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Showing posts with label psychiatry. Show all posts
Showing posts with label psychiatry. Show all posts

Sunday, 30 June 2013

Methylphenidate (Ritalin) – does use by ‘healthy’ students matter?

In their report in the Telegraph, @Josiensor and Rosa Silverman discuss implications of a survey from Cambridge which notes that so-called 'smart' drugs continue to be used by students to try to improve their academic performance, with methylphenidate (Ritalin) a common choice.

Why should this be of public interest?

Methylphenidate has been in use since 1960 for treating ADHD, with effects mainly considered to be improvement in attention and concentration. It is used to treat a number of rare syndromes involving abnormalities in chemical transmission in the brain. The drug is also reported to be in widespread use by students in the UK, the US and elsewhere in the hope that it will improve studying, learning and exam performance.
 
1.    Does it work? Studies of possible effects on studying and learning are typically short-term and usually based on artificial tests – ie not usually test possible benefits of the drug what students may be trying to learn, or effects on the types of exams students may be sitting. Evidence compared to placebo of benefits or risks appears limited to studies lasting 4 weeks or less.
The evidence of benefits from methylphenidate in apparently healthy students is disappointing. For example, in a study in health young volunteers there was a reported benefit from the 1st dose for a spatial (3D) task and for planning, but not for attention or fluency. However even these effects were not sustained: with a second dose, spatial task performance was less good; ie there was little evidence of sustained benefit on repeat use of the drug and possible evidence that performance might be worse. And one of the side effects is insomnia – fatigue could also therefore be an indirect reason why performance might be impaired by the drug. There are also reports by users that with the drug, too much focus on details may make it difficult both to complete an assessment and to consider a broad enough range of issues to give a complete answer.
2.    Is use of methylphenidate any different from using caffeine? Because of the lack of convincing evidence of benefit from methylphenidate and concerns about serious risks, methylphenidate is not approved for use in the absence of specified medical conditions – e.g. ADHD. As for other drugs, the balance between risk and benefit must be considered by prescriber and user. In the event of any benefit for studying from the drug, others not using it are put at a disadvantage. In contrast caffeine is widely available for those who chose to use it. Too much caffeine, or sensitivity to caffeine can cause troublesome symptoms, including anxiety, tremor, sleep disturbance and palpitations. 
3.    Risks of methylphenidate Potential risks may be serious and include serious cardiac and psychiatric disorders. This has lead to important restrictions by regulatory authorities such as the FDA on use of the drug, even when the drug is medically indicated. 
Withdrawal symptoms of methylphenidate can include psychosis, depression and irritability.
Risks of the drug may be greater if there are medical problems, in particular if the user has a medical history of cardiovascular or psychiatric problems. Use without clinical advice may mean that important underlying conditions are not identified, for example high blood pressure, disorders of heart rhythm, and psychiatric risk; and potential important interactions with other drugs (including other stimulants) may not be considered. For example: 
-      alcohol can delay clearance of the drug from the body, increasing risk of adverse effects; 
-      concurrent use of stimulants such as caffeine would be expected to increase risk from methylphenidate of serious disorders of heart rhythm.

4.    What about access to the drug from internet pharmacies? For the above reasons, licensed pharmacies would not supply methylphenidate in the absence of specified medical conditions. Unlicensed internet pharmacies should be avoided. The quality of medicines is not reliable, with serious risk of being supplied poorly active or counterfeit or contaminated medicines. And medical contra-indications need to be identified and discussed to minimize the risk of preventable serious adverse effects.

5.    Fairness and coercion There are also a number of ethical concerns including:
a)    the need to protect students and others from using so-called ‘smart drugs’ in response to pressure to compete, both in exams and in professional life; 
b)    being fair to other students who do not have access to the drug, or do not wish to use what may be a medically harmful pharmacological aid to improving performance in examinations or to meeting challenges at work.

See also
June 2009: Opposing opinions in the British Medical Journal from John Harris and Anjan Chatterjee
September 2011: Methylphenidate and delayed puberty
July 2012: Methylphenidate for Parkinson's disease
November 2012: Commentary in the Guardian by William Leith: Ritalin before an exam fails the test of common sense 
June 2013: Cautionary report in from Canada on methylphenidate use and learning in  ADHD

Wednesday, 16 May 2012

2012 Hippocrates winning Open and NHS poems in the New Scientist

2012 winner Nick MacKinnon ©Hippocrates Press
@HealthMed The 2012 Hippocrates Awards Symposium are discussed in the New Scientist by Kelley Swain in a feature - 'Balm for the soul: when poetry meets medicine' - which includes the 1st Prize Open and Ist Prize NHS entries in this year's awards.


The extraordinary imagery in the poetry in this year’s winning entries illustrates many themes, from the history of medicine, to the experience of patients and health professionals, and the engagement of researchers in translating new medical ideas into practice: Open winner Mary Bush from North Texas touching on the human side of medical research in her multi-layered poem about the role of women at the forefront of clinical science; and NHS winner Nick MacKinnon illustrating the impact on patients and staff of the progression over the past century of treatment for disorders of the mind.

Fellow organizers Michael Hulse, Sorcha Gunne and I were delighted by the increasing international interest in the interface between poetry and medicine which has been stimulated by the Hippocrates poetry and medicine initiative, with entries from 32 countries this year, and from 44 countries since the launch of the Hippocrates awards in 2009.

Saturday, 12 May 2012

2012 Hippocrates Awards announced


Judges, winners and organizers ©Hippocrates Press
@HealthMed In London on 12th May, judges broadcaster Martha Kearney, Paris-based US poet Marilyn Hacker and medical researcher Professor Rod Flower FRS  announced the awards for the 2012 Hippocrates Awards for Poetry and Medicine

The £5000 open international Hippocrates first prize went to American poet Mary Bush from North Texas for a multi-layered poem reflecting on the role of women at the forefront of medical science. Writer-in-healthcare Shelley McAlister won the £1000 second open prize for a poem on health inequalities, and academic and writer Kelly Grovier won the £500 third open prize for a poem on medical archaeology. 

The £5000 NHS-related Hippocrates first prize went to former nurse Nick McKinnon from Winchester for a poem illustrating the progression over the past century of treatment for disorders of the mind. The £1000 NHS-related second prize was awarded to medical librarian Andy Jackson for a poem inspired both by volunteering for research and by Hancock's 'The Blood Donor'. Former dentist Jane Kirwan won the £500 third prize for a poem on multiple worlds of asylum, centred on Czech poet Ivan Blatný. 

The 46 awarded and commended entries have been published in the 2012 Hippocrates Awards Anthology, launched at the 2012 Hippocrates Awards in London, on Saturday 12th May.

The awards were supported by the Fellowship of Postgraduate Medicine and the Cardiovascular Research Trust.

Themes ranged from identity and immunity to psychiatry and alienation, and from global health to medicine in archaeology, and the role of women in health (see winners' biographies and judges' comments below).
The judges also awarded commendations for 20 entries in the NHS category and 20 in the Open International category - 2 from Australia, 1 from New Zealand, 7 from the USA and 10 from the UK. Commended entries considered themes from birth to imaging, cancer, health and disease in art, history of medicine and illness in the family.

Awards were announced by the judges on Saturday 12th May in London at an International Symposium on Poetry and Medicine at the Henry Wellcome rooms, with speakers and readers from the USA, France, Denmark, Cyprus, Greece and the UK.

Useful links

Open International and NHS-related awards and commended entries 

NHS-related
awards
1st prize - Claybury    Nick MacKinnon
2nd prize - Allogeneic   Andy Jackson
3rd prize - Mr Blatný perseveres   Jane Kirwan

Top 20 commended NHS-related entries
I must speak for this man - Edward John Anderson
At the clinic - Neil Ferguson
Into the tunnel - Alex Josephy
A nurse's châtelaine - Alex Josephy
Sara's wig - Frances-Anne King
Anatomy - Jane Kirwan
Delivery - Jane Kirwan
Heal thyself - Jane Kirwan
Not raging - Jane Kirwan
Eighteen - Denise Kitchiner
These are the stories doctors tell - Jonathan Knight
A question for neuroscientists - Valerie Laws
Rorschach - Andrew Thomas Martin
Intensive care, Friday afternoon - Kev O'Donnell
Still birth - Janet Smith
The bones - Sarah Stringer
Shrink - Tricia Torrington
Whitby - Carol Whitfield
Syphilis II: Treponema pallidum - Alison Wood
The little mercury I have taken - Chris Woods

Open International awards
1st prize - Women’s Work - Mary Bush
2nd prize - Los Subiros - Shelley McAlister
3rd prize - The Edwin Smith papyrus - Kelly Grovier

Top 20 Commended Open International entries
A lobsterman looks at the sea - Richard Berlin
The lonely walk - Timothy Edward Brewis
Recent past events - Rafael Campo
Artifact - Amanda Carver
R-O-M-J-X - Martyn Crucefix
Heartburn - Claudia Daventry
Bone says  - Julie Dunlop
Post-traumatic stress disorder - Elizabeth Anne Gleeson
Ana and I - Natalie Ann Holborow
To an anatomical Venus - Matthew Howard
In the ward with my son - Leah Kaminsky
Careful - Kathleen M Kelley
Ablation - Connie Levesque
Birth - Renee Liang
Forensic pathology - Kona Macphee
District nurse - Alice Malin
Next of kin - Vicky Paine
Rembrandt - Lynn Roberts
Tomorrow will be a day beloved of your father & of you - Rosie Shepperd
Day off - Caroline Wilkinson

Further details on award-winning and commended entries for the 2012 Hippocrates Prize
A former nurse, a dentist, and an emerging US poet, were among the finalists for this year’s Hippocrates Prize for Poetry and Medicine - one of the highest value poetry awards in the world for a single poem. Themes ranged from medicine in archaeology to the role of women in new life science, and from health in the developing world to frailty and memory.
Now in its third year, the winning and commended entries for the 2012 Hippocrates Prize for Poetry and Medicine were selected by judges broadcaster Martha Kearney, distinguished US poet Marilyn Hacker and medical scientist Professor Rod Flower FRS, from over 1000 entries from 32 countries.

The prize, which has a £15,000 award fund, has two strands – an open category and an NHS category with both carrying a first prize of £5,000.

The winners were announced at an International Symposium on Poetry and Medicine on May 12th at the Wellcome Collection rooms in London.

The judges also agreed commendations for 20 entries in the NHS category and 20 in the Open International category - 2 from Australia, 1 from New Zealand, 7 from the USA and 10 from the UK. Commended entries considered themes from birth to imaging, cancer, health and disease in art, history of medicine and illness.

Martha Kearney said: ‘Who would have thought that such beautiful poetry could be inspired by lab instruments, tissue engineering or MRI scans? It has been fascinating to sift through such an interesting range of work right at the very nexus of science and art.’
Rod Flower added: 'Like literary X-rays, these poems penetrate into the emotional structure of humankind’s age-old struggle against disease, whether it be at the hospital, the patient's bedside or in the science laboratory'.
Marilyn Hacker said: 'The best of these poems reminded the reader of poetry's capacity to delight and instruct. They find their strength in merging knowledge, craft and feeling: they affirm poetry's ability to arise from and to address crucial issues of human life, both individual and collective'.

The awards symposium considered the relationship between poetry and medicine, with topics including poetry as therapy, using poetry in health professional training, the impact of health and disease on the professional poet and the history of poetry and medicine.
Speakers on the day came from the around the UK, the USA, Cyprus, Denmark, France, Greece, and Russia. MEP Eleni Theocharous gave a keynote lecture and attendees were treated to a reading by Jo Shapcott, the recent winner of the Queen’s Gold Medal for Poetry.
The Hippocrates Initiative – winner of the 2011 Times Higher Education Award for Innovation and Excellence in the Arts – is an interdisciplinary venture that investigates the synergy between the medicine, the arts, and health.

To attend the Symposium see http://go.warwick.ac.uk/cpt/poetry/symp/

Notes to editors
Photos of all of the award winners, along with extracts of their poems are available on request. The winners have agreed to be contacted by press and other media. For more information, please contact hippocrates.poetry@gmail.com

Awards: In each category: 1st prize £5,000, 2nd prize £1,000, 3rd prize of £500, and 20 commendations each of £50.  
Entries are judged anonymously. To avoid the judges seeing clustered runs of entries by the same poet, judges are given the anonymous entries ordered alphabetically by title.

2012 Hippocrates Prize for Poetry and Medicine

Open Awards 
1st Prize - Mary Bush: Women’s Work
Mary Bush recently (2011) earned a Ph.D. in Creative Writing/Poetry from the University of North Texas while continuing to work in my long-term career as a project manager in the Information Technology industry. I write poetry for pleasure, and I have always been interested in the overlap of art and science—whether writing “scientific” poetry or “elegant” software. My husband and I have three adult children, one of whom is autistic, and his unique use of language fascinates and inspires me. We live in a ramshackle old house in a small town in North Texas, where my husband plays loud guitar and I write poems.
She said: ‘I was inspired to write this poem by reading about the tissue engineering work of Dr. Doris Taylor (http://www.nytimes.com/2008/01/14/health/14heart.html). I was taken first by the fact that a woman was a leader and spokesperson for this cutting-edge scientific work and secondly by the notion of using a detergent or shampoo as part of the engineering process, as in a commercial context, detergent and shampoo are stereotypically considered "women's products." Everything about tissue engineering seemed beautiful to me, from the ethereal nature of the scaffolds to the idea of re-use and rebirth implicit in the process.’

2nd Prize - Shelley McAlister: Los Subiros
Shelley McAlister grew up on the west coast of America and came to the UK in 1977. She writes short fiction and poetry and has previously been a writer in residence in healthcare on the Isle of Wight where she lives. She was commended in the 2010 Hippocrates Prize and has poems in a variety of publications including Magma, Iota and The Rialto. Her first poetry collection, Sailing Under False Colours, was published by Arrowhead Press in 2004.

Inspiration for the poem
As a lecturer in health and social care, I often read about inequalities in health. On this occasion I had a dream about a hospital on top of a mountain where the poorest people had no access to healthcare. I am fascinated by carriers of all kinds so once I had this setting clear in my mind, I knew that this was a poem about the bringers.  

3rd Prize - Kelly Grovier: The Edwin Smith Papyrus
Kelly Grovier is the author of two collections of poetry with Carcanet Press: A lens in the palm (2008) and The Sleepwalker at Sea (2011). He is a regular contributor on arts to The Times Literary Supplement and co-founder of the scholarly journal European Romantic Review. In 2008, his popular history of London’s infamous Newgate Prison, entitled The Gaol (John Murray publishers), was a BBC Radio 4 Book of the Week. He is a lecturer in the Department of English and Creative Writing at Aberystwyth University and co-founder and co-director of the interdisciplinary David Jones Centre.
About the poem he said: ‘I’ve always been drawn to poems about fragments and ruin. So I found especially exciting the subject of ancient surgical papyri: those endlessly deteriorating tissues ironically intended to reverse the deterioration of tissues. “All composition is decomposition”, so the eighteenth-century traveller Walking Stewart once wrote. In the case of the so-called Edwin Smith papyrus (the oldest treatise on trauma we have, written around 1500 BCE), the allure was only amplified by hints of the interweaving of science and superstition, medicine and myth, and enticing allegations of possible forgery on the part of Smith himself, who acquired it in Egypt in 1862. In the poem I try to imagine the word and the world, the writer and the written, pixels and stars, in a ceaseless cycle of visions and division.’
 
NHS-related Awards 


1st Prize - Nick MacKinnon: Claybury
Nick MacKinnon was an auxiliary nurse on Duncuan psychogeriatric ward of the Argyll and Bute Hospital in the early 1980s. The subject of his poem is Claybury Asylum where his mother Rosan worked as an SRN in the 1970s. Claybury's water tower is still the chief landmark in Roding Valley, but the buildings are now the gated housing estate Repton Park. The poem aspires to be a history of psychiatry from Victorian place of safety to our Care in the Community, from the point of view of the tower.
2nd Prize  - Andy Jackson: Allogeneic
Andy Jackson is from Manchester but lives in Fife, Scotland, where he is Medical Librarian at Ninewells Teaching Hospital in Dundee. His poems have appeared in Magma, Blackbox Manifold, Trespass and Gutter. He won the National Galleries of Scotland competition in 2008 and the inaugural Baker Prize in 2012. Debut collection The Assassination Museum was published by Red Squirrel Press in 2010 and he is editor of Split Screen : Poetry Inspired by Film & Television, also published by Red Squirrel in 2012. Currently working with WN Herbert on an historical anthology of poems about the city of Dundee.
The poem Allogeneic is partly informed by experience as a patient having bloods taken as part of a research programme into cholesterol levels conducted by the Tayside Medical Science Centre and partly by the eternally wonderful Hancock’s Half Hour episode The Blood Donor.

3rd Prize - Jane Kirwan: Mr Blatný Perseveres
Jane Kirwan qualified as a dentist in 1970, retiring in 2005, now divides her time between London and the Czech Republic where Ivan Blatný is still admired as a poet. Her mother and sister have worked as psychiatrists. She has had two poetry collections published by Rockingham Press and more recently a prose-poem memoir with her partner, a Czech dissident and former political prisoner. In 2002 she won an Arts Council Writers Award. She is currently working with Wendy French on a project about the NHS. 

The Hippocrates Prize judges
Rod Flower is Professor of Biochemical Pharmacology at the WIlliam Harvey Research Institute[21] in London. His main scientific research interests concern inflammation and anti-inflammatory drug mechanisms. He was formerly President of the British Pharmacological Society and is a Fellow of the Academy of Medical Sciences.

Marilyn Hacker's book of poetry Presentation Piece (1974) won the National Book Award. In 2009, she won the PEN Award for Poetry in Translation for King of a Hundred Horsemen by Marie Étienne. In 2010, she received the PEN/Voelcker Award for Poetry.

Martha Kearney is the main presenter for BBC Radio 4’s lunchtime news programme ‘The World at One’. She previously worked for Channel 4, presented the BBC’s Woman’s Hour, Today and PM and was political editor for Newsnight. She has been commended for her national and international reporting, including for work on child poverty. She has been a judge for the Webb Essay Prize and the Guardian First Book Award, and has chaired the judging panel for the Orange Prize for Fiction.

Hippocrates Prize Organisers
Donald Singer is Professor of Clinical Pharmacology and Therapeutics, University of Warwick, and President of the Fellowship of Postgraduate Medicine. His interests include research on discovery of new therapies, and public understanding of drugs, health and disease.
Michael Hulse is a poet and translator of German literature, and teaches creative writing and comparative literature at the University of Warwick. He is also editor of The Warwick Review. His latest publications are: The Secret History (poems, Arc) and The Notebooks of Malte Laurids Brigge (translation of Rilke's novel, Penguin Classics). With Donald Singer he co-founded in 2009 the International Hippocrates Prize for Poetry and Medicine.
Sorcha Gunne is a Post-doctoral Teaching Fellow in the Department of English and Comparative Literary Studies. Prior to this appointment,she was an Early Career Fellow at the Institute of Advanced Study. Her research specialism is World Literatures in English, particularly twentieth-century and contemporary writing.

The 2012 Hippocrates prize is supported by
The Fellowship of Postgraduate Medicine, a national medical society founded in 1918 and publisher of the Postgraduate Medical Journal and Health Policy and Technology.
The Cardiovascular Research Trust, a charity founded in 1996, which promotes research and education for the prevention and treatment of disorders of the heart and circulation. 

Sunday, 29 April 2012

Launch of 2012 Hippocrates Anthology at 12th May Awards in London

@HealthMed The 2012 Hippocrates Anthology of the 46 award-winning and commended poems will be launched in London on Saturday 12th May at the Wellcome Collection, 183 Euston Road.

The launch will take place at the close of the 2012 Hippocrates Prize Awards, to be presented by judges broadcaster Martha Kearney, Paris-based US poet Marilyn Hacker, and scientist Prof Rod Flower FRS. Places are still available for the 12th May Symposium and Hippocrates Awards for Poetry and Medicine.

The 2102 Hippocrates Anthology contains the 3 Open and 3 NHS award-winning entries and the 40 commended poems in the 2012 Hippocrates Prize for Poetry and Medicine.

The Open international short-list includes one poet from the USA and two from the UK. Themes ranged from identity and immunity, to psychiatry and alienation, and from global health to medicine in archaeology, and the role of women in health (see full details of short-listed names, biographies and judges comments).
In the Open section, 10 of the 20 commended poems were from overseas: 1 from New Zealand, 2 from Australia and 7 from the USA.

To order copies of the anthology, please provide your contact details on the online order form

Wednesday, 22 February 2012

Clinical pharmacology theme for Spring 2012 WMPA conference

@HealthMed Registration is now open for members and guests for the Spring meeting of the West Midlands Physicians Association.
The next meeting of the WMPA has updates on Clinical Pharmacology as its major theme and will be held on Wednesday 16th May 2012 at the Clinical Sciences Building at the University Hospital Campus in Coventry. Key speakers will include Dr Andrew Kicman (King's College London) on drugs in sport, Professor of Psychiatry Femi Oyebode (Birmingham) on medicines in psychiatry, Dr Richard Fitzpatrick (Liverpool) on advances in pharmacogenetics and Dr Paul Newrick (Worcestershire Royal Hospital)on medical advances in managing diabetes mellitus.
In view of the large number of high quality abstracts submitted, an attended poster session will be included in the May 2012 meeting.
Registration is open to members and guests (subject to availability of places).
For further information, contact the WMPA organizers.
See the WMPA blog or the WMPA website for more on the WMPA 2012 Spring conference and on the history of this 62 year old medical society.