bluuebunny/crossref_metadata_2025 huggingface dataset:
An East African safari
Authors: Cox John L.
Published: May 2008

To have been external examiner for the Masters Degree in Psychiatry (M Med) of the University of Nairobi for the last three years was an unusually stimulating opportunity, not only for a ‘busman's holiday’ (as my registrar called it) and a ‘good enough’ reason for a return to Africa, but it also enabled me to contribute again to training East African psychiatrists – a task which I first undertook in 1972 when a lecturer at Makerere University in Uganda. Because of the civil wars in Uganda, however, the Department of Psychiatry in neighbouring Kenya has now flourished and become one of the most substantial Departments in Central and Southern Africa. The Department, which includes one ‘full’ professor, two associate professors, four lecturers, two tutorial fellows, will soon have its own teaching in Kenyatta National Hospital as well as accommodation at the Mathari Mental Hospital, made famous by the pioneer observations of Carothers. In addition to its commitment to postgraduate training the Department provides three months teaching for other doctors taking an M Med in Medicine and Paediatrics and also teaches 150 medical students each year.
The restricted hospital order
Authors: Robertson Graham
Published: May 2008

Under the 1959 Mental Health Act of England and Wales, it was possible for courts to sentence offenders to hospital provided they had been found guilty of an offence which was punishable by a term of imprisonment. Higher courts could add restrictions to a hospital order if they so wished. This power has been retained in the 1983 Mental Health Act and this paper examines the nature and use of the restricted hospital order.
Substance misuse from adolescence to adulthood: service issues
Authors: Swadi Harith , Zeitlin Harry
Published: May 2008

Professionals dealing with young drug misusers, those providing mental health services for children, and those providing services for adult misusers have roles that converge and overlap (though occasionally diverge). While services for adult misusers may have been developing at a reasonable (though not to everyone's satisfaction) pace, those for adolescent misusers have not.
Responsibility to carers — an ethical dilemma
Authors: Atkinson Jacqueline M. , Coia Denise A.
Published: May 2008

The responsibility the health service owes to relatives who care for mentally ill patients is gradually being acknowledged. The Griffiths Report (1988) makes explicit both that families should care for their ill members and that the health service has a duty to provide some support. The new support for the family is more to enable them to be ‘better carers’ and to cope with the burdens of caring. One area of psychiatry where this support is a growth area is for relatives of people with schizophrenia. Research points to both the impact of some families on the career of the patient, including relapse rates, and the ways in which such negative impact can be reduced (Leff et al, 1989). This paper is concerned with the ethical issues involved in offering a service to relatives. The ethical dilemma of access to relatives is intimately related to the person at whom outcome is aimed.
Community child psychiatric nursing
Authors: Cottrell D. J. , Redford P. J. , Smith H. R. , Parker Y.
Published: May 2008

There has been a steady growth in the number of community psychiatric nurses (CPNs) working in this country over the last few years. Despite this there are still relatively few community child psychiatric nurses (CCPNs) and those that there are often work in relative isolation. It is difficult to find any articles concerning community child psychiatric nursing, either anecdotal accounts of individual practice or evaluations of a particular service.
A two year update of a regional survey of the training of junior psychiatrists in behavioural psychotherapy
Authors: Drummond Lynne M. , Bhat Ashok V.
Published: May 2008

In April 1987 the Bulletin of the Royal College of Psychiatrists published the results of a survey of the training of junior psychiatrists in behavioural psychotherapy in the South West Thames Region (Drummond & Bhat, 1987). This survey reported the experience of trainees based at 10 postgraduate teaching rotations in the Region. The survey was conducted shortly after the appointment of a new peripatetic senior lecturer. Prior to this appointment there had been no regular senior lecturer teaching in behavioural psychotherapy in the Region for at least one year. The paper demonstrated that the majority of trainees had received little or no previous teaching or supervision in behavioural psychotherapy. It also demonstrated that trainees welcomed the introduction of such teaching and that their knowledge of the subject improved significantly after three teaching sessions held at monthly intervals. However, after this short time only 17.1% of the trainees reported that they had started to use any of the techniques they had learned in clinical practice.
Mental Health Act Commission
Authors: Blom-Cooper Louis
Published: May 2008

A review of the role and function of the Mental Health Act Commission is a natural outcome of the first five years experience of its workings. By the Autumn, when the third Biennial Report will be published, the new direction and operation of the Commission will be determined by the Secretary of State for Health on the basis of the recommendations of the review. It is too early to indicate the changes that are likely to be wrought by this development. It is possible, however, to reflect on the activities to date.
Psychiatric intensive care after two years
Authors: O'Dwyer J. M. , Mann B. S.
Published: May 2008

The following is a descriptive study of Willoughby Ward, a psychiatric intensive care unit, opened in Parkside Hospital, Macclesfield, in July 1986. It provides a moderately secure facility for the treatment of psychiatric patients within both Crewe and Macclesfield Health Authorities. The unit has 15 beds, of which two are funded and used by Crewe area, where, unlike Macclesfield, the psychiatric unit is located in the district general hospital. Managed as a locked ward, the patients are admitted under the provisions of the Mental Health Act 1983. As well as being mentally ill as defined in the Act, the patients were disturbed to a degree as to be unmanageable in open conditions.
Psychotherapy, child abuse and the law
Authors: Kennedy Roger
Published: May 2008

Those working with families in the field of child abuse often find themselves becoming intimately involved with Family Law. Although the involvement may produce confusion and frustration in professionals untrained in the law, it may also help facilitate appropriate and effective treatment of severely disordered families. I believe not only that legal framework can help those working in the mental health field, but also that a psychotherapeutic understanding of individuals, families and groups can aid lawyers steer families more effectively and humanely through the legal process. By the term psychotherapy I mean a body of theoretical and clinical knowledge concerned with looking at people's conflicts, feelings, anxieties and reasons for actions, which includes an understanding of the unconscious processes of the mind. A psychotherapeutic approach cannot provide a substantial basis for legal theory, for the latter is heavily weighted towards the notion of the ‘reasonable’ man, whose unconscious ideas and emotions are significant only if they lead to an intention to act illegally and the carrying out of the illegal act. However, the day-to-day practice of law may perhaps be enriched by a more rigorous attempt to understand human emotions, particularly in the often emotionally painful areas of Family Law. Moreover, I suspect that there are a number of shortcomings in the current complex, sometimes muddled, way that families have to deal with the law, which the proposed new legislation (DHSS, 1987) may not address. A psychotherapeutic understanding of some of the reasons for this muddle as well as of the general issues in this field may have benefits for lawyers, mental health workers and clients.
Liaison psychiatry in Addenbrooke's Hospital: six months experience
Authors: Tarbuck Andrew F.
Published: May 2008

Addenbrooke's Hospital is large (approximately 1,000 beds) and serves the functions of an academic and teaching centre, as well as providing acute care in medicine, surgery and the specialties for the inhabitants of Cambridge and the surrounding area. Before January 1989, all psychiatric beds were located at Fulbourn Hospital, three miles from the main Addenbrooke's site and all liaison psychiatric cover was provided by links between individual medical and psychiatric teams. However, since that date, a small in-patient psychiatric unit has been established on the Addenbrooke's site and at the same time, in order to gain closer compliance with the Royal College Guidelines (1988), arrangements were made for one of the registrar posts associated with this unit to form part of a liaison psychiatry team.
Verdi's Macbeth
Authors: Jones Mark
Published: May 2008

Mark Jones continues this occasional series by examining Verdi's Macbeth of 1847 in the light of David Pountney's new production for the English National Opera premiered at the London Coliseum in April.

The ten year period 1840–1850 saw the appearance of ten operas by the young Giuseppe Verdi which now constitute his ‘early’ musical output. Not all the operas were equally successful and Verdi later acknowledged their inconsistencies; but here was the work of a genius who was to become the greatest composer in the Italian tradition, and at this time was thought of as a worthy successor to Rossini, Donizetti and Bellini.
The Henderson Hospital – a trainee's experience
Authors: Joughin Neil
Published: May 2008

In this issue of the Psychiatric Bulletin (pp 72–76), Dolan & Norton discuss the need to protect specialist psychiatric units such as the Henderson Hospital. They describe a variety of functions of these units, but only make brief reference to training. I would like to describe my six months in psychiatry spent as a registrar at the Henderson Hospital. My enjoyment of the placement may not be synonymous with the Henderson serving an important training function, but I hope that I can explain why the two may be linked.
Ronald David Laing 1927–1989: an appreciation
Authors: Clare Anthony W.
Published: May 2008

It is unarguable that R. D. Laing was the best-known and, certainly outside mainstream psychiatry, the most influential psychiatrist of his time. His ideas have continued to exercise an astonishing appeal to writers, film directors, sociologists and philosophers. He epitomised for many the so-called anti-psychiatry movement and its portrayal of psychiatrists as agents of social control, psychiatric institutions as centres of degradation and psychiatric treatment as a process of invalidation. His rolling Glaswegian rhetoric summoned forth once again the compelling romantic concept of the psychotically ill as bearers of a potent insight into the fallibility, the malevolence and the violence at the heart of the human condition. He was, as his old teacher, and fellow-psychiatrist and Scot, Morris Carstairs, observed in a review in the Times Literary Supplement in 1976, “a guru of our time”. Now that he is no longer with us, how will time remember him?
What can psychotherapy contribute to community psychiatry, and vice versa?-The North Devon experience
Authors: Holmes Jeremy
Published: May 2008

This paper is based on experiences over the past three years in North Devon (population 140, 000), a predominantly rural district that until 1986 based most of its psychiatric facilities in a large mental hospital in Exeter, nearly 40 miles away. When Exeter went ‘Italian’, services were devolved to local districts, and North Devon was given the responsibility for providing comprehensive psychiatric care based on a DGH unit, a Day Centre, two hostels and a small multidisciplinary team. No formal psychotherapy services were included in this plan. This is a familiar enough pattern, one that can be found throughout Europe and North America. I shall try to chart the movement from the heady days of decarceration to current uncertainties about community care, a state which might be called post-deinstitutionalism.
Psychogeriatric day hospitals: open to audit?
Authors: Thompson A. E.
Published: May 2008

Day care has been called one of psychiatry's gifts to medicine. The British psychiatric day hospital movement began in the post war years and its philosophy continues to flourish with the decline of institutional care.
Music therapy
Authors: Dunne F. J. , Schipperheijn J. A. M.
Published: May 2008

Music and medicine have been closely associated for centuries. Indeed, Pythagoras believed that if music were used in daily life in a prescribed manner it would make a salutary contribution to one's health, a concept which led him to investigate the physics of sound and to develop the fundamentals of today's tonal system (Munro & Mount, 1978). During medieval times, music was imbued with significant therapeutic properties and used as a mood altering medium, an aid to digestion, an antidote to poison and as a wound healing stimulant. The idea of using a pure sinusoidal tone at a low frequency has been known for centuries, and in primitive cultures instruments and sounds were used to treat psychosomatic disorders (Skille et al, 1989). Today, music is acknowledged as a therapeutic modality, with scientific evidence attesting to its psychological and physiological effects.
Paranoia — is it cost effective?
Authors: Whyte C. R.
Published: May 2008

The cost effectiveness of treatment has to be a major consideration in any well managed service. It is, therefore, the job of management to ensure that effective treatment is delivered efficiently.
A state of insubordination and mutiny
Authors: Douglas A. D. M. , Oram E. G.
Published: May 2008

A strike involving nursing staff prior to the 1948 National Health Service Act was almost an unheard of event. In 1922 nurses at Saxondale, an 800 bedded mental hospital at Radcliffe-on-Trent near Nottingham, staged what was termed a “sit in strike” lasting four days for refusing to work a 66 hour week and accept a wage reduction as ordered by the employing authority.
The nuts and bolts of writing papers Number 5. Structure of the paper
Authors: Footring Ralph
Published: May 2008

Most papers require a summary, including literature reviews. Something snappy is recommended: why was the study done, how was it done, what was found, and so what? Four sentences should suffice — it is, after all, a summary. Some authors include an analysis, a consideration, a few ifs and buts, and a good deal of reflection.
Out-patients' perceptions of the clinical and psychosocial effects of neuroleptic medication
Authors: Chapman Tom , Mulvihill Eric
Published: May 2008

While research into the effectiveness of neuroleptic medication consistently demonstrates its value in improving psychotic symptoms, and in the prevention of relapse, the treatment continues to generate controversy. Indeed, McClelland (1989) has recently asserted that this treatment of choice is “an indispensable evil”; “indispensable” by virtue of its clinical effectiveness, and “evil” because of the wide range of adverse and distressing side effects experienced by patients.
Registrars and senior house officers in psychiatry
Authors: Bhate Surya
Published: May 2008

The Government's proposals in the White Paper have given rise to exceptional controversy and concern not only among professional groups working in the NHS but also among the general public. It is therefore not surprising that the medical profession has somewhat lost sight of the significance of the radical proposals in the report issued in October 1987. The report Hospital Medical Staff: Achieving a Balance ‘Plan for Action’ (1988) was issued on behalf of the UK Health Departments, the Joint Consultants Committee and the Chairmen of the Regional Health Authorities. The report, after a careful review of the alternatives, formulated proposals for an integrated package of measures to achieve gradual reform of hospital staffing structures in the interests of patients and doctors alike. The results of deliberations identified three principal areas:

(1) an increase in the number of consultants to provide leadership and career opportunities

(2) sensible planning of the number of doctors in career training grades, taking account of career prospects

(3) maintenance of necessary levels of support for consultants particularly in the acute specialities.
Coconuts and conduct disorder
Authors: Hackett Latha , Hackett Richard
Published: May 2008

A large crowd throngs the out-patient hall and all 300 children cry in unison. The father of an eight year-old girl pushes her through the crowd until she reaches a partitioned cubicle where four doctors sit round a table. He puts her in front of the first doctor and tells him about the chest pain she has had for months. The doctor, struggling to hear above the din, takes a brief history and examines the girl standing up. The history is inconclusive and there are no signs; he cannot understand why her parents have bothered to make the 30 mile bus ride that morning; why didn't they accept the advice of the paediatricians they had consulted nearer their home? Usually he would have written a prescription for a tonic costing the father two days' wages, but this time he directs the girl and her father back through the crowd to where I sit, alone in my cubicle, separated from the gaze of the attenders by a saloon bar door.
Spain. The new mental health care system in Navarra, Spain
Authors: Aizarna Jone , Inchauspe Jose A.
Published: May 2008

Your two correspondents are psychiatrists in their mid-30s working at two publicly-funded mental health centres in Navarra. We share the responsibility for co-ordinating the eight mental health centres, two day hospitals and two psychiatric units in general hospitals in the province. Each of us takes care of half these resources, grouped in a ‘mental health area’.
Community psychiatry: senior registrars' views on training
Authors: Dening T. R.
Published: May 2008

In view of the increasing emphasis on community psychiatry (Groves, 1990), there is much interest both locally and nationally as to what training experience is available or should be provided. So far, trainees have been bombarded by suggestions as to the essential content of training (e.g. Connolly & Marks, 1989), and enthusiastic accounts of experience gained have been published (e.g. Malcolm, 1989). Not surprisingly, anxiety has also been expressed (Haigh & Wear, 1989).
Audit in psychiatry: “failed discharges”
Authors: Jones E.
Published: May 2008

Medical audit has been defined as the systematic, critical analysis of the quality of medical care, including the procedures used for diagnosis and treatment, the use of resources, and the resulting outcome and quality of life for the patients (Department of Health, 1989). The medical profession has been under pressure to extend and improve audit procedures in recent years (McKee et al, 1989), but there have been doubts about the most satisfactory methods, particularly in psychiatry (Garden & Oyebode, 1989). There are numerous methodological problems in measuring the outcome of psychosocial care (Shaw, 1989; Royal College of Psychiatrists, 1989). Indicators of outcome which have been used in medicine include incidence of adverse events. Reintervention rates do offer some measure of outcome, and have been used widely in other medical specialities.
Electronic alert system for mentally handicapped adults incapable of consent — civilised technology or civil rights abuse?
Authors: Male Brian , El Komy Anwar , Clark Colin
Published: May 2008

It is the intention of the Mental Handicap Services of the Chichester Health Authority to implement a discrete electronic alert system for some of the patients who are incapable of consent. An activator, similar to the bar code in a library book, or tag in a clothing store will be kept in a pocket of the patient's clothing. When a patient who carries the activator walks through a magnetic field at the door of the unit, it will trigger a bleep held by the nurse in charge to inform him/her that this particular patient is leaving.
The long-stay psychiatric patient as consumer
Authors: Hughes I. C. T. , McLackland B. M. , Oles G. S. , Pryce I. G. , Griffiths R. D. P.
Published: May 2008

“Quality of life” (QOL) appears intrinsically important but difficult to measure. As a mental health professional, one might wish to know whether patients moving from the security of hospital to “the community” improve their QOL, or to evaluate their QOL against that of other groups in society. Simply looking at symptom change or economic cost-benefit misses much of the point behind innovations in psychiatric services. From previous QOL assessments (e.g. Lehman, 1983) one would focus upon positive aspects such as living situation, personal relationships, and general health and on negative aspects such as lack of money or being a victim of crime. Literature from the 1950s and 60s attests to the adverse effects of institutional care but more recently writers such as Kathleen Jones (Jones et al, 1986) have drawn attention to the benefits of living in such an environment. Also, various well-publicised “scandals” have suggested the pitfalls of inadequately thought-out discharge into the community.
Research and development for the National Health Service (Michael Peckham [1991]) Lancet, 338, 367–371
Authors: McCarthy Mark
Published: May 2008

Professor Michael Peckham's appointment as Director of Research and Development for the National Health Service in England reflects a new phase in central government's concern to influence health care research. Responding to the House of Lords' 1988 report Priorities in Medical Research, and to continuing doubts about the effectiveness of the Department of Health's own research management division, Professor Peckham's remit is to control all the research and development activities funded through the NHS - estimated at over £200 million.
A study of the use of log books in the training of psychiatrists
Authors: Cole Andrew , Scott Jan
Published: May 2008

There is an increasing interest in the role of audit in medical practice. Less emphasis has been placed on audit by trainees and it has traditionally involved the use of log books or case books for examination purposes. One type of log book simply lists the diagnoses of consecutive cases seen. Such a record is used in the Viva part of the Examination for Membership of the Royal College of General Practitioners. Another form of log book, often referred to as a case book, usually involves a more detailed account of the cases seen by the trainee. Case books form part of the Examination for Membership of the Royal College of Obstetrics and Gynaecology as well as the MRANZCP and Canadian Psychiatric Examination.
6. Liaison psychiatry
Authors: Guthrie Elspeth , Black Dawn , Creed Francis
Published: May 2008

This speciality is predominantly concerned with the psychiatry of patients in the general hospital setting. It involves the psychiatric management of patients who present with physical symptoms, and the treatment of psychiatric illness in physically ill patients. In addition, it also includes the management of patients who deliberately self-harm.
A community mental health team: assessment of urgent referrals
Authors: Matthews Helen P.
Published: May 2008

The Southsea Mental Health Team serves a geographically-defined catchment area of 80,000 adults under the age of 65. The area lies on the south coast of England, merging on its northern boundary with the naval city of Portsmouth. There is a variety of housing types including council housing estates, private housing and a significant number of large houses in multi-occupancy use as flats, bedsits or bed and breakfast accommodation.
Liaison meetings between a psychiatric team and general practitioners: description and evaluation of a pilot project
Authors: Westbrook David , Hawton Keith
Published: May 2008

For more than 20 years, in parallel with moves towards community care, psychiatric teams have been trying to develop closer links with general practice. Many styles of working with GPs have been developed, five of which are described by Mitchell (1989). The literature contains numerous reports of most of these, particularly the shifted out-patient model (see for example Tyrer, Seivewright & Wollerton, 1984). In this paper we describe a liaison project which is closest to Mitchell's (1989) ‘joint team consultation’ and report the results of a simple survey of GP satisfaction with this scheme.
Working with clozapine
Authors: Adams Clive , Essali M. Adib
Published: May 2008

Clozapine is an atypical antipsychotic drug with relatively weak D2 and D1 blocking properties and strong 5HT and cholinergic blockade. Its potency as an antipsychotic drug is surprising considering the ratio of receptor blockade and it represents a true advance in treatment of schizophrenia. The efficacy of clozapine calls for revision of the seemingly over simplistic dopamine theory of schizophrenia. Now clozapine is available in the UK to consultant psychiatrists who register with the Clozaril Patient Monitoring Service (CPMS).
The predicted impact of the NHS White Paper on the use and funding of a specialist service for personality disordered patients: a survey of clinicians' views
Authors: Dolan Bridget , Norton Kingsley
Published: May 2008

In an earlier report (Dolan & Norton, 1990) we commented upon the potential vulnerability of specialist psychiatric units following the implementation of Working for Patients and the NHS Bill. Specialist units provide a valuable resource, not only in terms of treatment, but as sources of practical training, education, development of new therapies and of research. Many such units previously enjoyed financial protection at the regional health authority level. Downloading financial responsibilities to DHAs or NHS trusts will complicate the issue of funding since contracts will now need to be entered with each relevant DHA or NHS trust. This more cumbersome system is inevitably more costly for a specialist unit to operate. Users of such units (customers and consumers) will find referral problematic since funding must be identified in advance. Difficulty in negotiating the new, more complicated contracting system, may lead to a decline in specialist referrals. This will in turn lead to questioning of how necessary such ‘regional’ or (as in the case of Henderson Hospital) ‘national’ specialities really are. Managers may tend to argue that referral patterns will reflect (eventually) the true needs for treatment of particular client groups.
Teaching social anthropology in relation to psychiatry
Authors: Lloyd Keith , Pezeshgi Sherin , Hodes Matthew
Published: May 2008

This article deals with the organisation and evaluation of a pilot series of seminars at the Institute of Psychiatry on the relevance of social anthropology to psychiatry. Despite increasing interest in the relationship of culture to psychiatry, trainees have few opportunities to learn about anthropological issues in psychiatric theory, practice and research. The present authors, all with higher degrees in social anthropology, believe that this is one of the first seminar series of its kind in the country specifically for mental health trainees. Some further possibilities for developing and applying this teaching are also considered.
Prescribing patterns in a psychiatric follow-up clinic
Authors: Shah A. K.
Published: May 2008

There have been several surveys of prescribing for psychiatric patients (Muijen & Silverstone, 1987; Johnson & Wright, 1990) indicating inappropriate prescribing and a tendency towards polypharmacy. Most studies have looked at prescriptions for psychiatric patients in all settings (out-patients, day-patients and in-patients) in conglomeration rather than just out-patients. Out-patients experience a comparatively lesser degree of supervision (hence a greater risk of non-compliance) and have other opportunities to acquire prescriptions (e.g. through general practice). With this in view a pilot study to observe prescribing pattern in a follow-up clinic was performed.
Kochi: Recent topics in psychiatry and mental health in Japan
Authors: Mino Yoshio , Inoue Shimpei
Published: May 2008

We intend to discuss recent developments in Japanese psychiatry and matters of major concern, i.e., psychiatric services following the amendment of Japan's Mental Health Law, schizophrenia, dementia and culture-specific problems to Japan.
The molecular biology of Alzheimer's disease
Authors: Whalley L. J.
Published: May 2008

For some years, the pace of progress in clinical neuroscience has progressively quickened but none more so than with molecular biological techniques. Clinical psychiatrists have been promised (some say forewarned) that the systematic application of these techniques will swiftly cut through the multifactorial aetiologies of many mental illnesses and revolutionise diagnosis, treatment and, possibly prevention. Not surprisingly, given the fact that Down's syndrome and Alzheimer's neuropathological changes (senile plaques and neurofibrillary tangles) are so tightly linked, understanding of Alzheimer's disease (AD) was the first mental illness to benefit from these new methods. Once the amyloid β protein component of the senile plaque had been isolated and its 39–43 constituent amino acids sequenced, then it became almost a routine matter to locate the gene and describe comprehensively the much larger (approximately 710 amino acids) amyloid β protein precursor (APP). Almost simultaneously, the gene responsible for familial pre-senile Alzheimer's disease (FAD) was located, like the APP gene, on chromosome 21 (Tanzi et al, 1989). Soon, a claim was made that these (FAD and APP) were the same gene, and, in a manner akin to the presumed causal gene dosage effects in Down's syndrome, Alzheimer's disease was attributed to excess production of amyloid (by way of APP). However, this was quickly refuted and data to support a gene dosage effect in AD were not confirmed. The trail then seemed to go cold. Several studies indicated that FAD was genetically heterogeneous and distinct from senile AD (St George-Hyslop et al, 1990), and the problems of prion disease in animals and man secured more attention (Westaway et al, 1989).
The journal clubs at St Edward's Hospital – a ten year audit
Authors: Hutchinson J. A. Tony , Puranik A.
Published: May 2008

During their period of training, trainee psychiatrists are usually involved in multiple educational activities. Clinical activities include case demonstrations at the bedside, ward rounds, and other multidisciplinary team meetings. Another group of activities, not directly clinical, include didactic teaching in the form of lectures, case presentations at conferences, seminars, audit and journal clubs.
Management training – practical aspects
Authors: Richardson G. J. R.
Published: May 2008

This article addresses Jadresic's quandary (1992) on management training. Learning about management requires the same process as learning about medicine; it is not just another topic or qualification to add to a CV. Doctors need to incorporate management skills into their everyday working lives to ensure the effective delivery of care to their patients. All trainees manage. They organise duty rotas by negotiating with colleagues, they prioritise their clinical workload etc., so they have a sound management base.
Management training – what do we need?
Authors: Jadresic Danitza
Published: May 2008

I have just finished a one-week non-residential course on management skills for senior registrars. Like many of the people who attended the course I had put my name down in order to get a better idea of what the post-1-April era would mean for my professional practice. We had by and large no major interest in a career in management and yet we were keen to acquire ‘management skills’ in order to ‘produce’ what was required of us by the ‘cultural’ changes affecting the NHS.
Towards an implementation of the Italian model of community psychiatry
Authors: Pergami Andrea
Published: May 2008

The Italian Reform Act (Law 180) has been considered one of the most revolutionary Mental Health Acts in Western countries and has been the subject of considerable attention since its promulgation in May 1978. Interest in the Italian model of community psychiatry has been reflected in the number of articles, special supplements and letters, published in noteworthy European and American journals. However, for a better understanding of the meaning of Law 180 (now part of Law 833 concerning general health measures) the political and sociocultural climate surrounding the enactment of the Italian Mental Health Act should be considered.
Psychiatry in the ‘New South Africa’
Authors: Kaliski Sean
Published: May 2008

Academic medicine in South Africa was created largely by talented graduates who, having travelled overseas (especially to Britain) for postgraduate training, returned to teach in the newly established medical schools and teaching hospitals. However, over the past three decades fewer have decided to return. Consequently academic medicine generally is in decline. Hospital specialists are demoralised, and about 80% of those recently surveyed indicated that they intended leaving the public health service if the present imbalance between service commitments, research opportunities, and poor pay persists (Curtin, 1991). About 40% of graduating medical students emigrate, usually to avoid conscription. The continuing violence and political uncertainty within the country probably ensure that few will ever return.
Reciprocal training in old age psychiatry and geriatric medicine in South Gwent
Authors: Rice Karl , Mulkerrin Eamon
Published: May 2008

Skill in physical medicine is an often neglected area in psychiatric training. It is nonetheless very important, particularly in the care of the elderly. The need for reciprocal training in geriatric medicine and old age psychiatry was highlighted in Care of Elderly People with Mental Illness (1989), the Joint Report of the Royal College of Physicians and the Royal College of Psychiatrists on services for the elderly and medical training. It recommends that, “Higher professional training for specialisation in the psychiatry of old age should include at least two months experience in geriatric medicine”, and suggests that this previously optional experience should become an obligatory part of specialist training. It indicates the alternative ways of gaining such experience: a short secondment, a weekly sessional commitment or a direct exchange of posts.
A gravid glimpse at rapport
Authors: Neilson Grainne
Published: May 2008

As a psychiatric trainee I have often been intrigued by the respect that is accorded to pregnant women, deservingly or not, by the general public. People give up their seats on crowded trains and buses, they open doors, refuse to allow any heavy lifting and generally pamper the pregnant woman. As the months pass and the woman is transformed into a potential mother, attitudes towards her adjust, and she begins to be viewed in a different light. Certainly such was the case for me during my pregnancy and it was fascinating to observe the way in which the doctor-patient relationship changed as a result of my pregnant state.
‘Emergency’ referrals to a South London community mental handicap team (CMHT)
Authors: Gravestock S. , Bicknell J.
Published: May 2008

As more people with mental handicaps∗ (MH) live in the community, in line with government community care policies (Department of Health, 1989), referrals to CMHTs∗ and other community based services will increase. Such referrals may be routine, urgent or emergency, come from various sources, and concern health and social care needs.
The Young People's Unit, Macclesfield – a senior registrar's training experience
Authors: Wood Alison
Published: May 2008

As a senior registrar training in child and adolescent psychiatry I am preparing for an uncertain future. In addition to essential clinical and management skills, the ability to withstand stress and burnout seems crucial. I should like to write about my experience of working as a senior registrar at the Young People's Unit (YPU) Macclesfield which is a specialist adolescent unit under chronic threat of closure.
Advice to Government on London health services
Authors: Crisp A. H.
Published: May 2008

In October 1991 the then Secretary of State for Health, William Waldegrave, appointed Sir Bernard Tomlinson to act as adviser on health services in London. Early on it was agreed that Sir Bernard would also take account of the role of these services in teaching and research. Previous reports have focused on one or other aspect, e.g. the Todd Report (1966) and Flowers Working Party Report (1979) primarily considered teaching and research while the report of the London Health Planning Consortium (1979) mainly addressed provision of services. While the former two reports have been followed by extensive change in the organisation of medical academic activities in London, there has been much less change in health care delivery. For instance, primary care and community care are still seriously deficient in parts of London while high technology hospital based medical practice, sometimes providing a nationwide service, has survived and sometimes continued to develop in an entrepreneurial way. The problem is riven by academic and professional concerns of nationwide relevance and importance.
Educating patients and relatives about electroconvulsive therapy: the use of an information leaflet
Authors: Jenaway Alison
Published: May 2008

Several studies in the United Kingdom have highlighted the lack of knowledge that patients show about electroconvulsive therapy (ECT), both before treatment starts (Malcolm, 1989) and after it is completed (Freeman & Kendell, 1980; Hughes et al, 1981), with only 10 to 15% of patients having a full understanding of the treatment. In an American study (Baxter et al, 1986) patients seemed slightly better informed; this might be because they were given written information. However, subjects who watched a videotape of someone having the treatment did not score higher on a knowledge questionnaire than a control group and the authors postulated a ‘ceiling effect’. Bird (1979) demonstrated that access to media coverage about ECT improved patients' knowledge without increasing anxiety about the treatment.
Who makes it in psychiatry: CV predictors of success in training grades
Authors: Katona C. L. E. , Robertson M. M.
Published: May 2008

A recent paper by Lewis (1991) found authorship of a publication to be the only variable that significantly predicted whether applicants for a senior registrar (SR) rotation in psychiatry at a London teaching hospital were shortlisted. We have re-examined curriculum vitae (CV) predictors of shortlisting at SR level within a comparable London teaching hospital rotation (University College and Middlesex Medical School, UCMSM), and extended the study to examine applicants for the corresponding SHO/registrar (REG) rotation. We have also compared the two groups in terms of demographic data and academic achievements. Our intention was to replicate Lewis' findings, and to examine in more detail the possible predictive effects of academic achievement and ethnicity.
Psychiatric services for remanded mentally disordered offenders: the Brixton Diversion Project
Authors: Bhui Kamaldeep , Brown Phillip , Savournin Ros , Parrott Janet
Published: May 2008

There is growing concern about the care received by mentally disordered offenders (MDOs). The prevalence of psychiatric disorder among the remanded group has received considerable attention (Coid, 1988). Some MDOs are remanded in custody following even petty offences on account of their vulnerability or because their homelessness prejudices bail. Where the offence is serious a remand in custody may be inevitable.
Expectations of prospective senior registrars and those who appoint them
Authors: Izaguirre Jon , Sireling Lester
Published: May 2008

Access to a senior registrar post is growing more difficult because of increasing competition. The College Court of Electors and Joint Committee for High Psychiatric Training have agreed only two criteria for appointment as SR in Psychiatry (possession of MRCPsych and at least three years of general professional training), but, despite heavy workloads, busy timetables, and the need to prepare for the membership examination, clinical skills and dedication to patients will not ensure career progress if they are not accompanied by other aspects of training, sometimes with insufficient facilities and supervision. Indeed, Lewis (1991), after reviewing a group of applications for SR posts, found that the only variable which predicted likelihood of being shortlisted was having published: “Trainers generally believe that evidence of completed research and publications say more about a trainee than a good reference ever can”.
‘Fly Fishing’ by J. R. Hartley: an introduction to psychotherapy
Authors: Stein Samuel M.
Published: May 2008

The author J. R. Hartley and his book on fly fishing do not exist in external reality. They are instead a product of the advertising fantasy world, dreamt up to promote the Yellow Pages. This advertisement was at its prime when I was trying to develop a suitable analogy for teaching medical students and junior doctors about psychotherapy and some of its techniques. When taking a short break in front of the television set, it suddenly struck me just how appropriate this advertisement was. J. R. Hartley himself lends credence to the analogy, while fly fishing as a sport provides an excellent comparison for the art of psychotherapy. Like the fictitious publication in the advert, psychotherapy and its techniques can prove exasperatingly elusive, as they constitute a series of shared internal beliefs and representations which exist largely within the collective mind. I therefore felt that this ambiguous character who is not part of the external real world, yet has a special inner meaning for a wide number of people, seemed like the ideal analogy for describing psychotherapeutic processes.
IX World Congress of Psychiatry
Authors: Wallis Geoffrey
Published: May 2008

The President of the World Psychiatric Association (WPA), Dr Jorge Costa de Silva, being Brazilian, this congress was the first to be held south of the equator and in a local winter. The choice of venue caused more then usual anticipatory anxiety because Rio, the largest of all tropical cities, accommodating ten million people who unify by calling themselves Cariocas but whose economic welfare is widely disparate, has a reputation for mugging rather than begging. In the event delegates were made so security conscious and the city administrators allocated so many hundreds of police to prevent trouble that there were only three or four materially untoward incidents. One story is that a delegate ventured to the beach wearing bathing trunks and sun glasses and returned with neither.
Comparative costs of adult acute psychiatric services
Authors: Peck Edward , Cockburn Maureen
Published: May 2008

There is currently considerable debate in the UK as to the preferred model of services for adults with an acute mental health problem. Most of this debate has focused on the apparent benefits of the various models. Little research has been undertaken, however, on the financial costs of the models. This paper attempts to present some initial costs for both innovative and standard models of service. It is intended to generate thought about the scale and nature of the financial costs entailed in different models of service.
Terminal care in old age psychiatry: a survey of professionals' attitudes and approaches
Authors: Richards Josephine Anne , Lindesay James
Published: May 2008

Few clinical decisions are more difficult than whether or not to withhold treatment from patients who are unable to make this choice for themselves. This is because they bring into conflict a number of principles central to clinical practice, such as the duty to save life, the duty to relieve suffering, and the duty to heed patients' wishes. In North America, advance directives (‘living wills’) from patients, made when they are fully competent, have achieved considerable popularity in recent years as a possible way out of these dilemmas (La Puma et al, 1991; Molloy et al, 1991); unfortunately, it is by no means clear whether these can in fact provide a workable solution to the problem of treating incompetent patients (Hope, 1992). For the time being, decisions about withholding treatment will continue to be made by the health professionals immediately involved at the time, often junior staff with little experience or training, and there is a need for a professional consensus as to the factors that should be properly taken into consideration. This study investigates the current attitudes and approaches of psychiatrists and psychiatric nurses in one health district to this problem. It examines the criteria used, and the conditions under which decisions about administering or withholding treatments are being made.
Survey of undergraduate teaching of old age psychiatry in the United Kingdom
Authors: Faire Gabrielle M. , Katona Cornelius L. E.
Published: May 2008

Old age psychiatry has been steadily developing as a specialty in the United Kingdom. In 1978 the Royal College of Psychiatrists established a specialist section for old age psychiatry, and since October 1989 it has been formally recognised as a sub-specialty of psychiatry. In 1989 the Royal College of Physicians and the Royal College of Psychiatrists published a joint report entitled ‘Care of Elderly People with Mental Illness’ in which recommendations were made about both postgraduate and undergraduate training.
Trainees and research
Authors: Atkinson Jacqueline M. , Coia Denise A
Published: May 2008

Over recent years there have been a number of articles in the Psychiatric Bulletin considering the vexed question of research and trainees in psychiatry, most recently the suggestion of ‘research troikas’ by Sims (1992). Although this might work well in teaching hospitals with a reasonable number of academic staff, we see problems for the more peripheral areas. This article addresses these problems particularly as they affect people working outside the main centres. We are not concerned here with what trainees need to know about research, but rather how conducting research fits into their clinical job. We will do this by posing a number of basic questions.
What the eye doesn't see: drugs psychiatrists and GPs don't know their patients are on
Authors: Clarke Nicholas A.
Published: May 2008

Personal experience shows that discrepancies are common when out-patient psychiatric medication records are checked with the information held by a patient's GP. This could lead to duplicated or conflicting treatment regimes, dangerous drug interactions, abuse of prescribed drugs, and failure to monitor therapeutic drug levels.
Survey of Postgraduate Education Available to Women Working Part-Time in Psychiatry
Authors: Black Dorothy
Published: May 2008

In the past five years increasing concern has been expressed within the medical profession at the wastage of medical manpower arising from the failure fully to utilize the skills of women doctors who are only able, because of domestic commitments, to work part-time.
Planning Registrar and Senior Registrar Training in Mental Handicap
Authors: Spencer D. A.
Published: May 2008

The development of more rotational training schemes in psychiatry for registrars and senior registrars is introducing more trainees to mental handicap. Generally, however, mental handicap is not regarded by the trainees as the most interesting or highly-prized assignment; because of the nature of the patients, the long-stay hospitals involved and unfamiliarity with its problems, mental handicap lacks the appeal of some other subspecialties in psychiatry.