc Mental Health Programmeby Nasir Warfa and Lesley Nott

Conference Reportsby Kamaldeep Bhui

PSI Student Interest Groupby Ania Korszun and Caroline Methuen

Upcoming Events

OPEN CALLfor Abstracts

Selected Publications

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by Stephen StansfeldProfessor of Psychiatry, Centre Lead for Psychiatry

Enthusing students and

young doctors in Psychiatry.

“FROM THE CENTRE LEAD’S DESK

An important task for our Centre is enthusing students and young doctors in Psychiatry and encouraging them to take this up as their future career.

The Psychiatry Student Interest Group, organised by Ania Korszun, has an enthusiastic following with regular meetings with speakers on topics of general psychiatric interest.

This Spring we have had an elective student from as far away as Sydney, Australia and have had two FY2 doctors, Dr Akshay Nair and Dr Joel Raffel carrying out successful academic placements in the Centre. We have also recruited to a new Academic Clinical Fellow post and have a new lecturer, Dr Ana Gomez, working with Ania Korszun on psychooncological projects.

Our continuing partnership with the East London NHS Foundation Trust involves both teaching and research. There is a jointly organised academic half day, usually held on the first Wednesday of the month, which attracts excellent national and international speakers and an audience of 150 on a regular basis.

In terms of our recent research, relevant to the local community, Professor Peter White reported the very successful PACE Trial results in the Lancet recently. This multicentre trial has provided evidence of safe effective treatments for Chronic Fatigue Syndrome. Professor Kam Bhui’s Cultural Consultation Service continues to inform the practice of health staff across the Foundation Trust and Professor Stefan Priebe’s group continues to produce clinically relevant research findings on patient clinician communication, subjective quality of life in schizophrenia and strategies to improve medication adherence in severe mental illness.

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FINDING THE RIGHT PACE FOR TREATING CHRONIC FATIGUE SYNDROME

Barts and The London

show the way!

The PACE trial shows that two treatments can safely help patients with chronic fatigue syndrome.

THE TRIAL DESIGN

PACE stands for Pacing, graded Activity, and Cognitive behaviour therapy: a randomised Evaluation. The trial compared the effectiveness and safety of four interventions for patients attending six hospitals with CFS (St Bartholomew’s, Kings College and the Royal Free in London, John Radcliffe in Oxford, Frenchay in Bristol and Western General in Edinburgh).

The four interventions included three therapies:

ADAPTIVE PACING THERAPY(APT or Pacing)

involved an assessment of daily activities and capacity, with mutual negotiation of a programme of rest balanced with activity, based on the presumption that energy reserves are finite and should not be overdrawn. Occupational therapists delivered the treatment.

COGNITIVE BEHAVIOUR THERAPY(CBT)

involved structuring daily rest, activity and sleep, and a gradual return to normal activity, with assessment of illness beliefs and coping strategies, all individually negotiated in collaboration with the patient. Clinical psychologists and nurse therapists delivered the treatments.

GRADED EXERCISE THERAPY(GET)

involved an assessment of physical capacity and mutual negotiation of an individually designed graded aerobic exercise programme, with feedback and mutual planning of new goals. Physiotherapists delivered the treatment.

These therapies were provided individually over 15 sessions spread over about five months. All participants were also offered at least three sessions of specialist medical care. The fourth group received SMC alone. All treatments were described in manuals for both clinicians and patients, and therapy integrity was confirmed by independent assessors.

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by Peter WhiteProfessor of Psychological Medicine

WHY WE DID THE TRIAL?

Chronic fatigue syndrome (CFS) is a chronic disabling condition of unknown cause and no certain treatment. Some 250,000 to 500,000 people suffer from it in the United Kingdom, the difference in prevalence depending on how it is defined. Some differentiate myalgic encephalomyelitis (ME) from CFS, whereas others think it the same condition. This difficulty in defining it is but one of the controversies that affect CFS, the others being what causes it and how to treat it. The controversy has in the past led to demonstrations to the Department of Health, petitions to government and debates in parliament. Patient organisations complain that the National Health Service does not take CFS seriously, does not provide appropriate health services, and that patients are denied benefits to which they are entitled, leading to poverty and hardship.

One way to resolve controversy is through science, and the PACE trial was designed with the help of a patient charity, Action for ME, to provide some much needed empirical data regarding safety and effectiveness of commonly available treatments. The National Institute of Healthcare and Clinical Excellence (NICE) had previously recommended two rehabilitative interventions, cognitive behaviour therapy (CBT) and graded exercise therapy (GET), but this was on the basis of a few relatively small trials. In contrast, patient organisations had reported concerns that CBT and GET were ineffective, or even harmful, with one patient survey finding that 50% of patients reported that thought GET had harmed them. In contrast, patient organisations supported pacing (see below) and specialist medical care. The PACE trial was therefore designed to test safety and effectiveness of these four interventions.

WHAT THE TRIAL SHOWED

The PACE trial was published in the Lancet in March this year. The complete paper and web appendix are freely available to download on: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2811%2960096-2/abstract

CBT and GET were more effective in improving both fatigue and physical function than either SMC alone or APT. This was the case no matter how we defined CFS or ME or whether patients also had a comorbid depressive illness, suffered by a third of our patients. By a year, some six out of ten patients made a clinically useful improvement in both fatigue and function after both CBT and GET compared to about four out of ten for APT and 45% for SMC alone. About three out of ten were within normal population ranges for both fatigue and function a year after both CBT and GET; about twice the numbers than for APT and SMC alone.

Serious adverse reactions to trial treatments were uncommon (2% or less for all four interventions), with no differences between arms. The proportions of patients with a serious deterioration, which can sometimes happen with CFS, did not differ between treatment arms.

Only 5% dropped out of trial follow up, and 11% or less withdrew from treatment, with no differences between treatment arms on either measure.

CONCLUSIONS

We concluded that both cognitive behaviour therapy and graded exercise therapy were safe and moderately effective additions to specialist medical care, compared to both adaptive pacing therapy and specialist medical care alone. Adaptive pacing therapy showed no additional benefit when added to specialist medical care alone. NICE responded that the PACE trial results re-affirmed their guidance on the management of CFS.

FUTURE PAPERS

We are now writing papers that include the health economic outcomes (to test cost-effectiveness), the moderators and mediators of the interventions (to find whom they best work for and why), and long-term follow up to see if effects last.

WHO DID WHAT?

The trial was sponsored by Queen Mary University of London, and was led by Professor Peter White (lead principal investigator – Centre for Psychiatry) as well as Professor Trudie Chalder (King’s College London) and Professor Michael Sharpe (University of Edinburgh). The trial was coordinated from Queen Mary, with Hannah Baber (trial manager), and Vicki Bates (senior data manager) providing technical leadership. Other staff from the Centre for Psychiatry included Lucy Clark (treatment leader) and Julie Richards (Research Nurse). Barts and the London Trust staff included Dr Maurice Murphy (centre leader), and East London Foundation Trust provided nine therapists and nine doctors, funded by the National Institute of Health Research. Research funding was provided by the Medical Research Council, the Department of Health for England, Scottish Chief Scientist Office, and the Department for Work and Pensions. The paper acknowledges the full trial team of some 100 individuals who all contributed to the study.

Trial Design cont.

Fourth intervention:

SPECIALIST MEDICAL CARE

involved explanation of the diagnosis, being given general advice on how to manage CFS, and appropriate medications to help sleep, pain and other symptoms. CFS specialist doctors delivered the treatment.

640 patients were recruited into the trial and followed up three times over one year after randomisation. The main eligibility criterion was meeting the Oxford criteria for CFS, which required that fatigue was the principal symptom for six months, with disability and no alternative diagnosis that could explain the illness. We stratified randomisation by two alternative definitions of CFS and ME, and by comorbid depressive illness. The primary outcomes were self-rated fatigue and physical function, while secondary outcomes included a more objective walking test (how far one can walk in six minutes). Safety outcomes included all adverse events, and independent scrutineers judged how serious the adverse events were and whether they were reactions to trial treatments.

FINDING THE RIGHT PACE FOR TREATING CHRONIC FATIGUE SYNDROME CONT.5

REPORT FROM THE

FRONTLINEOld Age Psychiatry in CIty and Hackney

THE PLEASURE AND CHALLENGE OF WORKING AS AN OLD AGE PSYCHIATRIST IN CITY

AND HACKNEY IS MASSIVELY UNDERESTIMATED. IT IS ONE OF THE BEST-KEPT SECRETS

IN THE BUSINESS AND I AM ABOUT TO SPILL THE BEANS…

“The population of older people (sixty five and over) in the two boroughs is thought to be about 23,000, assuming the 2001 census to have been filled-in correctly. The catchment area spans about 7 miles west to east from the Barbican and Golden-lane estate, full of retired bankers and lawyers, and ret ired nursing sisters and civi l servants respectively, to Hackney Wick where our lovely new resource centre is located. The terrain between, E9, E5 E8 and N1, and N16 to the North is as different in character as the population which it houses. Hackney dwellers speak over 47 different languages, and represent a wide variety of ethnicities and religious beliefs. Unlike Tower Hamlets to the south and Newham to the east (all part of East London Foundation Trust), which tend more to monocultures in their immigrant populations, Hackney has welcomed each wave of new arrivals, who have settled and created small enclaves of interest for the clinical teams that serve them. In Dalston particularly around the Ridley road market, there are many of the early wave of West Indians who arrived in the 1950s: many of whom worked in the local hospitals, and some whom were my colleagues not so long ago. The Chasidim are particularly concentrated in Stamford Hill and often provide their own excellent services for frail and dementing members of their community. Africans from Ghana and Nigeria, Vietnamese and Somalis are often to be found among the indigenous Caucasians of E5 and E9. Some have escaped political and military unrest and are troubled by PTSD and depression. Turkish, Greek and Italian are among the districts to the north and to the west, many of the residents have run small businesses locally and have their own community centres for

older non-English speaking elders. More recently the Bangladeshi community have started to be referred to us.

In terms of providing a mental health service to these and the ageing indiginous “EastEnders”, we need to be mobile, flexible and open-minded. We also need to be particularly good at history and mental state examinations via an interpreter. We see a lot of psychosis. We look after people with established schizophrenia as they age, become physically frail and maybe less independent. There is also a great deal of “first-episode psychosis” among older adults, and those presenting in City and Hackney are often also suffering from some evidence of early cognitive impairment. In some communities, psychotic experiences such as hearing voices, and occasionally unpleasant somatic hallucinations are attributed by the sufferers and their families to a hex, or djin or some other supra-natural force. Medication tends only partially to relieve their symptoms and not the experiences themselves, and certainly not the belief systems. We find that by working with our psychologists to provide a culturally sensitive therapy, we can continue to engage these patients and help them over time.

Depression and anxiety is common among older people. Those who suffered depression when younger are vulnerable to continued depression in later life, although we see plenty of people with bipolar disorders too. They can present with hyperactivity, such as cooking for scores of potential guests when manic!

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by Sandra EvansConsultant / Senior Lecturer Mental  Health Care for Older People

REPORT FROM THE FRONTLINE CONT.

We are referred fewer people with depression nowadays compared to ten or more years ago. Local general practitioners (many who have trained with us) seem to be treating people with a modern antidepressant at least before referring to our community teams, but many have yet to receive psychological therapies. Most older patients with depression can make use of psychotherapy and it is important that they have equal access to effective and safe therapy.

We are also aware that persistent mood disorders may also be linked to the presence of a co-existing personality disorder, (which was deemed a rarity amongst older adults when I was a student). A better understanding of the lifelong effect of early trauma and its impact on interpersonal relationships helps explain why losses sustained in late adult life can cause problems that improved in younger happier times, to re-emerge. An estimated 20 percent of inpatients and community-managed patients have some form personality disorder.

Anxiety disorders appear to be on the rise. Depression with anxiety is linked with “vascular depression”, which means that it is a likely early presentation of a previously unsuspected vascular dementia. The black and ethnic minority population are more at risk of this due to their increased risk of diabetes and hypertension. Here there is scope for doing secondary prevention work in conjunction with GPs. A good understanding of the physical factors involved is really important. Primary prevention is even better! Those of us nearing retirement could do worse than check our blood pressure, cholesterol and intake of fatty foods and alcohol. We could also ensure physical fitness and make sure we use the stairs and consider walking or Boris biking to work.

At last the nation is starting to address the huge area of dementia. The National Dementia Strategy UK (Banerjee 2009) exhorts us all to diagnose dementia wherever it exists, and to do it a whole lot earlier. It is estimated that in excess of 750,000 people in the UK have dementia and some 20% -25% of City and Hackney’s population of over 80s will have dementia. Each of the districts that make up East London Foundation Trust has opened a diagnostic memory service and a dementia team. They exist to improve the quality of life for dementia sufferers and their carers.

The Raybould centre for dementia was named after a colleague who worked with the Alzheimer’s society and us. Ania Korszun and I won a grant to create a teaching video made with the help of colleagues in Hackney. The film is a care pathway - or put more simply a dramatised journey of a man - the eponymous Brian (played by an actor), who takes his memory worries to his GP. She takes an excellent initial history and some sensible blood tests before sending him of to the Homerton Hospital for further neuropsychological testing and a CT scan. This film, which will be available on Web - CT, will help medical and nursing undergraduates understand and recall some of the most important issues in dementia diagnosis and treatment. Home visits are still the mainstay of first assessments, and the "fridge sign" (the contents of the fridge can often be linked to need for admission), never ceases to fascinate the students who accompany us on our travels.

While definitive treatment for dementia is still a long way off, we continue to diagnose and provide support and education. We can teach excellent communication skills for working with dementia sufferers, and evidence-based management such as psychosocial interventions.

Just in case I have given the impression that all of old age psychiatry is dementia and depression, I should mention that alcohol and drug related problems are on the increase in older people, whose problems mirror those of younger people in the borough. To put old age psychiatry into perspective, our patients may differ in age by more than 30 years. The cohort of "baby boomers” are now reaching their sixties. The Mary Quant generation are the young old 60+ and the old old 90+ are those born just after the First World War. This range of patients, psychopathology and characters makes variety the spice of later life.

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MSC MENTAL HEALTH PROGRAMMEPSYCHOLOGICAL THERAPIES AND TRANSCULTURAL MENTAL HEALTHCARE

The MSc Transcultural Mental Healthcare was established in 2001 at Queen Mary, University of London. An additional pathway, Psychological Therapies was subsequently included in the Programme. At the end of 2007 a Distance Learning study option was introduced including all the necessary additional materials and real time on-line academic supervision using pre recorded Lecture and Course material, and tutorials held via Skype/Adobe Connect and teleconference technology.

This is an innovative and well received course which was developed in response to local, national and international demands for developing cultural competency skills for health and social care professionals working with diverse populations, and the only course currently offering such relevant topics for study in the current mental health climate. Our courses currently attract 170 plus applications for a place, bringing over £350,000 income (not including HEFCE) to QMUL.

Mental disorders make up five of the top 10 disorders implicated in the global disease burden and it is projected that by 2030, depressive disorders will become the third leading cause of disease burden in the World. Therefore, health and social care workforce development must include high quality education that addresses not only skills but also knowledge and attitudes, particularly given the high prevalence and incidence rates of mental health disabilities found in several vulnerable groups in the in the world.

Therefore, the MSc programme has been developed to a) benefit people with social and psychiatric disabilities through improved quality of care; this is achieved by b) developing the academic skills of the workforce to promote reflective and evidence based practice. It is for these above-mentioned reasons the demand for

places on the course has grown from strength to strength. Our current and previous students are health and social care professionals who come from all over the world. Students on this course aim to:

Develop more advanced understanding of the basis of assessment, diagnosis, formulation and care management of mental disorders in general and then in diverse racial, ethnic and cultural groups drawing on cultural psychiatry, social sciences and allied disciplines.

Have access to an academic programme that prepares competent practitioners to deliver effective mental health treatments for people with mental health problems.

Develop knowledge of research methods and systematic and critical review

Develop and have access to a network of mental health professionals and established academics

The current Mental Health Programme consists of the following two courses, and is divided into three modules over the academic year:

MSc Transcultural Mental Healthcare (TMH)MSc Psychological Therapies (PT)

Module1: (Advanced Mental Health Assessment) is compulsory and completion of this alone is accredited for exit with a certificate in mental health assessment. This is a compulsory module for all students.

Module 2: the programme offers two pathways options (Transcultural Mental Healthcare and Psychological Therapies). Completion of this module and module one permits exit with a diploma in TMH or PT.

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by Nasir WarfaSenior Lecturer & Deputy Director, MSc Mental Health Studies

and Lesley NottCourse Administrator

MSC MENTAL HEALTH PROGRAMME CONT.

Module 3: is compulsory to all students and includes research methods and evidence based practice. Students aiming for the MSc award are required to undertake a dissertation on an original topic that includes original research or an original and comprehensive literature review using systematic methods wherever possible. Completion of modules 1, 2 and 3 is accredited for exit with a MSc in TMH or PT.

Lecturers deliver their specialised subjects as part of the Course from within QMUL, and also as guest lecturers from other Universities. We are fortunate to attract eminent professionals from worldwide organisations and hospitals, NHS Trusts and Institute of Psychiatry.

Moreover, the programme provides a flexible blended learning environment in which students can develop both their knowledge base and key transferable skills in E-learning and IT technology, as well as group work, debating and presentation skills, writing and communication skills. The demand for places on the course is a reflection of the high quality and effective delivery of the programme curriculum and content, including teaching, learning and assessment strategies.

The MSc Team consists of:

Professor Kamaldeep Bhui - Course DirectorDr Nasir Warfa - Course Co-ordinator & Senior LecturerDr Ken Carswell - TutorDr Robert White - Distance Learning TutorMrs Tina Rowe - E-Learning TechnologistMrs Lenka Buss & Miss Lesley Nott - Course Administrators

The Team endeavour to provide full and flexible support to all students to enrich their experience and increase their academic and working potential after successfully completing the Mental Health Programme courses. Students enjoy social occasions and entertainment throughout the academic year, which facilitates excellent Student/Staff relations.

Many students have contr ibuted glowing testimonials attesting to the quality of the Course and the Team:

“I will proudly recommend this course for the people working in multicultural areas in UK, especially to psychiatrists, psychologists, nurses, general practitioners and other linked professionals to mental health for the reasons mentioned above.

This will also help the professionals to minimize the chances of mis-diagnosis and will help appropriate treatment." Dr Amjad Mahmood

“I have greatly enjoyed the interesting teaching provided by Dr Nasir Warfa during the Transultural Mental Healthcare MSc course. He is and enthusiastic teacher who has been available and approachable, providing useful support and supervision particularly with regard to my research project.” Mr Julian Summerfield

“This course has already helped me with the development of services and the importance of consulting and accessing community and spiritual leaders, BME service users and carers when shaping services. I hope that I will always be able to raise the profile of BME communities and also be an educator to the staff. Finally can I thank the college for undertaking to run this course." Hilda Wright, a Psychiatric Nurse and Service Manager, NHS Trust.

Our Open Day’s have attracted important Guest Speakers including Baroness Molly Meacher, Chair East London NHS Foundation Trust, and more recently Dr Hugh Griffiths, National Director for Mental Health, Department of Health, presented the key points from the Government's New Mental Health Strategy, and have been extremely well attended by people wishing to apply for the Courses.

On 25th May 2011 we are holding an Open Day and are most fortunate to have Lord Victor Adebowale CBE, member of the Ministerial Advisory Group on Mental Health to discuss equality in Mental Health, his role in the Delivering Race Equality (DRE) programme with the Secretary of State for Health, and the Turning Point organisation. He is a patron of Careif. Presentations will also be made by Prof Kamaldeep Bhui and Mr Robert Jones from East London NHS Trust, with whom we enjoy a supportive relationship.

The MSc Team continues to work enthusiastically towards fulfilling the aims of the Mental Health Programme, and attracting and supporting students through to successful completion and a fulfilling academic experience at Queen Mary, University of London.

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MSc and PG Diploma in Mental Health:Transcultural Mental Healthcare and Psychological Therapies

Date: Wednesday 25 May 2011 Time: 4-7pm

Guest speakers: • Lord Victor Adebowale CBE MA MCIH, Chief

Executive of Turning Point and member of theMinisterial Advisory Group on Mental Health

• Dr Nasir Warfa, Senior Lecturer & MSc ProgrammeCoordinator, Queen Mary, University of London

• Prof Kam Bhui, Professor of Cultural Psychiatry and Epidemiology and MSc Course Director, Queen Mary, University of London

• Robert Jones, Associate Director of Equality and Diversity, East London NHS Trust

Venue: Dawson Hall, Wolfson Institute of PreventiveMedicine, Charterhouse Square, Queen Mary,University of London, London EC1M 6BQ Refreshments provided - All welcome

www.mentalhealthcaredegrees.com/index.htmlwww.wolfson.qmul.ac.uk/psychiatry/courses/tmh

Further informationCentre for PsychiatryOld Anatomy Building,Wolfson Institute of Preventive MedicineCharterhouse Square London EC1M 6BQTel: 020 7882 2013email: tmh-admin@qmul.ac.uk

Open Day10

CONFERENCE REPORTSby Kamaldeep Bhui

Professor of Cultural Psychiatry & Epidemiology; Hon Consultant Psychiatrist

Migration Challenges and Mental Health

The World Psychiatric Association’s Transcultural Section meeting took place in Paris (bringing together researchers, practitioners, policy makers and managers, and trainees and PhD students from around the world. This was the first international conference on cultural psychiatry in the French-speaking world; so all presentations had simultaneous translations, undertaken by very experienced interpreters who appeared never to strain whilst translating complex emotional, conceptual, philosophical and clinical concepts. Plenary lectures were given by Marianne Kastrup, Jim Boehnlein, Norman Sartorius, Goffredo Bartocci (President of World Association of Cultural Psychiatry), Richard Rechtman Ron Wintrob (chair of the Transcultural Section of WPA), Driss Moussaoui, Stephanie Larchanche, Boris Cyrulnik, Marie Rose Moro, and Rachid Bennegadi. These provided for rich discussion and debate about the varieties of migration experience, its impact, and its consequences, including challenges for the service providers and for practitioners. The interplay of biological and cultural factors in the genesis, expression and management of mental distress was debated from diverse disciplinary perspectives of sociology, anthropology, philosophy, and neuroscience including cognitive and brain imaging studies. There were also symposia on the earthquake in Japan, and natural disasters and our responses to these ever more frequent disasters. Cultural consultation, cultural competence, models of service provision in child and adolescent services were presented and formed some of the rich fabric of the congress.

1st International Conference On Cultural Psychiatry In The French Speaking World. 18 - 20 April 2011 | Georges Pompidou European Hospital, Paris.

Goffredo Bartocci (top) and Richard Rechtman (bottom) giving plenaries.

The venue for the meeting, the Georges Pompidou European Hospital, provided a spacious and welcoming venue that was a constant reminder of the clinical importance of the congress presentations. Paris was beautifully sunny, and welcoming, reflecting the ambience and the organisational skills of Dr Rachid Bennegadi (Conference Organiser) and his senior and junior colleagues at the Minkowska Centre. A boat trip along with Seine sealed the romantic fate of many couples (congratulations). The team from Barts & The London School of Medicine & Dentistry in London presented two symposia on the experiences of cultural consultation services in East London and on cultural identity and health and well-being (Bhui, Ascoli, Palinski, Warfa, Morgan). As well as meeting old friends, and enjoying Paris, the delegates wasted little time and debated the academic content of the programme to the fullest extent possible, during the conference, during the breaks, and in the evenings over dinner. Alas, this wonderful meeting had to come to an end, but future collaborations will prove to be fruitful.

As well as meeting old friends, and enjoying Paris, the delegates wasted little time and debated the academic content of the programme to the fullest extent possible, during the conference, during the breaks, and in the evenings over dinner.

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Laurence Kirmayer (chair of congress) assembled delegates from academic institutions around the world, and presented papers on relationship break-ups, new romantic relationships, personality difficulties and how the internet can be used in health promotion, the use of the internet to mount campaigns that protect human rights and led to the release of detainees in Iraq, the use of the internet in terrorism and radicalisation and counter-terrorism, the impact of second-world and gaming that engages millions of people in alternate realities.

The presentations on communications and identity and community were remarkable in showing the complexity of identity negotiations within a private-public space, a privileged yet risky space that is often assumed to be an intimate, private and safe place. The transitional space created during an interaction with self or other on the Internet was debated to offer possibilities for change and hope, as well as occasional disappointments and regrets. Does this experience lead to an altered time sense, an altered sense of self, and perhaps trance-like, or liminal states in which the realities are suspended and do not constrain the imagination? Projections and introjections appear to take place with little constraint.

The role of the Internet in social networking and in mobilising communities to enact change in local governance was also well illustrated in many high and low-income countries. Despite great variations in the types of use to which the internet is put, the core issues were similar, and included the nature of the negotiation that takes place, the impact on identity and community, and the influence of on-line and off-line relationships on each other.

Papers presented at this meeting were initially presented in a two day workshop, with intimate and intense discussion about the propositions, assumptions, and evidence of impacts, promoting a rich and varied discourse about ethics, philosophy, clinical practice and policy.

A wonderful presentation that seemed to capture the fun, risks and rewards of the internet was given on the subject of Trolls and Tricksters by Gabriella Coleman from New York University.

The two-day congress that followed had more presentations and benefited enormously from the earlier workshops, which seemed to provide a natural link between papers as well as generate common dilemmas in the ethics, methods and findings of research on the Internet.

The social programme of arts, film and dining was well attended and welcoming, bringing together friends, mentors and their students in an exciting and stimulating forum.

26 - 29 April 2011 | McGill University, Montreal, Quebec

CONFERENCE REPORTS CONT.

Advanced Study InstituteCultures of the Internet:

Identity, Community and Mental Health

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PSI - THE BARTS AND THE LONDON PSYCHIATRY STUDENTS INTEREST GROUP

Our aim is to interest all our medical students in psychiatry and nurture a lifelong respect for patients with mental health disorders. We would also like to inspire some of them to become psychiatrists or to give them a special interest in mental health whatever their speciality.

To this end we have set up PSI - the Barts and The London Psychiatry Students Interest Group and so far 134 students have signed up to the group from all medical school years.

We have planned a varied programme and we kicked off this year with something quite different – a presentation from Dr Vanessa Crawford and the Sock Mob. The Sock Mob are a group of friends who engage with homeless people in London, spend time with them as well as distribute socks – something that we learned in our meeting was very welcome to homeless people. As well as two of the “Sock Ladies” we hosted two homeless people who shared their experiences and answered the students’ many questions. It was a very interactive and pleasant evening and of course everyone brought socks. We gave our visitors socks and they provided us with a rich experience and a new perspective on life in the streets of London.

The next meeting was on Cancer and Ania Korszun was joined by Iain Hutchison and Ian Mackenzie to discuss the multidisciplinary approach to cancer that takes into account the latest research findings, their incorporation into treatment and meeting the needs identified by the patients themselves. The (not so curious) incident of the dog in the night covered the history of autism. Our next meeting was on the topic of autism and autistic spectrum disorders. We heard from Dr Helen Bruce about the key features of the disorder in childhood and dispelled some the myths about autism. We had a fascinating discussion, chaired by Dr Ian Hall, with a group of service users from Newham who came to tell us about their experiences of living with the disorder. The students enjoyed a lively question and answer session with the patients. We are extremely

grateful to the service users who gave their time to bring this topic to life and who stayed afterwards to chat and socialise with the students over some refreshments.

We had a performance of ‘Dementia Diaries’ in April, a play about an Anglo-Polish family struggling to cope with the effects of dementia. The interweaving monologues from the family members and their carer really brought the subject to life and provided a rich vein for the stimulating discussion afterwards.

As well as our monthly meetings we have organized a mentorship programme for students interested in psychiatry with a wide range of participating academic and clinical mentors.

Our Schools programme is also very popular with students – where we go out to local schools in our area to talk about mental health. Many of the stigmatizing attitudes to psychiatry and people with mental health begin early and by going out to schools and raising awareness we can change this and also encourage students to apply to Barts and The London. One of our aims is to make our school the medical school of choice for those with an interest in mental health.

Our PSI website is in preparation and will contain details of all our activities and resources.

AND NOW FOR SOMETHING COMPLETELY DIFFERENT!by Ania Korszun, Professor of Psychiatry and Education and Caroline Methuen, Senior Lecturer in Psychiatry Education

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FUTURE EVENTS

A Classic Film NightThursday, June 9thGuest speaker: Dr Raj Persuad

Design for LivingExploring how interior design can contribute to a therapeutic environment. September (date tbc)Venue: Charterhouse

UPCOMING EVENTS

24 May, 4pm

Money MattersThe economics of risk and public protection

Contact: Prof Jeremy CoidVenue: William Harvey House, Barts Hospital, West Smithfield

25 May, 3:45pm

Postgraduate courses in Mental HealthPsychological Therapies and Transcultural Mental Healthcare Open Day

Led by: MSc TeamVenue: Sir Anthony Dawson Room at Charterhouse Square

25 May, 2pm - 5pm

Cultural Consultation Club Meeting

Contact: Jane ArcherVenue: Charterhouse Square

15 June, 12:30pm

Adolescent mental health in Cape TownStudent Health and Well-Being Study (SHaW)

Led by: Prof Stephen Stansfeld and Dr Cath RothonVenue: Room 106, Old Anatomy Building, Charterhouse Square

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Centre for Psychiatry SeminarsFor further information, please contact Lisa Kass: psychiatry@qmul.ac.uk

6 June, 2pm - 3pm

Best practice health care for

immigrants in Europe

Led by: Sima SandhuVenue: Academic Unit Lecture Theatre

13 June, 2pm - 3pm

Patients' preferences for how

psychiatrists introduce themselves - the video clip study

Led by: Stefan Priebe & Jelena Jankovic Venue: Academic Unit Lecture Theatre

20 June, 2pm - 3pm

Communication in psychiatric

outpatient consultations

Led by: Laura ThompsonVenue: Academic Unit Lecture Theatre

29 June, 2pm - 5pm

Cultural Consultation Club Meeting

Contact: Jane ArcherVenue: Charterhouse Square

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The Scientific profile of the 3rd World Congress will emphasise life-course understandings of mental distress, resilience and well-being, with a particular focus on young people. We are faced with many new frontier of cultural psychiatry, and a focus on life-course, well being, resilience, and young people is one of the new frontiers. Other themes include the neuro-scientific basis of violence and psychiatric symptoms, that neurobiology of violence and psychiatric symptoms; terrorism and conflict; self harm and suicide; diagnostic precision; culture and psychopathology; ethno-pharmacology; spirituality, religion and mental health; the future of cultural psychiatry; migration, training and education; public policy, service organisation and delivery, trainee workshops, media & mental health; ‘research and reviews’; clinical practice and policy in a culturally diverse context.

OPEN CALL

FOR ABSTRACTSNOTE EARLY BIRD REGISTRATION CLOSES JULY 1ST 2011

Mental capital, mental disorders, resilience and well-being through the life-course.

You are invited to submit abstracts now for consideration in the OPEN CALL.

Registration and to download Form: www.wacp2012.org

PRE & POST CONGRESS EVENTS

7 March 2012, 2pm - 5pm Cultural Consultation-International Perspectives

8 March 2012, 1pm - 5pm Culture, Spirituality & Psychopathology at

St Paul’s Cathedral

Co-sponsored by The Royal Society of Medicine, London.

Tickets £25: for delegates of the congress only; limited places

12 March 2012Trainee/Student day, prize for best poster

Free to students/trainees registering for main congress

SOCIAL EVENTS

Evening of 8th March Historical walks in East London

Evening of 9th MarchFilm evening with Mohan Agashe

Evening of 10th March Gala Dinner & Presentations

Tickets £45: for conference delegates only

CONFIRMED PLENARY LECTURES BY Dr Micol Ascoli, UK | Prof. Goffredo Bartocci, Italy | Prof Sergio Javier Villaseñor-Bayardo, Mexico

Prof. Jim Boehnlein, US | Dr Nicolay Bokan, Russia | Prof Ahmed El-Dosoky, EgyptProf. Paul Heritage, UK | Dr Madelyn Hicks, UK | Prof. Laurence Kirmayer, Canada

Prof. Roland Littlewood, UK | Prof. Wielant Machleidt, Germany | Prof. David Ndetei, KenyaProf. Vikram Patel, India & UK | Prof. Ron Wintrob, Canada

Prof. Wen-Shing Tseng, US | Prof Xudong ZHAO, China

Please visit the website regularly for updates: www.wacp2012.org

C E N T R E F O R P S Y C H I AT RYSelected Publications

K BHUIJayakody, A., Sinha, S., Tyler, K., Khadr, S. N., Clark, C., Klineberg, E., Booy, R., Bhui, K., Head, J. J., Stansfeld, S., Roberts, H., & Viner, R. M. 2011, "Early sexual risk among black and minority ethnicity teenagers: a mixed methods study", J Adolesc Health, vol. 48, no. 5, pp. 499-506.

Bhui K. Cultural psychiatry and epidemiology: Researching the means, methods and meanings. Transcult Psychiatry. 2011 Apr;48(1-2):90-103.

Bhui KS, Dinos S, Ashby D, Nazroo J, Wessely S, White PD. Chronic fatigue syndrome in an ethnically diverse population: the influence of psychosocialadversity and physical inactivity. BMC Med. 2011 Mar 21; 9(1):26.

Bhugra D, Gupta S, Bhui K, Craig T, Dogra N, Ingleby JD, Kirkbride J, Moussaoui D, Nazroo J, Qureshi A, Stompe T, Tribe R. WPA guidance on mental health and mental health care in migrants. World Psychiatry. 2011 Feb; 10(1) 2-10.

C CLARKPaunovic, K., Stansfeld, S., Clark, C., & Belojevic, G. 2011, "Epidemiological studies on noise and blood pressure in children: Observations and suggestions", Environ Int, vol. 37, no. 5, pp. 1030-1041.

Crombie, R., Clark, C., & Stansfeld, S. 2011, "Environmental noise exposure, early biological risk and mental health in 9 to10 year old children: a cross-sectional field study", Environmental Health. (in press)

Goodwin, L., White, P. D., Hotopf, M., Stansfeld, S. A., & Clark, C. 2011, "Psychopathology and physical activity as predictors of chronic fatigue syndrome in the 1958 british birth cohort: a replication

study of the 1946 and 1970 birth cohorts", Ann Epidemiol, vol. 21, no. 5, pp. 343-350.

Clark, C., Goodwin, L., Stansfeld, S. A., Hotopf, M., & White, P. D. The premorbid risk markers for chronic fatigue syndrome in the 1958 British birth cohort. British Journal of Psychiatry. 2011. (In press)

J COIDUllrich, S. & Coid, J. 2011, "Protective factors for violence among released prisoners-effects over time and interactions with static risk", J Consult Clin Psychol. [Epub ahead of print][Epub ahead of print]

Coid, J. & Ullrich, S. 2011, "Prisoners with psychosis in England and Wales: Diversion to psychiatric inpatient services?", Int J Law Psychiatry, vol. 34, no. 2, pp. 99-108.

Coid, J. & Yang, M. 2011, "The impact of psychopathy on violence among the household population of Great Britain", Soc Psychiatry Psychiatr Epidemiol, vol. 46, no. 6, pp. 473-480.

D CURTISCurtis, D., Vine, A. E., McQuillin, A., Bass, N. J., Pereira, A., Kandaswamy, R., Lawrence, J., Anjorin, A., Choudhury, K., Datta, S. R., Puri, V., Krasucki, R., Pimm, J., Thirumalai, S., Quested, D., & Gurling, H. M. 2011, "Case-case genome-wide association analysis shows markers differentially associated with schizophrenia and bipolar disorder and implicates calcium channel genes", Psychiatr Genet, vol. 21, no. 1, pp. 1-4.

Pereira, A. C., McQuillin, A., Puri, V., Anjorin, A., Bass, N., Kandaswamy, R., Lawrence, J., Curtis, D., Sklar, P., Purcell, S. M., & Gurling, H. M. 2011, "Genetic association and sequencing of the insulin-like

growth factor 1 gene in bipolar affective disorder", Am J Med Genet B Neuropsychiatr Genet, vol. 156, no. 2, pp. 177-187.

S EVANSRitchie, C. W., King, M. B., Nolan, F., O'Connor, S., Evans, M., Toms, N., Kitchen, G., Evans, S., Bielawski, C., Lee, D., & Blanchard, M. 2011, "The association between personality disorder and an act of deliberate self harm in the older person", International Psychogeriatrics, vol. 23, no. 2, pp. 299-307.

A KORSZUNRivera, M., Cohen-Woods, S., Kapur, K., Breen, G., Ng, M. Y., Butler, A. W., Craddock, N., Gill, M., Korszun, A., Maier, W., Mors, O., Owen, M. J., Preisig, M., Bergmann, S., Tozzi, F., Rice, J., Rietschel, M., Rucker, J., Schosser, A., Aitchison, K. J., Uher, R., Craig, I. W., Lewis, C. M., Farmer, A. E., & McGuffin, P. 2011, "Depressive disorder moderates the effect of the FTO gene on body mass index", Mol Psychiatry.(In press)

R McCABEPriebe, S., Richardson, M., Cooney, M., Adedeji, O., & McCabe, R. 2011, "Does the therapeutic relationship predict outcomes of psychiatric treatment in patients with psychosis? A systematic review", Psychother Psychosom, vol. 80, no. 2, pp. 70-77.

Priebe, S., McCabe, R., Schutzwohl, M., Kiejna, A., Nawka, P., Raboch, J., Reininghaus, U., Wang, D., & Kallert, T. W. 2011, "Patient characteristics predicting better treatment outcomes in day hospitals compared with inpatient wards", Psychiatr Serv, vol. 62, no. 3, pp. 278-284.

16

SELECTED PUBLICATIONS CONT.17

S PRIEBEPriebe, S., Sandhu, S., Dias, S., Gaddini, A., Greacen, T., Ioannidi, E., Kluge, U., Krasnik, A., Lamkaddem, M., Lorant, V., Puigpinos, I. R., Sarvary, A., Soares, J. J., Stankunas, M., Strassmayr, C., Wahlbeck, K., Welbel, M., & Bogic, M. 2011, "Good practice in health care for migrants: views and experiences of care professionals in 16 European countries", BMC Public Health, vol. 11, no. 1, pp.187.

Katsakou, C., Marougka, S., Garabette, J., Rost, F., Yeeles, K., & Priebe, S. 2011, "Why do some voluntary patients feel coerced into hospitalisation? A mixed-methods study", Psychiatry Res, vol. 187, no. 1-2, pp. 275-282.

Barnicot, K., Katsakou, C., Marougka, S., & Priebe, S. 2011, "Treatment completion in psychotherapy for borderline personality disorder - a systematic review and meta-analysis", Acta Psychiatr Scand, vol. 123, no. 5, pp. 327-338.

S A STANSFELD

Stansfeld, S. & Crombie, R. 2011, "Cardiovascular effects of environmental noise: Research in the United Kingdom", Noise.Health, vol. 13, no. 52, pp. 229-233.

Rothon, C., Goodwin, L., & Stansfeld, S. 2011, "Family social support, community "social capital" and adolescents' mental health and educational outcomes: a longitudinal study in England", Soc Psychiatry Psychiatr Epidemiol.

Rothon, C., Arephin, M., Klineberg, E., Cattell, V., & Stansfeld, S. 2011, "Structural and socio-psychological influences on adolescents' educational aspirations and subsequent academic achievement", Soc Psychol Educ, vol. 14, no. 2, pp. 209-231.

Rothon, C., Head, J., Klineberg, E., & Stansfeld, S. 2011, "Can social support protect bullied adolescents from adverse outcomes? A prospective study on the effects of bullying on the educational achievement and mental health of adolescents at secondary schools in East London", J Adolesc, vol. 34, no. 3, pp. 579-588.

S ULLRICH

Ullrich, S. & Coid, J. 2011, "Protective factors for violence among released prisoners-effects over time and interactions with static risk", J Consult Clin Psychol. [Epub ahead of print]

Coid, J. & Ullrich, S. 2011, "Prisoners with psychosis in England and Wales: Diversion to psychiatric inpatient services?", Int J Law Psychiatry, vol. 34, no. 2, pp. 99-108.

N WARFAWhite, R. & Warfa, N. 2011, "Building Schools of Character: A Case-Study Investigation of Character Education's Impact on School Climate, Pupil Behavior, and Curriculum Delivery", Journal of Applied Social Psychology, vol. 41, no. 1, pp. 45-60.

P D WHITEWhite, P. D., Goldsmith, K. A., Johnson, L., Potts, L., Walwyan, R., DeCesare, J. C., Baber, H. L., Burgess, M., Clark, L. V., Cox, D. L., Bavington, J., Angus, B. J., Murphy, G., Murphy, M., O'Dowd, H., Wilks, D., McCrone, P. M., Chalder, T., Sharpe, M., & on behalf of the PACE trial management group 2011, "Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial", The Lancet. Vol. 377, No 9768, pp 823-836.

Issue 2 www.wolfson.qmul.ac.uk/psychiatry

For further information, please contact:

Lisa KassCentre for PsychiatryBarts and The LondonSchool of Medicine and DentistryOld Anatomy BuildingCharterhouse SquareLondon EC1M 6BQ

Tel: +44 (0)20 7882 2021 Fax: +44 (0)20 7882 5728Email: psychiatry@qmul.ac.uk