Are serum hsCRP and IL-6 prognostic markers in somatic symptom disorder and related disorders? An exploratory analysis in a prospective cohort study.

OBJECTIVE: To investigate the roles of hsCRP and IL-6 as prognostic markers for treatment outcome in SSRD. METHODS: In this prospective cohort study, 237 consecutive outpatients diagnosed with SSRD at the Clinical Centre of Excellence for Body Mind and Health, the Netherlands were assessed. At intake, venepuncture was performed for serum hsCRP and IL-6. Baseline scores for PHQ-9, GAD7, physical symptom score (PSQ-51) and BPI questionnaires were obtained. Patients were followed up at the end of their usual treatment programme, which lasted approximately 12 months. RESULTS: Higher baseline hsCRP was associated with high physical symptom scores (PSQ-51), but not BPI, GAD-7 and PHQ-9 questionnaire scores at end of treatment. No association was identified between baseline IL-6 and follow-up symptom questionnaire scores after treatment. Adjustment for age, gender and somatic comorbidity showed no significant change in the association. CONCLUSION: This exploratory analysis provides some evidence that in patients with SSRD, high baseline serum hsCRP may predict poorer treatment outcomes in physical symptoms but not depression, anxiety or pain symptoms. Baseline serum hsCRP may therefore be a useful factor in identifying SSRD patients who are at risk of a persistent high physical symptom burden.

Anti-inflammatory medications for the treatment of mental disorders: A scoping review.

This scoping review assessed the effect of anti-inflammatory medications in mental disorders. A search in Medline and the Cochrane database focusing on randomised controlled trials and systematic reviews identified 53 primary research articles, conducted in major depression, bipolar disorder, schizophrenia and somatic symptom disorders and related disorders (SSRD). The findings suggest that there is scope to consider the use of anti-inflammatory agents in mental disorders, however, not as a one-size-fits-all solution. Treatment could be especially helpful in subgroups with evidence of baseline inflammation. Anti-inflammatory medications that seem mostly effective in bipolar disorder or major depressive disorder, such as Celecoxib, Pioglitazone and statins, may differ from the ones with indications of effectiveness in schizophrenia, such as Minocycline and Aspirin. This might suggest a different underlying mechanism for treatment success in those two main illness groups. Further studies with larger sample sizes are needed that take levels of inflammation markers into account.

Clergy as a frontline mental health service: a UK survey of medical practitioners and clergy.

BACKGROUND: Christian clergy have often been identified as 'frontline mental health workers' and gatekeepers to mental health services. However, despite this, collaboration between clergy and mental health services remains poor, with some US clergy referring on as little as 10% of cases. AIMS: In this study, we aimed to evaluate the collaborative relationship between UK clergy and medical practitioners, with the purpose of identifying key issues that should be addressed to improve such collaboration between the two services. METHODS: We surveyed 124 clergy, 48 general practitioners and 13 psychiatrists in Wales. Part 1 of the survey covered four main themes: demographics; types of mental health cases seen by clergy and practitioners; referral rates between clergy and mental health services; attitude and relationship between clergy and mental health services. Part 2 was directed at clergy only and assessed how sensitive clergy were in identifying and referring on mental health disorders by using seven virtual case vignettes. RESULTS: Clergy frequently encountered mental health cases and around 60%-80% regularly referred on to a healthcare professional. Clergy appeared very effective at identifying and referring on high risk scenarios, such as psychosis, suicidal ideation and substance misuse, however were less effective at identifying and referring on clinical depression and anxiety. Clergy rarely received referrals from medical professionals. Both medical professionals and clergy felt they needed to engage in a more collaborative relationship, and around of one-third of practitioners were prepared to offer training to clergy. CONCLUSION: Most clergy in Wales regularly encounter mental health cases and appear effective at recognising and referring on mental health disorders; however, a large minority do not (20%-40%). Clergy generally do not receive referrals from mental health professionals, despite the proven benefits. Therefore, improving collaboration, developing spiritual training for mental health professionals, and mental health training for clergy is likely useful, a notion that many clergy and medical professionals deem important and are prepared to support.