Premenstrual exacerbation of mental health disorders: a systematic review of prospective studies.

Mental health disorders can be exacerbated during periods of hormonal fluctuation (e.g. pregnancy, menopause), and the risk factors for sensitivity to these fluctuations are similar to those of mental disorders (e.g. trauma). However, the extent to which hormonal fluctuations during the menstrual cycle impact symptoms of preexisting mental disorders remains unclear. Prospective methodology is considered the gold standard for measuring symptoms across the menstrual cycle. Thus, the aim of the review was to address this knowledge gap by summarising all available studies prospectively measuring symptoms of mental disorders across the menstrual cycle. A systematic review with narrative synthesis was conducted; meta-analysis was precluded due to methodological heterogeneity of included studies. Electronic databases MEDLINE, Embase, PyschINFO and CINAHL were systematically searched from inception. Risk of bias for individual studies was assessed using a modified version of the Newcastle-Ottawa Scale. The search identified 629 studies from which 35 met inclusion criteria. There was clear evidence of symptom exacerbation during the perimenstrual phase for psychotic disorders, panic disorder, eating disorders, depression and borderline personality disorder. Less consistent evidence was found for anxiety, and a different pattern of symptom exacerbation was observed in bipolar disorder. Sample size and methodology varied considerably amongst studies. Overall, there was mixed evidence for perimenstrual exacerbation across mental disorders, which could be partly explained by methodological limitations of the studies. However, hormonal fluctuations during the menstrual cycle may exacerbate psychiatric symptoms in a subgroup of individuals who are hormone sensitive.

How to advise and refer inpatients who smoke.

Patients who smoke are more likely to experience postoperative complications than non-smokers and up to one-third of all hospital patients are estimated to be smokers. Inpatients are receptive to an offer of stop-smoking support but are not always referred to stop-smoking services. A pilot of a acute care referral system trained staff to deliver very brief advice on smoking via a short online training module, and provided a streamlined electronic referral system to local NHS stop-smoking services. The three-month pilot resulted in a 600% increase in referrals. Nursing staff felt that the system was simple and effective, and that patients had benefited.

The contribution of mental health services to a new strategic direction for sexual assault and abuse services.

A new strategy for sexual assault and abuse services was published by NHS England earlier this year. It called for better coordination of services along the Sexual Assault Referral Centre (SARC) pathway following a sexual assault including mental health services for children, young people and adults. Previous research has highlighted the fact that up to two-thirds of those attending SARCs either have a history of mental health problems or are being currently treated for one. The NHS England commissioning guidance for SARCs calls for clear pathways between SARCs and different types of mental health services including: Community mental health teams (CMHTs); child and adolescent mental health services (CAMHS) or crisis teams (CTs). In this survey of Mental Health Trusts, using freedom of information requests (FOIs) we found that very few mental health services had formally negotiated pathways with SARCs however there were several examples of good practice which it is important to report. We conclude that there is an important role for CCG and NHS England commissioners and the Care Quality Commission (CQC) in improving the relationships between SARCs and Mental Health Services.

History and First Descriptions of Autism: Asperger Versus Kanner Revisited.

When reading Michael Fitzgerald's chapter entitled 'Autism: Asperger's Syndrome-History and First Descriptions' in 'Asperger's Disorder' edited by Rausch, Johnson and Casanova, a while ago, one of us was struck by his contention that Kanner was guilty of plagiarism as well as non-attribution of Asperger's 1938 paper 'Das psychisch abnorme kind' (Fitzgerald in Asperger's disorder. Informa Healthcare, New York, 2008) published in a Vienna weekly. Steve Silberman has discovered evidence that Kanner rescued Asperger's chief diagnostician from the Nazis in 1944 so must have been aware of Asperger's work and conclusions. Fitzgerald was on the right track but it appears that Kanner may have plagiarised Asperger's ideas rather than his 1938 paper.