Comment on Osler et al : misinterpretation of pre‐post‐differences invalidate the authors’ conclusions

This is the peer reviewed version which has been published in final form at 10.1111/acps.13110. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.Osler and colleagues published a cohort study investigating antidepressant medication and suicidal behaviour and violent crime in patients and conscripts. They report an increased incidence rate for both events before and after treatment initiation when compared to the follow‐up period. They conclude that there is likely no causal effect of antidepressants on either of the two endpoints, because the rates between treated and untreated individuals did not differ substantially at each time‐point and the rates of both events did not increase in the antidepressant group after treatment initiation as compared to the pre‐treatment time period

Suicide attempts in clinical trials with paroxetine randomised against placebo

BACKGROUND: Inclusion of unpublished data on the effects of antidepressants on children has suggested unfavourable risk-benefit profiles for some of the drugs. Recent meta-analyses of studies on adults have indicated similar effects. We obtained unpublished data for paroxetine that have so far not been included in these analyses. METHODS: The documentation for drug registration contained 16 studies in which paroxetine had been randomised against placebo. We registered the number of suicides, suicide attempts and ideation. We corrected for duration of medication and placebo treatment and used a standard Bayesian statistical approach with varying priors. RESULTS: There were 7 suicide attempts in patients on the drug and 1 in a patient on placebo. We found that the probability of increased intensity of suicide attempts per year in adults taking paroxetine was 0.90 with a "pessimistic" prior, and somewhat less with two more neutral priors. CONCLUSION: Our findings support the results of recent meta-analyses. Patients and doctors should be warned that the increased suicidal activity observed in children and adolescents taking certain antidepressant drugs may also be present in adults

New Foundations: Pseudo-pacification and special liberty as potential cornerstones of a multi-level theory of homicide and serial murder

Over the past 30 years the industrialized West has witnessed a move towards space, heterogeneity and subjectivity in the criminological study of violence and homicide. Although large-scale quantitative studies of the temporal and spatial distribution of homicide continue to provide a broad empirical context, aetiological explanations tend to be based on analyses of the heterogeneous psychological interactions and experiences of individual subjects at the micro-level. However, mid-range studies of the temporal and spatial distribution of perpetrators and victims of homicide between unrelated adults have provided a useful link between the micro- and macro-levels. Focusing primarily on British homicide and serial murder, this article attempts to strengthen this link by combining contemporary micro-analyses of the subjective motives of perpetrators with mid-range analyses of space, which can therefore be seen as part of the structural tradition of theorizing about homicide and serial murder. Placing these analyses in a broad underlying context constituted by major historical shifts in political economy and the cultural forms of ‘pseudo-pacification’ and ‘special liberty’ will lay the initial cornerstones for an integrated multi-level theory. © The Author(s) 2014

Attempting to stop antipsychotic medication: success, supports, and efforts to cope

Purpose To explore supports and coping strategies used during attempts to discontinue antipsychotic medication and test for associations with success. Method 144 people who were taking or had taken antipsychotics completed The Experiences of Antipsychotic Medication Survey. Among them, 105 people had made at least one discontinuation attempt and answered a series of questions about their most recent attempt to stop. Content analysis and Chi-square tests of independence were used to categorise the data and explore associations. Success was defined as stopping all AM use irrespective of the duration of the medication-free period or whether relapse occurred, which were explored separately. Results Among the 105 people who had attempted discontinuation, 61.9% described unwanted withdrawal effects and 27.6% of the group described psychotic or manic relapse during the withdrawal period. Within this group 55% described successfully stopping all AM for varying lengths of time, half reported no current use, and half described having some form of professional, family, friend, and/or service user or peer support for their attempt. Having support was positively associated with success and negatively associated with both current use, and relapse during withdrawal. A range of coping efforts were described, but having coping strategies failed to show significant associations with any of the dependent variables explored. Among those who described successfully stopping, some described returning to AM for short periods when needed, while others reported managing well with alternative methods alone. Conclusions Findings cannot be readily generalised due to sampling constraints, but results suggest a wide range of supports and coping strategies may be used when attempting to discontinue antipsychotics. Many people may attempt to discontinue antipsychotics without any support. Those who have support for their attempts may be significantly less likely to relapse during withdrawal and more likely to succeed in their attempt. There is a pressing need for further research in this area