bluuebunny/crossref_metadata_2025 huggingface dataset:
Dance, communication and schizophrenia
Authors: Loftus Josephine
Published: October 2008

“Dancing possesses all the features of a beautiful language, yet it is not sufficient to know the alphabet alone. But when a man of genius arranges the letters to form words and connects the words to form sentences, it will cease to be dumb, it will speak with both strength and energy; and the ballets will share with the best plays the merits of affecting and moving”

(Noverre, 1760; cited in Copeland & Cohen, 1983. p. 290)

“I should like to emphasise that some of the clinical pictures outlined are no more than attempts to present part of the material observed in a communicable form”

(Kraepelin, 1920; cited in Hafner et al, 1987, pp. 29–38)
Supervision register in practice
Authors: Vaughan Phillip J.
Published: October 2008

A sample of 19 consultant psychiatrists and 28 keyworkers were interviewed to determine their views on using the supervision register and to see whether it was affecting their practice. The majority felt that the supervision register was politically motivated and had little effect on direct clinical practice. However, there was a slight increase in indirect patient activities such as administration and meetings and some keyworkers were more vigorous in their outreach work. Most patients did not challenge their registration and the use of advocates in Care Programme Approach meetings may be needed. There was also a need for improved training and supervision for keyworkers.
Suicide attempts by jumping
Authors: Joyce John , Fleminger Simon
Published: October 2008

Those who attempt suicide by jumping often have a history of major psychiatric disorder, are left with a high level of physical and psychological morbidity and have a poor outcome. Services are failing this group in that national statistics may underestimate its size, and even when patients are in contact and are symptomatic and expressing suicidal intent before the incident many go on to jump. Care in hospital and preparation for follow up is uncoordinated.
Alcohol and smoking history on admission to a psychiatric hospital
Authors: Farid B. T. , Bird R. H. , Naik B.
Published: October 2008

This is a retrospective study of 173 consecutive admissions to a general psychiatric hospital. The aim was to establish the frequency and adequacy with which alcohol and tobacco use were recorded. Regarding alcohol, in 41% of the notes there was no adequate quantitative history, in 29.5% there was a descriptive mention and in 29.5% no history was recorded. Female patients were less likely to have an alcohol history taken than male patients. With tobacco, in 64% of the notes there was an adequate quantitative history, in 6.4% there was a descriptive comment and in 28.9% no history was recorded. It is to be stressed to all doctors that an assessment of alcohol and tobacco use should be made for every patient, whatever their age, gender or ethnic origin.
North American Group of the Royal College of Psychiatrists
Authors: Cleary Michael F.
Published: October 2008

Since 1978, Members and Fellows of the College have met once or twice annually at meetings of the American and Canadian Psychiatric Association. Although small in numbers, the meetings off the North American Group have served to maintain contact with the College. The College President, Immediate Past President and Registrar have attended recent meetings. There are over 500 Fellows and Members in the USA and Canada, and with increased awareness off the existence of the North American Group, which was officially recognised by the College in 1996, expansion of activities to include educational programmes is expected. For this to occur, the membership would need to respond in greater numbers than heretofore.
Violence, dissatisfaction and rapid tranquillisation in psychiatric intensive care
Authors: Hyde Clive E. , Harrower-Wilson Colina , Morris Julie
Published: October 2008

We examined the associations of violence, patient dissatisfaction and occurrence of rapid tranquillisation in psychiatric intensive care, using an on-line nurse-based computerised database over a two-year period. Non-Caucasians were over-represented in violent incidents with physical threat, and previous forensic history was associated with more violent means of attack. Dissatisfaction related to non-understandable provocation and the total number of violent incidents. There was no correlation between rapid tranquillisations or side-effects and dissatisfaction. Remedial action and education in the psychiatric intensive care unit may reduce violence, and better prescribing habits, avoiding anti-psychotic polypharmacy in rapid tranquillisation, should be encouraged.
GPs' views on prioritisation of child and adolescent mental health problems
Authors: Jones Stephen M. , Bhadrinath Bindumadhava R.
Published: October 2008

The demand for child and adolescent psychiatric services outstrips the supply of resources, leaving a large unmet demand. One way of managing this is to prioritise referrals. A sample of Norfolk general practitioners were interviewed face to face. They were asked to prioritise child and adolescent mental health problems that might present to them in the surgery. A high response rate was obtained. Anxiety provoking problems were considered to be of the highest priority. Service provision and prioritisation should take cognisance of the wishes of referrers themselves. Mental health care training priorities in general practice include substance misuse and psychiatric emergencies.
Legal and contractual implications of the informal admission of psychiatric patients
Authors: Azuonye Ikechukwu Obialo
Published: October 2008

The lack of official consideration of the legal and contractual implications of the informal admission of psychiatric patients has resulted in a situation in which individual hospitals and mental nursing homes have generated their own mistaken assumptions about the nature of this form of admission, often to the detriment of patients.
How to appraise an article on diagnosis
Authors: Rampes Hagen , Warner James P. , Blizard Robert
Published: October 2008

In our evidence-based journal club we appraised an article investigating the use of the CAGE questions in screening psychiatric populations for alcohol misuse. We calculated a likelihood ratio of four for a score of two or more positive CAGE questions, suggesting the CAGE is a moderately useful screening instrument.
Training and supervision of deliberate self-harm assessments
Authors: Taylor Simon
Published: October 2008

Over a decade has now elapsed since the last national guidelines from Government health departments about the management of deliberate self-harm, although the scale of the problem has remained unchanged. Three years ago the Royal College of Psychiatrists issued a consensus statement which set standards for suitability of staff, particularly with regard to training, experience and supervision, the available facilities for assessment, the range of appropriate management options, communication of these and management of services. This postal questionnaire study in one health region of England of all senior house officers and registrars working in psychiatry found that levels of training and supervision varied widely and often fell below those suggested.
Reflections on the death of Diana, Princess of Wales
Authors: Kapp Elinor
Published: October 2008

Apparently more than 15 books have already been written about the death of Diana and the associated phenomena, and as many again are shortly to be published. You will be glad to know that I am not writing one of them. Nor am I going to add to the numerous research papers, since I cannot write phrases like “Diana functions as a radical fetish of virtual reality, a move beyond alienation to a principle of otherness raised to perfection” (Diane Rubinstein in That's the Way the Mercedes Benz: Di, Wound Culture and Fatal Fetishism’; The Sunday Times, 5 April 1998). The humorist, Alan Coren writes that soon we will all have to undergo official tests on our attitude to Di before we will be allowed a mortgage, a credit card, or a subscription to Reader's Digest the catch being we will never know if we should be for or against her.
Use of psychotropic medication in an adolescent in-patient unit
Authors: McLoughlin Peter , West David , Phillips Jean , Holman Dorothea
Published: October 2008

In January 1991, the adolescent in-patient unit in Leeds became a seven-day residential unit. This study set out to review the first five years' intake of patients, with regard to basic demographic details, diagnoses, use of regularly prescribed psychotropic medication and episode length. Using clinical case notes as the primary data source, we reviewed 154 completed patient episodes, representing 128 patients. The study revealed that about a third of patients had been prescribed regular psychotropic medication, and that this group had significantly longer episodes and were significantly more likely to return to the unit than those for whom there had not been regularly prescribed medication.
Optimising neuroleptic treatment for psychotic illness
Authors: Searle Geoffrey
Published: October 2008

The release of the antipsychotic agents risperidone, sertindole and olanzepine forces difficult choices upon clinicians. The new compounds are better tolerated than neuroleptics, expensive and their long-term side-effects unknown. These choices can be made easier by the dose and side-effect minimisation procedure set out below, which aims to produce the greatest benefit and least harm from conventional neuroleptics.
Audit of anticholinergic treatment in a psychiatric patient population
Authors: Williams Justin H. G.
Published: October 2008

Aims and method

An audit was performed to look at how carefully anticholinergic medication was prescribed and monitored in a population of psychiatric patients on depot medication.

Results

The mean duration of prescription was 47 months and 44% of patients' prescriptions went unaltered for over three years. Evidence was lacking for rational initial anticholinergic prescription.

Clinical implications

Anticholinergic treatment needs to be prescribed more rationally with regular monitoring of extra-pyramidal symptoms.
Characteristics of admissions considered inappropriate by junior psychiatrists
Authors: Elwood Peter Y.
Published: October 2008

Aims and method

The aim of the study was to identify medical and socio-demographic characteristics of admissions considered inappropriate by psychiatrists. Appropriateness of admission was assessed by questionnaire. Medical and socio-demographic characteristics of each admission were obtained by case note review.

Results

Twenty-five per cent of admissions were considered inappropriate. These patients showed high levels of adverse socio-demographic characteristics and commonly were diagnosed as personality disordered or as substance misusers. Junior doctors commonly admitted patients despite considering admission inappropriate.

Clinical implications

Regular audit of the admission, process should be encouraged.
Solo obstetric liaison service
Authors: Smith Sue
Published: October 2008

Aims and method

To set up a liaison psychiatry service for an obstetric department and review how much of the work involved in such a service can be undertaken by a senior registrar in two special interest sessions.

Results

It was clear there was a demand for a service for women with psychiatric problems associated with childbirth. Referrals from colleagues in general psychiatry meant that the available time was soon used up. This did therefore not allow time to develop efficient systems for referral and management or to then see the extra referrals this would have produced. The limited and temporary service was well received by other professionals and by patients. The number of referrals received fell far short of the expected morbidity.

Clinical implications

In an area with this number of births and its consequent level of psychiatric morbidity, it would not seem possible, within two special interest sessions, to develop a more formalised or comprehensive system.
Psychiatry in Barbados: a personal experience
Authors: Evans Ceri
Published: October 2008

As a registrar, I took part in a six-month exchange between the Maudsley Hospital in London and the Psychiatric Hospital in Barbados. My main motivation for taking up this opportunity was a long-standing desire to spend at least part of my psychiatric training in a less well-developed setting. My expectations were that Barbados would provide this kind of experience, with the emphasis being on service delivery in a very different cultural setting to which I was accustomed.
Recruitment, undergraduate education and the possible impact of Tomorrow's Doctors
Authors: Cottrell David
Published: October 2008

Recruitment into psychiatry varies across medical schools. There is evidence that positive attitudes towards psychiatry at the end of undergraduate education influence career choice and that a major determinant of positive attitudes is exposure to well organised and well taught psychiatry programmes. The General Medical Council's (GMC) guidance on undergraduate medical education provides many opportunities for psychiatrists to increase the exposure of medical students to psychiatry. These opportunities should be seized if we wish to increase recruitment into psychiatry.
College census
Authors: Pidd Sally
Published: October 2008

Manpower planning is not normally a topic of considerable interest for most psychiatrists. That is, until their trust is faced with recruiting a new or replacement consultant from what may seem to be an ever diminishing pool of qualified applicants. “Where have all the specialist registrars gone?” is often the woeful cry which goes up after increasingly large and ever more expensive advertisements fail to draw in desperately needed recruits. Having an accurate picture of the current state of the psychiatric workforce and seeing the trends in recruitment and retention at all grades is vitally important for the profession. It was the realisation of the gross inadequacy of officially collected statistics some years back which led to the first College census on psychiatric staffing.
Determining whether senior and specialist registrars choose or reject a career in general adult psychiatry
Authors: Davies Mark , Schlich Tom
Published: October 2008

Aims and method

Following concerns over recruitment into general adult psychiatry, this study was undertaken to determine which factors influence senior trainees in psychiatry with regard to whether or not they choose a career in general adult psychiatry. The method used was by postal survey of all senior and specialist registrars in the UK.

Results

Of those responding, 32.6% had chosen a career in general adult psychiatry, while 38.9% had actively rejected such a career. Twenty-six per cent of respondents had chosen another speciality without actively rejecting general adult psychiatry. For those actively rejecting general adult psychiatry, the top three factors cited were poor resources (57.6%), high workload (43.2%) and poor working conditions (30.7%).

Clinical implications

Through an awareness of why senior trainees reject general adult psychiatry as a possible career, resources can be targeted more specifically in the future at the factors responsible, and thereby improve recruitment into this speciality.
A survey of flexible trainees in psychiatry in the North and South Thames Region
Authors: Herzberg Joe , Goldberg llfra
Published: October 2008

Aims and method

To review the experience, examination success and career progress of trainees on the flexible scheme in psychiatry in the North and South Thames region. Trainees in psychiatry who enrolled on the flexible training scheme 1993–1997 were Included In the retrospective survey of flexible training records.

Results

Trainees on the flexible training scheme had gained experience in a broad range of posts before entering psychiatry for a mean time of 14 months. Forty-nine per cent entered flexible training during basic specialist training and 41% during higher specialist training. This cohort of trainees performed better in the MRCPsych examinations than the national average. Forty-nine per cent of the trainees intended to become child and adolescent psychiatrists. Flexible trainees' progress to consultant status was slower.

Implications

The flexible training scheme attracts trainees of comparable quality to full-time trainees and encourages their retention in the workforce.
The myth of recovery from mental illness
Authors: Whitwell David
Published: October 2008

Recovery from mental illness is a fairly straightforward concept to members of the general public: “am I going to recover”, “what are the chances of recovery”, or “is our son/daughter ever likely to recover”? These are the sorts of questions that doctors and psychiatrists get asked every day.
Invited commentary: Community treatment orders
Authors: Burns Tom
Published: October 2008

Moncrieff & Smyth (1999, this issue) are certainly right that community treatment orders (CTOs) are high on the agenda and that psychiatrists need to think long and hard about them – about the political and ethical implications, not just their practical and therapeutic applications. Their concerns are important and reflect a wide constituency – identical views were expressed and considered during the consultation that preceded the College's document proposing a Community Supervision Order in 1993 (Royal College of Psychiatrists, 1993). Moncrieff & Smyth make no mention of that document, nor the limited, but recent, survey of psychiatrists' opinions that accompanied it (Burns et al, 1993). Do all College documents achieve obscurity quite so quickly?
Early detection of antipsychotic side-effects
Authors: Chaplin Robert , Gordon Julie , Burns Tom
Published: October 2008

Aims and methods

Staff from five community mental health teams (CMHTs) were trained to use structured rating scales for akathisia, tardive dyskinesia and Parkinsonism. Detection rates of these side-effects were compared for the six months before and after the intervention.

Results

Fifty-seven per cent of the target professionals participated, screening 200 (52%) eligible patients. This resulted in significant increases in the recording of all three side-effects as positive but no increase in their formal diagnosis.

Clinical implications

Detection rates of these side-effects can be increased to those predicted by research with significant reductions in drug dose and non-adherence and without clinical deterioration.
The first 12 months of a perinatal outreach service
Authors: Patel Meena , Lewin Jona , Stevens Ann
Published: October 2008

Aims and method

This paper describes and evaluates a new community treatment service for women suffering from mental Illness during the perinatal period. Data about referrals, treatment methods and outcome were analysed for the first year of Its service.

Results

The service was acceptable to patients and effective in improving the mental health and parenting skills of mothers but less successful in improving relationship problems.

Clinical implications

A specialised perinatal outreach service is likely to be more acceptable to new mothers than the traditional psychiatric service and may also be able to reduce the need for hospital admission and length of admission.
WebGuide
Authors: Briscoe Martin , Hicks Trevor
Published: October 2008

British Medical Journalwww.bmj.com – this is an excellent site. It has the full text of all articles published in the British Medical Journal since the beginning of 1997.
Preventive detention exhumed – and enhanced
Authors: Chiswick Derek
Published: October 2008

In 1997 there were 57 000 notifiable crimes of serious or sexual violence recorded by police in England and Wales (Home Office, 1998) – more than 1000 per week or approximately one every 10 minutes. On 15 February 1999 the Home Secretary, Jack Straw, announced new measures “better to protect the public from dangerous people in our society” (House of Commons, 1999). He said the measures were to target “those who are capable of committing acts of a serious sexual or violent nature”. Of the 57 000 potential targets, Mr Straw believes 1800 men are already detained in prisons and special hospitals; he intends to identify a further 500 or so men currently at liberty and lock them away indefinitely, in advance of their offending. His intention in respect of the other 54 700 violent or sexual offenders, responsible for 99% of serious violence, is not stated. Mr Straw believes that the 500 men in the community (and the 1800 in custody) share a common psychiatric condition and that this is what makes them dangerous. His policy for identifying the men, and what he intends to do with them and similar people, is contained in the recently published consultation paper on dangerous people with severe personality disorder (Home Office & Department of Health, 1999).
Treating offenders with personality disorder
Authors: Maden Tony
Published: October 2008

While carrying out research in a special hospital, I encountered a small group of middle-aged patients who spent most of their time engaged in sporting activities. They had considerable freedom within the high security perimeter, and were regarded as presenting no risks, as long as they had no access to children. All were detained under the legal category of psychopathic disorder, and none of them were receiving psychiatric treatment, unless the term milieu therapy were to be stretched to include a patient's mere presence within a hospital. Their past offences were such as to lead to a shared understanding that they were unlikely ever to be released, and a compromise had been reached. The patients were aware that they enjoyed a quality of life that was as good as they could expect in the circumstances. The hospital accepted that it would have the patients for as long as their restriction orders lasted, and saw itself as providing a valuable public service by keeping them locked up.
Clinical governance in mental health services
Authors: Kennedy Peter
Published: October 2008

This is one of three articles describing how one National Health Service (NHS) trust is tackling clinical governance. The first is by the trust chief executive, the ‘accountable officer’ in the White Paper The New NHS (Department of Health, 1997). The second is by the trust's director of research and development whose responsibilities include assisting clinical directorates to carry out an annual programme of improvements in clinical effectiveness. The third paper is by the mental health lead clinician’ for clinical governance.
Clinical governance in mental health services
Authors: Lyne Jake
Published: October 2008

Clinical audit has had a limited impact in the NHS because clinical outcomes and standards, while important to clinicians, have not received the investment required from NHS management which has been preoccupied with efficiency and customer satisfaction. With the advent of A First Class Service (Department of Health, 1998) the emphasis is changing and clinical audit committees and departments now have a central role.
The views of voluntary patients
Authors: Moss Julia , Doyle Anne , Macdonald Andrew , Upadhaya Ajaya
Published: October 2008

Sir: We read with interest Paul & Oyebode's paper regarding the competence of voluntary psychiatric patients (Psychiatric Bulletin, August 1999, 463–466). We too have data on a related, but distinct, area of research. One hundred consecutive informal patients were interviewed on the third day of admission and one week later. At the first assessment, 78% thought they needed to be in hospital and 74% thought they needed treatment. Only 43% recalled receiving an explanation of their admission and treatment plan. We assessed their knowledge of their rights to refuse admission and treatment. At the first assessment, 67% were aware of their right to refuse treatment with 52% anticipating coercion if they exercised this right. Seventy-three per cent were aware of their right to leave hospital an 42% anticipated coercion if they exercised this right.
Mental health legislation
Authors: Zigmond A. S.
Published: October 2008

Sir: Szasz's views (Psychiatric Bulletin, September 1999, 23, 517–519) are both illogical and barbaric.
Young people, mental illness and stigmatisation
Authors: Bailey Susan
Published: October 2008

In a recent review of the literature, Hayward & Bright (1997) offer four possible answers to the question of “What is the root cause of an unfavourable view of ‘mental illness’?” First, dangerousness: people fear the mentally ill because they believe them to be prone to violence. Second, attribution of responsibility: sufferers of mental/behavioural problems are seen as more responsible for their condition, implying a belief that the mentally ill ‘choose’ to behave as they do. Third, conditions perceived as being chronic, difficult to treat and having a poor prognosis are more stigmatised, and fourth, the cause for stigma lies in the disruption of normal social interactions based on social role.
Care of older people with mental illness
Authors: Jolley D. J.
Published: October 2008

Older people comprise an increasingly significant proportion of the population of the UK and other developed countries. Most remain fit and able to make continuing contributions to their families and society, but they are at risks of periods of ill health and other stresses. Dementia, especially Alzheimer's disease, is one of the major health problems of our times and particularly affects older people. Mental ill health, physical ill health and social difficulties are often intertwined, calling for close working between health and social services to provide appropriate help for patients and their carers.
Diagnosis, assessments and admissions from a community treatment team
Authors: Brimblecombe Neil , O'Sullivan Geraldine H.
Published: October 2008

Aims and method

A community treatment team, offering rapid assessment and intensive home treatment as an alternative to admission is described. The relationship between diagnosis and outcome was examined, in terms of initial ‘take on’ rates, admissions to in-patient areas at both initial assessment and subsequently.

Results

There was a significant relationship between diagnosis and outcome, with marked variation between diagnostic categories.

Clinical implications

Home treatment teams prevent admissions with the majority of people from all diagnostic groups, but less successfully with people with personality disorder.
Monitoring lithium treatment: evaluation of current management
Authors: Kotak Anita , Arnold Ann Elaine , Frost Peter
Published: October 2008

Aims and method

A postal survey of 81 general practitioners (GPs) who were Involved in lithium monitoring was undertaken, to compare their views on lithium therapy with their monitoring practice, and with the practice of psychiatrists.

Results

Forty-seven replied (response rate 50.6%). There was considerable variation in GP knowledge of lithium therapy. GPs made fewer requests but wanted more information.

Clinical implications

Written reminders and information on lithium would be useful to GPs.
Psychotherapy experience in Ireland
Authors: Rooney Siobhan , Kelly Gabrielle
Published: October 2008

Aims and method

A questionnaire was sent to members of the Psychotherapy Section of the Irish Division of the Royal College of Psychiatrists to assess psychotherapy training.

Results

Members from Northern Ireland, compared with those from the Republic, had more mandatory psychotherapy experience in a variety of psychotherapies, had attended more lectures on the theories of the psychotherapies, had cases longer in analysis and were more satisfied with their level of supervision. Few non-consultant hospital doctors had obtained mandatory psychotherapy training as outlined by the College guidelines and they were also generally dissatisfied with their basic training in psychotherapy.

Implications

Although there were clear qualitative differences in psychotherapy training between Northern Ireland and the Republic, 100% of members believed there should be improvements in the training of psychotherapy in Ireland. If the Royal College guidelines are to be adhered to, these results would imply that changes in the structure of psychotherapy training in Ireland particularly for non-consultant hospital doctors are required.
Information and advice received by carers of younger people with dementia
Authors: Husband Hilary J. , Shah Meera N.
Published: October 2008

Aims and method

Retrospective information on advice and information received post-diagnosis was obtained from 40 carers of younger people with dementia, using a semi-structured interview.

Results

Twelve carers received services from old age psychiatry, the remaining 28 from predominantly adult psychiatry or neurology. Those in receipt of old age services reported greater adequacy of diagnostic information, higher levels of advice giving and more frequent referral to social services.

Clinical implications

While old age services were more successful on the parameters examined, the gradually emergent nature of the diagnosis may be a crucial factor in the lack of information and advice received by the comparison group.
Facilitating a staff support group on an oncology ward: some observations
Authors: Montgomery Charles
Published: October 2008

Aims and method

In this paper an experience of facilitating a weekly support group for nursing staff on an oncology ward is described. A brief overview of burnout among oncology nurses is followed by a description of the processes by which the support group was established.

Results

Some of the functions that the group has come to provide and recurring themes are highlighted along with a more theoretical understanding of the nature of groups within institutions.

Clinical implications

Support groups can help prevent isolation and demoralisation.
New community mental health team for acute psychiatric illness
Authors: Brown S. J. , Guthrie M. F. , Shepherd B. M.
Published: October 2008

Aims and method

The aim was to provide effective time-limited management of acute episodes of mental illness in the community, thus reducing dependency on the psychiatric services. A multi-disciplinary team supplied intensive psychological and pharmacological interventions.

Results

Fifty-nine per cent were discharged within 12 weeks to the care of their general practitioner. Twelve per cent were admitted to in-patient care.

Clinical implications

A time limited multi-disciplinary approach will have benefits to patients and the service.
Disruption of children's lives by maternal psychiatric admission
Authors: Hawes Valerie , Cottrell David
Published: October 2008

Aims and method

The aim of the study was to investigate changes in child care arrangements after admission of mothers to acute psychiatric wards. Data were collected by interview where possible and from case notes.

Results

Twelve out of 63 children of mothers interviewed had to move house. Chronicity of psychiatric disorder was evident in half the mothers.

Clinical implications

Children's lives are affected by maternal psychiatric admission with the likelihood of repeated disruption where psychiatric disorder is chronic.
Reducing the time you and your patients wait
Authors: Srivatsa Kadiyali M. , Allen Danny
Published: October 2008

Aims and methods

In an attempt to reduce patient non-attendance at first appointments, consultant referrals were handled differentially over three years. From referral letters some patients were referred elsewhere, some sent appointments and some invited to make appointments.

Results

There was a reduction in patients who did not attend an appointment and an increase in the proportion of patients, not referred elsewhere who were seen.

Clinical implications

This system reduces consultant waiting time in clinics and the interval before a patient is seen.
Psychiatrists' views of evidence-based psychiatric practice
Authors: Carey Stephen , Hall David J.
Published: October 2008

Aims and method

To determine the attitudes of psychiatrists towards the practice of evidence-based medicine by use of a postal questionnaire. A survey was sent to Consultant Psychiatrists and to Higher Trainees in Psychiatry in the West of Scotland Region.

Results

While older influences on decision-making such as tradition and deference still play a part, almost all respondents consider the adoption of more effective care based on best available external evidence desirable; most think it attainable. The technology is generally available, but further training is desired to access the information and its critical analysis.

Clinical implications

Educational activities should increasingly focus on skills for data search and critical analysis.
The outcome of rough sleepers with mental health problems admitted to a psychiatric ward
Authors: Graham Zoë C. , Salton-Cox Frankie S. , White Peter D.
Published: October 2008

Aims and method

To describe the outcome of rough sleepers admitted to an acute psychiatric ward; the professional most involved with the person was interviewed.

Results

Eleven out of 12 people admitted with a psychosis were accommodated and in touch with mental health services at follow-up (median of 21 months) compared with two out of 10 people, admitted without a psychosis, accommodated and four out of 10 people in touch with mental health services.

Clinical implications

Psychiatric admission with good aftercare is worthwhile for rough sleepers with a psychosis, even if it requires involuntary admission.
Cognitive therapy of psychosis in clinical practice
Authors: Bishay Nagy Riad
Published: October 2008

Aims and method

The study aimed at developing a brief cognitive intervention suitable for everyday management of psychotic patients. A brief cognitive therapy package was developed and tested on different patients with psychosis.

Results

In conjunction with medication, a brief cognitive intervention helped some patients with psychosis at different stages of the illness.

Clinical implications

This encouraging report justifies more detailed studies.
Olanzapine in practice: a prospective naturalistic study
Authors: Taylor David , Mir Shameem , Mace Shubra
Published: October 2008

Aims and method

The study aimed to evaluate the effectiveness of the naturalistic use of olanzapine. Prescribers of olanzapine were asked to provide baseline and six-week Brief Psychiatric Rating Scale scores for 56 in-patients. Withdrawals from treatment were also noted.

Results

Olanzapine was not effective in any of the 12 patients with refractory schizophrenia and four patients worsened. In 36 patients with non-refractory schizophrenia, 16 (44%) improved and 10 (28%) were categorised as treatment failures. of eight patients with non-schizophrenic psychosis, only one improved and two were treatment failures.

Clinical implications

Olanzapine is effective in treating non-refractory schizophrenia, but appears to have no beneficial effect in refractory schizophrenia.
Supervised discharge orders in England
Authors: Pinfold Vanessa , Bindman Jonathan , Friedli Karin , Beck Andrew , Thornicroft Graham
Published: October 2008

Aims and method

Supervised discharge orders were introduced in April 1996. This paper describes two national surveys of their use in all mental health provider trusts in England. Data were collected from key informants in mental health provider trusts using a postal survey in 1997, and a follow-up telephone survey in 1998.

Results

The total number of patients subject to supervised discharge in 1997 was 160, a mean of one per trust. In 1998, there were 378 cases, a mean of two cases per trust. The annual period prevalence in 1998 can be estimated as 510 cases, approximately one per 100000 total population per year. Seventeen applications of the ‘power to convey’ were identified.

Clinical implications

Supervised discharge is regarded as suitable for very few patients, though its use is growing. The controversial power to convey is seldom used in practice and barriers to its use are described.
Experience and application of HoNOS65+
Authors: Allen Lesley , Bala Sushila , Carthew Richard , Daley Stephanie , Doyle Eugene , Driscoll Pat , Grey Barbara , Macdonald Alastair
Published: October 2008

Aims and method

The implementation of the Health of the Nation Outcomes Scales for Old Age Psychiatry services (HoNOS66+) in a National Health Service trust is described. Some preliminary data are reported for illustrative purposes.

Results

Lessons learnt from this process are identified, and further work needed both on the glossary for the scales and on systems for trapping data is suggested.

Clinical implications

These remain uncertain. It may be that HoNOS65+ will remain a purely administrative tool.
Children's needs when their mothers are admitted to psychiatric units
Authors: Tamarit Leonor Montoliu , Lau A. Yin-Har
Published: October 2008

Aims and methods

Due to a concern over the low level of referrals of children to the child and adolescent psychiatry team, an audit was designed to investigate the possible causes. An audit was undertaken in which the case notes of 100 consecutive adult female admissions to acute wards in Goodmayes Hospital were screened. The case notes were screened for mention of children, any actions taken on their behalf, in addition to a number of demographic and social factors.

Results

The findings of the audit indicate that children of psychiatrically ill mothers do not receive the attention they need, as indicated by the literature on the topic.

Implications

More detailed case history-taking by the parent's psychiatrist and closer cooperation between adult and child psychiatry departments are suggested as two methods of addressing this need.
Malaise in psychiatric recruitment and its remedy
Authors: Thompson D. J. , Sims A. C. P.
Published: October 2008

Aims and method

Surveys of career intention among medical students, Membership Examination results and manpower figures are used to examine trends in recruitment to psychiatry over the last 10 years.

Results

Problems of recruitment to psychiatry have increased. Consultant expansion contrasts with a fall in the number of medical students. The increase in the number of career senior house officers and specialist registrars is insufficient to fill existing consultant vacancies notwithstanding new and replacement posts. The popularity of general psychiatry and psychotherapy have declined.

Clinical implications

Proposals include an increase in the number of medical students, the introduction of psychiatry in the pre-registration year, increased specialisation and closer integration of general adult psychiatry with general medicine.
Adolescent counselling services in the voluntary sector
Authors: Mitchell Mary
Published: October 2008

Aims and method

While Youth Access attempts to organise voluntary counselling services for young people on a national level research describing such agencies is lacking. In order to investigate their activity with a view to multi-agency collaboration, a questionnaire was distributed to eight agencies in Hampshire.

Results

The responses demonstrate a strong emphasis on accessibility and informality. Although agencies have reported increasing numbers of service user contacts little attempt has been made to quantify and evaluate the service provided.

Clinical implications

Efforts to organise, evaluate and improve accountability in the voluntary sector might spoil these fundamental components for the disaffected adolescent.
National differences in disulfiram prescribing
Authors: Chick Jonathan , Brewer Colin
Published: October 2008

Aims and method

To test the impression of wide national differences in the use of deterrent medication in the treatment of alcohol dependence, data showing comparative sales of disulfiram in 13 countries were obtained.

Results

Sales in Britain were lowest, and less than a tenth of those in Denmark. Rates bore no relation to alcohol sales or an index of alcohol-related problems in the 13 countries.

Clinical implications

British doctors may apply a particularly cautious risk/benefit ratio for disulfiram. The disparity may also reflect the predominantly nonmedical approach to treating alcohol dependence in Britain.
Refusal of prescribed drugs in a psychiatric hospital
Authors: Ballinger Brian R. , Irvine Elizabeth-Anne
Published: October 2008

Aims and methods

A survey of recorded refusal of drug administration to patients in a psychiatric hospital over a six-month period in 1996 was made using drug administration records. For comparison 150 patients were randomly selected from the 1975 drug sheets and instances of drug refusal noted.

Results

Eighteen per cent of patients refused drugs on at least one occasion, and of those over 65 years of age 26.2% refused drugs. All the main diagnostic categories and groups of drugs were involved. of the 150 patients studied from 1975 only four refused drugs.

Clinical implications

Doctors should be alert to the possibility of refusal of drug treatment in a wide range of psychiatric conditions. When refusal occurs interventions are likely to be necessary, including a review of drug treatment.
A dedicated district poisons treatment unit: response to the College guidance on the management of deliberate self-harm
Authors: Scorer R. C. , Beck P. , Bisson J. , White S. , Routledge P. A.
Published: October 2008

Aims and method

An examination of the activities of a district-wide dedicated admission unit for poisoned patients in Cardiff, Wales, between 1987 and 1997. Number of admission episodes, gender, drugs taken. intent, psychiatric diagnosis and disposal were recorded.

Results

Although the number of admission episodes almost doubled over the 10–year period, the median length of stay fell by almost half.

Clinical implications

The results suggest that a dedicated unit is a cost-effective model for the management of poisoned patients.
Neuroleptics in dementia
Authors: Wismayer Franz Schembri , Sipos Attila
Published: October 2008

Aims and method

We surveyed the prescription of neuroleptic drugs in patients with a diagnosis of dementia discharged from a general psychiatric hospital over two consecutive years. The surveys looked at documentation of information around prescribing and communication to primary care teams. Our aim was to help to minimise the potential contribution of hospital practice to unnecessary or continuing unreviewed neuroleptic prescription in the community.

Results

The first survey led to the adoption of new clinical standards in the Department of Old Age Psychiatry. The second survey found improvements in all surveyed parameters.

Clinical implications

Clear communication of information around prescribing and follow-up arrangements could help to reduce inappropriate community prescription of neuroleptics in this vulnerable group of patients.
The effect of structured consent on recall of information pre- and post-electroconvulsive therapy: a pilot study
Authors: Greening J. , Bentham P. , Stemman J. , Staples V. , Ambegaokar S. , Upthegrove R. , Day E.
Published: October 2008

Aims and method

A randomised, blind comparison of a structured consent procedure against routine consent was conducted to determine whether it had any utility in improving treatment knowledge In patients receiving electroconvulsive therapy (ECT). Additionally we aimed to determine whether degree of cognitive impairment intelligence and severity of depression influenced recall of information.

Results

Thirty-two subjects were investigated. Structured consent significantly improved the number of knowledge items recalled pre-ECT (P<0.05). Knowledge scores declined significantly after completion of the treatment course in both structured consent (P<0.05) and control groups (P<0.06). There was a significant correlation between Mini-Mental State Examination (MMSE) scores and the number of knowledge items recalled both pre- (r=0.43, P<0.05) and post-ECT (r=0.53, P<0.01).

Clinical implications

Structured consent procedures may be a useful way of improving patient knowledge of ECT and merit further study. Low scores on MMSE should caution clinicians to take particular care when consenting patients to ECT.
Usage of clozapine and the new neuroleptics
Authors: Bristow M. F.
Published: October 2008

Aims and method

To explore clozapine and atypical antipsychotic usage in England and Wales, particularly availability, restrictions on use and shifting of prescribing to general practitioners. To examine the hypothesis that respondents in acute trusts would encounter more restrictions. Method used – postal questionnaire sent to general psychiatrists derived from the 1996 Medical Directory.

Results

There was an 80% response rate and over 90% of respondents used clozapine, with only 9% reporting any difficulty in obtaining it. Difficulty was not associated with any particular type of trust. Only about 4% of respondents suggested that general practitioners regularly took over the prescribing costs of the drug.

Clinical implications

Optimistic, with widespread usage and few difficulties in obtaining clozapine. General practitioner prescribing is still very low and needs to increase.
Management of psychiatric in-patient violence in the Anglia region
Authors: Dowson J. H. , Butler J. , Williams O.
Published: October 2008

Aims and method

A total of 384 incidents of violence against the person (six ‘serious' and 378 ‘mild’), by adult in-patients in general psychiatric units (GPUs) and learning disability units (LDUs) in 10 National Health Service trusts in the Anglia region, were evaluated by Interviews with staff and examination of records.

Results

The findings, when compared with standards derived from previous recommendations, showed deficiencies in the documentation of incidents (there was no satisfactory written record of physical restraint for 97% of incidents in GPUs and 86% in LDUs), in the training of staff in ‘control and restraint’ procedures (If two or more staff were involved In physical restraint, for 3% of incidents in GPUs and 100% in LDUs, the staff had received no training within the previous 12 months) and in policies for victim support (there was no written policy that included procedures for victim support in relation to 84% of incidents in GPUs and 44% in LDUs).

Clinical implications

Trusts should consider reviewing their policies on the prevention and management of violence, particularly in relation to staff training.
WebGuide
Authors: Briscoe Martin , Hicks Trevor
Published: October 2008

The Internet has been likened to a vast unmanned, unmanaged library that never closes. Its files are stored on a global, interconnected web of about 43 million computers. One hundred and forty-seven million people worldwide use its facilities including 7.2 million people in the UK. In such a big place it can be difficult to find things. To avoid this we invite you to join our guided tour. This series will highlight some of the major sources of useful information and also direct you to resources that a lone visitor might overlook.
Ultra-rapid opiate detoxification in hospital
Authors: London Mervyn , Paul Eddi , Gkolia Ionna
Published: October 2008

Aims and method

To evaluate ultra-rapid opiate detoxification under sedation. Symptom control was analysed in the first 12 hours of detoxification in 20 patients and case notes were examined 12 weeks later for outcome.

Results

Good symptom control was achieved, except for restlessness. At 12 weeks 25% patients were abstinent.

Clinical implications

While long-term outcome is similar to conventional methadone detoxification, the ultra-rapid technique is safe, more acceptable to patients and more cost-effective.
The Scottish Health Advisory Service visit
Authors: Macdonald Shiona
Published: October 2008

The Scottish Health Advisory Service (SHAS) was established in 1970 to provide information to the Secretary of State for Scotland and the Health Board on the management and running of hospitals for the elderly and for patients with mental illness and learning disability. The Health Advisory Service serves a similar purpose in England and Wales. The purpose of SHAS is to promote high standards of health care for these patients. The SHAS achieves this in different ways, but one of their main functions is to visit the hospitals regularly to assess the quality and effectiveness of the service.