bluuebunny/crossref_metadata_2025 huggingface dataset:
Grand rounds: ‘I'll knock elsewhere’ – the impact of past trauma in later life
Authors: Ong Y. L. , Carter P.
Published: September 2002

“And when life has no more meaning in old age, the will to meaning is lost; when life no longer seems to be worth living, some people who have experienced disasters and are unable to cope, may throw their lives away.” (Wilson et al, 1988) There continues to be a great deal of interest among psychiatrists, psychologists and sociologists about post traumatic stress disorder (PTSD) related to war crimes and experiences. Twentieth century studies of Holocaust victims and Far East prisoners of war, Korean and Vietnam veterans and the recent experiences of people in Bosnia have honed the diagnosis and increased awareness of the gradations of these disorders. Almost every conceivable variable has been examined in attempts to explore the motivating and resulting behaviours. Initially most studies dealt with the immediate impact of the event, but more recently articles have focused on the longer-term effects on relatives and the next generations of the earlier events (Sigal, 1998). Time has allowed this. The passage of time has also established that post-traumatic stress symptoms can be reactivated as much as half a century after the original trauma (Krasucki et al, 1995). Reactivation of events from 40 or 50 years previously may occur via current stressors such as social isolation and upheaval. Equally perceived helplessness precipitated by the somatic process of ageing could reactivate previous feelings and a delayed onset or exacerbation of clinical PTSD may emerge during the process of ageing. Institutionalisation itself could re-awaken feelings associated with incarceration or victimisation (Aarts & Op den Velde, 1996; Sadavoy, 1997). Late-life PTSD is more often associated with sleep disturbance, nightmares, intrusive ideation and avoidance of reminders of the original events (Kuch & Cox, 1992).
Changing Minds: Every Family in the Land
Authors: Crisp Arthur
Published: September 2002

Our 5-year long campaign to reduce the stigmatisations of and discriminations against people with mental illnesses, launched as an outline endeavour in October 1998, is now in its third year. This update is intended to reveal that since 1998 we have been constructively busy and are poised to go public’ in major ways. We are now therefore appealing to the membership at large to join in the tasks. To this end we have been busy generating a tool kit that you may wish to draw upon and a series of proposed projects, some of which are already underway and some of which you may be able to pick up on or adapt for local purposes, in addition to any of your own initiatives.
Screening prisoners for psychiatric illness: who benefits?
Authors: Birmingham Luke
Published: September 2002

Until recently the provision of health care within prisons was the sole responsibility of the prison service. The Prison Health Service (formerly known as the Prison Medical Service) is the oldest civilian medical service in Britain. In addition to being much older than the NHS the Prison Health Service is much smaller, less well developed and less well resourced. Prison health care was coordinated by the Directorate of Health Care at the Home Office; the Department of Health and the NHS had no direct input. As a result, prisoners were afforded a standard of health care well below that provided by the NHS, and without radical reform there was little prospect of improvement. However, in recent years things have begun to change and last year collaboration between the prison service and the NHS resulted in the creation of a partnership between these two organisations (Joint Prison Service and NHS Executive Working Group, 1999). Although the intention is to improve health care standards for prisoners, the formal nature of this partnership also has the effect of making the NHS more directly responsible for health care in prisons.
Prescribing of unlicensed medicines or licensed medicines for unlicensed applications in child and adolescent psychiatry
Authors: Johnson Joanne , Clark Andrew F.
Published: September 2002

Aims and Method

Child and adolescent mental health services in north-west England (n=21) participated in a prospective collection of information regarding all instances of new prescribing of medication over the 6–month period September 1999 to February 2000.

Results

A total of 478 new prescriptions were issued to 411 individuals. Eight prescriptions (2%) were for an unlicensed drug and a further 188 (39%) were of licensed drugs but used in a manner outside of their product licence.

Clinical Implications

This level of unlicensed and outside-licence prescribing is similar to levels previously found in studies both within paediatric practice and in adult mental health practice. Anxiety about excessive beyond-licence prescribing by child mental health services is unlikely to be justified.
Trainees' attitudes to single and dual training in old age psychiatry
Authors: Allen Ruth , Butler Rob
Published: September 2002

AIMS AND METHODS

To undertake a nationwide survey to find out the attitudes of old age specialist registrars (SpRs) towards single and dual training. A questionnaire was sent to all old age SpRs in the UK.

Results

Two-thirds of SpRs were undergoing dual training. Most trainees favoured a flexible system that offers the choice of single or dual accreditation. Many trainees had concerns about single accreditation. Schemes vary in whether they encourage one type of training or another.

Clinical Implications

Training schemes appear to vary unacceptably in their attitudes to training. There needs to be a more consistent approach nationally. Clearer guidance from the College may help.
Is there a role for the depot clinic in the modern management of schizophrenia?
Authors: O'Ceallaigh Séamus , Fahy Thomas A.
Published: September 2002

The value of antipsychotic medication in preventing relapse in schizophrenia has been apparent since soon after its introduction (National Institute of Mental Health, Psychopharmacology Service Centre Study Group, 1964) but non-compliance remains a problem. Failure to take prescribed medication is a challenge in general medicine but presents special difficulties when treating mental illness; residual symptoms of psychosis and impaired insight after discharge increase the likelihood that a patient will stop taking antipsychotic medication, thereby contributing to higher relapse rates. The development of depot antipsychotic medication that could be administered intramuscularly at intervals of several weeks raised treatment and outcome expectations for patients who were felt to be at higher risk of non-compliance when in the community. The need for regular administration and monitoring of patients receiving depot medication led to depot and maintenance medication clinics. Today, with increasing numbers of patients who would previously have been receiving depot medication now taking atypical oral antipsychotics, is there still a need for the depot clinic?
The experience of patient suicide among trainees in psychiatry
Authors: Courtenay Kenneth P. , Stephens John P.
Published: September 2002

Aims and Method

We set out to ascertain how common this is for psychiatric trainees in South Thames and the effects it has, if any. An anonymous postal questionnaire was circulated to 400 trainees.

Results

Of the 400 trainees, 203 (51%) responded and 109 (54%) of the respondents had had one or more patient suicide and 168 suicides were reported.We judged the effect of the suicide on the doctor to be moderate or severe in 126 (75%) of the 168 suicide events.

Clinical Implications

Patient suicide must have a higher profile in training. Formal systems need to be created to provide support and education in this area.
A national survey of the hospital services for the management of adult deliberate self-harm
Authors: Slinn Rebecca , King Amanda , Evans Jonathan
Published: September 2002

Aims and Method

Services were compared for the management of deliberate self-harm with existing national guidance. A postal survey was sent to all clinical directors of adult psychiatry at all NHS trusts assessing adult patients admitted to general hospital following deliberate self-harm in England.

Results

Responses were received from 129 (65%) trusts.Thirty per cent of trusts do not use secondary psychiatric services for psycho-social assessment following deliberate self-harm; 52% have designated self-harm liaison staff and 69% of general hospitals have a ward to which most cases of deliberate selfharm are admitted. However, only 18% have staff with psychiatric experience. In 82% of trusts training is provided for junior psychiatrists at induction but in only 56% are observed-assessments undertaken. Forty-two per cent of the trusts have a deliberate self-harm services planning group.

Clinical Implications

Standards for deliberate self-harm services fall substantially below existing national guidelines, particularly in the areas of planning and training.
Service innovations: Sherbrook partial hospitalisation unit
Authors: Wesson M. L. , Walmsley P.
Published: September 2002

Aims and Method

Nationally, a variety of community care projects are being developed to replace institution-based care. We describe an innovative system of providing mental health care in Southport, combining an extended day service with short-term hospital admission – the partial hospitalisation philosophy.

Results

During the first year of operation 438 assessments took place with 27% of patients being admitted to a crisis bed and a further 25% supported via attendance at the unit.Twelve per cent needed in-patient admission and 10% were deemed not to require any involvement of the mental health service.

Clinical Implications

The use of short-stay admission coupled with extended day care and crisis line support can provide a viable alternative to admission to the acute ward.
Mental health day centres
Authors: Catty Jocelyn , Burns Tom
Published: September 2002

Aims and Method

Mental health day centres have been little researched. We carried out a 1-week census at the four day centres run by a London borough.

Results

The centres catered for a g roup with long-standing mental health problems, mostly under community mental health team care. A surprising number were suffering from physical ill health. They attended the centres primarily for social reasons or to participate in creative groups such as music and art.Very few were concurrently attending day hospitals.

Clinical Implications

Further work is essential to understand the distinction between NHS day hospitals and Social Services day centres in terms of utilisation and client group.This client group's needs, particularly for physical health care, require urgent attention.
Future of academic psychiatry: Professors of Psychiatry (PoP) Club
Authors: Ghodse Hamid
Published: September 2002

During the 1960s psychiatry was particularly concerned with academic issues, both postgraduate and undergraduate. In response, the late Professor Sir Dennis Hill called a meeting of the professors of psychiatry, of whom there were only 16 or 17 in the UK at that time, and 15 assembled in the Great Northern Hotel in King's Cross, London. He suggested that perhaps they should form an informal club. This was duly supported by those present and, on 21 January 1967, the Professors of Psychiatry (PoP) Club was established.
The continuing professional development needs of ‘retired’ psychiatrists
Authors: Brown A. C.
Published: September 2002

A postal questionnaire survey of a sample of members and fellows of the College listed as retired revealed that 56% are still engaged in some work, but only 11% are registered for continuing professional development (CPD). Thirty-eight per cent intend to apply for revalidation to remain on the Specialist Register. Their CPD needs are, therefore, important.
Starting out in psychodynamic psychotherapy
Authors: Wilson Jon
Published: September 2002

Many trainees, like myself, are so daunted by the prospect of working with patients within a psychodynamic framework that their anxieties can overcome them, and their experience of psychotherapy suffers. As a result they can end up deeply sceptical of this style of treatment. Later in their career, when they are more confident of their general skills, they may wish to return to psychotherapy to try to understand at a deeper level the interaction between individuals, in particular between doctors and patients. Often though, there is too little time to develop these skills at this stage.
General practitioners and child and adolescent psychiatry: awareness and training of the new commissioners
Authors: Foreman D. M.
Published: September 2002

Aims and Method

General practitioners' (GPs’) informed awareness of the various medical specialities underpins their ability to manage and commission services for their patients. Three questions, relevant to GP practice, to test awareness of child and adolescent mental health services (CHMHS) were developed and sent to 238 GP principals in North Staffordshire. One hundred and seventy-six responded.

Results

Forty-seven per cent had no undergraduate training in CAMHS and 93% had negligible postgraduate experience. Only 27% thought they saw CAMHS cases frequently. Sixty-four per cent usually referred those they saw. Relevant expertise made referral to CAMHS less likely, as did membership of the Royal College of General Practitioners. Seventythree per cent wanted more training, but only 7% thought training easy to obtain.

Clinical Implications

These findings confirm the need for child and adolescent psychiatrists to become directly involved in the commissioning of their services and GP training.
Service innovations: a depersonalisation research unit progress report
Authors: Phillips M. L. , Sierra M. , Hunter E. , Lambert M. V. , Medford N. , Senior C. , David A. S.
Published: September 2002

Depersonalisation was described clinically over 100 years ago, yet there has been little research into this interesting but distressing psychiatric disorder. The symptom of depersonalisation can occur alone or in the context of other psychiatric and neurological illnesses and is characterised by the experience of detachment from one's senses and the outside environment, and may be present for several years without remission. Two years after the establishment of the depersonalisation research unit at the Maudsley Hospital, London, we report on current neurobiological and clinical research findings, including functional magnetic resonance imaging, psychophysiology and neuroendocrinology and progress regarding the development of effective treatments.
Service innovations: Maple House – an autistic-friendly NHS facility
Authors: Jabarin Ziad , Crocombe Juli , Gralton Ernest , Carter Steve
Published: September 2002

Maple House, a unique in-patient facility for learning-disabled adults with autism, has recently been developed in Exeter. The design of this facility has been based on the principles of Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH), a well researched and validated educational programme developed for autistic children in North Carolina, USA. The design tenet of Maple House was that the environment should reflect these principles, facilitating communication and, therefore, allowing the comprehensive assessment of autistic individuals. Overall, the service provision for this group in the UK is deficient. Maple House may be a model for future NHS facilities for people with autism.
Psychotherapy training in Singapore
Authors: Ang Anthony
Published: September 2002

Like many countries in Asia, Singapore has its own system of postgraduate training and specialist accreditation in psychiatry. Psychiatry trainees are strongly encouraged, but not required, to receive supervision in psychotherapy with patients during the 6-year period of basic and advanced training since the inception of the Masters of Medicine in Psychiatry (MRCPsych equivalent) in 1985.
Effectiveness of audit in improving interview room safety
Authors: Osborn David P. J. , Tang Sylvia
Published: September 2002

Aims and Methods

Safety features of rooms used for clinical interviews were assessed throughout our mental health unit. Following this pilot survey, 12 safety standards were agreed and adopted by a multi-disciplinary audit meeting. Recommendations were disseminated throughout the trust. Adherence to the accepted standards for interview room safety was assessed at 6 months and 1 year after baseline. Following each assessment, results were presented so that the audit cycle was completed twice.

Results

At 6 months 46 interview rooms were assessed against the 12 accepted standards and many were found to be unsatisfactory. After presentation of these results, the 1 year assessment discovered few changes in safety features of the 50 rooms now being used.

Clinical Implications

Unsafe rooms compromise the safety of staff and patients and this is clearly unacceptable. The audit process in itself failed as amethod of improving standards.
Crisis intervention: the professionals' perspective
Authors: Lazaro Fernando , Kulinskaya Elena , Tobiansky Robert
Published: September 2002

Aims and Method

To describe the attitudes of the professionals of a multi-disciplinary crisis intervention service (CIS) towards the service they provide. To establish whether there are differences in attitudes between the different professional disciplines involved. A questionnaire was mailed to all the professionals working in the Barnet CIS (n=94). Differences were analysed using the Kruskal–Wallis test.

Results

The overall response rate was 84%. Statistically significant differences were found between the different disciplines in 10 of the 37 questions (27%) on the questionnaire. Opinions differed most on issues of safety and acceptance of clinical responsibility.

Clinical Implications

Despite general ag reement on most issues, we found differences of opinion in important areas such as arrangements for team safety and clinical responsibility. These differences may create tensions within the multi-disciplinary groups and may influence the attitudes of professionals to crisis work. Measures need to be taken to address these issues in order to improve morale and staff satisfaction.
Deliberate self-harm
Authors: Whyte Sean , Blewett Andrew
Published: September 2002

Aims and Method

A repetition after 5 years of a prospective case note audit, looking at the impact of a recently established deliberate self-harm (DSH) assessment team on the quality of DSH assessments at Kettering general hospital.

Results

Aspecialist DSH team achieved improvement in the quality of psychiatric assessments for the majority of patients who harmed themselves. Assessments of mental state by accident and emergency (A & E) and medical staff before referral to the psychiatric team remain problematic.

Clinical Implications

Setting up aspecialist team to assess patients who harm themselves can improve the quality of the psychiatric care they receive, but emphasis must still be placed on an adequate assessment of mental state by medical and nursing staff in A&E and on medical wards.
Clinical implications of psychiatric genetics in the new millennium – nightmare or nirvana?
Authors: Jones Ian , Kent Lindsey , Paul Moli , Craddock Nick
Published: September 2002

We are on the verge of major advances in understanding the pathophysiology of major mental illnesses – including the likely discovery of several susceptibility genes for these conditions. For many this holds the prospect of a future in which improved prevention and better treatments will end the terror these conditions hold over so many lives (Farmer & Owen, 1996; Jones & Craddock, 1997, 1998). For others the vision is of a ‘brave new world‘, our futures mapped from birth by the genetic hand we have been dealt and in which those with mental illness will suffer increased stigma and discrimination (Rose, 1998). This debate (McGleenan, 1995) occurs in the dark shadow cast by the eugenic movements of the 19th and early 20th century (Galton, 1943) and the horrors to which they led (Hanauske-Abel, 1996; Seidelman, 1996). As we leave the decade of the brain and enter the new millennium it is an appropriate point to ask what advances are likely to occur and to consider the moral and ethical issues that will undoubtedly arise.
Informed consent to medication in long-term psychiatric in-patients
Authors: Billcliff N. , McCabe E. , Brown K. W.
Published: September 2002

Aims and Methods

We wished to ascertain to what extent patients had given informed consent to their medications. Therefore, 68 long-term psychiatric in-patients were interviewed about their knowledge and attitudes towards their medications.

Results

Two-thirds of patients did not know the purpose of their medication; one-tenth knew about the side-effects. Longer length of stay, older age and voluntary status were associated with less knowledge. Despite poor knowledge, most patients accepted their treatment. However, few realised that they had any choice.

Clinical Implications

The prevalence of true informed consent is low among this group and raises issues about patients' rights.
The environment psychiatric patients create for themselves: the varying perceptions of professional staff
Authors: Gralton Ernest , Pearson Steve , Sutherland Alastair , Donovan Martin , Lewis Geraint
Published: September 2002

Aims and Methods

A pilot study was undertaken to investigate whether there was evidence that professional staffs' perception of a patient's environment were significantly altered by certain variables.

Results

Gender and, to a lesser extent, age were found to be variables that significantly affect the perception of a patient's personal environment.

Clinical Implications

Psychiatrists and other mental health professionals should be aware that there may be significant differences between the way individual professionals perceive the same visual environment. Psychiatry may benefit from future links with environmental psychology research.
Service innovations: a service for the homeless with mental illness in Aberdeen
Authors: Wood Angie , Sclare Paul , Love John
Published: September 2002

Aims and Method

To evaluate the first 3 years of a newly developed service for the homeless mentally ill in Aberdeen. All 86 referrals to the service between 1996 and 1999 were reviewed.

Results

The majority of referrals came from social care staff and self-referrals.

Half were diagnosed as having severe and enduring mental illness and of these one-quarter (11 cases) were engaged in long-term psychiatric care. A total of 744 in-patient days were required, only one admission was a compulsory detention.

Clinical Implications

It has proven possible to identify and engage with a number of homeless individuals who have untreated serious mental illness by setting up a small dedicated service that has close links with an established adult mental health team and which establishes close working relationships with colleagues in social care settings.
Service innovations: early intervention in psychosis as a core task for general psychiatry
Authors: Whitwell David
Published: September 2002

Early intervention in psychosis is a strategy for which there is increasing theoretical and pragmatic justification. Many studies have been published describing the benefits of early intervention as carried out by specialised and innovative projects. The present paper describes how a generic community mental health team (CMHT), covering a population of 50 000, introduced strategies for early intervention with no extra funding. The team worked together to change old attitudes and practices. A style of intervention was developed to engage with and keep in contact with people with recent onset psychosis. This appears to be achievable – and this model may be an alternative to the setting up of specialised teams.
Geriatric psychiatry from a geriatrician's viewpoint
Authors: Callahan Christopher M.
Published: September 2002

I can vividly remember my first exposure to psychiatry as a medical student in the USA. By drawing the short straw, I won the privilege of night call on my first day on the service. It was February and by early evening it was black and cold outside. To avoid the night, I took a seldom travelled tunnel between the hospital and the state mental facility. Alone, and frequently passing broken-down equipment from a bygone era, I felt as if I were entering another world. I took an elevator to the sixth floor. The elevator was operated by a middle-aged pale woman who wore a calf length skirt that blew around in the wind generated by the elevator's ascent. She said nothing. To this day I remain unconvinced that she was not an apparition. My patient was a severely cognitively impaired woman who was said to have neurosyphilis. My task was to replace her nasogastric feeding tube, which she had pulled out despite wrist restraints. Her nose was bleeding and she was spitting blood between attempts to bite anyone who came near her. It was a sad and dehumanising interaction for both of us. When the psychiatry resident came to help, at my request, she displayed only callousness and incompetence. The night nurse was certain to tell me this after the house officer had left. This event, among others during my training more than a decade ago, froze the worst stereotypes of psychiatry into my mind. Subsequent positive experiences in out-patient psychiatry were too weak to thaw the negative perceptions.
Approaching employment
Authors: O'Flynn David
Published: September 2002

Most people with severe mental illness (SMI) may now live in the community, but few have jobs and many are socially isolated. Unemployment rates for people with serious mental health problems range from 60% to nearly 100%, and are particularly high if people have additional disadvantages in the labour market – being a member of an ethnic minority, having poor educational and employment history or possessing a criminal record. Unemployment is a cause of poverty, physical and mental ill health and is a cost to the community. Paid employment is central to human health and offers financial, psychological and social benefits to people with mental health problems: an income not derived from benefits, social contacts, a social role other than that of psychiatric patient, psychological recovery and possibly symptom reduction. These psychosocial and health gains may follow from any work – paid employment, low paid or unpaid work, training or education. Many mental health service users want jobs and alternatives to welfare dependency and traditional day centres. The Government wants to improve health and to reduce welfare spending and social exclusion. For deinstitutionalisation to achieve social integration and employment as well as relocation there is a need for a range of actions; public psycho-education, political reform and development and research of modern alternatives to sheltered work and industrial therapy.
Use of a prescribing protocol in routine clinical practice: experience following the introduction of donepezil
Authors: Jari Jaiker , Prettyman Richard
Published: September 2002

Aims and Method

Following the introduction of donepezil into clinical practice a protocol for prescribing it was developed in Leicestershire. A prospective clinical audit was undertaken to monitor compliance with the protocol, which also provided an opportunity to evaluate the outcome of therapy in routine clinical practice.

Results

Overall there was close adherence to the protocol by the clinicians and clinical factors, as well as organisational and resource-related factors, were important in determining who received treatment. The principal outcome measures (Mini-Mental State Examination, Barthel ADL Index and Clinical Dementia Rating Scale) did not demonstrate any significant treatment effect.

Clinical Implications

This study demonstrates the feasibility and acceptability of using a protocol-based approach to manage the introduction of new drug treatments in psychiatry.
‘Sadly confused’: the detection of depression and dementia on medical wards
Authors: Rao Rahul
Published: September 2002

Aims and Method

Dementia and depression are common psychiatric diagnoses in older people, and are common reasons for referral to liaison psychiatry services. The present study examined the accuracy of physicians' diagnoses for both disorders in consecutive referrals to a liaison old age psychiatry service.

Results

Positive predictive values for depression and dementia were high, but levels of treatment of depression and documentation of past psychiatric history were both poor. Alcohol misuse and stroke accounted for the commonest accompanying disorders.

Clinical Implications

The findings have implications for the encouragement of physicians to treat depression when this is suspected. Educational programmes for this purpose may be useful, incorporating an exploration of attitudes and knowledge of physicians towards depression in older people.
Precursors of compliance with lithium treatment in affective disorders
Authors: Macleod Mairi S. , Sharp Donald M.
Published: September 2002

Aims and Method

Objective and subjective lithium compliance was investigated in 30 out-patients attending at an affective disorders clinic. Possible precursors of compliance levels were investigated; namely lithium knowledge and attitudes, patient satisfaction and dosage of lithium administered.

Results

All patients were defined as currently compliant. Patients with a previous history of non-compliance were exclusively diagnosed with manic depression. Patient satisfaction, lithium knowledge and attitudes were not good predictors of lithium compliance.

Clinical Implications

Compliance with lithium can remain excellent in the presence of moderate lithium knowledge and poor attitudes. Poor attitude towards lithium worsens with years on medication, despite high levels of compliance. Clinicians should be aware that larger prescribed dosages of lithium may be associated with poorer compliance.
Service innovation in drug misuse services
Authors: Charnaud A. B.
Published: September 2002

This review looks at the need for partnerships in delivering services for drug misusers, to provide a broad base service. It reviews a number of specific partnerships set up between statutory and non statutory agencies based upon identified need and demonstrates the improvement in outcomes that can be achieved through partnerships interventions. In conclusion it reviews some of the basic lessons learnt in the process of setting up successful partnerships particularly the need for joint training between agencies.
Can deception ever be justified on therapeutic grounds?
Authors: Sandford J. J. , Gralton E. , Donovan W. M.
Published: September 2002

The behaviour of X in childhood had been described as ‘difficult‘, ‘aggressive’ and ‘bizarre‘, including bizarre gestures, mannerisms, ‘making scenes in public‘, ripping her clothes and trying to set fires.
Using the internet as a source of self-help for people who self-harm
Authors: Prasad Vibhore , Owens David
Published: September 2002

Aims and Method

To describe the information and help available on the internet for people who self-harm. We searched the internet using a meta-search engine. We visited sites and followed up links with e-mails and letters. We also searched bibliographic databases, seeking published material about the internet and self-harm.

Results

The support that we found largely took the form of information about suicide, self-injury and psychological issues. Less often, sites offered e-mail support and online discussions. We found little information about self-poisoning, and most about self-injury. There is little published research about self-harm and the internet.

Clinical Implications

The unregulated sites of the internet contain much material about self-injury. Although it is not possible at present to weigh up risks and benefits, many individuals and organisations plainly regard internet information about self-harm as a valuable service.
Post colonial psychiatric care in Ghana
Authors: Ewusi-Mensah I.
Published: September 2002

The development of psychiatric care in Ghana since the colonial era in the 19th century, up to the present, is described. Distorted planning and limited accessibility to psychiatric services in many parts of the country, coupled with shortage of trained staff of all grades (including psychiatrists and nurses) plus inadequate funding, have adversely affected the establishment of a fully comprehensive psychiatric service. Suggestions for improving services into the 21st century are briefly discussed.
The use of the Royal College of Psychiatrists' trainee's log book: a cross-sectional survey of trainees and trainers
Authors: Cornwall Peter L. , Doubtfire Ali
Published: September 2002

Aims and Method

The use of the Royal College of Psychiatrists' trainee's log book was evaluated by a cross-sectional survey of psychiatric trainees and their consultant trainers.

Results

One-quarter of trainees had not received a log book. There was a lack of mutual commitment to using the log book, with fewer than 45% of trainees believing their trainers were committed to its use. There had been little use of the log book beyond the setting of educational objectives. However, concern that trainees would be against using the log book for formative assessment was not observed.

Clinical Implications

More work needs to be done by the College to promote the use of the log book to both trainees and trainers.
Institutional racism in British psychiatry
Authors: Sashidharan S. P.
Published: September 2002

How racist is British psychiatry? Why does psychiatric practice in this country continue to discriminate against Irish, Black and Asian people? How do we, as a profession, respond to the charge of institutional racism, increasingly accepted as a major problem within British psychiatry?
Improving the assessment of risk of violence: a clinical audit of case note documentation
Authors: Campbell Michael , Chaplin Robert
Published: September 2002

Aims and Methods

To improve the rate of documentation of risk in new referrals to a community mental health team. A retrospective audit of 46 case notes was followed by a training session on risk of violence. The following 50 case notes were studied for changes in risk assessment.

Results

Prior to the study there were very low rates of documentation of risk of violence. Significant improvements were made in 45% of the items in the history and mental state although not in the formulation of a risk assessment statement.

Clinical Implications

It is possible to improve the risk of violence documentation with no extra time, resources or paperwork and with true multi-disciplinary involvement.
Questionnaire survey of automobile driving among users of a substance misuse service
Authors: Bradbeer Tim , Ormsby Jim , Fleming Philip
Published: September 2002

Aims and Method

Users of a substance misuse service were asked to complete a questionnaire, detailing information about driving habits as well as attitudes about substance use and driving.

Results

Of 120 subjects, 94 had ever driven, with only 36 currently driving. Fifty-six subjects had been charged with a driving offence but only 18 stated that they had been involved in an accident while intoxicated. The majority would not use drugs before driving and remain within a safe level of alcohol use. Most subjects stated that they were not informed of current legal issues concerning driving and substance use.

Clinical Implications

Users of a substance misuse service were reasonably responsible in their driving habits, however, it is still important for clinical staff working in such services to make their patients aware of the danger of driving under the influence of substances.
How many patients self-medicate with St John's wort?
Authors: Redvers A. , Laugharne R. , Kanagaratnam G. , Srinivasan G.
Published: September 2002

Aims and Method

St John's wort is popularly taken as a herbal remedy, but it interacts with prescribed drugs. The aim of this survey was to estimate the prevalence of patients self-medicating with St John's wort. All new referrals to a community mental health team over 5 months were asked about any use of St John's wort.

Results

Fifteen patients, of 101, had taken St John's wort at some time and of those seven were currently taking it. Patients who used St John's wort tended to be younger and female. Only nine of the 15 patients took it for depressive symptoms and none had received medical advice. One patient was taking an interacting medication.

Clinical Implications

A significant number of patients are taking St John's wort. In order to prevent drug interactions, doctors should ask all patients whether they use it, especially young women who may be on the contraceptive pill. Patients need better education about its risks and benefits and it should be taken with medical advice.
Eating disorders in Scotland: starved of resources?
Authors: Lemouchoux Camille , Millar Harry , Naji Simon
Published: September 2002

Aims and Method

To describe eating disorder services in Scotland. Fifty-two services completed a postal questionnaire.

Results

Six of the mainland health board areas, with a total population of 1.5 million, were not covered by any (self-defined) ‘specialist’ service. Although most services had access to in-patient facilities, we identified only one designated bed in Scotland for eating disorder patients, and this in a non-specialist service. In many other ways, services did not meet published recommendations for the provision of eating disorders services.

Clinical Implications

It is suggested that a national strategy should be formulated, and a model of service provision is proposed.
Severe mental illness and airports – the scope of the problem
Authors: Wieshmann U. C. , Anjoyeb M. , Lucas B. B.
Published: September 2002

Aims and Method

Mental illness may cause specific problems in the environment of an international airport. The aim of our study was to assess frequency, presentation and safety implications of mental disorders requiring formal admission at an international airport. We performed a retrospective study over 4 years including patients who were detained by the police and admitted.

Results

The frequency of admissions was one per million passengers, the frequency of incidents raising safety concerns was four per 10 million passengers. An in-flight disturbance occurred in 1.4 per 10 million arriving passengers. Most common were schizophrenia or schizotypal disorder (46.8%) and mania (22.6%). Twenty per cent of patients presented with wandering.

Clinical Implications

Emergency admissions and incidents causing safety concerns were rare. Airport wandering was a frequent presenting sign that should be recognised.
Is compulsory community treatment ever justified?
Authors: Pinfold Vanessa , Bindman Jonathan
Published: September 2002

On the evening of 23 February 2000 at the Maudsley Hospital in London the motion ‘This house believes that compulsory community treatment is not justified’ was debated in front of an audience of mental health professionals, carers, service users and other members of the general public. Peter Campbell, a mental health system survivor, and Dr Frank Holloway, consultant psychiatrist at the South London and Maudsley Trust, supported the motion. Cliff Prior, Chief Executive of the National Schizophrenia Fellowship (NSF), and Professor Tom Burns, professor of community psychiatry at St George's Hospital Medical School, opposed it.
What role can/should the College and its members play in the World Psychiatric Association?
Authors: Martindale B.
Published: September 2002

Last year the World Psychiatric Association (WPA) celebrated its 50th Anniversary with a Jubilee conference in Paris. The Grand Amphitheatre of the Sorbonne, where the WPA was launched in 1950 with a conference organised by Henri Ey, was also the site of the Jubilee opening ceremony last June.
Breaking the chains
Authors: Malik Sa'ad B. , Bokharey Iram Z.
Published: September 2002

Pakistan is a developing country and thereby burdened with the problems that all developing countries share. There are over 13 million people suffering from mild to severe mental disorders and with barely 200 psychiatrists throughout the country, the mental health services remain painfully inadequate and poorly developed. Both psychiatrists and psychiatric services are restricted to the major cities and, therefore, the 70% of the population that live in the rural areas have almost no access to modern day psychiatric facilities. Their only hope remains, as has been for centuries, with the local quack and faith healer.
That ‘praecox feeling’
Authors: Anonymous
Published: September 2002

I've worked in psychiatry now for over a decade but never have I experienced that ‘praecox feeling’ with such certainty and dread as I did with Alyson.
Choosing antipsychotic drugs in schizophrenia
Authors: Bebbington Paul
Published: September 2002

Clinical psychiatrists are today in a position to prescribe an expanded range of antipsychotic drugs for the treatment of schizophrenia and related psychoses. The introduction of chlorpromazine in 1952 was followed by many others. They varied in potency and in side-effect profile, but they shared the capacity to cause extrapyramidal side-effects (EPS). These side-effects were produced by a mechanism intrinsically similar to that responsible for the antipsychotic effectiveness of the drug. They seemed to be the price that had to be paid for the resolution of psychotic symptoms.
The National Schizophrenia Fellowship on treatment guidelines
Authors: Hogman Gary
Published: September 2002

The National Schizophrenia Fellowship (NSF) believes that people should be offered choice and the means to exercise that choice.
Managing dangerous people with severe personality disorder: a survey of forensic psychiatrists' opinions
Authors: Haddock A. , Snowden P. , Dolan M. , Parker J. , Rees H.
Published: September 2002

Aims and Method

To canvass the opinions of psychiatrists working in forensic settings on the recent proposals relating to dangerous people with severe personality disorder (DSPD). Psychiatrists from secure settings were invited to a series of meetings. A questionnaire was circulated and the discussions recorded.

Results

Opinion remains divided over diagnosis, treatability and assessment of risk in personality disorders. The medicalisation of DSPD to allow indeterminate detention in unconvicted cases is unacceptable to the majority (75%). There is no consensus on the Government proposals relating to DSPD. Only a minority (20%) of psychiatrists would work in a new specialist service, which has significant implications for service development.

Clinical Implications

The involvement of psychiatrists in preventative detention solely for public protection requires greater discussion.
Attention-deficit hyperactivity disorder and the use of methylphenidate
Authors: Ball Claire
Published: September 2002

Aims and Method

General practitioners (GPs) were surveyed on their experience of and attitudes towards attention-deficit hyperactivity disorder (ADHD) treatment using methylphenidate, and asked about prescribing practice.

Results

Most GPs have experience of children with ADHD and the use of methylphenidate. The majority felt that it was a drug that should be initiated by a specialist who should continue to provide clinical monitoring, but that primary care could provide ongoing prescribing and physical monitoring. There was a lack of training in this area, with most GPs requesting further training both on ADHD and its management.

Clinical Implications

ADHD is a topical issue both in the health service and with the public. This survey suggests that GPs may be willing to play a role in the management of ADHD once the child has seen a specialist, but that child and adolescent mental health services need to consider how training will be provided.
Home or away: which patients are suitable for a psychiatric home treatment service?
Authors: Harrison Judy , Alam Nooreen , Marshall John
Published: September 2002

Aims and Method

Home treatment offers an alternative to in-patient care, but little has been written about the practicalities of running such a service. Using routine information sources, details of referral and outcome are presented for patients assessed by a home treatment service over 6 months.

Results

Forty-eight per cent of referrals were not accepted, mainly because of lack of cooperation, risk to self or others or the illness not being acute enough. Referrals from junior doctors and accident & emergency were least likely to be accepted. Seventy-two per cent of patients accepted suffered from schizophrenia, bipolar affective disorder or depression with psychosis, similar to the diagnoses for in-patients. Twenty per cent of patients accepted had to be transferred to in-patient care later.

Clinical Implications

Staffing levels need to take account of time spent assessing patients. Junior doctors need training in how to use home treatment services appropriately and a wider range of options are needed to manage patients in crisis out of hours. It is possible to target patients with severe mental illness in a home treatment setting, but a significant number will need transfer to inpatient care.
Psychotherapy training and the Calman reforms
Authors: Logan Katharine E. , Muzaffar Nabila
Published: September 2002

Aims and Method

There have been major changes in the duration and the requirements of higher specialist training in psychotherapy in the UK. A postal survey was sent to all higher specialist trainees in psychotherapy to study their attitudes to, and experience of, these changes.

Results

Eighty-nine per cent of trainees responded. The majority of trainees expressed concern about the reduction in length of training. There were gaps in provision of some essential training modalities. A substantial group of trainees did not have protected research time.

Clinical Implications

Psychotherapy trainees believe the changes in training sacrifice depth for breadth. This highlights the ongoing debate about the future of psychotherapy within the NHS.
‘Juridogenic’ harm: statutory principles for the new mental health tribunals
Authors: Obomanu W. , Kennedy H. G.
Published: September 2002

The new Mental Health Act for England and Wales is likely to extend the powers of mental health review tribunals (MHRTs) by giving tribunals the power to approve all compulsory treatment (Department of Health, 1999a, b). The medical member may be dropped entirely from the tribunal's proceedings (Richardson & Machin, 2000). In Ireland, a proposed new Mental Health Act will introduce MHRTs for the first time (Calvert, 2000). The 1983 Mental Health Act contains no explicit statement of underlying principles, although some were introduced in the revised Code of Practice. The Expert Committee (Department of Health, 1999b) suggested that the new Act should specify broad principles where these would help in statutory interpretation, particularly because a range of practitioners working in different settings will be required to understand and implement its provisions. The Green Paper initially suggested that the proper place for setting out principles should be a Code of Practice, but ended by inviting comments on the principles proposed by the Expert Committee, and on whether inclusion of principles would aid interpretation of the new Act.