Alex J Mitchell

University of Leicester | LE · Department of Cancer Studies and Molecular Medicine

Introduction: Informal caregivers of children and adolescents with intellectual disabilities and attention deficit/hyperactivity disorder (ADHD) face numerous challenges. However, no study has yet compared the HRQoL of the caregivers of children with these two conditions. We aimed to compare the HRQoL and perceived stress of intellectual disabil...

Background Detecting anxiety in oncology patients is important, requiring valid yet brief measures. One increasingly popular approach is the Patient Reported Outcomes Measurement Information System (PROMIS); however, its validity is not well established in oncology. We assessed the convergent and criterion validity of PROMIS anxiety measures in an...

A range of anxiety measures is used in oncology but their comparability is unknown. We examined variations in measurement across three commonly used instruments: Hospital Anxiety and Depression-Anxiety subscale (HADS-A); Depression, Anxiety, Stress Scale - Anxiety subscale (DASS-A); and Generalised Anxiety Disorder scale (GAD-7). Participants (n =...

Epigenetics, hypothalamic-pituitary axes, environmental and metabolic influences, and transgenerational plasticity govern social behavior. Cognitive research considers the brain's default mode network (DMN) as a central hub that integrates various cognitive and social processing domains responsible for emotion perception, empathy, theory of mind...

Backround and objective This study aimed to determine the degree of depression and anxiety in cancer patients using the Emotion Thermometers (ET) and confirming their clinical usefulness compared to the gold standard interview, as well as determining optimal cut-off values for the appropriate identification of cancer patients' distress. Methods We...

Screening for distress is a vital component of healthcare that has an important place in psychosocial oncology. Over the last 10 years the evidence base for screening has strengthened significantly, but important unanswered questions remain. Successful development and validation of numerous instruments have occurred, followed by the large-scale imp...

Multiple studies have demonstrated that cancer patients are likely to encounter complex biopsychosocial distress at time of diagnosis and during treatment, recurrence, and end-of life care. Since the branding of distress as the sixth vital sign, there has been widespread attention to seeing comprehensive biopsychosocial screening and monitoring pat...

Psycho-Oncology, 4th edition, follows the publication of Psycho-Oncology, 3rd edition in 2015. This is the latest in the series of textbooks which have defined the field of psycho-oncology. William Breitbart, MD, serves as the new senior editor along with associate editors Phyllis N. Butow, PhD, MPH, of the University of Sydney; Paul B. Jacobsen, P...

A brain tumour is the most feared cancer diagnosis by the general public. Primary brain tumours account for about 1.5% of all new cases of cancer, and 2.5% of all cancer deaths. However, most brain tumours are, in fact, metastases from other cancer sites. Brain tumours cause considerable psychological and psychiatric complications, as well as a bur...

Oxford Textbook of Neuropsychiatry helps to bridge the gap between general psychiatric textbooks and reference texts in neuropsychiatry. Organised into four sections, the book covers the basic knowledge and skills relevant to neuropsychiatry, the various neuropsychiatric conditions, the principles of treatment, and perspectives for neuropsychiatry...

Background: Specific cognitive alterations could be one of the predictors that lead to the complex activities of daily living (CADL) impairment in mild cognitive impairment (MCI) and, hence, help to explain the continuum between MCI and dementia. Objective: We aimed to reevaluate the existing uncertainty regarding the impact of memory and execut...

Objective We aimed to investigate which clinical and metabolic tests offer optimal accuracy and acceptability to help diagnose diabetes among a large sample of people with serious mental illness in receipt of antipsychotic medication. Methods A prospective observational study design of biochemical and clinical factors was used. Biochemical measure...

Cancer is a disease that impacts not only the patient but also affects the entire family. Family members experience high levels of distress. Therefore, screening for cancer-specific distress among family members of people with cancer is important but relatively unexplored. This cross-sectional study aims to analyze the psychometric properties of a...

Brief talk on the Emotion Thermometers tool. For permission to use this tool for free in clinical practice go to www.bit.ly/etpermission

Purpose We aimed to assess the impact of implementing Edmonton Symptom Assessment System (ESAS) screening on health-related quality of life (HRQoL) and patient satisfaction with care (PSC) in ambulatory oncology patients. ESAS is now a standard of care in Ontario cancer centers, with the goal of improving symptom management in cancer patients, yet...

A key element of supportive care is the reliable assessment and measurement of psychological health. This includes detection of frank psychiatric disorders as well as broader psychological symptoms and generalized distress. Many organizations have made recommendations for assessment of psychiatric disorders and psychological distress, but despite t...

Purpose The distress thermometer (DT) and the emotion thermometers (ET) are short screening instruments for use in oncological practice. The aim of this study was to provide normative values and to analyze the correlational structure of the ET. Methods A representative sample of the adult German general population (N = 2437) completed the ET, the...

Purpose: To assess the convergent validity of the Patient-Reported Outcomes Measurement Information System (PROMIS) depression measures relative to legacy measures and criterion validity against a structured diagnostic interview for depression in an oncology sample. Methods: 132 oncology/haematology outpatients completed the PROMIS Depression Co...

BACKGROUND Given the adverse consequences of psychiatric and psychosocial morbidity on the quality of life for patients with cancer, prompt detection of psychological symptoms is mandatory. The authors examined the properties and accuracy of the Brief Symptom Inventory (the 53‐item version [BSI] and the 18‐item version [BSI‐18]) for the detection o...

The Mini-Mental State Examination (MMSE) is the most commonly used brief cognitive tool in the assessment of a variety of cognitive disorders. The tool comprises a short battery of 20 individual tests covering 11 domains and totalling 30 points. Typical completion time is 8 min in cognitively unimpaired individuals, rising to 15 min in those with d...

Assessment of a patient after hospital-treated self-harm or psychiatric hospitalization often includes a risk assessment, resulting in a classification of high risk versus low risk for a future episode of self-harm. Through systematic review and a series of meta-analyses looking at unassisted clinician risk classification (eight studies; N = 22,499...

Editor's Summary In a recent Round the Corner, Mitchell commented on a Cochrane Review of exercise therapy for chronic fatigue syndrome (CFS). One of the trials included in that review, and discussed by Mitchell, was the PACE trial. In this month's Round the Corner we are publishing a response we received from authors of the PACE trial (Chalder, Wh...

Parity of esteem means valuing mental health as much as physical health in order to close inequalities in mortality, morbidity or delivery of care. There is clear evidence that patients with mental illness receive inferior medical, surgical and preventive care. This further exacerbated by low help-seeking, high stigma, medication side-effects and r...

Chronic fatigue syndrome (CFS) is syndrome of unremitting fatigue of at least 6 months’ duration that causes significant disability. Exercise therapy has a proven track record in medicine and could be effective for some patients with CFS. An updated Cochrane review of eight studies appeared to suggest that exercise helps fatigue symptoms, but with...

Background Despite the known heightened risk and burden of various somatic diseases in people with depression, very little is known about physical health multimorbidity (i.e. two or more physical health co-morbidities) in individuals with depression. This study explored physical health multimorbidity in people with clinical depression, subsyndromal...

Objective To determine the prevalence and predictors of mood disorders, determined by structured clinical interviews (ICD or DSM criteria) in people after stroke. Methods Major electronic databases were searched from inception to June 2015 for studies involving major depression (MDD), minor depression (MnD), dysthymia, adjustment disorder, any d...

Background: Although depression and mood-related disorders are common in persons with cancer, these conditions remain frequently overlooked in clinical practice. Negative consequences of depressive disorder spectrum have been reported (e.g. suicidal ideation, increase physical complications and somatic symptoms, negative influence on prognosis), i...

Background In people with psychosis, physical comorbidities, including cardiovascular and metabolic diseases, are highly prevalent and leading contributors to the premature mortality encountered. However, little is known about physical health multimorbidity in this population or in people with subclinical psychosis and in low- and middle-income cou...

Purpose The importance of distress identification and management in oncology has been established. We examined the relationship between distress and unmet bio-psychosocial needs, applying advanced statistical techniques, to identify which needs have the closest relationship to distress. Methods Oncology outpatients (n = 1066) undergoing QUICATOUCH...

Antipsychotics are associated with an increased risk of type 2 diabetes mellitus (T2DM). T2DM affects around 10% of people receiving antipsychotics. The consequences of T2DM in this population include increased rates of micro- and macrovascular complications, acute metabolic decompensation, and premature mortality. Multiple complex mechanisms under...

Purpose: A number of studies have suggested that depressed mood is one of the most important predictors of quality of life (QoL) in patients with epilepsy. However, the QoL measure used in previous studies was limited to the Quality of Life in Epilepsy (QOLIE) scales. It could be questioned whether correlation of QOLIE with measures of depression...

Objective: Repeated intentional self-harm (SH) is associated with economic costs and increased risk of suicide. Estimates of repetition vary according to method of data capture and are limited by short periods of follow-up observation. Some sources use hospital records and others self-reported SH (SRSH). Our aim was to examine the relationship bet...

Coping with Cancer Explained is a brief practical workbook (32 pages) on how to cope emotionally after a cancer diagnosis. It is suitable for patients and families. It has been written by Professor Alex J Mitchell of University of Leicester and includes a brief 6-week step-by-step programme to manage emotional difficulties. This short book addresse...

The appeal of ketamine – in promptly ameliorating depressive symptoms even in those with non-response – has led to a dramatic increase in its off-label use. Initial promising results await robust corroboration and key questions remain, particularly concerning its long-term administration. It is, therefore, timely to review the opinions of mood diso...

Background The Patient Health Questionnaire (PHQ) is the most commonly used measure to screen for depression in primary care but there is still lack of clarity about its accuracy and optimal scoring method. Aims To determine via meta-analysis the diagnostic accuracy of the PHQ-9-linear, PHQ-9-algorithm and PHQ-2 questions to detect major depressiv...

Collaborative care' (involving a case manager) and 'primary care liaison' or 'consultation liaison' (with no case manager) are models of liaison psychiatry in primary care. Here, I briefly consider the evidence for collaborative care, discuss Gillies et al 's Cochrane review on consultation liaison, and suggest avenues for future study and developm...

The article by Smith et al (2016) provides a valuable summary on the usefulness and interpretation of systematic reviews. This commentary adds a discussion of confirmation bias and a summary of some of the most useful influential systematic reviews and meta-analyses in mental health.

Evidence regarding the relationship between performance on specific cognitive domains and cause of death is scarce. We assessed whether specific cognitive domains predicted mortality and the presence of any association with specific causes of death in a population-dwelling sample of non-demented older adults. In this population-based, prospective s...

Reply We thank Dr Carney, Bradshaw and Yung for their useful insights into our question 'can we prevent cardiometabolic problems before they begin?' We welcome their research suggesting individuals with prodromal schizophrenia or even those at ultra high risk (UHR)may have high rates of smoking, substance misuse and low levels of physical activity...

Background: The predictive value of diverse subtypes of mild cognitive impairment (MCI) for dementia and death is highly variable. Objective: To compare the predictive value of several MCI subtypes in progression to dementia and/or mortality in the NEDICES (Neurological Disorders in Central Spain) elderly cohort. Methods: Retrospect algorithmi...

The prevalence of diabetes mellitus is twofold to threefold higher in people with severe mental illness (SMI) than in the general population, with diabetes mellitus affecting ~12% of people receiving antipsychotics. The consequences of diabetes mellitus are more severe and frequent in people with SMI than in those without these conditions, with inc...

The Mini-Mental State Examination (MMSE) is the most widely used bedside cognitive test. It has previously been shown to be poor as a case-finding tool for both dementia and mild cognitive impairment (MCI). This month's Cochrane Corner review examines whether the MMSE might be used as a risk prediction tool for later dementia in those with establis...

Metabolic syndrome (MetS) and its components are highly predictive of cardiovascular diseases. The primary aim of this systematic review and meta-analysis was to assess the prevalence of MetS and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder, comparing subjects with diffe...

Background: The use of different depression self-report scales warrants co-calibration studies to establish relationships between scores from 2 or more scales. The goal of this study was to examine variations in measurement across 5 commonly used scales to measure depression among patients with cancer: Hospital Anxiety and Depression Scale-Depress...

Early separation of mild cognitive impairment (MCI) from normal aging and mild cases of dementia remains a challenge, especially in the general population. We aimed to analyze the diagnostic accuracy of a brief neuropsychological battery (BNB) in dementia and MCI cases from the Neurological Disorders in Central Spain (NEDICES) population-based coho...

Background: Bipolar affective disorder has a high rate of comorbidity with a multitude of psychiatric disorders and medical conditions. Among all the potential comorbidities, co-existing anxiety disorders stand out due to their high prevalence. Aims: To determine the lifetime prevalence of comorbid anxiety disorders in bipolar affective disorder un...

Background Patients with depression may be at increased risk of type 2 diabetes (T2DM) which is a risk factor for cardiovascular diseases and premature mortality. We aimed to clarify the prevalence and predictors of T2DM in patients with major depressive disorder (MDD) and where possible compare the prevalence of T2DM in those with MDD versus gener...

Objective: This systematic review and meta-analysis assessed the prevalence and predictors of T2DM in people with bipolar disorder. We also compared the prevalence of T2DM in people with bipolar disorder versus age- and gender-matched healthy controls. Data Sources: PubMed, EMBASE, PsycARTICLES and CINAHL were searched from inception till October 2...

Objective A recent meta-analysis showed that breast cancer probably is more common in female patients with schizophrenia than in the general population (effect size = 1.25, P < 0.05). Increasing experimental and epidemiological data have alerted researchers to the influence of prolactin (PRL) in mammary carcinogenesis. We therefore investigated the...

Up until now, no information has existed regarding a comparison of the pattern and frequency of cognitive deficits between radiologically isolated syndrome (RIS) and clinically isolated syndrome (CIS) patients. Within this objective, Rao's Brief Repeatable Battery and Stroop test were administered to 28 RIS patients, 25 CIS patients, and 22 healthy...

Consultation-liaison psychiatry (CLP) is a psychiatric subspecialty addressing the psychological care of medically ill patients as well as the relationship between medical and psychiatric disorders. As a specialty, it has developed over the last 30 years. Yet several cultural and organizational problems in different countries have emerged, includin...

Radiologically isolated syndrome (RIS) is characterized by incidental lesions suggestive of multiple sclerosis (MS) on MRI without typical symptoms of MS. Clinically isolated syndrome (CIS) is characterized by a first episode of neurologic symptoms caused by demyelination in the central nervous system. To date, psychiatric disorders have not been s...

Acquiring a diagnosis of schizophrenia reduces life expectancy for many reasons including poverty, difficulties in communication, side-effects of medication and access to care. This mortality gap is driven by natural deaths; cardiovascular disease is a major cause, but outcomes for people with severe mental illness are worse for many physical healt...

Objective To conduct a meta-analysis investigating the prevalence of type two diabetes mellitus (T2DM) in people with schizophrenia compared to controls.Method Systematic review of electronic databases from inception till November 2014. Articles reporting the prevalence of T2DM in people with schizophrenia and healthy controls (without mental illne...

This commentary questions a Cochrane review that examined whether first-rank symptoms are a useful diagnostic tool for differentiating schizophrenia from other psychotic disorders. It concludes that first-rank symptoms are not particularly accurate in this role, although they might be useful initial screening questions in community surveys or waiti...

Objective: Cardiorespiratory fitness (CRF) is a major modifiable risk factor for cardiovascular disease (CVD). We conducted a clinical overview to highlight the reduced CRF expressed as maximal oxygen uptake (VO2max) (or predicted) or peak oxygen uptake (VO2peak) in people with schizophrenia compared to the general population. We also aimed to iden...

Objective High rates of smoking and nicotine dependence are associated with increased physical comorbidity and premature death in people with schizophrenia. We conducted a clinical overview to establish how smoking cessation should be promoted in practice.Method Systematic clinical review of major electronic databases from inception till November 2...

Cardiorespiratory fitness (CRF) is a major modifiable risk factor for cardiovascular disease (CVD). We conducted a clinical overview to highlight the reduced CRF expressed as maximal oxygen uptake (VO2max) (or predicted) or peak oxygen uptake (VO2peak) in people with schizophrenia compared to the general population. We also aimed to identify correl...

Delirium is a complex but common disorder in palliative care with a prevalence between 13 and 88 % but a particular frequency at the end of life (terminal delirium). By reviewing the most relevant studies (MEDLINE, EMBASE, PsycLit, PsycInfo, Cochrane Library), a correct assessment to make the diagnosis (e.g., DSM-5, delirium assessment tools), the...

This is a chapter on hospice and home care in the book "Psycho-Oncology.

Multiple sclerosis (MS) patients have high rates of complications and disability, including cognitive impairment, that often, impact on caregivers' emotional health. Clarification may help identify improved supportive strategies for both caregivers and patients. We aimed to analyse whether MS domain-specific cognitive impairment can influence the s...

Depression is the most common neuropsychiatric complication in HIV-infected patients and may occur in all phases of the infection. Accurately, diagnosing major depressive disorder in the context of HIV is an ongoing challenge to clinicians and researchers, being complicated by the complex biological, psychological, and social factors associated wit...

About half of patients treated for urological cancer will experience some degree of psychological distress and about a quarter have some degree of depression at some time in their illness. Patients with prostate cancer have lower levels of anxiety and depression compared to some other cancers. Psychological symptoms may be overshadowed by physical...

Background There is a higher mortality rate due to cancer in people with mental illness and previous work suggests suboptimal medical care in this population. It remains unclear if this extends to breast cancer population screening. Aims To conduct a systematic review and meta-analysis to establish if women with a mental health condition are le...

The prevalence of diabetes mellitus is twofold to threefold higher in people with severe mental illness (SMI) than in the general population, with diabetes mellitus affecting ∼12% of people receiving antipsychotics. The consequences of diabetes mellitus are more severe and frequent in people with SMI than in those without these conditions, with inc...

Objective Many patients who experience distress do not seek help, and little is known about the reasons for this. We explored the reasons for declining help among patients who had significant emotional distress.Methods Data were collected through QUICATOUCH screening at an Australian hospital. Oncology outpatients scoring 4 or more on the Distress...

There is evidence of the presence of a disturbed pattern of anger in multiple sclerosis (MS). Emotion changes, including anger, are thought to influence health-related quality of life (HRQoL). However, although deleterious consequences of anger on physical health have been well reported, there are no studies that have analysed the effects of anger...

ABSTRACT Distress is common in patients with gastrointestinal (GI) cancers. Most conventional scales are too long for routine clinic use. We tested the Emotion Thermometers (ET) tool, a brief visual-analogue scale. There are four emotional upset thermometers: distress, anxiety, depression, and anger. 69 surgical patients were recruited from an acad...

Active Surveillance (AS) is recommended for the treatment of localised prostate cancer; however this option may be under-used, at least in part because of expectations of psychological adverse events in those offered or accepting AS.Objective(1) Determine the impact on psychological wellbeing when treated with AS (non-comparative studies). (2) Comp...

BACKGROUND: Research evidence shows that self-help, peer support and internet-based therapies can all be therapeutic for distress. Meta-analyses suggest about 40% of people suffer significant psychological complications early in the course of cancer yet uptake of conventional treatment is low with only 40% accepting help. CancerStories© is an innov...

BACKGROUND Distress has been described as the 6 th vital sign in cancer. A number of instruments exist for measuring distress but in clinical practice short tools, such as visual-analogue scales are most acceptable.

Objective To investigate whether people with subjective memory complaints (SMC) but no objective deficits are at increased risk of developing mild cognitive impairment (MCI) and dementia.Method Major electronic databases were searched till 03/2014, and a meta-analysis was conducted using inception cohort studies.ResultsAcross 28 studies, there were...

Objective To undertake a meta-analysis of suitable diagnostic accuracy studies of the Addenbrooke's Cognitive Examination (ACE) and its revised version (ACE-R) for the diagnosis of dementia. Results Of 61 possible publications identified, meta-analysis of qualifying studies encompassed 5 for ACE (1090 participants) and 5 for ACE-R (1156 participant...

Distress is a common and clinically relevant complication of breast cancer which can occur at any time. Several organizations have recommended systematic screening for distress but, because there is still a debate about its effectiveness, uptake has been slow. Screening research can be divided into studies of diagnostic validity that test the accur...