Black dog

BMJ 2001; 322 doi: (Published 31 March 2001) Cite this as: BMJ 2001;322:0

Dog eared wounds come in three varieties, Minerva reminds us: the standing full cone, the lying half cone, and the pseudo dog ear (p 806). Making the incision more than three times longer than it is wide avoids most problems. And don't expect a dog ear to settle on its own because it won't.

Would that such straightforward advice was possible for other problems identified this week, especially the three Ds—distress, depression, and dementia. They hover over this week's journal like a cloud.

Commenting on Reid and colleagues' study of medically unexplained symptoms in frequent attenders of secondary health care (p 767), Turner sees a large amount of underlying distress “that is neither appropriately identified nor addressed” (p 745).

Although exercise has emerged as one of the panaceas of the age (and for the aged—see p 796), it doesn't seem to work for depression. A systematic review of randomised controlled trials found no particular benefit (p763). In another study Chilvers and colleagues report that generic counselling may be as good as antidepressant drugs for mild to moderate depression, although drugs act faster (p 772).

We've known for some years of the distress of relatives caring for people with dementia. Margallo-Lana and colleagues looked at the psychological health of staff caring for such people. Although levels of distress were lower than those reported among other healthcare workers and relatives caring for people with dementia, they highlight the importance of “positive coping strategies” (p 769). This week's instalment of the care of older people reviews mental health problems in detail. Baldwin and colleagues tell us that depression is the commonest mental health disorder in later life: it is “eminently treatable, but psychological therapies are underused” (p 789).

Depression and distress lurk amid the reviews. In later life, “boarding school survivors” may experience stress related disease, inability to sustain meaningful intimate sexual relationships, and mental and emotional breakdowns, says a review of The Making of Them: The British Attitude to Children and the Boarding School System (p 803). And to finish us off, Soundings describes two variants of Barraclough's syndrome —where depression follows whiplash, litigation, and breakup with boyfriend, or where depression follows whiplash and litigation alone (p 805).

Respite comes, as it so often does, from the obituaries (pp 800-1). Leslie Lauste “had a love of foreign travel, always with a historical purpose, such as a search for Xanadu.” At the time of his death John White was planning the world's largest “ring of roses” with 1500 children.


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