Author: Andrew Marshall

Founder & Editor of the BootCampMilitaryFitnessInstitute.com, MilitaryGogglebox.com, and Mental-Health-Matters.org.

What is Chlordiazepoxide?

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Introduction

Chlordiazepoxide, trade name Librium among others, is a sedative and hypnotic medication of the benzodiazepine class; it is used to treat anxiety, insomnia and symptoms of withdrawal from alcohol and other drugs.

Chlordiazepoxide has a medium to long half-life but its active metabolite has a very long half-life. The drug has amnesic, anticonvulsant, anxiolytic, hypnotic, sedative and skeletal muscle relaxant properties.

Chlordiazepoxide was patented in 1958 and approved for medical use in 1960. It was the first benzodiazepine to be synthesized and the discovery of chlordiazepoxide was by pure chance. Chlordiazepoxide and other benzodiazepines were initially accepted with widespread public approval but were followed with widespread public disapproval and recommendations for more restrictive medical guidelines for its use.

Brief History

Chlordiazepoxide (initially called methaminodiazepoxide) was the first benzodiazepine to be synthesized in the mid-1950s. The synthesis was derived from work on a class of dyes, quinazolone-3-oxides. It was discovered by accident when in 1957 tests revealed that the compound had hypnotic, anxiolytic, and muscle relaxant effects. “The story of the chemical development of Librium and Valium was told by Sternbach. The serendipity involved in the invention of this class of compounds was matched by the trials and errors of the pharmacologists in the discovery of the tranquilising activity of the benzodiazepines. The discovery of Librium in 1957 was due largely to the dedicated work and observational ability of a gifted technician, Beryl Kappell. For some seven years she had been screening compounds by simple animal tests for muscle relaxant activity…” Three years later chlordiazepoxide was marketed as a therapeutic benzodiazepine medication under the brand name Librium. Following chlordiazepoxide, in 1963 diazepam hit the market under the brand name Valium – and was followed by many further benzodiazepine compounds over the subsequent years and decades.

In 1959 it was used by over 2,000 physicians and more than 20,000 patients. It was described as “chemically and clinically different from any of the tranquilisers, psychic energizers or other psychotherapeutic drugs now available.” During studies, chlordiazepoxide induced muscle relaxation and a quieting effect on laboratory animals like mice, rats, cats, and dogs. Fear and aggression were eliminated in much smaller doses than those necessary to produce hypnosis. Chlordiazepoxide is similar to phenobarbital in its anticonvulsant properties. However, it lacks the hypnotic effects of barbiturates. Animal tests were conducted in the Boston Zoo and the San Diego Zoo. Forty-two hospital patients admitted for acute and chronic alcoholism, and various psychoses and neuroses were treated with chlordiazepoxide. In a majority of the patients, anxiety, tension, and motor excitement were “effectively reduced.” The most positive results were observed among alcoholic patients. It was reported that ulcers and dermatologic problems, both of which involved emotional factors, were reduced by chlordiazepoxide.

In 1963, approval for use was given to diazepam (Valium), a “simplified” version of chlordiazepoxide, primarily to counteract anxiety symptoms. Sleep-related problems were treated with nitrazepam (Mogadon), which was introduced in 1972, temazepam (Restoril), which was introduced in 1979, and flurazepam (Dalmane), which was introduced in 1975.

Medical Uses

Chlordiazepoxide is indicated for the short-term (2-4 weeks) treatment of anxiety that is severe and disabling or subjecting the person to unacceptable distress. It is also indicated as a treatment for the management of acute alcohol withdrawal syndrome.

It can sometimes be prescribed to ease symptoms of irritable bowel syndrome combined with clidinium bromide as a fixed dose medication, Librax.

Contraindications

Use of chlordiazepoxide should be avoided in individuals with the following conditions:

  • Myasthenia gravis.
  • Acute intoxication with alcohol, narcotics, or other psychoactive substances.
  • Ataxia.
  • Severe hypoventilation.
  • Acute narrow-angle glaucoma.
  • Severe liver deficiencies (hepatitis and liver cirrhosis decrease elimination by a factor of 2).
  • Severe sleep apnoea.
  • Hypersensitivity or allergy to any drug in the benzodiazepine class.

Chlordiazepoxide is generally considered an inappropriate benzodiazepine for the elderly due to its long elimination half-life and the risks of accumulation. Benzodiazepines require special precaution if used in the elderly, pregnancy, children, alcohol- or drug-dependent individuals and individuals with comorbid psychiatric disorders.

Pregnancy

The research into the safety of benzodiazepines during pregnancy is limited and it is recommended that use of benzodiazepines during pregnancy should be based on whether the benefits outweigh the risks. If chlordiazepoxide is used during pregnancy the risks can be reduced via using the lowest effective dose and for the shortest time possible. Benzodiazepines should generally be avoided during the first trimester of pregnancy. Chlordiazepoxide and diazepam are considered to be among the safer benzodiazepines to use during pregnancy in comparison to other benzodiazepines. Possible adverse effects from benzodiazepine use during pregnancy include, abortion, malformation, intrauterine growth retardation, functional deficits, carcinogenesis and mutagenesis. Caution is also advised during breast feeding as chlordiazepoxide passes into breast milk.

Adverse Effects

Sedative drugs and sleeping pills, including chlordiazepoxide, have been associated with an increased risk of death. The studies had many limitations: possibly tending to overestimate risk, such as possible confounding by indication with other risk factors; confusing hypnotics with drugs having other indications. Common side-effects of chlordiazepoxide include:

  • Confusion.
  • Constipation.
  • Drowsiness.
  • Fainting.
  • Altered sex drive.
  • Liver problems.
  • Lack of muscle coordination.
  • Minor menstrual irregularities.
  • Nausea.
  • Skin rash or eruptions.
  • Swelling due to fluid retention.
  • Yellow eyes and skin.

Chlordiazepoxide in laboratory mice studies impairs latent learning. Benzodiazepines impair learning and memory via their action on benzodiazepine receptors, which causes a dysfunction in the cholinergic neuronal system in mice. It was later found that scopolamine impairment in learning was caused by an increase in benzodiazepine/GABA activity (and that benzodiazepines were not associated with the cholinergic system). In tests of various benzodiazepine compounds, chlordiazepoxide was found to cause the most profound reduction in the turnover of 5HT (serotonin) in rats. Serotonin is closely involved in regulating mood and may be one of the causes of feelings of depression in rats using chlordiazepoxide or other benzodiazepines.

In September 2020, the US Food and Drug Administration (FDA) required the boxed warning be updated for all benzodiazepine medicines to describe the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions consistently across all the medicines in the class.

Tolerance

Chronic use of benzodiazepines, such as chlordiazepoxide, leads to the development of tolerance, with a decrease in number of benzodiazepine binding sites in mouse forebrain. The Committee of Review of Medicines, who carried out an extensive review of benzodiazepines including chlordiazepoxide, found – and were in agreement with the Institute of Medicine (USA) and the conclusions of a study carried out by the White House Office of Drug Policy and the US National Institute on Drug Abuse – that there was little evidence that long-term use of benzodiazepines were beneficial in the treatment of insomnia due to the development of tolerance. Benzodiazepines tended to lose their sleep-promoting properties within 3-14 days of continuous use, and in the treatment of anxiety the committee found that there was little convincing evidence that benzodiazepines retained efficacy in the treatment of anxiety after 4 months’ continuous use due to the development of tolerance.

Dependence

Chlordiazepoxide can cause physical dependence and what is known as the benzodiazepine withdrawal syndrome. Withdrawal from chlordiazepoxide or other benzodiazepines often leads to withdrawal symptoms that are similar to those seen with alcohol and barbiturates. The higher the dose and the longer the drug is taken, the greater the risk of experiencing unpleasant withdrawal symptoms. Withdrawal symptoms can, however, occur at standard dosages and also after short-term use. Benzodiazepine treatment should be discontinued as soon as possible through a slow and gradual dose-reduction regime.

Chlordiazepoxide taken during pregnancy can cause a postnatal benzodiazepine withdrawal syndrome.

Overdose

Refer to Benzodiazepine Overdose.

An individual who has consumed excess chlordiazepoxide may display some of the following symptoms:

  • Somnolence (difficulty staying awake).
  • Mental confusion.
  • Hypotension.
  • Hypoventilation.
  • Impaired motor functions:
    • Impaired reflexes.
    • Impaired coordination.
    • Impaired balance.
    • Dizziness.
    • Muscle weakness.
  • Coma.

Chlordiazepoxide is a drug that is very frequently involved in drug intoxication, including overdose. Chlordiazepoxide overdose is considered a medical emergency and, in general, requires the immediate attention of medical personnel. The antidote for an overdose of chlordiazepoxide (or any other benzodiazepine) is flumazenil. Flumazenil should be given with caution as it may precipitate severe withdrawal symptoms in benzodiazepine-dependent individuals.

Pharmacology

Chlordiazepoxide acts on benzodiazepine allosteric sites that are part of the GABAA receptor/ion-channel complex and this results in an increased binding of the inhibitory neurotransmitter GABA to the GABAA receptor thereby producing inhibitory effects on the central nervous system and body similar to the effects of other benzodiazepines. Chlordiazepoxide is anticonvulsant. There is preferential storage of chlordiazepoxide in some organs including the heart of the neonate. Absorption by any administered route and the risk of accumulation is significantly increased in the neonate. The withdrawal of chlordiazepoxide during pregnancy and breast feeding is recommended, as chlordiazepoxide rapidly crosses the placenta and also is excreted in breast milk. Chlordiazepoxide also decreases prolactin release in rats. Benzodiazepines act via micromolar benzodiazepine binding sites as Ca2+ channel blockers and significantly inhibit depolarization-sensitive Calcium uptake in animal nerve terminal preparations. Chlordiazepoxide inhibits acetylcholine release in mouse hippocampal synaptosomes in vivo. This has been found by measuring sodium-dependent high affinity choline uptake in vitro after pre-treatment of the mice in vivo with chlordiazepoxide. This may play a role in chlordiazepoxide’s anticonvulsant properties.

Pharmacokinetics

Chlordiazepoxide is a long-acting benzodiazepine drug. The half-life of Chlordiazepoxide is 5-30 hours but has an active benzodiazepine metabolite (desmethyldiazepam), which has a half-life of 36-200 hours. The half-life of chlordiazepoxide increases significantly in the elderly, which may result in prolonged action as well as accumulation of the drug during repeated administration. Delayed body clearance of the long half-life active metabolite also occurs in those over 60 years of age, which further prolongs the effects of the drugs with additional accumulation after repeated dosing.

Despite its name, chlordiazepoxide is not an epoxide; they are formed from different roots.

Recreational Use

Refer to Benzodiazepine Use Disorder.

In 1963, Carl F. Essig of the Addiction Research Centre of the National Institute of Mental Health stated that meprobamate, glutethimide, ethinamate, ethchlorvynol, methyprylon and chlordiazepoxide as drugs whose usefulness “can hardly be questioned.” However, Essig labelled these “newer products” as “drugs of addiction,” like barbiturates, whose habit-forming qualities were more widely known. He mentioned a 90-day study of chlordiazepoxide, which concluded that the automobile accident rate among 68 users was 10 times higher than normal. Participants’ daily dosage ranged from 5 to 100 milligrams.

Chlordiazepoxide is a drug of potential misuse and is frequently detected in urine samples of drug users who have not been prescribed the drug.

Internationally, chlordiazepoxide is a Schedule IV controlled drug under the Convention on Psychotropic Substances.

Toxicity

Animal

Laboratory tests assessing the toxicity of chlordiazepoxide, nitrazepam and diazepam on mice spermatozoa found that chlordiazepoxide produced toxicities in sperm including abnormalities involving both the shape and size of the sperm head. Nitrazepam, however, caused more profound abnormalities than chlordiazepoxide.

Availability

Chlordiazepoxide is available in various dosage forms, alone or in combination with other drugs, worldwide. In combination with Clidinium as NORMAXIN-CC and in combination with dicyclomine as NORMAXIN for IBS, and with the anti-depressant Amitriptyline as Limbitrol.

What is the Chinese Classification of Mental Disorders?

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Introduction

The Chinese Classification of Mental Disorders (CCMD; Chinese: 中国精神疾病分类方案与诊断标准), published by the Chinese Society of Psychiatry (CSP), is a clinical guide used in China for the diagnosis of mental disorders.

It is currently on a third version, the CCMD-3, written in Chinese and English. It is intentionally similar in structure and categorisation to the International Classification of Diseases (ICD) and DSM, the two most well-known diagnostic manuals, though it includes some variations on their main diagnoses and around 40 culturally related diagnoses.

Brief History

The first published Chinese psychiatric classificatory scheme appeared in 1979. A revised classification system, the CCMD-1, was made available in 1981 and further modified in 1984 (CCMD-2-R). The CCMD-3 was published in 2001.

Many Chinese psychiatrists believed the CCMD had special advantages over other manuals, such as simplicity, stability, the inclusion of culture-distinctive categories, and the exclusion of certain Western diagnostic categories. The Chinese translation of the ICD-10 was seen as linguistically complicated, containing very long sentences and awkward terms and syntax (Lee, 2001).

Diagnostic Categories

The diagnosis of depression is included in the CCMD, with many similar criteria to the ICD or DSM, with the core having been translated as ‘low spirits’. However, Neurasthenia is a more central diagnosis. Although also found in the ICD, its diagnosis takes a particular form in China, called ‘shenjing shuairuo’, which emphasizes somatic (bodily) complaints as well as fatigue or depressed feelings. Neurasthenia is a less stigmatising diagnosis than depression in China, being conceptually distinct from psychiatric labels, and is said to fit well with a tendency to express emotional issues in somatic terms. The concept of neurasthenia as a nervous system disorder is also said to fit well with the traditional Chinese epistemology of disease causation on the basis of disharmony of vital organs and imbalance of qi.

The diagnosis of schizophrenia is included in the CCMD. It is applied quite readily and broadly in Chinese psychiatry.

Some of the wordings of the diagnosis are different, for example rather than borderline personality disorder as in the DSM, or emotionally unstable personality disorder (borderline type) as in the ICD, the CCMD has impulsive personality disorder.

Diagnoses that are more specific to Chinese or Asian culture, though they may also be outlined in the ICD (or DSM glossary section), includes:

  • Koro or Genital retraction syndrome: excessive fear of the genitals (and also breasts in women) shrinking or drawing back into the body.
  • Zou huo ru mo (走火入魔) or qigong deviation (氣功偏差): perception of uncontrolled flow of qi in the body.
  • Mental disorders due to superstition or witchcraft.
  • Travelling psychosis.

The CCMD-3 lists several “disorders of sexual preference” including ego-dystonic homosexuality, but does not recognise paedophilia.

Koro

Koro or Genital retraction syndrome is a culture-specific syndrome from Southeast Asia in which the patient has an overpowering belief that the genitalia (or nipples in females) are shrinking and will shortly disappear. In China, it is known as shuk yang, shook yong, and suo yang (simplified Chinese: 缩阳; traditional Chinese: 縮陽). This has been associated with cultures placing a heavy emphasis on balance, or on fertility and reproduction.

Zou Huo Ru Mo

Zou huo ru mo (走火入魔) or “qigong deviation” (氣功偏差) is a mental condition characterised by the perception that there is uncontrolled flow of qi in the body. Other complaints include localised pains, headache, insomnia, and uncontrolled spontaneous movements.

What is the Chinese Society of Psychiatry?

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Introduction

The Chinese Society of Psychiatry (CSP; Chinese: 中华医学会精神病学分会; lit. ‘Chinese Medical Association Psychiatry Branch’) is the largest organisation for psychiatrists in China.

It publishes the Chinese Classification of Mental Disorders (“CCMD”), first published in 1985. The CSP also publishes clinical practice guidelines; promotes psychiatric practice, research and communication; trains new professionals; and holds academic conferences.

Origins and Organisation

The organisation developed out of the Chinese Society of Neuro-Psychiatry, which was founded in 1951. This separated into the Chinese Society of Psychiatry and Chinese Society of Neurology in 1994. Since then, successive committees have run the organisation, currently the 3rd Committee, which started in 2003, whose president is Dongfeng Zhou. The CCMD is now on its third revision.

The official journal of the CSP is the Chinese Journal of Psychiatry (中华精神科杂志).[2] The Society held its seventh annual academic conference in 2006. The Society is a member of the World Psychiatric Association.

As of 2005, the CSP had 800 members.

Brief History

In 2001, the CSP declassified homosexuality and bisexuality as a mental disorder. However, the organization specified that, “although homosexuality was not a disease, a person could be conflicted or suffering from mental illness because of their sexuality, and that condition could be treated”, according to Damien Lu, founder of the Information Clearing House for Chinese Gays and Lesbians. Reportedly, this loophole is used to promote conversion therapy in China.

Beginning in 2014, the CSP began collaborating with the McLean Hospital. The purpose of the programme is to share research cross-culturally between specialists in psychotic and mood disorders.

Controversy

The Chinese Society of Psychiatrists (CSP) has been criticised for alleged complicity in the government’s political abuse of psychiatry towards Falun Gong practitioners – including by detaining individuals via diagnosing adherents as “political maniacs” or with “Qi Gong psychosis”. Antipsychotic drugs were wrongly prescribed to practitioners.

In 2004, the CSP agreed on a joint response with the World Psychiatric Association to the allegations. According to the CSP, certain psychiatrists had “failed to distinguish between spiritual-cultural beliefs and delusions” due to “lack of training and professional skills”, and this led to misdiagnoses. However, they claimed this was not a systematic issue and invited the WPA to correct the problem.

The WPA stated, “What has become clear… has been the need to assist Chinese colleagues in matters concerning forensic psychiatry, medical ethics, patients’ rights, mental health legislation, diagnosis and classification, to help them improve the care of mentally ill in China and prevent future abuses.” Arthur Kleinman, a psychiatrist at Harvard University, said he believed the claims about systematic abuse of psychiatry were exaggerated, while acknowledging that it did occur in some cases. Abraham Halpern, a psychiatrist at New York Medical College and board member of the Friends of Falun Gong, USA, criticised the WPA for not demanding an investigative mission in China.

A follow-up review of the controversy was written by Alan A. Stone, a professor of psychiatry and president of the American Psychiatric Association, and published in the Psychiatric Times. Stone determined that psychiatrists in China were generally poorly trained and did not receive the sort of medical training which was standard in the West. Stone said this was cause for the misdiagnoses.

On This Day … 13 December

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People (Deaths)

  • 1931 – Gustave Le Bon, French psychologist, sociologist, and anthropologist (b. 1840).
  • 1955 – Antonio Egas Moniz, Portuguese psychiatrist and neurosurgeon, Nobel Prize laureate (b. 1874).

Gustave Le Bon

Charles-Marie Gustave Le Bon (07 May 1841 to 13 December 1931) was a leading French polymath whose areas of interest included anthropology, psychology, sociology, medicine, invention, and physics. He is best known for his 1895 work The Crowd: A Study of the Popular Mind, which is considered one of the seminal works of crowd psychology.

A native of Nogent-le-Rotrou, Le Bon qualified as a doctor of medicine at the University of Paris in 1866. He opted against the formal practice of medicine as a physician, instead beginning his writing career the same year of his graduation. He published a number of medical articles and books before joining the French Army after the outbreak of the Franco-Prussian War. Defeat in the war coupled with being a first-hand witness to the Paris Commune of 1871 strongly shaped Le Bon’s worldview. He then travelled widely, touring Europe, Asia and North Africa. He analysed the peoples and the civilisations he encountered under the umbrella of the nascent field of anthropology, developing an essentialist view of humanity, and invented a portable cephalometer during his travels.

In the 1890s, he turned to psychology and sociology, in which fields he released his most successful works. Le Bon developed the view that crowds are not the sum of their individual parts, proposing that within crowds there forms a new psychological entity, the characteristics of which are determined by the “racial unconscious” of the crowd. At the same time he created his psychological and sociological theories, he performed experiments in physics and published popular books on the subject, anticipating the mass-energy equivalence and prophesising the Atomic Age. Le Bon maintained his eclectic interests up until his death in 1931.

Ignored or maligned by sections of the French academic and scientific establishment during his life due to his politically conservative and reactionary views, Le Bon was critical of democracy and socialism. Le Bon’s works were influential to such disparate figures as Theodore Roosevelt and Benito Mussolini, Sigmund Freud and José Ortega y Gasset, Adolf Hitler and Vladimir Lenin.

Antonio Egas Moniz

António Caetano de Abreu Freire Egas Moniz GCSE GCIB (29 November 1874 to 13 December 1955), known as Egas Moniz, was a Portuguese neurologist and the developer of cerebral angiography. He is regarded as one of the founders of modern psychosurgery, having developed the surgical procedure leucotomy – ​better known today as lobotomy – for which he became the first Portuguese national to receive a Nobel Prize in 1949 (shared with Walter Rudolf Hess).

He held academic positions, wrote many medical articles and also served in several legislative and diplomatic posts in the Portuguese government. In 1911 he became professor of neurology in Lisbon until his retirement in 1944.

On This Day … 11 December

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People (Deaths)

  • 1966 – Augusta Fox Bronner, American psychologist, specialist in juvenile psychology (b. 1881).
  • 1979 – James J. Gibson, American psychologist and author (b. 1904).

Augusta Fox Brunner

Augusta Fox Bronner (22 July 1881 to 11 December 1966) was an American psychologist, best known for her work in juvenile psychology.

She co-directed the first child guidance clinic, and her research shaped psychological theories about the causes behind child delinquency, emphasizing the need to focus on social and environmental factors over inherited traits.

James J. Gibson

James Jerome Gibson (27 January 1904 to 11 December 1979), was an American psychologist and one of the most important contributors to the field of visual perception.

Gibson challenged the idea that the nervous system actively constructs conscious visual perception, and instead promoted ecological psychology, in which the mind directly perceives environmental stimuli without additional cognitive construction or processing. A Review of General Psychology survey, published in 2002, ranked him as the 88th most cited psychologist of the 20th century, tied with John Garcia, David Rumelhart, Louis Leon Thurstone, Margaret Floy Washburn, and Robert S. Woodworth.

What is Body-Focused Repetitive Behaviour?

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Introduction

Body-focused repetitive behaviour (BFRB) is an umbrella name for impulse control behaviours involving compulsively damaging one’s physical appearance or causing physical injury.

Body-focused repetitive behaviour disorders (BFRBDs) in ICD-11 is in development.

BFRB disorders are currently estimated to be under the obsessive-compulsive spectrum.

Cause(s)

The cause of BFRBs is unknown.

Emotional variables may have a differential impact on the expression of BFRBs.

Research has suggested that the urge to repetitive self-injury is similar to a BFRB but others have argued that for some the condition is more akin to a substance abuse disorder.

Researchers are investigating a possible genetic component.

Onset

BFRBs most often begin in late childhood or in the early teens.

Diagnosis

Types

The main BFRB disorders are:

  • Skin:
    • Dermatillomania (excoriation disorder), skin picking.
    • Dermatophagia, skin nibbling.
  • Mouth:
    • Morsicatio buccarum, cheek biting.
    • Morsicatio labiorum, inner lip biting.
    • Morsicatio linguarum, tongue biting.
  • Hands:
    • Onychophagia, nail biting.
    • Onychotillomania, nail picking.
  • Nose:
    • Rhinotillexomania, compulsive nose picking.
  • Hair:
    • Trichophagia, hair nibbling.
    • Trichotemnomania, hair cutting.
    • Trichotillomania, hair pulling.
  • Eyes:
    • Mucus fishing syndrome – compulsion to remove or “fish” strands of mucus from the eye.

Treatment

Psychotherapy

Treatment can include behaviour modification therapy, medication, and family therapy. The evidence base criteria for BFRBs is strict and methodical. Individual behavioural therapy has been shown as a “probably effective” evidence-based therapy to help with thumb sucking, and possibly nail biting. Cognitive behavioural therapy was cited as experimental evidence based therapy to treat trichotillomania and nail biting; a systematic review found best evidence for habit reversal training and decoupling. Another form of treatment that focuses on mindfulness, stimuli and rewards has proven effective in some people. However, no treatment was deemed well-established to treat any form of BFRBs.

Pharmacotherapy

Excoriation disorder, and trichotillomania have been treated with inositol and N-acetylcysteine.

Prevalence

BFRBs are among the most poorly understood, misdiagnosed, and undertreated groups of disorders. BFRBs may affect at least 1 out of 20 people. These collections of symptoms have been known for a number of years, but only recently have appeared in widespread medical literature. Trichotillomania alone is believed to affect 10 million people in the United States.

What is Decoupling for Body-Focused Repetitive Behaviours?

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Introduction

Decoupling is a behavioural self-help intervention developed for body-focused and related behaviours (DSM-5) such as trichotillomania, onychophagia (nail biting), skin picking and lip-cheek biting (Mortiz & Rufer, 2011).

Background

The user is instructed to modify the original dysfunctional behavioural path by performing a counter-movement shortly before completing the self-injurious behaviour (e.g. biting nails, picking skin, pulling hair). This is intended to trigger an irritation, which enables the person to detect and stop the compulsive behaviour at an early stage. A systematic review from 2012 showed the efficacy of decoupling, which was corroborated by Lee and colleagues in 2019. Whether or not the technique is superior to other behavioural interventions such as habit reversal training awaits to be tested.

Reference

Lee, M.T., Mpavaenda, D.N. & Fineberg, N.A. (2019) Habit Reversal Therapy in Obsessive Compulsive Related Disorders: A Systematic Review of the Evidence and CONSORT Evaluation of Randomized Controlled Trials. Frontiers in Behavioral Neuroscience. 13:79. doi:10.3389/fnbeh.2019.00079.

Moritz, S. & Rufer, M. (2011) Movement Decoupling: A Self-Help Intervention for the Treatment of Trichotillomania. Journal of Behavior Therapy and Experimental Psychiatry. 42(1), pp.74-80. doi:10.1016/j.jbtep.2010.07.001.

Further Reading

What is the Gatsby Charitable Foundation?

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Introduction

The Gatsby Charitable Foundation is an endowed grant-making trust, based in London, founded by David Sainsbury in 1967.

Background

The organisation is one of the Sainsbury Family Charitable Trusts, set up to provide funding for charitable causes. Although the organisation is permitted in its Trust Deed to make general grants within this broad area, its activities have generally been restricted to a limited number of fields. At the time of writing, these fields are:

  • Science and Engineering Education.
  • Plant science.
  • Neuroscience.
  • Poverty alleviation in Africa.
  • The arts.
  • Public policy.

However, these categories may change from time to time.

Amongst its activities, the Gatsby Charitable Foundation funds the Gatsby Computational Neuroscience Unit at University College London, the Sainsbury Management Fellowships, the Institute for Government based in Carlton House Terrace, and the Sainsbury Laboratory. It has long funded the Centre for Mental Health but is mostly withdrawing that funding in 2010. More recently, the foundation has become a co-sponsor of the University Technical Colleges programme, in conjunction with the Baker Dearing Trust.

According to the OECD, the Gatsby Charitable Foundation’s financing for 2019 development increased by 40% to US$18.9 million.

What is the Blackthorn Trust?

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Introduction

Blackthorn Trust is a UK charity in Maidstone, Kent which offers specialist therapies and rehabilitation through work placements in the Blackthorn Garden.

They offer help to people with mental health difficulties, chronic pain and type 2 diabetes. The charity’s work is based on the work of Rudolf Steiner (an Austrian philosopher, social reformer), and the charity aims to assist individuals to progress towards their full potential.

Brief History

In 1983, Dr David McGavin was in general practice in Maidstone. Through his work in the local community, he found out that conventional medicine was not able to help patients with chronic illness and were becoming increasingly passive and inactive, which was not helpful for their illness. He then met Hazel Adams (an art therapist) working on anthroposophical principles of Rudolf Steiner. As they worked on few of the Dr McGavin’s most severe patients, several noted improvements were made. More therapists were brought into the small practise but this became impractical. So he decided to set up a new trust and a new medical centre.

Blackthorn Medical Centre

This is owned by the Blackthorn Trust and part of it rented to the Practice. It was built in 1991, designed by Camphill Architects (from the Camphill Movement) and opened in December. As a result of the fundraising and hard work of patients, their families and friends, local and national industry, grant making trusts and the National Health Service. They may be prescribed anthroposophic medication and one of a number of anthroposophic therapies which are available on a one-to-one or group basis. These include biographical counselling, eurythmy therapy, rhythmical massage (developed by Ita Wegman) or art therapy. Therapies are offered at the discretion of the doctor.

It provides the usual family doctor services for around 7,200 people and is a GP training practice. Blackthorn Trust rents its premises via the NHS to the primary care team and the complementary practitioners.

The centre and trust is partially funded by the NHS, but needs to raise an additional £100,000 per year to cover its running costs. This is achieved by grants, donations, bequests and fund raising activities (including selling produce from the garden).

Blackthorn Garden

On the site of the grounds of the former psychiatric hospital of Oakwood Hospital, it occupies 22 acres and is under the direction of the Trust Management Team. Founded in 1991 and funded by the Trust. It has a flower garden, greenhouse and lath house (a framework of treated lumber covered with plastic netting, giving shade and protection for young plants). The lath house is a relic from the mental asylum. There is also a very large vegetable garden, a craft room for art therapy, a Cafe and kitchen serving organic lunches.

The garden has up to 60 people working in the garden per week.

In 1995, the garden and its therapies were evaluated by the Centre for Mental Health.

The aims of the garden:

  • To establish a place of rehabilitation through work for the mentally ill in the community.
  • To create a place of social integration and cultural activity in the Barming District of Maidstone.
  • To encourage the meeting and working together of the various disciplines concerned with mental health and community care.

The garden is opened, Monday to Saturday, 9:30 am to 3:30 pm. On Saturdays, workshops are open to the general public.

The garden also has a shop (run by volunteers) selling second-hand clothes and other used items.

The trust has various events during the year including Spring Fair, Summer Fair, Christmas Fairs. Selling local handmade crafts and specialist food stalls as well as the traditional stalls.

Funders

The local community and the people of Kent, Abbey National Trust, Alchemy Trust, Aylesford Samaritan Benevolent Fund, Big Lottery Fund, Esmée Fairbairn Foundation, European Social Fund, The Hambland Foundation, Hayward Foundation, Interreg IIIa, Smith’s Charity, Invicta Community Care NHS Trust, Kent Social Services, Kimberly Clark PLC, Lankelly Chase, Lloyds TSB PLC, Mental Health Foundation, The Percy Bilton Charity, The Pilgrim Trust, Rochester Bridge Trust, Smith Kline Beecham PLC, South East Regional Health Authority, Tudor Trust, West Kent Health Authority and Wimpy PLC.

Awards

  • Leisure and Outdoor Furniture Association (LOFA) Charity Award 1999.
  • NHS Beacon Training Practise 1999/2000.
  • Joint Winner HRH Prince of Wales Award for ‘Good Practice in Integrated Health’ 2001 and 2002.
  • Finalist in 2003 NHS Health & Social Care Awards, patient-centred cancer care section.
  • Royal College of General Practitioners (RCGP)/ Leonard Cheshire / RCGP 2009 Disability Care Award.

Visits

  • Julia Cumberlege, Baroness Cumberlege Minister of Health (1992-1997) for the House of Lords.
  • Nigel Crisp Chief Executive NHS (2000-2006).
  • Jonathan Shaw (politician) Labour Minister for Disabilities in Department for Work and Pensions (2008-2010), in 2012 after losing his seat he has now become a Blackthorn Trust Member.
  • Charles, Prince of Wales.

What is the Centre for Mental Health (UK)?

Published on by Andrew Marshall2 Comments

Introduction

The Centre for Mental Health is an independent UK mental health charity. It aims to inspire hope, opportunity and a fair chance in life for people of all ages with or at risk of mental ill health.

The Centre acts as a bridge between the worlds of research, policy and service provision and believes strongly in the importance of high-quality evidence and analysis. It encourages innovation and advocates for change in policy and practice through focused research, development and training.

Brief History

The Centre for Mental Health began in March 1985 as the National Unit for Psychiatric Research and Development (NUPRD). It was founded by the Gatsby Charitable Foundation, an independent grant-making trust set up by Lord Sainsbury of Turville to ‘advance education and learning in the science and practise of mental health care, to promote research into mental health and publish the useful results and to assist the provision of mental health care for those in need of it’. The aim was for NUPRD to tackle these issues by working in a different way to other organisations. NUPRD was initially staffed by a small group of people working in an office at Lewisham Hospital. After 1989, it was renamed the Research and Development for Psychiatry (RDP), moving into the current offices on Borough High Street.

RDP eventually became the ‘Sainsbury Centre for Mental Health’ in February 1992. It was at the centre of developing and helping to implement the National Service Framework for Mental Health, and in 1995, evaluated the Blackthorn Trust garden (in Maidstone, Kent) and its therapies for two years.

From 2006, the Centre changed its work to focus on mental health and employment, in which it already had an established programme, as well as a new area of work on mental health and the criminal justice system. A new look and logo were subsequently introduced in 2007 to accompany this change in focus.

The Gatsby Charitable Foundation, one of the Sainsbury Family Charitable Trusts, provided the Centre’s core funding each year from 1985 until 2009, when it announced that it would begin to spend out its funds, its annual grant to the Centre ceasing the following year. A final grant covering three years was then announced by the foundation in the summer of 2010. The charity has since been known as the Centre of Mental Health.

Focus

  • Criminal justice: Identifies effective methods of supporting and diverting people with mental health problems in the criminal justice system.
  • Employment: Develops and promotes new ways of helping people with mental health problems get and keep work.
  • Recovery: Helps mental health services across the UK to support people more effectively to make their own lives better on their own terms.
  • Children: Undertakes work which aims to improve the life chances of children through the support they need early in life.
  • Mental and Physical Health: Recognises the strong association between mental and physical ill health and works with partners to review the evidence on cost of co-morbidities, as well as carrying out related research on liaison psychiatry.
  • Workplace training: Train managers and staff to understand, identify and support people with depression and anxiety at work.