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Biomedical subjects

Simon Hatcher

Publications and source records attributed to Simon Hatcher.

12 recordsLinked to original sources
PubMed2006

Depression and randomized, controlled trials: problems and solutions.

Research into what works in depression is in trouble. All treatments appear equally effective and what happens in research trials does not seem to translate into clinical practice or, to put it another way, clinical practice is not reflected in randomized controlled trials. We run the risk of designing cosmetic trials with no real relationship to clinical services that only serve to demonstrate that new treatments are effective in artificial settings. This article outlines possible reasons for this, which include how depression is diagnosed, how people are recruited into trials, the design of trials and how outcomes are assessed. The solutions to these problems involve changing how patients are recruited, considering other trial designs and using different outcome measures.

Antidepressive Agents↗
PubMed2005

Do get in touch.

Explore the source record for details and available documents.

Correspondence as Topic↗
PubMed2005

Burnout in psychiatrists: an etiological model.

OBJECTIVE: This article reviews burnout in psychiatrists. A model of burnout is presented which considers three factors: those which may predispose, precipitate, and perpetuate burnout. Lastly, recommendations are made for future research. METHODS: We conducted a selective literature review to expand on two recent systematic reviews to examine the etiology, prevalence, and consequences of burnout in psychiatrists. We distinguish the effects of burnout, depression, and work-related stress. RESULTS: An etiological model for the development of burnout in psychiatrists is described here in terms of an interaction between the predisposing, precipitating, and perpetuating factors. CONCLUSIONS: Research is needed on the long-term effects of work-place stress on psychiatrists, to identify possible protective factors, and to utilize this information to inform the design of interventions that protect or mitigate the effects of work-place stress on psychiatrists.

Burnout, Professional↗
PubMed2004

Depressive disorders.

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Antidepressive Agents, Second-Generation↗
PubMed2003

Efficacy and tolerability of selective serotonin reuptake inhibitors compared with tricyclic antidepressants in depression treated in primary care: systematic review and meta-analysis.

OBJECTIVE: To compare the efficacy and tolerability of tricyclic antidepressants with selective serotonin reuptake inhibitors in depression in primary care. DESIGN: Systematic review and meta-analysis of randomised controlled trials. DATA SOURCES: Register of the Cochrane Collaboration's depression, anxiety, and neurosis group. Reference lists of initial studies and other relevant review papers. Selected authors and experts. SELECTION OF STUDIES: Studies had to meet minimum requirements on: adequacy of sample size, adequate allocation concealment, clear description of treatment, representative source of subjects, use of diagnostic criteria or clear specification of inclusion criteria, details regarding number and reasons for withdrawal by group, and outcome measures described clearly or use of validated instruments. MAIN OUTCOME MEASURES: Standardised mean difference of final mean depression scores and relative risk of response when using the clinical global impression score. Relative risk of withdrawing from treatment at any time, and the number withdrawing due to side effects. RESULTS: 11 studies (2951 participants) compared a selective serotonin reuptake inhibitor with a tricyclic antidepressant. Efficacy between selective serotonin reuptake inhibitors and tricyclics did not differ significantly (standardised weighted mean difference, fixed effects 0.07, 95% confidence interval -0.02 to 0.15; z=1.59, P<0.11). Significantly more patients receiving a tricyclic withdrew from treatment (relative risk 0.78, 95% confidence interval 0.68 to 0.90; z=3.37, P<0.0007) and withdrew specifically because of side effects (0.73, 0.60 to 0.88; z=3.24, P<0.001). Most studies included were small and supported by commercial funding. Many studies were of low methodological quality or did not present adequate data for analysis, or both, and were of short duration, typically six to eight weeks. CONCLUSION: The evidence on the relative efficacy of selective serotonin reuptake inhibitors and tricyclic antidepressants in primary care is sparse and of variable quality. The study setting is likely to be an important factor in assessing the efficacy and tolerability of treatment with antidepressant drugs.

Antidepressive Agents, Tricyclic↗
PubMed2003

Life events, difficulties and dilemmas in the onset of chronic fatigue syndrome: a case-control study.

BACKGROUND: The role of stress in the onset of chronic fatigue syndrome is unclear. Our objectives in this study were first, to determine the relation between the onset of chronic fatigue syndrome and stressful life events and difficulties. Secondly, we examined the role of a particular type of problem, dilemmas, in the onset of chronic fatigue syndrome. METHOD: We used a case-control design with 64 consecutive referrals from an Infectious Diseases/ Liaison Psychiatry Fatigue clinic and 64 age- and sex-matched controls from a general practice population control group in Leeds. We had two main outcome measures; the odds ratios of the risk of developing chronic fatigue syndrome after experiencing a severe life event, severe difficulties or both in the year and 3 months preceding onset; and the proportion of subjects in each group who experienced a dilemma prior to onset. RESULTS: Patients with chronic fatigue syndrome were more likely to experience severe events and difficulties in the 3 months (OR = 9, 95% CI 3.2 to 25.1) and year (OR = 4.3, 95% CI 1.8 to 10.2) prior to onset of their illness than population controls. In the 3 months prior to onset 19 of the 64 patients (30%) experienced a dilemma compared to none of the controls. CONCLUSIONS: Chronic fatigue syndrome is associated with stressful events and difficulties prior to onset. Those events and difficulties characterized as being dilemmas seem to be particularly important.

Adult↗
PubMed2003

Depressive disorders.

Explore the source record for details and available documents.

Antidepressive Agents, Second-Generation↗
PubMedDate not supplied

Stigma toward the mentally ill in the general hospital: a qualitative study.

BACKGROUND: Stigma associated with mental illness is frequently reported in the community but there is little published information about stigma within general hospitals. OBJECTIVES: The objective of this study was to describe the experience of stigma in patients and health professionals using a Liaison Psychiatry service in a general hospital. DESIGN: We used a grounded theory qualitative method to analyze audiotaped interviews of participants. SETTING: A general hospital in Auckland, New Zealand. SUBJECTS: Ten participants, five patients and five referrers. MEASUREMENTS: The qualitative method generated various categories that made up the construct of "stigma" in the general hospital. RESULTS: A central category of "Relating Mind to Matter" was developed and linked to the major categories of "It's a Scary Business," "It's All Hopeless," "She's One of Them," "Expressions of Relatedness," "You are Not Genuinely Ill" and "Playing by the Roles." CONCLUSION: The presence, or suspicion, of a mental illness in a patient has a negative impact in the general hospital setting. The key experiences are silence, disbelief and invalidation. The category title "Relating Mind to Matter" refers to the tensions in the patient-health professional relationship and to the uncomfortable relationship between the mind and the body.

Adult↗