bluuebunny/crossref_metadata_2025 huggingface dataset:
Oslo
Authors: Wilkinson Simon R.
Published: May 2008

It did not take me long to find that I belonged to the ‘marginal’ section of Norwegian society. Both as foreigner and psychiatrist I seemed to be a threat. Nevertheless it is from society's marginal groups that healers have often come (Miller, 1987) and so I continue to work with a necessary and natural cultural naivety and therapeutic optimism! I present here an overview and critique of the services provided for children in Oslo from the privileged position of a migrant. The high staffing levels and the profile of child and adolescent psychiatry appear to have exaggerated the ‘psychologising’ of problems and a search for therapy. These have the potential to inflame both interprofessional conflicts and interdisciplinary conflicts because of the emphasis on therapeutic skills to the relative exclusion of a relevant knowledge base.
A survey of attitudes to NHS reform among consultant psychiatrists in trust administered hospitals
Authors: Bullmore Edward , Persaud Rajendra , Dare Christopher
Published: May 2008

Most previously published opinion has indicated that the medical profession is predominantly opposed to the package of NHS reforms outlined in the Government's white paper Working for Patients and especially opposed to the administration of hospitals by self-governing trusts (Lister, 1990). Yet only Whitfield et al (1989) can claim to have independently and directly polled the opinions of a representative sample of a defined population of doctors on this subject, and their survey was published two years before NHS reform began to impinge on hospital practice.
The psychiatric careers of male shelter users in Nottingham
Authors: Roy Leena , Read Sue
Published: May 2008

Descriptions of psychiatric morbidity among the homeless have generally been carried out in community settings (Marshall, 1990) or among those who have come into contact with psychiatric services.
The therapeutic use of case-by-case audit agreements in an adolescent unit
Authors: Goldberg David , Bernard Francis , Sevitt Michael
Published: May 2008

The aim of audit is to monitor and evaluate clinical practice with the intention of refining and improving practice. Once implemented the changes can in turn be monitored, creating the audit cycle. This paper illustrates one way to capitalise on the changes generated by an auditing process in an in-patient adolescent unit.
Psychiatry in Gibraltar: in-patient statistics
Authors: Seth Ram , Monegriffo Cecil , Ruiz Michael
Published: May 2008

Gibraltar is one of the few remaining British colonies and the historical development of medical services on the Rock, named after its Moorish conqueror Gebel Tariq in AD 700, has been reviewed by Montegriffo (1978). The Rock provides a useful small community for studying the mental health of its population, being 1 × 3 miles in area and with a population of 29,166 (1986 census). The population has remained static for the last decade with the male/female ratio 15/14. There were 507 births, male/female ratio 254/253 and 290 deaths (154 males and 136 females, 1986 census). The age distribution has altered; the percentage over 65 years in 1970, 9.8% and in 1980, 11.2%.
Selective serotonin re-uptake inhibitors: use in depression
Authors: Ferrier I. N. , Silverstone T. , Eccleston D.
Published: May 2008

This short review outlines the clinical profile of the selective serotonin re-uptake inhibitors (SSRIs). There has been much recent publicity and promotion of this group of drugs and this review attempts to give a balanced account of their current place in the treatment of depression. Although a large number of preclinical and clinical trials have been carried out many questions and problems remain – it is important to proceed carefully and carry out (and replicate) controlled independent clinical trials. The views of general psychiatrists and GPs about these drugs in normal clinical practice will be the acid test – this will be particularly important in view of their cost.
My left leg
Authors: Pitt Brice
Published: May 2008

On Saturday, 9 March 1991, I had a great fall. I think I'd been heading for it for a year or two – rushing endlessly and never quite catching up. I was just back home from the Section for the Psychiatry of Old Age's meeting in Chester. I hurried downstairs and lost my footing. My right leg shot suddenly down seven or eight stairs, leaving the left behind; I didn't even make the bottom of the staircase. The pain, swelling and distortion clearly indicated something more than a sprain. My first thought was of my appointments diary, crammed for the next two months. My second was “I hope I don't get a DVT!”
2. Viruses – prevention, detection, and removal
Authors: Johnson Bankole A. , Wells Lynda T.
Published: May 2008

Most medical researchers rely on computers to store their data, often many years of work. It is, however, surprising that many give little thought to protecting their machine from malicious damage caused by computer viruses. This article examines how to prevent, detect, and remove computer viruses.
Training for trainees
Authors: Davies Steffan , Junaid Ola
Published: May 2008

The rotational training scheme now forms the basis of psychiatric training. The advantages include the provision of experience in a wide variety of posts, while permitting educational continuity as well as the stability that accrues from having a job over a long period of time. Achieving a Balance threatens to change the structure of the rotation and thus the very nature of psychiatric training. The main consequences are the division of combined rotations into separate senior house officer and registrar rotations, competitive interviews for registrars, and the expansion to multi-district rotations.
Family therapy experience in the training of general psychiatrists
Authors: Wilkinson Philip , Boxel Pieter van
Published: May 2008

This paper describes the work of a family therapy team which includes a senior house officer, or registrar, and discusses how such experience is of value to the trainee in general adult psychiatry.
Psychogeriatric training for senior registrars in geriatric medicine
Authors: Forsyth Duncan R.
Published: May 2008

Since the late 1960s the number of psychiatrists choosing to specialise in old age psychiatry has increased dramatically (Wattis, 1988) and in 1989 the Royal College of Psychiatrists recognised the specialty's status. Recent recommendations of the Royal Colleges of Physicians and Psychiatrists (Report of a Joint Working Party of the Royal Colleges, 1989) have considerable implications for the continued development of cooperation between psychogeriatricians and geriatricians and for senior registrar (SR) training in both specialties. This study attempts to describe the availability of and attitudes towards training in psychogeriatrics (PG) of geriatric SRs.
General practitioners' referrals for compulsory admission under the Mental Health Act, II: the process of assessment
Authors: Sheppard Michael
Published: May 2008

This is the second of two articles on GP referrals for compulsory admission, and seeks to examine the process and outcome of assessment by (a) comparing GP with other section assessment referrals and (b) comparing GP referrals who were compulsorily admitted to hospital with those not compulsorily admitted or voluntarily admitted. In relation to the law the main relevant sections for this article are sections 2, 3 and 4. There are two basic grounds for admission: that the patient is suffering from a mental disorder and that admission is in the interests of his/her own health or safety or for the protection of others. Section 4 requires one and sections 2 and 3, two medical recommendations, as well as an application by an approved social worker (ASW) or nearest relative. Section 2, admission for assessment, involves admission for up to 28 days; section 4, emergency admission for assessment, involves admission for up to 72 hours; and section 3, admission for treatment, allows admission for up to six months, and is renewable.
Violence and junior doctors working in psychiatry
Authors: Kidd Brian , Stark Cameron R.
Published: May 2008

Aggression directed towards health care workers has been widely discussed (Health Services Advisory Committee, 1987), but information relating to British psychiatry has been anecdotal. The Collegiate Trainees' Committee (CTC) has recently expressed concern about the apparent dearth of training opportunities in the recognition and management of aggression, and the difficulty in obtaining post-incident counselling (1991).
Human rights and psychiatry
Authors: Ramsay Rosalind
Published: May 2008

Physicians for Human Rights (PHR UK) is an independent group of doctors and health professionals launched two years ago by Drs Ian Munroe, former editor of the Lancet and Peter Kandela, a Middlesex GP. The group's aim is to direct the influence of the medical profession towards the defence of human rights, most immediately by bringing the skills of the medical profession to the aid of victims of human rights abuses (Hall, 1991).
Generic services for people with a mental handicap
Authors: Nolan Mary E. , Radakrishnan G. , Lewis John
Published: May 2008

There has been much discussion on the most suitable services for mentally handicapped people with special needs such as additional mental illness or marked behavioural disorders. A number of policy documents have advocated the use of generic services as a matter of course, such as the All Wales Strategy (1983), while others have acknowledged a possible need for specialist input when such services are used e.g. Needs and Responses (Department of Health, 1989). In 1986 the Royal College of Psychiatrists stated that the psychiatric needs of this group required a specialised service and suggested that ideally this would be integrated with other psychiatric specialities as part of a comprehensive service.
Consent for treatment in mental handicap hospitals in Scotland
Authors: Young Steven C.
Published: May 2008

Consent for operation/treatment of a mentally handicapped person has been an issue stimulating much discussion. Generally, in the past, relatives or consultants responsible for their care have given ‘consent’ for treatment when mentally handicapped people were unable to do so. It was appreciated that legally this was not valid once the person was over the age of 16 and so we felt that the ‘consent’ procedure operating at our hospital should be reviewed. We were unsure of the practices in other areas, apart from Lothian Area where we knew new ‘consent’ forms had been devised, and felt that a good starting point would be to contact mental handicap hospitals in Scotland to gather information regarding the present ‘consent’ practices overall.
Good practice in ECT
Authors: Delany Norma
Published: May 2008

At the Department of Psychiatry, Royal South Hants Hospital, an Audit Committee of two consultant psychiatrists and the three senior registrars working in the department meet every two to three weeks to plan and execute audit projects.
Establishing psychiatric attachments to general practice: a six stage plan
Authors: Strathdee Geraldine , Fisher Nigel , McDonald Elizabeth
Published: May 2008

Since the 1970s there has been a growing trend for psychiatrists to establish formal attachments to primary care and these now form an important component of community psychiatry (Strathdee & Williams, 1984). In this paper a six stage plan for the establishment of a psychiatric attachment is proposed. The framework outlined may be modified in the light of local service, training and research needs.
A mothers' group in a child guidance clinic
Authors: Goulden Annette , Dorkings Elund
Published: May 2008

We decided to set up a short-term, closed group of mothers attending our local clinic, with the following questions in mind.
Use of rating scales by consultant psychiatrists
Authors: Rice Karl , Donnelly Peter
Published: May 2008

The number and diversity of rating scales and tests of psychiatric status has increased dramatically in the last 20 to 30 years. Tests are in screening, e.g. for dementia the Mini Mental State Examination and the Abbreviated Mental Test; to aid clarification of the diagnosis in difficult cases, e.g. Walton-Black New Word Learning Test, to differentiate between depression and dementia; and in assessing severity of symptoms, e.g. Hamilton Depression Rating Scale.
Disability Living Allowance – how it affects psychiatrists
Authors: Steadman Philip
Published: May 2008

Disability Living Allowance (DLA) is a new benefit which was introduced from April 1992. Note, however, that claims for DLA have been accepted from 3 February 1992 with payment starting from April.
Will the information recorded in psychiatric notes change when patients have the right to read them?
Authors: McShane Rupert , Rowe Dermot , Julier David
Published: May 2008

Psychiatric patients have had the right to see their notes from 1 November 1991. The ‘Access to Health Records Act (1990)’ makes provision for certain parts of the record to be exempt, including information which may cause serious mental or physical harm to the patient or anyone else. In addition, patients should not have access to information given by third party informants unless appropriate consent has been obtained. The legislation only applies to records made after 1 November 1991. It does not cover informal arrangements where written application for access is not made.
Do GPs want community mental health facilities?
Authors: Hughes Ian , Kidd Robert , Cantor Ralph , Killick Stephen
Published: May 2008

Much of a typical general practitioner's time is spent dealing with people who present with “psychological” problems. Of those people who are detected as suffering from a mental health problem, most are then dealt with by the GP without recourse to specialist services. There is a wide variation in referral rate, and a recent review (Wilkinson, 1989) suggests that GPs are most likely to refer a patient to a psychiatrist when he/she has failed to respond to previous GP treatment, an opinion about diagnosis is sought, or there is some specific request either by the patient or another person involved. One of the reasons why GPs are disinclined to refer is their perception of stigma associated with attending a psychiatric clinic, although they do not appear to be unduly perturbed by aspects of the referral process itself, such as a waiting list. Overall, it appears that around 95% of patients in general practice presenting with mental distress arenotreferred to a psychiatrist. As well as being concerned about the stigma associated with traditional psychiatric services, we hypothesise that another concern of GPs may be a lack of liaison and consultation between primary and secondary care services.
Overseas Doctors Training Scheme
Authors: McWilliam C. , McClelland R.
Published: May 2008

The Overseas Doctors Training Scheme was established by the Royal College of Psychiatrists in August 1989. Feedback from trainees placed in post has indicated that their early experience in the UK could have been eased had they been able to attend an induction course which addressed their specific needs. In response to this the Overseas Liaison Committee decided to hold their first induction course on 27 and 28 January 1992 for all the sponsored trainees commencing in post in February. Fourteen doctors attended this course which consisted of a series of short seminars on a variety of subjects together with a talk from trainees already in post and an evening reception.
Ranking of therapeutic and toxic side-effects of lithium carbonate
Authors: Colgate Robert
Published: May 2008

The purpose of this study was to establish whether any agreement existed about the side-effects of lithium carbonate between the consultant psychiatrists in a single health district responsible for care of patients maintained on lithium therapy.
Method in our madness? An audit of a regional adolescent unit
Authors: Gowers Simon , Entwistle Ken , Cooke Norman , Okpalugo Bella , Kenyon Ann
Published: May 2008

Adolescent psychiatric services differ considerably in terms of the patient groups they seek to address and in their modes of treatment (Health Advisory Service, 1986). The Prestwich Adolescent Unit is a general purpose, seven day, regional service for adolescent psychiatry, based in Salford Health Authority. Serving a population of 4½ million, it offers a mix of in-patient, day-patient, out-patient and consultation/liaison work, specialising in the treatment of mental illness.
Lothians post disaster counselling service
Authors: Freeman C. P.
Published: May 2008

In mid 1988 after Piper Alpha but before the Lockerbie disaster, the Social Work Department and the Mental Health Unit independently began to discuss plans for a post disaster counselling service. Over the next few months a joint working party was set up which during 1988 and early 1989 evolved the service described below.
Mental illness in the medical profession: Nigeria in the world
Authors: Ogunlesi A. O. , Akande E. O.
Published: May 2008

It is widely acknowledged that the medical profession can be highly stressful. In addition, practitioners in many developing countries face the peculiar problems of poor remuneration, lack of necessary clinical facilities and a heavy clinical case load (due to the lack of qualified manpower). Such a scenario can easily aggravate those medical practitioners with pre-existing deeply rooted emotional conflicts as well as personality vulnerabilities and can result in mental decompensation.
An introductory course
Authors: Williamson D. J.
Published: May 2008

Imagine an “intelligent” sheet of paper, on which you could record data in an organised fashion, and format its appearance for publishing purposes, but which could also do it's own calculations, (with the answer appearing automatically), and draw graphs of the results. This is essentially what a spreadsheet does.
Getting psychiatric patients to the polls in the 1992 General Election
Authors: Humphreys Martin , Chiswick Derek
Published: May 2008

Universal suffrage has been a cornerstone of democracy in Britain since 1948. However, by application of the common law, the vote is denied to people deemed “insane” or “idiots”. In practice mentally disordered people have been, until recently, disenfranchised by section 4(3) of the Representation of the People Act 1949 which prevented recognition of a mental hospital as a place of residence for the purpose of electoral registration. Significant change was introduced by section 7 of the Representation of the People Act 1983 which applies to both England and Wales, and Scotland. This enables informal patients in mental hospitals to register for the vote provided they can complete a patient's declaration. We examined the implementation of these provisions in the 1992 general election at two hospitals in Edinburgh for people with mental illness and learning disabilities respectively.
Medical students' evaluation of their experience of the psychiatry of mental handicap
Authors: Holt G. , Bouras N. , Brooks D.
Published: May 2008

With changing patterns of care, it is expected that more doctors will have contact with people with mental handicap. This study looks at medical students' evaluation of an aspect of the training they received to prepare them for such contact.
A bereavement counselling course: training for a multidisciplinary group of mental health professionals
Authors: Rands Gianetta , McKiernan Fionnuala
Published: May 2008

For some time it has been recognised that death and non-death loss events are commonly associated with the onset of psychiatric illnesses, especially affective conditions (e.g. Murphy, 1982). Studies have shown that counselling targeted at high risk grievers can significantly reduce their psychological and psychosomatic manifestations of grief, with an associated reduction in the use of statutory services (Raphael, 1977; Parkes, 1980). Bereavement counselling thus offers one of the few opportunities to implement preventive psychiatry.
Floods of tears but nobody drowned: a resident dies unexpectedly
Authors: Richards Josephine Anne
Published: May 2008

When I began my six month placement at The Lodge, an in-patient therapeutic community for those with emotional and personality disorders, there were 13 residents. Three left and two more joined us over the following month. Our consultant was on annual leave when the community was devastated by the unexpected death of a long-standing resident, who I will refer to as B. At the time of his death he was a well integrated member of the community.
Casemix in psychiatry
Authors: Anthony Philip , Elphick Martin , Lelliott Paul
Published: May 2008

Just as the management of individual patients requires specific and timely information upon which clinical decisions can be based, so managers and clinicians, responsible for service planning, require appropriate information on the activity levels and functions of their services. This is true at all levels, from individual clinicians and teams who wish to audit their activities, through clinical directors and managers of departments and units, to those who plan for Districts and Regions. Casemix is an attempt to facilitate this process by developing a meaningful language, to describe and measure clinical activity.
Gender differences in undergraduate performance in psychiatry
Authors: Scott Jan , Allardyce Judith , Ferrier Nicol
Published: May 2008

Earlier research reported that female undergraduates performed significantly better than their male counterparts in medical school examinations. Such findings were partly explained by biases in admission policies with women (who formed only 25% of the student body) being higher achievers than men prior to entry to medical school. While some recent studies provide evidence of higher achievement levels by women (Norcini et al, 1985), it is increasingly recognised that these differences do not apply to all specialities within medicine (unpublished observation, Ferrier & Scott, 1987).
Mental illness in British newspapers (or My Girlfriend is a Rover Metro)
Authors: Barnes Richard C. , Earnshaw Stephen
Published: May 2008

The main source of topical information in most parts of the world is through the mass media – principally newspapers and television. Television news and current affairs have a duty to remain impartial, as they provide a service for the whole population. Newspapers, on the other hand, have a greater journalistic and editorial freedom as they target subgroups. British newspapers are currently being scrutinised as to how they report both factual and speculative information of a general kind. At the same time there seems to be an increase in their interest in psychological matters. However, work on newspaper reporting of psychiatric disorders (Day & Page, 1986; Matas et al, 1986) has shown that the mentally ill are usually portrayed in a rather negative light with few positive images.
The Royal College of Psychiatrists Philosophy Group – a brief history of ideas
Authors: Foreman D. M.
Published: May 2008

This article summarises the aims, interests and history of this Special Interest Group since its inception in 1988. It also sets out to show that psychiatry requires philosophical training and research.
The landladies of Fishponds
Authors: Arnott Stephen , Smith Jeanette
Published: May 2008

Over the last four decades there has been a substantial reduction in the number of psychiatric hospital beds. Alternative residential facilities in the community have been developed. These include staffed hostels, group homes and supportive lodgings providing bed and breakfast. While hostels and group homes are often integrated with psychiatric services and run by experienced staff, this may not be the case with the small privately run homes. Anstee (1978, 1985) described two supportive lodging schemes and suggested that such facilities were particularly helpful for people with schizophrenia. However, there has been little further research in this area even though supportive lodgings may constitute a significant proportion of long-stay residential facilities. We know little about the landladies, their background, training, experience and particularly the rewards and frustrations of their work. The extent of psychiatric morbidity and the overall burden of care for these landladies is also unknown.

The aim of the present study was to gather information about the carers, the residents and the level of care provided in these facilities.
Training and supervision of electroconvulsive treatment in a psychiatric training rotation
Authors: Ramsay N. , McPhillips M. A.
Published: May 2008

In 1992, Pippard reported a comprehensive audit of electroconvulsive treatment, (ECT), in two NHS regions. He found deficiencies in most aspects of ECT administration (Pippard, 1992), particularly the training and supervision of the administering doctor, usually an SHO or registrar. Regrettably, the competence of a trainee to administer ECT appeared to have improved but little in the 11 years since the same author first reported on the subject (Pippard & Ellam, 1981). In particular, it failed to meet the guidelines issued by the Royal College of Psychiatrists in 1989. This was reflected in inadequate administration of ECT as assessed by direct observation and by determining the provision made for teaching and supervision of ECT by senior staff. Pippard concluded that the overall standard of training was inadequate and that “The responsibility for this mediocrity rests squarely on the consultants as a whole and not just on those whose nomination to be in charge appears to absolve the rest…”.
Destruction in Cambridge and Hollywood On the scent of analytical meanings behind a recent film
Authors: Pearce Jennifer
Published: May 2008

As part of winding-down from the Society for Psychotherapy Research's conference in Ravenscar and the Royal College of Psychiatrist's meeting in Cambridge on destruction, I went to see the award winning film Scent of a Woman∗. There was a synchronicity to this choice since in retrospect it seemed to me to reflect much of what was to be gained from the two conferences.
Patterns of mental health care in a seaside lodging house
Authors: Barnes John , Wilkinson Greg
Published: May 2008

Much of the medical care of the long-term mentally ill falls to the general practitioner (Wilkinson et al, 1985) and, for example, a survey in Buckinghamshire showed that these patients consult their general practitioner (GP) twice as often as mental health services. Lodging house dwellers are known to show an increased prevalence of major mental illness and to suffer much secondary social handicap, presenting a challenge to helping services of all disciplines. For this reason we chose a lodging house in which to explore further the relationships between mental illness and residents' present contact with their GP, mental health services and other local sources of help.
Consumer audit of psychiatric training
Authors: Cunningham Sara , Aquilina Carmelo
Published: May 2008

Postgraduate psychiatric training is usually assessed by regular College visits. A number of training schemes, including the Liverpool training scheme, also scrutinise their training independently of the College. As far as we know, trainees as the ‘consumers’ of training have never assessed its quality themselves. The following account deals with two such audits in the Mersey region organised under the mantle of the Association of Liverpool Psychiatrists in Training (ALPIT).
Personal time management: a suggested approach for trainees in psychiatry
Authors: Johnson Christine
Published: May 2008

The concept of personal time management does not, perhaps, generate immediate enthusiasm among junior doctors: the terminology seems somewhat alien and the idea more relevant to the world of business than that of clinical practice. There is a lack of coverage of this issue in the citations concerning the applications of time management to the medical profession. Although allied professions have made an attempt to address the matter (Shubin, 1988), they have tended to concentrate more on personality types (McAlvanah, 1989) and obstacles to effectiveness (Sheridan, 1988), rather than providing practical guidelines.
The Access to Health Records Act: what difference does it make?
Authors: Butler Robert E. , Nicholls Dasha E.
Published: May 2008

The Access to Health Records Act came into force on 1 November 1991. This legislation allows patients access to their written medical records (access to computerised records is covered by separate legislation). Concerns have been expressed about the implications of this Act for staff and patients, particularly in psychiatry. These concerns have included detrimental effects on patients exposed to their notes and the restrictions it could place upon staff in recording speculation or subjective opinion. We report the following findings: staff attitudes to the new legislation including awareness of the Act, evaluation of the Act as useful or detrimental and the Act's implications on clinical practice.
The Adventure of the Missing Triform
Authors: Ridley-Siegert Drew
Published: May 2008

It was a day of quite intemperate heat as into our office in the Department of Applied Management Need burst an individual of some 40 years, perspiring as much, perhaps, from the heat and haste as the layers of clothing he affected. Beneath a pristine white coat he wore a pin-striped waistcoat and trousers, a starched shirt, striped tie and crimson kerchief fountaining from his breast pocket.
Managing sexual abuse disclosure by adult psychiatric patients – some suggestions
Authors: Babiker I. E.
Published: May 2008

The main principle of the Children Act 1989 is that the welfare of a child at risk of abuse or neglect takes precedence over all other considerations. In complying with the Act, these considerations may include the principle of medical confidentiality and the health and safety of some adult patients. Nowhere is this more poignantly illustrated than in the case of childhood sexual abuse disclosure by a distressed psychiatric patient who may be unprepared or unwilling to cooperate with the immediate reporting and ensuing investigation of their abuse as required by the Act.
Research and development in the NHS
Authors: Harrison Judy
Published: May 2008

In April 1991, the government announced the development of a new research and development programme for the NHS. Professor Michael Peckham was duly appointed Director and the first strategy document appeared in September of the same year (DOH, 1991). The suitably broad objective of the strategy is to “ensure that the content and delivery of care in the NHS is based on high quality research relevant to improving the health of the nation”.
Mental Health Review Tribunals in practice
Authors: Langley G. E.
Published: May 2008

Effective participation in the work of Mental Health Review Tribunals (hereafter the “Tribunal(s)”) held under the Mental Health Act 1983 (MHA) requires a knowledge and understanding of detailed points of law, and practice. This summary and commentary may be of assistance to new or infrequent participants.
False confessions: a note on the McKenzie judgement
Authors: Kellam A. M. P.
Published: May 2008

The Court of Appeal in its judgement of this case ruled that special care needs to be taken in cases where the defendant suffers from “a significant degree of mental handicap” (This term is used with a specific legal meaning – see below) if the only evidence against him is his confession.
A learning disability register – how accurate are the psychiatric data?
Authors: Curran L. Jennifer
Published: May 2008

Registers on people with learning disability are widely held (Cubbon & Malin, 1985). They have been set up in a variety of ways, hold differing types of data, and are put to various uses. Service planning and management is a common function for which register data may be required. However, a literature search revealed that no accuracy studies had been undertaken on such registers, apart from a reliability study on the Wessex Mental Handicap Register developed by Kushlick et al (May et al, 1982). In Wandsworth, an inner city health authority, the Register for People with Learning Difficulties is jointly funded and managed by the health authority and local social service department. The register holds data on just under 1,000 people who use services for people with learning disabilities, and the data are updated annually by questionnaires sent out by the register organiser. The questionnaire includes enquiry into demographic information, functional ability and service use. It also notes the presence or absence of additional complications, including psychiatric disorder and behaviours presenting specific management problems. This article describes a pilot study of the accuracy of the psychiatric and behaviour problem data held on the Wandsworth Register.
Referrals for panic disorder to a clinical psycho-pharmacology research unit
Authors: Dratcu Luiz , Bond Alyson
Published: May 2008

Clinical research attempts to find out the best way to treat patients and audit attempts to make sure that patients are treated in the best possible way. The two are thus inextricably linked and should benefit from each other (Smith, 1992). In running a clinical research unit in which the personnel involved (two psychiatrists and two psychologists) have only honorary contracts, it is sometimes difficult to match the service offered to the clinical population required. A constant flow of patients does not mean a constant flow of those prepared or suitable to participate in research projects. Unlike clinical referrals, which are received passively, referrals of patients for research have to be looked for, even when treatment is on offer.
Ethics and Section 58 of the Mental Health Act (1983)
Authors: Oyebode Femi
Published: May 2008

Section 58 is in the part (Part IV) of the Act which is largely concerned with consent to treatment by patients detained on Sections 2, 3, or 37 of the Mental Health Act (1983). It applies to drug treatment if three months or more have elapsed since drugs were first given during the period of detention. It also applies to ECT at any time during the period of detention. Where a patient consents to treatment which comes under Section 58, and which the responsible medical officer (RMO) has proposed and explained to the patient, the RMO is required to certify in writing, on Form 38, that the patient is capable of understanding the nature, purpose and likely effect of the treatment and that the patient has consented (DOH, 1987). The Code of Practice (DOH, 1990) advises that the RMO should indicate on the certificate the drugs proposed, by the classes described in the British National Formulary (BNF), indicating the dosages if they are above BNF advisory maximum limits. The method of administration should also be indicated. This paper will argue that Section 58 in its present form does not strengthen the patient's right to consent to treatment and that the form of words advised in the Code of Practice with respect to Form 38 is faulty in conception.
Community care: Italy's ‘U’ turn
Authors: Rollin Henry R.
Published: May 2008

Give or take a few months, it must be 20 years since I led a College Study Tour Group on a tour of Italy, or, to be more exact, of the area north of Rome, economically privileged and steeped in the academic tradition from the Renaissance onwards.
Are short term savings worth long term costs? Funding treatment for personality disorders
Authors: Menzies D. , Dolan B. M. , Norton K.
Published: May 2008

The new system of funding introduced by the National Health Service reforms has led to an increased awareness of financial concerns within the NHS. This was indeed one of the main aims of the reforms, with the expectation that a more efficient and better quality service would result. This may be a realistic aim, as long as clinicians' freedom to make appropriate secondary and tertiary referrals do not become totally dependent upon financial considerations. Yet it has become clear from findings within our own unit, Henderson Hospital, that, in at least 42% of cases, requests for ECR funding for treatment were refused on a purely financial basis (Dolan & Norton, 1992).
Training needs of psychiatrists in non-training posts
Authors: Britto Darryl J. J.
Published: May 2008

This study was undertaken to analyse training needs and to formulate a training plan to meet the needs of psychiatrists in non-training posts.
Readmissions of long-stay psychiatric patients to the acute services from hostels in the community
Authors: Shepperd Rosie
Published: May 2008

The asylum movement was developed in the 19th century to provide care and cure for people with mental disorders. In the 20th century the old vision of asylum was abandoned, but no new alternative vision of community mental health care has taken its place. A divide between acute psychiatric services and provision for the social aspects of care has been described by Murphy (1991).
Registrars with research – the right stuff, or the wrong stuff?
Authors: Bowen Joanna , Cox Stuart
Published: May 2008

A leading article in the British Medical Journal (Miller, 1992) comprehensively criticised the Joint Planning Advisory Committee (JPAC) for failing to implement the changes in manning levels needed for Achieving a Balance. This leader came as no surprise to psychiatric trainees, and nor did it offer much comfort. The ‘bottleneck’ between registrar and senior registrar has become a ‘log-jam’ and although prospects for trainee psychiatrists are not as bleak as for the unfortunate would-be thoracic physicians cited in the leader, they are bad enough. For example, when a single SR post in adult psychiatry was recently advertised for the NW Thames region, there were over 60 enquiries, 45 of which transformed into definite applications, even though the post offered was in a less than popular sub-speciality. Local selection committee members for NW Thames in other psychiatric specialities have also been surprised by the number of applicants. JPAC may not be entirely to blame: the economic recession may be a disincentive for consultants wishing to retire early, thus slowing-up career progression throughout the profession.
Mentality: a childish enquiry
Authors: Nunn C. M. H.
Published: May 2008

A question asked by most children but avoided by adults is “Why am I me?”. It seems obvious and important when one is young but, to a grown-up, is too difficult and perhaps meaningless. Questions of this sort often have culturally sanctioned answers. For instance, “How did the world begin?” could have been answered (somehow) by any educated adult in any period of which we have records, and now the cosmologists are adding their own gloss to the replies.
Guidelines for the prevention and treatment of benzodiazepine dependence
Authors: Pether Richard
Published: May 2008

The Substance Misuse Committee of the Mental Health Foundation has produced a booklet called Guidelines for the Prevention and Treatment of Benzodiazepine Dependence. The problem addressed is twofold: encouraging and managing withdrawal, and preventing new cases of dependence. There is no room for complacency because although prescriptions for anxiolytics have halved over the past ten years, prescriptions for hypnotics are unchanged – now twice the number for anxiolytics. The average GP can expect to have about 50 long-term benzodiazepine users on his or her list. The long-term safety of these drugs is uncertain and there are side effects, e.g. memory impairment, ataxia and falls in the elderly, and road traffic accidents.
2. Report to the Working Party
Authors: Russell Gerald
Published: May 2008

The Working Party was set up to consider the question posed by the DHSS as to whether there should be a ‘teaching increment’ to the consultant target, i.e. should Districts with special teaching responsibilities have more consultants than similar ‘non-teaching’ Districts?
How to get your Paper Published
Authors: Crammer J. L.
Published: May 2008

Few intending authors appreciate how the editors of medical and scientific periodicals work. The British Journal of Psychiatry rejects about two-thirds of the papers submitted to it, and many of those accepted have to be partially re-written before they appear in print. Some explanation of the editorial reasons for this behaviour may be helpful. I, for one, am often saddened at having to refuse a contribution which is clearly the fruit of several people's hard work—a script which has been carefully written and retyped, diagrams beautifully drawn—and even more so when the study has involved many sessions of clinical interviews or many hours of laboratory effort. The author may be offering a little bit of his individual creative self, and in refusing his paper I am rejecting him. Of course there are plenty of journals in the world, and his piece may find a home elsewhere, but before turning it down we do often ask ourselves whether the observations and results it contains could be salvaged in some form for us.
The use of Consultant Time in Child Psychiatry—Seven Years On
Authors: Black Dora , Black Michael
Published: May 2008

In 1974 we published a pilot study on the use of consultant time in child psychiatry, based on detailed timesheets kept by a group of child psychiatrists in and near London (1). The group, which is still meeting, decided to see what changes, if any, have occurred over the last seven years in the way we allocate our time. The primary purpose of the group, now, as then, is ‘the provision of a forum where members can exchange views and compare experiences relating to the problems encountered while engaging in and often being professionally responsible for administering a child psychiatric service.’ A nucleus of about six consultants took part in both studies.
Trainees' Views of Approval Visits
Authors: Thomas Philip
Published: May 2008

The Approval exercise is an attempt to standardize psychiatric training in different hospitals, following the introduction of the Membership examination ten years ago. Very little, however, has been said about how standards are defined, who defines them, how reliable they are, or how valid in respect of the attributes required to become a consultant psychiatrist. The College is now directing its attention to these issues in considering a syllabus for the examination, a document setting out the aim of training in psychiatry and, of particular importance to this paper, the possibility that the Central Approval Panel should become more accountable to those whose interests it primarily represents—the trainees in the hospitals whose approval status it decides.
An Alternative ‘Been to America’
Authors: Ben-Tovim David
Published: May 2008

Travel has always been a part of medical education. Many of the great figures of British psychiatry seemed to have derived some of their inspiration from periods spent in European clinics, and more recently no c.v. seemed truly complete without the all important ‘Been to America’. Unfortunately, as the Atlantic has become cheaper to cross, the professional welcome at the other end has become increasingly lukewarm and the VQE and FLEX have proved substantial deterrents. There are, however, several alternatives which are worth considering. From 1980 to 1983 I worked as a psychiatrist in Africa, in the Republic of Botswana, and I thought a description of some of the practical aspects involved in making such a step might be of interest.
Attitudes of British and Nigerian Teachers to Training African Psychiatrists in the UK
Authors: Cox John L. , Famuyiwa O. O.
Published: May 2008

The increased fees for postgraduate trainees from overseas and their difficulty passing the MRCPsych examination have made some British teachers question whether Departments of Psychiatry should continue to provide training for such doctors. The change in the relationship between old and new Commonwealth countries, and the increased availability of postgraduate training in Nigeria, Kenya or Zimbabwe are other factors to be considered.
Does Medicine Need Liaison Psychiatry?
Authors: Thomas C. J.
Published: May 2008

In February 1984 at the Quarterly Meeting of the Royal College of Psychiatrists, Professor A. Guz from the Department of Medicine, Charing Cross Hospital, presented a paper with the above title. In this paper he raised a number of points regarding the role of liaison psychiatry and of the psychiatrists involved in practising it. The paper collated the views of himself and other professors of medicine, and obviously it is important that we as psychiatrists take note of the opinions expressed by people with such an extensive knowledge of medicine. Many of the points which Professor Guz raised I found myself to be in total agreement with; however, there were one or two issues which I think perhaps deserve a reply and I would like to attempt to do this through the Bulletin. As many of the Bulletin readers will know, there is an increasing interest in liaison psychiatry and this has been recognized by the College in the recent establishment of a special interest group. I should perhaps point out, however, that the views expressed in this article are mine alone and do not necessarily represent those of any other liaison psychiatrist, or of the special interest group.
Endoplasmic Reticulum Stress-Induced Activation of Activating Transcription Factor 6 Decreases Insulin Gene Expression via Up-Regulation of Orphan Nuclear Receptor Small Heterodimer Partner
Authors: Seo Hye-Young , Kim Yong Deuk , Lee Kyeong-Min , Min Ae-Kyung , Kim Mi-Kyung , Kim Hye-Soon , Won Kyu-Chang , Park Joong-Yeol , Lee Ki-Up , Choi Hueng-Sik , Park Keun-Gyu , Lee In-Kyu
Published: May 2008

The highly developed endoplasmic reticulum (ER) structure of pancreatic β-cells is a key factor in β-cell function. Here we examined whether ER stress-induced activation of activating transcription factor (ATF)-6 impairs insulin gene expression via up-regulation of the orphan nuclear receptor small heterodimer partner (SHP; NR0B2), which has been shown to play a role in β-cell dysfunction. We examined whether ER stress decreases insulin gene expression, and this process is mediated by ATF6. A small interfering RNA that targeted SHP was used to determine whether the effect of ATF6 on insulin gene expression is mediated by SHP. We also measured the expression level of ATF6 in pancreatic islets in Otsuka Long Evans Tokushima Fatty rats, a rodent model of type 2 diabetes. High glucose concentration (30 mmol/liter glucose) increased ER stress in INS-1 cells. ER stress induced by tunicamycin, thapsigargin, or dithiotreitol decreased insulin gene transcription. ATF6 inhibited insulin promoter activity, whereas X-box binding protein-1 and ATF4 did not. Adenovirus-mediated overexpression of active form of ATF6 in INS-1 cells impaired insulin gene expression and secretion. ATF6 also down-regulated pancreatic duodenal homeobox factor-1 and RIPE3b1/MafA gene expression and repressed the cooperative action of pancreatic duodenal homeobox factor-1, RIPE3b1/MafA, and β-cell E box transactivator 2 in stimulating insulin transcription. The ATF6-induced suppression of insulin gene expression was associated with up-regulation of SHP gene expression. Finally, we found that expression of ATF6 was increased in the pancreatic islets of diabetic Otsuka Long Evans Tokushima Fatty rats, compared with their lean, nondiabetic counterparts, Long-Evans Tokushima Otsuka rats. Collectively, this study shows that ER stress-induced activation of ATF6 plays an important role in the development of β-cell dysfunction.