Parity of esteem within the biopsychosocial model: is psychiatry still a psychological profession?

In recent years, the Royal College of Psychiatrists has been engaged in activities to ensure parity of esteem for mental health within the National Health Service, seeking to bring resources and services more in line with those available for physical health conditions. Central to this has been the promotion of psychiatry as a profession that takes a biopsychosocial approach, considering all aspects of the patient's presentation and history in the understanding and treatment of mental disorders. However, there has been a drift away from considering the psychological aspects of the patient's difficulties in recent years. This potentially has profoundly negative consequences for clinical care, training, workforce retention and the perception of our identity as psychiatrists by our colleagues, our patients and the general public. This editorial describes this issue, considers its causes and suggests potential remedies. It arises from an overarching strategy originating in the Royal College of Psychiatrists Medical Psychotherapy Faculty to ensure parity of esteem for the psychological within the biopsychosocial model.

Cognitive Analytic Therapy for Bipolar Disorder: A Pilot Randomized Controlled Trial

The evidence base for treatment of bipolar affective disorder (BD) demands the evaluation of new psychotherapies in order to broaden patient choice. This study reports on the feasibility, safety, helpfulness and effectiveness of cognitive analytic therapy (CAT). In a pilot randomized controlled trial, BD patients in remission were randomized to either receiving 24 sessions of CAT (n = 9) or treatment as usual (n = 9) and were assessed in terms of symptoms, functioning and service usage over time. In the CAT arm no adverse events occurred, 8/9 completed treatment, 5/8 attended all 24 sessions and 2/8 were categorized as recovered. The most common helpful event during CAT was recognition of patterns in mood variability, with helpfulness themes changing according to phase of therapy. No major differences were found when comparing the arms over time in terms of service usage or psychometric outcomes. The study suggests that conducting further research into the effectiveness of CAT in treating BD is warranted and guidance regarding future trials is provided. Copyright © 2016 John Wiley & Sons, Ltd.

KEY PRACTITIONER MESSAGE

Treating BD with CAT appears feasible and safe. Retaining fidelity to the reformulation, recognition and revision structure of CAT appears useful. Participants stated that across the phases of CAT, focussing on patterns of mood variability was consistently helpful.

Optimization of the sensitivity of high-performance liquid chromatography in the detection of heterocyclic aromatic amine mutagens

Solid-phase extraction with the weak cation-exchange resin Fractogel TSK CM650(S) (TSK CM) was used to optimize the sensitivity and chromatographic resolution by HPLC of the mutagenic heterocyclic aromatic amines MeIQx, 4,8-DiMeIQx, IQ, MeIQ, PhIP, Trp-P-1, Trp-P-2, amino-alpha-carboline and the co-mutagens norharman and harman. The clean-up using cation exchange was applied after purification on Extrelut and propylsulphonic acid-silica gel cartridges (PRS tandem purification). Only the clean-up with TSK CM enabled low detection limits of the mutagenic compounds to be achieved (in the order of ng heterocyclic amines/g experimentally overheated process-flavour sample).