bluuebunny/crossref_metadata_2025 huggingface dataset:
Hot beds of general psychiatry
Authors: Beer M. Dominic , Paton Carol , Pereira Stephen
Published: October 2008

Little is known of the facilities available nationally to treat the most disturbed patients. A postal survey sent to all pharmacists in the UK known to have a special interest in psychiatry identified 110 psychiatric intensive care units. They varied in size from four to 30 beds, with the small units having low and the larger units very high occupancy levels. Many units accepted a mixture of informal patients directly from the community, detained patients and referrals from the prison service. Medical cover was variable, multidisciplinary team-working poor, and the existence of written policies unsatisfactory. Staff often felt undervalued with little control over admissions and discharges. There is currently no national or local support network for these units.
The Defeat Depression Campaign
Authors: Macaskill Ann , Macaskill Norman , Nicol A.
Published: October 2008

The Royal College of Psychiatrists launched a five year campaign in 1992 to better inform health practitioners and the public about depression. A questionnaire survey of Sheffield general practitoners (GPs) to assess the impact of the Defeat Depression Campaign on their knowledge and clinical management of depression was carried out in May 1994, half way through the campaign. Overall, 75% of GPs who responded indicated that the Defeat Depression Campaign had had little or no impact on their clinical practice. It would appear that at its mid-point the Defeat Depression Campaign failed to achieve its main goals in relation to educating GPs about depression and its management.
A repeat audit of the Cognitive Analytic Therapy Clinic at Guy's Hospital
Authors: Dunn Mark , Golynkina Katya , Ryle Anthony , Watson J. P.
Published: October 2008

A repeat audit of referrals to the CAT Clinic of Guy's Hospital is reported. Changes in training and supervision of therapists instituted since earlier audits are believed to have contributed to a lower drop-out rate and a higher attendance for follow-up. Mean score reductions on three questionnaires are significant and consistent in the three cohorts. Some characteristics of samples of patients who dropped out and failed to attend for follow up are described.
Alcohol detoxification: a postal survey
Authors: Agarwal Meena , Gaskell Keith , McArdle Paul
Published: October 2008

A survey of 92 in-patient alcohol detoxification services revealed that they varied in their goals, organisation and treatment approaches. We argue that detoxification units and alcohol treatment units should increasingly take on the assessment and treatment role hitherto played by general psychiatric wards in the management of the problem drinker. However, we also suggest that the general psychiatric wards should work closely with community alcohol teams and more specialist services in order to provide a comprehensive service for these patients.
An investigation of the adequacy of psychiatric interviews conducted through an interpreter
Authors: Farooq Saeed , Fear Christopher , Oyebode Femi
Published: October 2008

We evaluated clinical Information gained directly from 10 English-speaking and from 10 non-English-speaking subjects both directly and through interpreter-mediated Interviews. High levels of agreement between raters, when assessing both cohorts, were found for all data with a non-significant tendency towards better agreement in the Asian than the English-speaking sample for family history data. Analysis of the interview contents showed a number of errors of interpretation which were similar to those noted in previous studies. The addition of quantitative data represents a significant advantage over previous studies, allowing the qualitative results to be placed into perspective. Recommendations are made for optimising and avoiding the pitfalls of interpreter-mediated interviews.
Management of suicide risk
Authors: Morgan H. G.
Published: October 2008

The risk of suicide pervades much of day-to-day clinical practice. Effective management encompasses its recognition, evaluation of severity, and the use of techniques which reduce it to an acceptable level during treatment of the condition which it complicates.
Administration of ECT by trainee psychiatrists
Authors: Hillam Jonathan , Thompsell Amanda , Tobiansky Robert
Published: October 2008

There has been increasing concern in recent years that trainee psychiatrists are not receiving adequate training and are not fully competent in the administration of electroconvulsive therapy (ECT). This has led to the publication of guidelines by the Royal College of Psychiatrists recommending measures to improve supervision and tuition. This study compares the results of two surveys, five years apart, exploring levels of supervision, satisfaction with training and confidence in the procedure among trainee psychiatrists on the Royal Free Hospital scheme. The findings are discussed in the light of Improvements to teaching of ECT in the interim. Continuing problems with supervision are highlighted, and the need for organised training is emphasised.
Chlorpromazine equivalents: a consensus of opinion for both clinical and research applications
Authors: Atkins Maria , Burgess Adrian , Bottomley Clare , Riccio Massimo
Published: October 2008

A consensus of available information is used to produce a working table of conversion for the most commonly used drugs to chlorpromazine equivalents. A user-friendly computer program has also been developed from this information. The use of the concept In the clinical setting and for research purposes is briefly discussed.
Eleventh Annual TAPS Conference
Authors: Freeman Hugh
Published: October 2008

The 1996 Conference of the Team for the Assessment of Psychiatric Services attracted a larger audience than ever, including many from overseas. Dr Douglas Bennett looked at the historical evolution of community services over a 50-year period, in which no grand plan can be found. It has been a step-by-step process in which each step has followed either a successful innovation by pioneering psychiatrists, some advance in medical treatment, or a political or social change in our society. In his own experience of working with Dr Maxwell Jones at Belmont Hospital, he had not realised at first how revolutionary it was then for the staff to meet in groups. Wartime experience, when some of the traditional restrictions had to be given up, influenced some medical superintendents to open the doors of their hospitals in the 1950s. When industrial therapy introduced paid work, it provided an adult social role to those from whom nothing had been expected up to then. For chronic patients, social changes were the most important ones; in the 1950s, these started to release both patients and staff from the separate world they had inhabited up to then. The mental hospital ceased to be seen as the centre of psychiatric care; it was replaced by the comprehensive mental health service for a district.
Is there a real need for a short-stay unit in Al Ain, United Arab Emirates?
Authors: Daradkeh Tewfik K. , El-Rufaie Omer E. F. , Younis Yahia , Ghubash Rafia
Published: October 2008

This study explores the rationale and need for a short-stay psychiatric unit at Al Ain (United Arab Emirates) district hospital. The paper describes the demographic and diagnostic characteristics of patients with brief admissions over 40% – of all psychiatric admissions – most of whom have neurotic, stress-related and adjustment disorders. Only 12% of patients were severely disabled and in about half the patients, anxiolytic or no medications were prescribed. Significant reduction of distress was achieved by brief admission. In current circumstances, we believe that the short-stay unit might be the best available and least costly option.
The Collegiate Trainees' Committee position on the use of logbooks in training
Authors: Sullivan Gary , Cornwall Peter , Cormac Irene , Atkins Maria
Published: October 2008

The Caiman report (Caiman, 1993) aimed to reduce the period of postgraduate specialist training to about seven years, introduce the Certificate of Completion of Specialist Training (CCST), reduce the number of training grades to two, and introduce more structured training. Caiman also recommended four themes which should guide postgraduate training: flexibility, choice, competency and assessment on merit.
Who's assessing needs-led assessment?
Authors: Dick Peter H. , Reid David , Simpkins Audrey , Durham Tessa
Published: October 2008

Pre- and post-change audits of the effect of the changes in community care assessments and funding intro-duced in April 1993 were carried out on a psychiatric in-patient rehabilitation unit in Dundee. There was a substantial reduction in throughput in the rehabilitation unit (from 43 to 22) and in placements to funded staffed accommodation (from 11 to three) despite an increase in void community tenancies. By three months, 17 of 22 referrals for needs assessment were still incomplete, and at one year only three patients had had their needs assessed and appropriately met. Recommendations arising from these findings are discussed.
The Oxford University Department of Psychiatry 1969–1996
Authors: Gelder Michael , Mayou Richard
Published: October 2008

The Oxford University Department of Psychiatry was founded in 1969 during a period in which new psychiatry departments were being established in most undergraduate medical schools. It was the realisation of plans that had been formulated over at least 10 years by local psychiatrists and by leading members of the Clinical School, most notably by Sir George Pickering, the first clinically active Regius Professor since Osier.
Specialist work schemes: user satisfaction and costs
Authors: Schneider Justine , Hallam Angela
Published: October 2008

This paper is a study of the costs and quality of life of 157 people attending specialist employment schemes for people with long-term mental health problems in southeast England. The research, work force, and the seven work settings are described and differences found between service users in satisfaction, social networks and costs at 1994–95 levels are reported. This is the first such study of work schemes in this country, and while still not generalisable, it supplies valuable empirical evidence for all those concerned with psychiatric rehabilitation.
Service provision for elderly people with long-term functional illness
Authors: Green S. , Girling D. M. , Lough S. , Ng A. M. N. , Whitcher S. K.
Published: October 2008

A postal survey of old age psychiatrists was carried out to examine the pattern of services currently available for elderly people with chronic functional mental disorder, and to identify innovative models of care for this group. The opinion of respondents was sought regarding problems with service provision and additional resources that would be desirable. The majority of respondents felt that the needs of individual patients should determine whether they should be cared for by old age, general or rehabilitation services. Seventy-three per cent of respondents felt that more specialist residential care outside hospital was needed to improve the care of this group.
Reports prepared for Mental Health Review Tribunals and Managers' Reviews
Authors: Davison Phil , de Albeniz Alberto Perez
Published: October 2008

Little advice is offered in the literature for the novice report writer, despite the gravity of the situation, for example, a patient appealing against detention. Section 20, which renews the authority for detention after periods of 6 months or a year, is a useful reminder for clinicians, as it outlines the components that must be present in order for detention to continue.

This audit established guidelines for the completion of reports for Mental Health Review Tribunals and Managers' Reviews. A structure and list of ‘features to be included’ was compiled. This was used to rate the standard of reports prepared in the Warneford Hospital between 1991–1993. Following peer consultation within the hospital, the guidelines were considered acceptable and useful. At re-audit after 8 months the standard of reports had improved in most respects.
Using evidence about clinical effectiveness in everyday psychiatric practice
Authors: Geddes John
Published: October 2008

Most clinicians understand the advantages of basing their practice on the best available evidence, but sometimes doubts are voiced about the feasibility of applying the strategies of evidence-based medicine (EBM) in everyday clinical practice. This article describes one strategy for beginning to use EBM in ‘real-time’ which could already be used by the majority of clinicians. The rapid developments in clinical informatics are likely to enhance the feasibility and value of this strategy.
Drug treatment in attention deficit disorder: a survey of professional consensus
Authors: Sayal Kapil , Taylor Eric
Published: October 2008

The strong recent public interest in attention deficit disorder and its drug treatment has led to the need for, and development of, guidelines for clinical practice. As a first step in this process our aim was to ascertain the current level of professional consensus on certain points regarding the use of medication in attention deficit disorder. Although a high level of consensus was found in relation to indications and prescribing issues, opinion was divided on details of how the treatment should be delivered – including the role of paediatricians, and the use of psychological treatments.
A volunteer project for elderly people with mental health problems
Authors: Spear Jon , Kaanders Hetty , Moulton June , Herzberg Joe
Published: October 2008

A volunteer project for elderly people with severe mental health problems and social isolation was developed with close links with a community mental health team. The functioning of this service is described from 1988–1995. The volunteers benefited from training and supervision from the professional community team, while the volunteers took over the role of monitoring, allowing the earlier discharge of these patients by the community team.
Meetings with doctors in the staff grades: the development of affiliate status
Authors: Stein George
Published: October 2008

For many years, doctors in the staff grades, clinical assistants and associate specialists have made a substantial contribution to the care of psychiatric patients in the NHS but their position within the NHS and the College has been largely unrecognised. This article will describe recent attempts to remedy this situation. Numerically they comprise an important group of doctors (Table 1) and have always been more important in psychiatry than in other specialities, particularly in non-teaching districts where there are fewer consultants and junior doctors.
Rapid tranquillisation: are we getting it right?
Authors: Mannion Laura , Sloan Darina , Connolly Louise
Published: October 2008

Trainees in psychiatry frequently employ rapid tranquillisation (RT) measures. In this study we surveyed trainees as to RT regimes used. We found that a variety of drugs were chosen. On 45 (46%) occasions one drug was used, on 53 (54%) a combination. Drugs were administered in intramuscular form in 88 (90%) incidents. Zuclopenthixol acetate was prescribed on a total of 45 (46%) occasions. In 38 (39%) incidents the trainee used a high-dose regime. The literature regarding RT indicates inconsistency in practice. We address the reasons for this and make suggestions as to possible improvement in practice.
Workload and child sexual abuse: an argument for joint commissioning
Authors: Cole Mary , Vereker Margaret
Published: October 2008

Recent studies in child mental health show that fundholding general practitioners regard sexual abuse work as a priority service, and also that sexually abused clients take up more out-patient time than others in the same diagnostic group. This paper provides supporting data on the issue of workload and argues that specific purchasing arrangements should be made to cover this area of well recognised need.
The Care Programme Approach: comment on ‘Time for frank talking’
Authors: Kingdon David
Published: October 2008

After seven years of circulars, monitoring, conferences and discussion, frank talking about the CPA may still be welcome, but proposals to CPA coordinators and members of community mental health teams (CMHTs) to revise the procedures implemented by trusts are less likely to be. The previous paper (Burns & Leibowitz) identified a number of difficulties that have accompanied the implementation of the Care Programme Approach, particularly confusion related to care and case management. The CPA was introduced in response to the Spokes Inquiry (Spokes, 1988) as a therapeutic strategy to ensure that a coordinated safety-net of care for people with severe mental illness (SMI) was put in place in every district. Identification of those with SMI means that the approach includes all those accepted by mental health services; those with SMI need a coordinated multidisciplinary response. The CPA Audit Tool developed by the College Research Unit for the National Health Service Executive (NHSE) and disseminated to all districts in 1995/96 may be valuable in reassessing CPA implementation.
Membership course or Masters course?
Authors: Sullivan Gary , Jones Ian R.
Published: October 2008

Doctors who are embarking upon general professional training in psychiatry as Senior House Officers (SHOs) are now faced with making a choice between two types of training schemes. The first type offers training on a membership course aimed primarily at teaching the skills required to pass Part 1 and Part 2 of the MRCPsych. The second type offers training on a university course leading to the award of a Masters degree in psychiatry.
Women and children living with HIV infection
Authors: Melvin Diane , Sherr Lorraine
Published: October 2008

HIV infection is a relatively new disease affecting families (Pizzo & Wilfert, 1994). As with other chronic and life-threatening illnesses, families are faced with many changes and losses as well as much uncertainty about the future (Eiser, 1990). Unlike most other conditions, however, there can be extra stigma-related stresses, such as fear and secrecy, which can compound existing burdens of illness and coping (Richmond & Ross, 1995). As further knowledge of the full impact on HIV on families evolves, there is a need to consider the effects of multiple loss and changes on the mental health and adjustment of the children as well as their parents (Melvin & Sherr, 1995; Reidy, 1995).
Review of ECT prescription and outcome in depression
Authors: Robertson Carol , Eagles John M.
Published: October 2008

Few recent studies have investigated the prescription of electroconvulsive therapy (ECT) to depressed patients and their progress thereafter under ordinary clinical conditions. From case records, 412 courses of ECT were studied. ECT was efficacious in the short term, especially for patients with psychotic depression and for those over 65 years of age. Fifty-three per cent of patients required readmission in the six months following the index course. Neither age nor psychosis predicted whether readmission occurred. While short-term outcome is good, notably for the elderly and the psychotically depressed, patients are highly liable to relapse after ECT. High quality after-care is thus of paramount importance.
First light: old age psychiatry in Wolverhampton 1995–1996
Authors: Jolley David , Jenkins Rosie , Dixey Simon
Published: October 2008

In a survey of services conducted by the Section of Old Age Psychiatry in 1993, Wolverhampton was identified as one of 24 Districts with no consultant Old Age Psychiatrist in post (Benbow & Jolley, 1996). This encouraged the newly formed NHS Trust responsible for mental health and other community services to arrange for the secondment of D. J. from South Manchester, for a period of two years, with a view to setting up and running an appropriate service for older people with mental illnesses (Jolley, 1996). We are reporting here some of the changes which have occurred during the first year of this secondment.
The Bexley Hospital population nine years on
Authors: Kelly Sarah J.
Published: October 2008

A survey was undertaken at the beginning of 1995 of all the patients in the Bexley Hospital. Demographic information was compared with the findings obtained from a previous survey conducted in 1986. Results indicated that during the 9–year interval, changes had occurred in the characteristics of the population. Most markedly, the group was younger than that originally studied, and the total proportion of legally detained patients had increased. If such trends are representative of the country at large, adequate planning must be made to cater for an ever-evolving patient group.
Substance misuse in secondary students in Hong Kong
Authors: Yeung Wai-song
Published: October 2008

This study surveys the extent of substance misuse behaviour among secondary students in Hong Kong. One-fifth of the sample were misusing substances themselves and one-quarter had friends misusing substances. On seeking help regarding substance misuse, two-thirds would see the school social worker; the second preferred helper was a friend.
Junior doctors' training in the theory and the practice of electroconvulsive therapy
Authors: Duffett Richard , Lelliott Paul
Published: October 2008

Recent advances in knowledge about effective administration of electroconvulsive therapy (ECT) has placed great emphasis on the importance of good training and supervision of those administering it. The American Psychiatric Associaton requires that doctors be specifically accredited before they are allowed to give ECT. In England and Wales training is much more informal and ECT is often given by junior doctors. Doctors rostered to administer ECT in Wales and in two areas of England were surveyed as part of the College's third audit of ECT. About two-thirds of respondents were at senior house officer level. The training in ECT appeared of variable quality and one-half had not been supervised by an experienced psychiatrist on the first occasion they administered ECT. Responses to exam-type questions revealed that 45% lacked knowledge about one or more basic issue related to effective administration of ECT.
Loose talk: psychiatrists, the media and ethics
Authors: Timms Philip
Published: October 2008

“Prince was far too stressed out to fly says royal shrink … Bungling Prince Charles was lashed by a top psychiatrist last night” (Airs, 1994). This colourful fragment from a national tabloid illustrates one of the less savoury aspects of the increasing visibility of psychiatry in the media. The College Public Education Committee (PEC) was established in 1988 and has monitored press references to the College. In the three years prior to its establishment, it was able to find only seven press references to the College. A more recent survey, from September 1992–1993, found 736 such references (D. Hart, Royal College of Psychiatrists, personal communication). This dramatic increase has been partly due to the increasing politicisation of health care in general. However, a significant role has been played by the PEC. It has established an efficient machine which not only disseminates information from the College to the media, but also responds to inquiries from the media. On the whole, the results of this sort of activity are beneficial, the main complication being that of misrepresentation. We tend to be painfully aware of the dubious practices of the media, in particular the iniquities of the tabloid press. However, we also need to consider the possible ethical blunders that we may commit. The whole enterprise of speaking or writing about psychiatry in the public arena has generated several areas of ethical concern.
Maintenance doses for clozapine
Authors: Murphy Bernadette , Long Colm , Paton Carol
Published: October 2008

The British National Formulary (BNF) entry for clozapine clearly distinguishes the treatment dose (200–450 mg daily, maximum 900 mg) from the maintenance dose (150–300 mg daily). We looked at 44 patients maintained on clozapine locally and found that 36 (82%) received doses above the BNF guidelines. This has considerable cost implications. While it is always good practice to maintain patients on the lowest possible dose of antipsychotic, the BNF guidelines are not based on objective outcome data, and should be treated cautiously.
Long-term treatment with antidepressants in primary care
Authors: Ali Imad M.
Published: October 2008

A postal survey of 222 patients receiving long-term antidepressants in a training general practice showed that the majority were GHQ-12 cases and 62% of respondents reported moderate or severe depressive symptoms on the BDI-13. Although these patients received significantly higher doses than those reporting few or no symptoms, only 40% were prescribed at least a therapeutic antidepressant dose. All patients reporting mild, moderate or severe depressive symptoms consulted their general practitioner significantly more frequently than those without symptoms and the content of these consultations suggested that the general practitioners were aware of these patients' psychological morbidity. Monitoring and appropriate management of patients receiving long-term antidepressants could lead to reduction in morbidity and consultation rate.
Cultural meanings of ethnic categories
Authors: Hodes Matthew , Creamer Jayne , Woolley James
Published: October 2008

This study investigated the links between aspects of cultural life and response to ethnic monitoring questions, and compared parental and adolescents' responses. Questionnaires were given to consecutive attenders at a child and adolescent psychiatry department situated in central London. Forty-seven parents participated, and 24 adolescents (aged 12–16 years) also completed questionnaires. Parents came from many parts of the world and their offspring were mostly born in the UK, but had varied cultural life with respect to language, peer group and diet. Just over half of the offspring were regarded as ‘White British’ by parents but the second largest group was that marked ‘other’, who all had mixed identity. There were differences in how parents described adolescents, especially in relation to peer culture. Since ethnic categories have limitations the data should be used carefully, and for many aspects of health planning and delivery other cultural variables would be useful. Consideration should be given to the need for specifying whether adolescents or their parents should respond to ethnic monitoring questions.
Crisis cards and self-help crisis initiatives
Authors: Sutherby Kim , Szmukler George
Published: October 2008

The concept of a ‘crisis card’ originated in the voluntary sector as an advocacy tool for use in mental health emergencies. This type of self-help initiative, and variations which include advance planning for mental health crises, are becoming more common, and have received Government and media attention (Brindle, 1993). The Health Committee's Fifth Report to the House of Commons (1993) on ‘Community Supervision Orders' included evidence given by Survivors Speak Out on the use of crisis cards or treatment contracts as an optional alternative to community supervision orders. Survivors Speak Out described how a user, “when in a rational state of mind, can set out in writing (on a crisis card) how they would like to be treated in circumstances when they are not the best judge of their own interests”. The Government's response was to encourage the informal use of crisis cards and the development of best practice and guidance on their use bearing in mind the central role of the user (Department of Health, 1993). They also recommended that ways of amending the law to provide for crisis cards to be legally effective should be examined. The Report of the Inquiry into the Care and Treatment of Christopher Clunis recommended that the Royal College of Psychiatrists should design a card for mentally ill people. This appeared to be a response to the identified need for improved provision of information, communication and liaison across geographical boundaries where necessary (Ritchie et al, 1994).
Dynamic psychotherapy supervision for psychiatric trainees
Authors: Kerr Mig , Birtle Jan , Bond Ann , Whitehouse Sue , England Simone
Published: October 2008

Following the recommendation by the College that all general psychiatric trainees have the opportunity for psychotherapy training, we describe a pilot scheme for supervised dynamic therapy, commenting on organisational and training issues.
Making a reality of user involvement in community mental health services
Authors: Bhui Kamaldeep , Aubin Anne , Strathdee Geraldine
Published: October 2008

User centred services as an ideology have not become a reality of everyday clinical practice. In this paper we introduce a series of articles which describe user centred practice in a south London community-based rehabilitation service for the severely mentally ill. We emphasise the medical consultation style adopted, the service management style and specific initiatives allowing users to influence our practice and shape functional and structural components of the service.
Locked ward patients 25 years on
Authors: Feakins Martin
Published: October 2008

Aims and method

A retrospective case note study of 43 patients who were residents of a locked ward in 1970, augmented by a cross-section of the ward's current residents was undertaken.

Results

The study established a profile of the 43 patients in 1970 and determined their outcomes. A brief comparison of the use of medication then and now was also undertaken.

Clinical implications

This view of the past aimed to provide a prospective on why and how the field has changed, and to facilitate planning for the future.
Primary health care service for long-stay psychiatric in-patients
Authors: Fisher Nigel , Roberts Judy
Published: October 2008

Aims and method

A retrospective review of the activity of a general practitioner employed specifically to provide a primary health care service to the residents of an ‘old long-stay’ psychiatric ward was undertaken.

Results

All but one patient had a chronic physical health problem requiring active management. Presenting pathology covered all organ systems. The review indicated that these health problems had not previously been satisfactorily managed by psychiatrists. This service was acceptable to and valued by patients.

Clinical implications

The success of the service was only achieved by dedicating specific resources to meet primary health care needs. The extent to which this model could be extended to ‘new long-stay’ populations located in dispersed hospital hostels is less certain.
Satisfaction of ottenders and non-attenders with their treatments at psychiatric out-patient clinics
Authors: Killaspy Helen , Gledhill Julia , Banerjee Sube
Published: October 2008

Aims and method

Non-attendance at psychiatric outpatient appointments has a substantial financial cost, and may also have clinical significance. To prevent non-attendance and formulate effective responses, its determinants need to be understood. Patient dissatisfaction with services has been suggested as a reason for non-attendance, we therefore investigated the role of patient satisfaction in attendance at psychiatric out-patients appointments. All patients booked for adult psychiatric out-patient follow-up appointments in a three-month period were studied using a brief, self-report questionnaire.

Results

Sixty-three per cent (340/538) of offenders and 54% (118/219) of non-attenders responded. Responders expressed high levels of satisfaction with their treatment (92% offenders, 91% non-attenders) and with the service (96% attenders 92% non-attenders). Despite adequate statistical power, there were no statistically significant differences in satisfaction between the two groups.

Clinical implications

In conclusion, patient satisfaction with psychiatric out-patient care was reported to be relatively high and did not seem to be an important determinant of non-attendance. Further work is needed to determine the impact of variables such as relapse and social disorganisation on attendance.
Mental health review tribunal medical reports
Authors: Ismail Khalida , Smith Shubulade , Maden Tony
Published: October 2008

Aims and method

Medical reports submitted to mental health review tribunals should be of a clinically acceptable standard. We examined 100 medical reports to assess whether they stated the four criteria for detention under Section 3 of the Mental Health Act 1983. We compared the standard of reports according to the seniority, qualifications and speciality of the doctor, and with the outcome from the tribunal.

Results

The majority of the reports were written by junior doctors and did not fulfil the criteria laid down by the Mental Health Act 1983. Consultant and forensic psychiatry status were associated with completed reports.

Clinical implications

This study was performed in one hospital only but highlights the ongoing need to review and improve the workings of the Mental Health Act before reform is considered.
Provision for people with anxiety disorder by a community health care trust
Authors: Middleton Hugh , Ball Lisa , Blore David , Dunn Helen , Foster Margaret , Hart Barbara , Majid Ifti , Rajan Peter
Published: October 2008

Aims and method

Provision for patients with loosely defined anxiety disorders has been reviewed. During a two-week period. 66 of the 69 adult mental health practitioners working in a modestly sized community health care trust surveyed all patients with anxiety disorder currently under their care.

Results

These practitioners were seeing a total of 758 patients who fitted a loose definition of anxiety disorder. A further 134 patients had been treated in anxiety management groups during the preceding year. Disparate treatments were being used, reflecting idiosyncratic approaches to this otherwise homeogenous group of patients.

Clinical implications

Less than one-tenth of the estimated population of anxiety disorder patients were receiving specialised treatment. Among those that were, choices of treatment were arbitrarily determined and idiosyncratic. It was clear that the management of these patients does not fulfill the requirements of ‘evidence-based practice’.
Death certification in a psychiatric hospital
Authors: Salib Emad
Published: October 2008

Aims and method

A retrospective review of death certificates issued at a large psychiatric hospital in North Cheshire during the 1980s and 1990s.

Results

Dementia, which was the recorded clinical diagnosis in 78% of all deceased, was reported in 31% of death certificates, while other psychiatric disorders (22% of all deceased) appeared in only 2% of certificates. Autopsy appears to have very little or no value in improving the quality of death certificates in psychiatry.

Clinical implications

The onus is on the clinicians to produce adequate death certificates. Recording chronic conditions present at death, such as dementia and other psychiatric disorders, in addition to those directly causing or contributing to death would improve the epidemiological value of death certificates.
Lamotrigine in bipolar affective disorder
Authors: Duncan Denise , McConnell Harry W. , Taylor David
Published: October 2008

Aims and method

The study aimed to assess the available data on the use of lamotrigine as a mood stabilising agent. We reviewed all published and unpublished data available to us through a Medline search from 1987–1998 and from our own files, which include reference materials presented at conferences as well as published reports.

Results

Most of the data found were derived from case reports or open trials. We could find no published double-blind, placebo-controlled studies. The data from initial open trials suggest that lamotrigine may be effective in bipolar disorder, but futher data are required before specific treatment recommendations can be made.

Clinical implications

At this early stage, there are too few data to recommend lamotrigine for first or second line therapy in bipolar disorder. However, initial reports are very promising and this agent may eventually be unequivocally shown to be useful in treating mania, hypomania, depression, rapid cycling and mixed affective states in people with bipolar disorder.
Rationale behind psychiatrists' choice of drug
Authors: Dickson-Mulinga John
Published: October 2008

Aims and method

The study investigated the reasons that influence medical staffs' choice of a specific drug over another given the same clinical situation, by use of a questionnaire-based survey. The study population was 88 clinicians of various ranks, at psychiatry units in National Health Service university and district general hospitals In Greater Manchester. Responses in the factors: personal experience, scientific evidence, influence from colleagues, economic consideration, influence by drug representatives, ward or unit policy and other in choice of prescription, were the main outcome measures.

Results

Of the 546 responses generated by the 88 clinicians, 263 (48.2%) were for personal experience as the most important influence on choice of prescription. Scientific evidence was the second most important factor with 117 (21.4%) responses. Economic consideration and influence by drug representatives were least important. This trend held for all ranks except for registrars, where scientific evidence was as important as personal experience.

Clinical implications

As prescribers, clinicians trust mostly in their own personal experience. This may not be unique to psychiatrists. An understanding of how clinicians gain ‘personal experience’ could be important in improving rational prescribing.
Assessing the physical health of psychiatric patients
Authors: Osborn David P. J. , Warner James P.
Published: October 2008

Aims and method

Most medical diagnoses are made from the physical history alone. In the psychiatric literature, physical assessment usually focuses on examination rather than history. We aimed to ascertain the relative importance that trainee psychiatrists attach to the physical history and examination, and to investigate their actual method of physical assessment. The relative weight that trainees attach to physical history and examination was assessed with a postal questionnaire. Their actual practice was evaluated by reviewing a selection of case notes from patients under their care.

Results

Trainees weighted the physical examination as more important than the history in theoretical terms (P=0.02). They also indicated that they attached more importance to examination in their own practice (P=0.03). On review of the case notes, 34 (71%) of inpatients had been physically examined, but only one (2%) had evidence of a physical history.

Clinical implications

It appears that many psychiatric trainees do not adhere to the basic medical principle of taking a physical history on which to base a physical examination. ‘Blind’ examinations are unlikely to yield medical diagnoses. These findings have implications for our patients' health and psychiatric training.
Psychotherapy on a shoestring: improving training using existing resources
Authors: Davies Stephen Paul
Published: October 2008

Aims and method

This article aims to describe qualitatively attempts in one NHS trust to improve psychotherapy training for psychiatry trainees, according to the Royal College of Psychiatrists' Guidelines, using existing multi-disciplinary resources.

Results

Training opportunities in a wide range of interventions were identified. A psychotherapy supervision group was established, and a psychotherapy training post was introduced for a trial period. The costs and benefits are discussed.

Clinical implications

Substantial improvements in psychotherapy training can be made using existing resources, even in the absence of a consultant psychotherapist. Flexibility and coordination are required.
Specialist assessment clinic for pervasive developmental disorders
Authors: Falls Niall
Published: October 2008

Aims and method

The Joint Committee on Higher Psychiatric Training lists the ability to carry out a thorough clinical assessment including physical and mental state examination, as one of the essential core skills in child and adolescent psychiatry. Experience of the assessment of comparatively rare disorders may depend upon the organisation of regional services, as well as good working relationships between teams willing to involve the trainee.

Results

This paper describes a six-month attachment to the first multi-disciplinary Specialist Assessment Clinic for Pervasive Developmental Disorders to be created in Northern Ireland. Assessments are multi-dimensional and multi-professional. Attachment to this specialist clinic has become a valuable resource, with demand exceeding availability of places.

Clinical implications

The pervasive developmental disorders are characterised by onset before 36 months, qualitative impairments in social interaction and communication (both verbal and non-verbal), and a pattern of repetitive or stereotyped activities or interests (DSM-IV). Diagnostic criteria for these disorders have broadened since the introduction of DSM-IV and ICD–10. For example, both have now agreed the validity of Asperger's syndrome, featuring difficulties in social interaction, restricted and repetitive areas of interest, without clinically significant impairment of intelligence or language development.
The psychotherapy department and the community mental health team: bridges and boundaries
Authors: Holmes Jeremy
Published: October 2008

Aims and method

The aim of the study was to clarify the role of psychotherapy departments in relation to a general psychiatric service, and in particular community mental health teams (CMHTs). Literature reviews of therapeutic activities in CMHTs and of psychotherapy delivery methods were undertaken. The implications of the National Health Service Executive document on Psychotherapy Services in England was considered, based on experience of the psychotherapy-general psychiatry interfaces in North Devon and Bristol.

Results

Psychological therapies are an integral part of psychiatric treatment provided in CMHTs, but are often delivered without careful assessment training or supervision. Psychotherapy departments contain expertise in the range of psychological therapies, but are sometimes perceived as remote from everyday psychiatric practice. Ways in which the divide between general psychiatry and psychotherapy might be bridged are suggested. A multi-disciplinary psychological treatment unit can offer specialist resources for the assessment and treatment of complex cases, especially those with personality disorders; psychological interventions in psychosis; and brief focused therapies for neurotic disorders unresponsive to drugs.

Clinical Implications

Consultation and liaison with the CMHT should become a key element in the work of a psychological treatment unit, and structured therapies under supervision similarly central to the work of CMHTs.
Patients' knowledge of their lithium therapy
Authors: Anderson J. , Sowerbutts K.
Published: October 2008

Aims and method

Using a semi-structured questionnaire, we surveyed the patients attending an out-patient affective disorders clinic, enquiring about their knowledge of their lithium therapy.

Results

The response rate was 68%. In general, the level of knowledge relating to their own treatment was good, however we were able to identify particular areas of deficiency in their theoretical knowledge.

Clinical implications

The only factor we could identify which had a significant effect on patients' level of knowledge was having received education on lithium in more than one form.
Medication refusal among patients treated in a community mental health rehabilitation service
Authors: Macpherson Rob , Alexander Minh , Jerrom W.
Published: October 2008

Aims and method

This study aimed to examine medication refusal and its associated variables in a representative sample of patients on the Gloucester rehabilitation service case register. One hundred and seventy-four of 199 patients on the Gloucester rehabilitation register were surveyed. Insight cognitive function, knowledge of treatment, psychopathology and patient satisfaction were independently rated.

Results

Thirty-five per cent of patients had refused treatment in the past month. Negative attitudes to treatment and historical indices of non-compliance were associated, identifying a consistent core of patients at continuing risk of refusal. However of refusers, 84% were persuaded within one month to take treatment, mostly by their community keyworker. Treatment refusal was associated with diagnosis of affective disorder, higher Brief Psychiatric Rating Scale score and failure to use a dosett dispenser, but not with insight cognitive function, satisfaction with treatment, knowledge of treatment, a range of illness and demographic factors or any particular treatment type.

Clinical implications

Drug refusal was evidently mostly managed by community keyworkers, and without recourse to the Mental Health Act. Simple techniques such as the use of dosett dispenser may be valuable. Problems of communicating with the severely mentally ill about their long-term treatment were discussed.
Model of forensic psychiatric community care
Authors: Whittle Mary C. , Scally Mark D.
Published: October 2008

Aims and method

The paper describes the establishment of a specialist forensic team providing an integrated model of forensic community psychiatric care.

Results

A description is provided of the problems encountered in setting up and running the service and of the ways in which those problems were managed.

Clinical implications

The integrated model has the advantage of minimising stigma, providing support and education for staff and enabling forensic expenditure to be provided for a wider group of patients and staff than would otherwise be possible.
New eating disorder service
Authors: Millar Harry R.
Published: October 2008

Aims and method

The paper describes the first three years experience of a new out-patient eating disorder service for adults. Clinical data on referrals using standardised assessments are presented.

Results

The referral rate rapidly rose to over 200 patients per annum. Forty-nine per cent of referrals were bulimic disorders and 26% had either anorexia nervosa or atypical anorexia nervosa. Seventy per cent were directly referred by general practitioners.

Clinical implications

The creation of a specialist eating disorder service quickly leads to a high referral rate suggesting a previously unmet need. A service based on assessment and treatment by nurse therapists is acceptable and feasible with appropriate training and support from psychiatry, clinical psychology and dietetics. Expectations of a specialist service include teaching, consultation, research and audit as well as the provision of direct clinical care.
How to appraise clinical guidelines
Authors: Warner James P. , Blizard Robert
Published: October 2008

Aims and method

We critically appraised clinical guidelines for the use of antidepressants, using an evidence-based approach.

Results

We were unable to identify recent guidelines. The appraisal tool we used failed to identify some of the difficulties now apparent when considering the validity and utility of guidelines.

Clinical implications

Critical appraisal tools are useful in providing a framework for assessing published material, but run the risk of blinding us with their simplicity.
‘The Health of the Nation’: suicide
Authors: Crammer John
Published: October 2008

The study of fatal suicides in York, 1990–1994, by Elwood & De Silva (1998) is valuable confirmation that other people than general practitioners (GPs) and psychiatrists have responsibilities in averting such deaths, but does not go far enough. It is assumed that the GP or general hospital doctor has failed to recognise the suicidal risk, and better teaching would have increased their diagnostic awareness and so saved lives. But examining the detailed sequence of events leading up to death (medical audit) will show that in a number of cases medical diagnosis was not lacking, and the problem lay elsewhere.