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The Royal College of Psychiatrists Improving the lives of people with mental illness

Kaleidoscope March 2017

Read the Kaleidoscope Column in the BJPsych


March’s Kaleidoscope column in the British Journal of Psychiatry explores novel psychoactive substances (NPS or (inaccurately) ‘legal highs’), particularly novel cannabinoids. The law in the UK changed in 2016, proscribing all psychoactive agents, including those not yet synthesised, except for those specifically exempted (e.g. antidepressants, alcohol etc.). How effective this will be has yet to be seen: so-called ‘headshops’ are shutting down, returning local drug purchasing to the realm of meeting a guy on a BMX bike with a knife in his pocket – a pyrrhic victory perhaps. Problematically, with over 500 novel agents, science and clinical practice are only coming to terms with NPS, and some of the novel cannabinoids are being identified as ‘ultra-potent’. Kaleidoscope picks up on a paper from the New England Journal of Medicine that describes a ‘zombie outbreak’ due to the highly depressant effects of a specific new agent identified. Long term concerns about potential impact on younger users continue. Changing tack, a fascinating editorial in the main journal by Matthew Nour and Robin Carhart-Harris re-evaluates psychedelics: this particular class of drug has never been as harmful as its reputation or notoriety might predict, and indeed it may have much to tell us about the science of ‘self’.

Which factors predict the development of PTSD following exposure to a trauma? There are growing data that interpersonal traumas, such as a sexual assault, are more damaging than non-interpersonal ones, such as road traffic accidents. The issue of individual predisposition has also attracted much attention: why, when faced with a similar trauma, do some but not others develop this condition? Problematically, much of the existing literature has had quite small sample sizes, challenging the validity and reproducibility of the findings. Now a large study has utilised data from almost 35,000 participants in a World Health Organisation survey. One’s past history also matters, and fitting with precipitating trauma data, a past history of violent traumas – but not other types – sensitises one to having later life PTSD triggered by subsequent events. Fascinatingly, the work also found an unexpectedly low prevalence of PTSD after natural disasters, and the authors argue that some past smaller studies suffered unintentional biases by focusing primarily on highly traumatised subpopulations.

How do you define pseudohallucinations? Am I alone in repeatedly stumbling with my response to that perennial question from medical students? I suspect that the ‘pseudo’ = ‘false’, and the presumed marriage to borderline personality disorder just jar with me. In any case, most clinicians will recognise the phenomenon, and likely associate it closely with BPD. Ian Kelleher and Jordan DeVylder challenge us in this month’s BJPsych, showing that epidemiological data show hallucinations/voice hearing to be equally common across the whole range of non-psychoses. They propose that the nature of BPD makes it more likely that individuals disclose/seek help for voices. It’s always good to have our assumptions tested.

Finally, do check out (and join in the debate by commenting on) Joe Hayes’ great blog, part of a new initiative between the BJPsych and the Mental Elf, on Tsoi et al’s paper in this month’s journal on depression severity and CBT outcomes:

Read the Kaleidoscope Column in the BJPsych


March's Kaleidoscope Monthly Quiz (True/False)

Q1: The Novel Psychoactive Substance legislative Act of 2016 has banned possession of all current and future so-called ‘legal highs’.
A1: False. Sale and distribution are banned, possession is not.


Q2: Past participation in sectarian violence has been shown to be associated with enhanced resilience to the later development of PTSD.
A2: True, but it is considered likely to be a selection bias: those who choose to engage in such violence are temperamentally different.


Q3: A large neuroimaging study has shown that ‘depression’ can be clustered into four neuroimaged biotypes, and these will predict response to neuromodulation treatment.
A3: True.


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