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Editorial – the outcome of that crucial encounter may have already been partly and significantly determined by what the patient experienced in the waiting room. Something the doctor may not just be unaware of, but may be usually beyond their control. Qualitative research has a long and respectable history in Anthropology and Sociology, though it may be sniffed at by medical colleagues; it’s just an example that other methodologies are available to us as research tools. You don’t need a high tech brain scanner to accomplish something meaningful. It should not be forgotten. Here are some possible research questions that I would be interested in assisting any staff member with conducting some kind of project, or which I believe others in the Trust may want to pick up. Why do patients complain and what is their experience of the complaints process? What leads to higher patient satisfaction after a complaint? What is the experience of the staff members who have been the subject of a complaint? What is the impact on them psychologically or in terms of the way they practice medicine afterwards? What is found most helpful by GPs in letters from Secondary Care clinics. What do they dislike the most in our letters to them? What impact do our letters have on care? What about a trial of different kinds of letters? When a patient first hears that a GP is thinking of referring them to a psychiatric services – what is their initial reaction? How does the encounter with services alter that? When trainees start psychiatry what are their expectations? How does doing a psychiatry placement alter this? Part of the new Trust journal could be devoted to throwing out research ideas and seeing who wants to collaborate over conducting. Part of the week could be set aside for doctors in the Trust to meet in order to discuss and assist with research projects. Remember as well that publishing doesn’t have to be restricted to publishing research – letters to journals can often be surprisingly influential. A good place to start in your research career is by submitting some letters. For that you must be aware of the literature and eventually dialogues and collaborations may develop. before you critique it and then eventually dialogues and collaborations often develop out of such initial correspondence. Colleagues could get together and submit more letters to journals - drawing attention to the implications of various research findings on clinical practice where we work? These are just questions – I don’t pretend to have the answers. But all great research at least starts with a good question. This is not as good a paper as I had hoped. It was done rather quickly and under difficult circumstances. But it might stimulate you to think of doing research. Remember, if you predict you’ll do, you are more likely to do it. 8 Surrey and Borders Online Journal www.sabp.nhs.uk/journal
Bipolar Disorder: how effective is our screening in primary care April 2010 By Helena Du Toit, Raja Mukherjee, Rebecca Farrell and Sudhir Rastogi Introduction Bipolar Affective Disorder (BPD) is a serious, recurrent psychiatric illness characterised by periods of mania or hypomania, and depression (ICD-10, 1992). BPD has a global prevalence of approximately 1-2%, which is stable over all population groups, however, when all forms of Bipolar Spectrum Disorder are included; the global lifetime prevalence rises to approximately 5% (Kessler RC et al, 1994; Angst J, 1998). It is a leading worldwide cause of disability (Hunter R et al, 2004), is associated with a high suicide risk (Sachs GS, 2003; Kasper, 2003) and costs the UK economy about £2 billion per annum through active costs of managing the disorder as well as through loss of productivity (Das Gupta R & Guest JF, 2002). The condition usually presents in adolescence or early adulthood and has a recurring, often lifelong course, and greatly affects the individual’s functioning in several areas and has wide reaching implications for close family, friends and colleagues (Kasper S, 2003; Weissman MM et al, 1988; Stang P et al, 2007). In spite of this, it is often several years from the first presentation of the illness until the diagnosis is finally established, sometimes being delayed by as long as 10 years. The under-recognition of BPD is due to several factors. Firstly, the illness often first presents with a depressive episode, and there may be several depressive episodes before the sufferer experiences a manic/hypomanic episode. These depressive episodes are often very difficult to distinguish from unipolar depression. Equally, the marked shifts in affect characteristic of emotionally unstable personality disorder and cyclothymia can be mistaken for BPD (Corona et al, 2007). Additionally, patients often do not present to medical services during hypomanic and sometimes even manic phases, as they find their increased energy levels and creativity during these periods quite enjoyable and often do not recognize them as pathological. Furthermore, clinicians often fail to screen for a past history of manic/hypomanic symptoms in patients presenting with a depressive episode (Brickman et al, 2002). Delayed diagnosis often leads to inadequate management of the illness, with associated recurrent illness, diminished social and occupational functioning and significant distress for both the sufferer and his/her family. To make matters worse, treating bipolar depression with antidepressant monotherapy is not only associated with a high rate of treatment failure, but also with a switch to rapid cycling BPD, increased mood instability and greater treatment resistance (Wehr TA & Goodwin FK, 1987). Conversely, there is good evidence that if the condition is diagnosed early and managed appropriately, it is associated with a significantly improved outcome and preserved social and occupational functioning (Bauer MS et al, 2006; Perry A et al, 1999), as well as a significant decrease in the suicide risk. The Mood Disorders Questionnaire (MDQ) is a short, self administered questionnaire that has been validated in several countries (including the UK) as being an appropriate screening tool for use in the community or a primary care setting (Hirschfeld RM 2002; de Dois et al, 2008). It has both acceptable sensitivity and specificity to be used as a screening tool, and although some studies have suggested that the false positive rate is unacceptably high, the Research and Audit Surrey and Borders Online Journal www.sabp.nhs.uk/journal 9
Page 1 and 2: Issue 1 Summer 2010 Surrey and Bord
Page 3 and 4: Do you ever wonder why you agree to
Page 5 and 6: We are not so aware of the hidden f
Page 7: esorting too soon to complex statis
Page 11 and 12: Research Method The study was condu
Page 13 and 14: Screened for Hypomania Yes No Total
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Page 21 and 22: An evolving service - results of a
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Page 29 and 30: Interview with Fiona Edwards, Chief
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