Unlocking progress in eating disorders
Plus: Set, setting and psychedelics; premenstrual exacerbation of psychiatric symptoms; and TikTok for mental health study recruitment
Unlocking progress in eating disorders
This short, sharp JAMA Psychiatry piece discusses why treatment for anorexia has apparently hit a wall, with decades-old guidelines and no new treatments in sight. The authors argue that it is both a homeless topic, which doesn't sit neatly in either mental or physical health, and over-specialised to the point that mainstream mental health services and funders don't consider it their business.
“This siloing has contributed to the attitude often expressed by general mental health services that they ‘don’t do eating disorders’—an attitude that has arguably flowed into research with an apparent reluctance or disinterest regarding eating disorders research from the rest of the mental health field. This siloing, together with the stigmatizing attitude that [anorexia nervosa] only affects young, affluent White females, has stymied collaboration with colleagues working in other areas of mental health research where greater advances in treatments have been made.
The authors argue that while treatment is clearly an urgent issue, we need research that focuses on mechanistic basics, as well as a re-assessment of what constitutes a successful treatment outcome (rather than simply, or exclusively, body weight).
ReSPCT: find out what it means to me
If you’ve read The Acid Queen, Susannah Cahalan’s excellent new book on Rosemary Leary, you’ll know all about the importance that early psychedelic explorers placed on “set and setting”, that is, the mental state in which an individual takes the substance, and the physical and social environment surrounding them. Thanks to a Delphi consultation process just published in Nature Medicine, we now have guidelines for “Reporting of Setting in Psychedelic Clinical Trials” or ReSPCT, the kind of tortuous acronym that adds so much joy to scientific research. The authors hope that ReSPCT will strengthen trial design and reporting, improve validity and reproducibility, and help us to aggregate and compare data from psychedelic studies.
Premenstrual exacerbation of psychiatric symptoms
The BJPsych has just published a collection of editorials on women’s mental health, including this piece on “premenstrual exacerbation of existing mental illnesses” (PME). I was familiar with the concept (ie, that pre-existing mental health problems can fluctuate over the menstrual cycle), but this piece contains lots of interesting new material. The authors posit that the drop in oestrogen levels during the luteal phase might be an important mechanism, affecting serotonergic and dopaminergic systems, and resulting in issues such as worsening of depression, mood instability in women with bipolar disorder, and cognitive problems in those with ADHD.
Management strategies are mostly based on first principles: consider altering medication, inquire about the menstrual cycle and track symptoms accordingly, and provide psychotherapy and psychoeducation. Future research recommendations include trialling oral contraceptives to see if stabilising hormones can tackle PME, and carrying out granular longitudinal studies to learn more about underlying mechanisms. A starting point might be to get a better idea of prevalence; the fact that 80% of the reproductive female population is affected by premenstrual syndrome and 3.2% by premenstrual dysphoric disorder suggests PME might not be a negligible issue.
Mental health study recruitment: pivot to video
Recruiting people to clinical trials in mental health isn’t easy, and the COVID pandemic made it even harder. In early 2022, the authors of this JMIR Mental Health paper were trying to recruit for a study validating a questionnaire for suicide assessment (SuPr-X) in Germany, and not having much luck: “we could not motivate GPs to cooperate”, they report, “due to the increasing spread of the highly contagious COVID-19 Omicron variant”. By the time autumn 2023 came around, the COVID situation had improved, but they were way behind their recruitment target.
So the researchers decided to do something different (with an appropriate ethics amendment, of course). In addition to “traditional recruitment strategies”—physician-led recruitment, leafleting clinics—they put ads on Facebook, Instagram, Google, and TikTok. Their evaluation of this strategy is presented in the paper.
In brief, there wasn’t much of a difference between the sample recruited “traditionally” versus that recruited online in terms of gender, age, and Patient Health Questionnaire-9 scores. A measured by cost per lead, the top-performing image for online recruitement was of a “sad woman” (compared with “sad man” and “senior male physician”), and a video featuring a layperson did better than one focusing on a physician. The team managed to recruit almost half of study participants online (239 of 521, or 46%), and report that this method “proved particularly effective in reaching vulnerable, hard-to-access populations and enhancing patient diversity.”