June 2017

Derek K. Tracy, Dan W. Joyce, Sukhwinder S. Shergill

Full text: The British Journal of Psychiatry Jun 2017, 210 (6) 441-442; DOI: 10.1192/bjp.210.6.441

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At airports and elsewhere, security services use ‘profiling’ as part of how they determine who to stop and question. How do you feel about that? They will use your gender, your age, and – challengingly - your race and your religion: the lead psychiatrist at the Fixed Threat Assessment Centre that monitors risks to public figures put it rather bluntly as being “the problem of being a man with a beard in the 21st Century”. How do you feel about this? Uncomfortable? If it stops a potential threat being realised is it worth the inconvenience, stigma, shame and resentment to which it subjects huge numbers? Well there’s a parallel problematic issue in risk prediction in mental health. We have screening tools assessing for future self-harm and harm to others. The problem is that they’re not very good. The issue is the challenge between what is known as ‘sensitivity’ and ‘specificity’ in tests. Imagine a test for a cancer: you would like the test to pick up everyone who had the illness, but then it will falsely pick up lots who do not, causing worry and stress to them. So it is with predicting harm to others, and further, like the airport tests, these scales pull in factors such as age, gender, minority ethnic status….An editorial by the highly respected and thoughtful Professor Seena Fazel debates these very real issues; they put forward an equally concerning challenge – our desire to remove stigma could lead us to remove factors from tests that actually have predictive value, even if unpalatable. Not an easy topic, but not one we can ignore.

Playing games to improve your mental health – would you like that to be true? It would certainly be an interesting counter-narrative to the screen-time-kills-children stories that sell newspapers. A research team have explored a very specific use: playing Tetris to help prevent the onset of PTSD. They gave the game to a group of individuals brought to A&E after a life threatening road traffic accident, and compared them to those who’d gone through a similar experience, minus the Tetris bit. Those who played the game…did better in terms of fewer flashbacks and nightmares. What’s going on here? Creating memories in one’s brain is a complex process: as well as experiencing something, there is a so-called ‘plastic window’ in the subsequent hours when the brain tries to cement in the memory. For those who’ve undergone trauma, this is often in the form of severe distressing visual memories (that pop up in flashbacks). Tetris counteracts this, placing what’s called a high visuospatial demand on one’s memory when playing it (if you’ve played Tetris, you’ll know the feeling), preventing the traumatic memories from properly embedding. Fascinating stuff, and as you might imagine, it’s an intervention that had few side-effects. To clarify, should you get caught at work playing on your mobile: it doesn’t necessarily work for Candy Crush, and one can’t do this prophylactically ‘just in case’ something bad happens to you in the future. Sorry.

Where would you invest research funding: into ‘basic’ early research, or clinical practice? It might seem obvious, but the area is actually quite complex. Take a condition or problem of your choice: most of the time, whether physical or mental health, our interventions are ok, but far, far from perfect. So while one’s natural inclination might be to pump the money into clinical care, perhaps returns will be smaller, instead of investing in really novel and potentially game changing early stage science….that might produce nothing….in twenty years. Another difficult topic that can’t be ignored. Well some scientists, being scientists, have tried to answer ‘what’s the best thing to do’ scientifically (they know no other way). They explored funding into the two major research types over about thirty years, and then looked at outputs in terms of things such as novel patents. Which one is the best bet for your money? Read the piece. We took our guidance from a line from Jay Z.