Joanna Moncrieff - Academia.edu (original) (raw)

Papers by Joanna Moncrieff

The psychoactive effects of psychiatric medications have been obscured by the presumption that th... more The psychoactive effects of psychiatric medications have been obscured by the presumption that these medications have disease-specific actions. Exploiting the parallels with the psychoactive effects and uses of recreational substances helps to highlight the psychoactive properties of psychiatric medications and their impact on people with psychiatric problems. We discuss how psychoactive effects produced by different drugs prescribed in psychiatric practice might modify various disturbing and distressing symptoms, and we also consider the costs of these psychoactive effects on the mental well-being of the user. We examine the issue of dependence, and the need for support for people wishing to withdraw from psychiatric medication. We consider how the reality of psychoactive effects undermines the idea that psychiatric drugs work by targeting underlying disease processes, since psychoactive effects can themselves directly modify mental and behavioral symptoms and thus affect the resul...

BMJ Evidence-Based Medicine

Survival analysis is routinely used to assess differences between groups in relapse prevention an... more Survival analysis is routinely used to assess differences between groups in relapse prevention and treatment discontinuation studies involving people with long-term psychiatric conditions. The actual outcome in survival analysis is ‘time to event’, yet, in the mental health field, there has been little consideration of whether a temporary delay to relapse is clinically relevant in a condition that can last for decades. Moreover, in psychiatric drug trials, a pattern of elevated early relapses following randomisation to placebo or no treatment is common. This may be the result of the withdrawal of previous treatment leading to physiological withdrawal effects, which may be mistaken for relapse, or genuine relapse precipitated by the process of withdrawal. Such withdrawal effects typically produce converging survival curves eventually. They inevitably lead to differences in time to relapse, even when there is little or no difference in the cumulative risk of relapse at final follow-up...

Wellcome Open Research

We argue that predictions of a ‘tsunami’ of mental health problems as a consequence of the pandem... more We argue that predictions of a ‘tsunami’ of mental health problems as a consequence of the pandemic of coronavirus disease 2019 (COVID-19) and the lockdown are overstated; feelings of anxiety and sadness are entirely normal reactions to difficult circumstances, not symptoms of poor mental health. Some people will need specialised mental health support, especially those already leading tough lives; we need immediate reversal of years of underfunding of community mental health services. However, the disproportionate effects of COVID-19 on the most disadvantaged, especially BAME people placed at risk by their social and economic conditions, were entirely predictable. Mental health is best ensured by urgently rebuilding the social and economic supports stripped away over the last decade. Governments must pump funds into local authorities to rebuild community services, peer support, mutual aid and local community and voluntary sector organisations. Health care organisations must tackl...

The British Journal of Psychiatry

Summary Esketamine has been licensed for ‘treatment-resistant depression’ in the USA, UK and Euro... more Summary Esketamine has been licensed for ‘treatment-resistant depression’ in the USA, UK and Europe. Licensing trials did not establish efficacy: two trials were negative, one showed a statistically significant but clinically uncertain effect, and a flawed discontinuation trial was included, against Food and Drug Administration precedent. Safety signals – deaths, including suicides, and bladder damage – were minimised.

Philosophy, Psychiatry, & Psychology

Social Psychiatry and Psychiatric Epidemiology

Purpose Neuroleptic (antipsychotic) drugs reduce psychotic symptoms, but how they achieve these e... more Purpose Neuroleptic (antipsychotic) drugs reduce psychotic symptoms, but how they achieve these effects and how the drugs’ effects are experienced by people who take them are less well understood. The present study describes a synthesis of qualitative data about mental and behavioural alterations associated with taking neuroleptics and how these interact with symptoms of psychosis and people’s sense of self and agency. Methods Nine databases were searched to identify qualitative literature concerning experiences of taking neuroleptic medication. A thematic synthesis was conducted. Results Neuroleptics were commonly experienced as producing a distinctive state of lethargy, cognitive slowing, emotional blunting and reduced motivation, which impaired functioning but also had beneficial effects on symptoms of psychosis and some other symptoms (e.g. insomnia). For some people, symptom reduction helped restore a sense of normality and autonomy, but others experienced a loss of important a...

BMJ Open

IntroductionAntipsychotic medication is effective in reducing acute symptoms of psychosis, but it... more IntroductionAntipsychotic medication is effective in reducing acute symptoms of psychosis, but it has a range of potentially serious and debilitating adverse effects and is often disliked by patients. It is therefore essential it is only used when benefits outweigh harms. Although multiple trials conducted with people with schizophrenia indicate an increased risk of relapse in the short-term following abrupt antipsychotic discontinuation, there is little evidence about the long-term outcome of a gradual process of reduction and discontinuation on social functioning, relapse and other outcomes.Methods and analysisThis is a multicentre, randomised controlled trial involving people with schizophrenia and related disorders who have had more than one episode. Participants are randomised to have a clinically-supervised, gradual reduction of antipsychotic medication, leading to discontinuation when possible, or to continue with maintenance treatment. Blinded follow-up assessments are condu...

Lancet (London, England), Sep 22, 2018

The Canadian Journal of Psychiatry

Philosophy, Psychiatry, & Psychology

The Psychiatrist

Aims and methodWe looked at the contribution of psychiatric disorders to occupancy of National He... more Aims and methodWe looked at the contribution of psychiatric disorders to occupancy of National Health Service (NHS) beds in England in the past 11 years, using publicly available data on Hospital Episode Statistics from the financial years 1998–1999 to 2008–2009.ResultsPatients with psychiatric disorders occupied between 14 and 16% of NHS beds in each year examined, and schizophrenia and mood disorders were among the top ten medical diagnoses of people occupying beds in every year. In terms of duration of admission, many individuals with psychiatric disorders, including schizophrenia and mood disorders, had a longer length of admission than those with other medical conditions. In 2008–2009 mean duration of admission for people with schizophrenia was 108 days and for people with mood disorders 42 days. In comparison, people with cerebrovascular disease stayed in hospital for 20 days on average.Clinical implicationsDespite modern treatments, people with psychiatric disorders occupy a ...

Journal of Mental Health

Background: Treatment decision-making that fully involves service users is an aim across medicine... more Background: Treatment decision-making that fully involves service users is an aim across medicine, including mental health. Aims: To explore service users' experiences of taking antipsychotic medication for psychotic disorders, and their perceptions of decision-making about this. Method: Semi-structured interviews with 20 users of community mental health services, conducted by service user researchers and analysed using thematic analysis. Results: Antipsychotic medication was perceived to have beneficial effects on symptoms and relapse risk, but adverse effects were prominent, including a global state of lethargy and demotivation. Weighing these up, the majority viewed antipsychotics as the least worst option. Participants were split between positions of 'willing acceptance', 'resigned acceptance' and 'non-acceptance' of taking antipsychotics. Many felt their choices about medication were limited, due to the nature of their illness or pressure from other people. They commonly experienced their prescribing psychiatrist as not sufficiently acknowledging the negative impacts of medication on life quality, and physical health concerns, and described feeling powerless to influence decisions about their medication. Conclusions: The study highlights the complexity of agendas surrounding antipsychotic medication, including the pervasive influence of coercive processes, and the challenges of implementing collaborative decision-making for people with serious mental health problems.

Psychiatric Bulletin

Aims and Method To examine trends in appeals to mental health review tribunals and hospital manag... more Aims and Method To examine trends in appeals to mental health review tribunals and hospital managers' panels in a hospital covering two outer London boroughs from 1997 to 2007. Data were also used to explore associations between demographic variables, including ethnicity, and the results of appeal hearings. Results The number of detentions under Mental Health Act Sections 2, 3 and 37 rose from 203 in 1996 to 279 in 2006. the percentage of these that went to appeal increased from 34% to 81% during the same period. However, there was no observed trend in the result of the appeals. the results were not associated with gender, ethnicity, marital status, age or the section involved; 12% of appeals were successful. Clinical Implications The study shows rising use of the Mental Health Act over the past 10 years and an increasing volume of appeals against its use. Since appeals are no more likely to result in discharge, the increased use of the Mental Health Act is not balanced by incre...

Canadian Journal of Psychiatry, Feb 1, 2007

Dr Moncrieff also highlighted concerns about the original Hamilton Depression Rating Scale (HDRS)... more Dr Moncrieff also highlighted concerns about the original Hamilton Depression Rating Scale (HDRS), which have been raised by others. 3 Nevertheless, the HDRS consistently identifies 4 items with high sensitivity and predictive value in assessing change in depressive ...

Human Givens 15 24 29, 2008

Psychologist 20 296 297, May 1, 2007

Http Www Libreriasaulamedica Com, 2013

The psychoactive effects of psychiatric medications have been obscured by the presumption that th... more The psychoactive effects of psychiatric medications have been obscured by the presumption that these medications have disease-specific actions. Exploiting the parallels with the psychoactive effects and uses of recreational substances helps to highlight the psychoactive properties of psychiatric medications and their impact on people with psychiatric problems. We discuss how psychoactive effects produced by different drugs prescribed in psychiatric practice might modify various disturbing and distressing symptoms, and we also consider the costs of these psychoactive effects on the mental well-being of the user. We examine the issue of dependence, and the need for support for people wishing to withdraw from psychiatric medication. We consider how the reality of psychoactive effects undermines the idea that psychiatric drugs work by targeting underlying disease processes, since psychoactive effects can themselves directly modify mental and behavioral symptoms and thus affect the resul...

BMJ Evidence-Based Medicine

Survival analysis is routinely used to assess differences between groups in relapse prevention an... more Survival analysis is routinely used to assess differences between groups in relapse prevention and treatment discontinuation studies involving people with long-term psychiatric conditions. The actual outcome in survival analysis is ‘time to event’, yet, in the mental health field, there has been little consideration of whether a temporary delay to relapse is clinically relevant in a condition that can last for decades. Moreover, in psychiatric drug trials, a pattern of elevated early relapses following randomisation to placebo or no treatment is common. This may be the result of the withdrawal of previous treatment leading to physiological withdrawal effects, which may be mistaken for relapse, or genuine relapse precipitated by the process of withdrawal. Such withdrawal effects typically produce converging survival curves eventually. They inevitably lead to differences in time to relapse, even when there is little or no difference in the cumulative risk of relapse at final follow-up...

Wellcome Open Research

We argue that predictions of a ‘tsunami’ of mental health problems as a consequence of the pandem... more We argue that predictions of a ‘tsunami’ of mental health problems as a consequence of the pandemic of coronavirus disease 2019 (COVID-19) and the lockdown are overstated; feelings of anxiety and sadness are entirely normal reactions to difficult circumstances, not symptoms of poor mental health. Some people will need specialised mental health support, especially those already leading tough lives; we need immediate reversal of years of underfunding of community mental health services. However, the disproportionate effects of COVID-19 on the most disadvantaged, especially BAME people placed at risk by their social and economic conditions, were entirely predictable. Mental health is best ensured by urgently rebuilding the social and economic supports stripped away over the last decade. Governments must pump funds into local authorities to rebuild community services, peer support, mutual aid and local community and voluntary sector organisations. Health care organisations must tackl...

The British Journal of Psychiatry

Summary Esketamine has been licensed for ‘treatment-resistant depression’ in the USA, UK and Euro... more Summary Esketamine has been licensed for ‘treatment-resistant depression’ in the USA, UK and Europe. Licensing trials did not establish efficacy: two trials were negative, one showed a statistically significant but clinically uncertain effect, and a flawed discontinuation trial was included, against Food and Drug Administration precedent. Safety signals – deaths, including suicides, and bladder damage – were minimised.

Philosophy, Psychiatry, & Psychology

Social Psychiatry and Psychiatric Epidemiology

Purpose Neuroleptic (antipsychotic) drugs reduce psychotic symptoms, but how they achieve these e... more Purpose Neuroleptic (antipsychotic) drugs reduce psychotic symptoms, but how they achieve these effects and how the drugs’ effects are experienced by people who take them are less well understood. The present study describes a synthesis of qualitative data about mental and behavioural alterations associated with taking neuroleptics and how these interact with symptoms of psychosis and people’s sense of self and agency. Methods Nine databases were searched to identify qualitative literature concerning experiences of taking neuroleptic medication. A thematic synthesis was conducted. Results Neuroleptics were commonly experienced as producing a distinctive state of lethargy, cognitive slowing, emotional blunting and reduced motivation, which impaired functioning but also had beneficial effects on symptoms of psychosis and some other symptoms (e.g. insomnia). For some people, symptom reduction helped restore a sense of normality and autonomy, but others experienced a loss of important a...

BMJ Open

IntroductionAntipsychotic medication is effective in reducing acute symptoms of psychosis, but it... more IntroductionAntipsychotic medication is effective in reducing acute symptoms of psychosis, but it has a range of potentially serious and debilitating adverse effects and is often disliked by patients. It is therefore essential it is only used when benefits outweigh harms. Although multiple trials conducted with people with schizophrenia indicate an increased risk of relapse in the short-term following abrupt antipsychotic discontinuation, there is little evidence about the long-term outcome of a gradual process of reduction and discontinuation on social functioning, relapse and other outcomes.Methods and analysisThis is a multicentre, randomised controlled trial involving people with schizophrenia and related disorders who have had more than one episode. Participants are randomised to have a clinically-supervised, gradual reduction of antipsychotic medication, leading to discontinuation when possible, or to continue with maintenance treatment. Blinded follow-up assessments are condu...

Lancet (London, England), Sep 22, 2018

The Canadian Journal of Psychiatry

Philosophy, Psychiatry, & Psychology

The Psychiatrist

Aims and methodWe looked at the contribution of psychiatric disorders to occupancy of National He... more Aims and methodWe looked at the contribution of psychiatric disorders to occupancy of National Health Service (NHS) beds in England in the past 11 years, using publicly available data on Hospital Episode Statistics from the financial years 1998–1999 to 2008–2009.ResultsPatients with psychiatric disorders occupied between 14 and 16% of NHS beds in each year examined, and schizophrenia and mood disorders were among the top ten medical diagnoses of people occupying beds in every year. In terms of duration of admission, many individuals with psychiatric disorders, including schizophrenia and mood disorders, had a longer length of admission than those with other medical conditions. In 2008–2009 mean duration of admission for people with schizophrenia was 108 days and for people with mood disorders 42 days. In comparison, people with cerebrovascular disease stayed in hospital for 20 days on average.Clinical implicationsDespite modern treatments, people with psychiatric disorders occupy a ...

Journal of Mental Health

Background: Treatment decision-making that fully involves service users is an aim across medicine... more Background: Treatment decision-making that fully involves service users is an aim across medicine, including mental health. Aims: To explore service users' experiences of taking antipsychotic medication for psychotic disorders, and their perceptions of decision-making about this. Method: Semi-structured interviews with 20 users of community mental health services, conducted by service user researchers and analysed using thematic analysis. Results: Antipsychotic medication was perceived to have beneficial effects on symptoms and relapse risk, but adverse effects were prominent, including a global state of lethargy and demotivation. Weighing these up, the majority viewed antipsychotics as the least worst option. Participants were split between positions of 'willing acceptance', 'resigned acceptance' and 'non-acceptance' of taking antipsychotics. Many felt their choices about medication were limited, due to the nature of their illness or pressure from other people. They commonly experienced their prescribing psychiatrist as not sufficiently acknowledging the negative impacts of medication on life quality, and physical health concerns, and described feeling powerless to influence decisions about their medication. Conclusions: The study highlights the complexity of agendas surrounding antipsychotic medication, including the pervasive influence of coercive processes, and the challenges of implementing collaborative decision-making for people with serious mental health problems.

Psychiatric Bulletin

Aims and Method To examine trends in appeals to mental health review tribunals and hospital manag... more Aims and Method To examine trends in appeals to mental health review tribunals and hospital managers' panels in a hospital covering two outer London boroughs from 1997 to 2007. Data were also used to explore associations between demographic variables, including ethnicity, and the results of appeal hearings. Results The number of detentions under Mental Health Act Sections 2, 3 and 37 rose from 203 in 1996 to 279 in 2006. the percentage of these that went to appeal increased from 34% to 81% during the same period. However, there was no observed trend in the result of the appeals. the results were not associated with gender, ethnicity, marital status, age or the section involved; 12% of appeals were successful. Clinical Implications The study shows rising use of the Mental Health Act over the past 10 years and an increasing volume of appeals against its use. Since appeals are no more likely to result in discharge, the increased use of the Mental Health Act is not balanced by incre...

Canadian Journal of Psychiatry, Feb 1, 2007

Dr Moncrieff also highlighted concerns about the original Hamilton Depression Rating Scale (HDRS)... more Dr Moncrieff also highlighted concerns about the original Hamilton Depression Rating Scale (HDRS), which have been raised by others. 3 Nevertheless, the HDRS consistently identifies 4 items with high sensitivity and predictive value in assessing change in depressive ...

Human Givens 15 24 29, 2008

Psychologist 20 296 297, May 1, 2007

Http Www Libreriasaulamedica Com, 2013