bluuebunny/crossref_metadata_2025 huggingface dataset:
Psychiatric advance directives: reconciling autonomy and non-consensual treatment
Authors: Halpern Adina , Szmukler George
Published: October 2008

This paper examines the potential for advance directives to be used by people with mental illness. Also known as a ‘living will’, an advance directive enables a competent person to make decisions about future treatment, anticipating a time when they may become incompetent to make such decisions. In Englishlaw, if “clearly established” and “applicable to the circumstances”, an advance directive assumesthe same statusas contemporaneous decisions made by a competent adult. A psychiatric advance directive, anticipating relapse of a psychosis, develops the concept of the living will. We argue it could reconcile two apparently contradictory themes in the current practice of psychiatry - on the one hand, the call to provide for non-consensual treatment outside hospital, and on the other, the promotion of patient autonomy.
Effects of education on attitudes to deliberate self-harm
Authors: Turnbull Gill , Chalder Trudie
Published: October 2008

Accident and emergency (A&E) staff completed a general knowledge and attitude questionnaire related to suicide and deliberate self-harm (DSH) before and after a teaching package. The results showed an increase in general knowledge while attitudes remained the same. Following the teaching package there was an increase in the number of patients who contacted the Specialist Service for DSH.
Role conflict and barriers to learning for senior registrars in child and adolescent psychiatry
Authors: Eminson D. M. , Green J. M.
Published: October 2008

The landscape of training in child psychiatry is changing fast. In recent years the content of theory and practice within the discipline has evolved rapidly and the latest Royal College guidelines for higher training (Royal College of Psychiatrists, 1995) show a daunting array of training areas to be encompassed in four years or less. The Caiman proposals (Department of Health, 1993) will abbreviate and so inevitably further intensify postgraduate training in the speciality. We argue in this paper that the fact of entering such an intensive training at the level of senior registrar can, under certain circumstances, create barriers to learning. We describe the efforts of trainees, consultants/trainers and scheme coordinators to adapt to these difficulties as they arise.
Attendance rate in an alcohol problem clinic
Authors: Ali Imad M. , McBride Andrew J.
Published: October 2008

The high rate of non-attendance for first appointments at psychiatric clinics is wasteful of health service resources. Previous studies have demonstrated reductions in the non-attendance rates when referred patients were asked to contact the clinic to confirm that they wished to be seen before an appointment was sent. The effect of introducing such a process to a community based alcohol service was investigated. Results showed that although there was a reduction in the non-attendance rate, the overall effect was to discourage patients from attending the clinic, resulting in a large reduction in the proportion of all referrals seen. Alternative approaches are discussed.
The description of primary delusions: confusion in standard texts and among clinicians
Authors: McAllister-Williams R. H.
Published: October 2008

A review of standard texts used by trainees reveals a wealth of differences in the description of primary delusions. The views of 52 consultants and trainees were obtained regarding the various descriptions present in textbooks. This demonstrated a high degree of disagreement between clinicians as to which description most clearly matched their own view. A scheme for the classification and description of primary delusions is suggested.
Psychological support for a community paediatric nursing team
Authors: Salmon Gill , Connor Anne Marie
Published: October 2008

We describe how a support group was set up and run over a ten-month period for members of a community paediatric nursing team. The views of the trainee who facilitated the group and of the nurse manager are offered.
The Collegiate Trainees' Committee
Authors: Sullivan Gary
Published: October 2008

Many trainees in psychiatry have only a vague idea about what the Collegiate Trainees' Committee (CTC) is or what it does. The Royal College of Psychiatrists is unique among the medical Royal Colleges in having a CTC. It was established in 1979, although its roots go back to the previously established Association of Psychiatrists in Training, which was independent of the College.
Violent children and the media
Authors: Bailey Susan
Published: October 2008

Few subjects attract the attention of the public and the media more than violent acts committed by children and adolescents. All too frequently, politicians, policy-makers, practitioners, the public and media become caught up in destructive cycles of blame, engendering within society itself a sense of helplessness and powerlessness for and about violent young people.
Clinical effectiveness – a series of perspectives
Authors: Marriott Sarah
Published: October 2008

Ensuring clinically effective practice and service models is now a major challenge for the National Health Service. It requires a clear focus on the purpose of healthcare provision – care which is most likely to result in the best possible individual or population outcomes within existing resources.
The Care Programme Approach: time for frank talking
Authors: Burns Tom , Leibowitz Judy
Published: October 2008

The Care Programme Approach (CPA) was introduced as a cornerstone of the Government's mental health policy in 1992 (Kingdon, 1994). It was meant to clarify the complex issues surrounding the coordination of care for the severely mentally ill and to promote interprofessional communication and effective targeting of resources by community mental health teams (CMHTs). The Ritchie report into the care of Christopher Clunis (Ritchie, 1994) underlined the need for clarity about who has overall responsibility for coordination and review of the progress of care – the key worker. The report makes a compelling case for a clearly documented care plan with identified problems, therapeutic goals and an unambiguous statement of who is responsible for what and when. How, then, could this virtuous proposal generate conflict and bad feeling? And why is there relatively little debate about it in the professional press?
CPA: should it carry a government health warning?
Authors: Watson P. E.
Published: October 2008

In common with other psychiatric units throughout the land, we have been struggling to come to terms with the Government directives regarding the Care Programme Approach. A great deal of time has been spent attempting to devise a system which is workable and useful but which might leave some time for face-to-face contact with patients; implementing it forces the psychiatrist into a catch–22 situation. If things are seriously wrong for a patient, the psychiatrist could be criticised for not putting somebody on CPA, or criticised for putting them on it but not carrying the process through thoroughly enough. In spite of this, I have participated in the scheme, if only because the consensus would seem to be that it is necessary to have the system in place, mainly as a defensive measure or in the hope of ensuring adequate resources. My overwhelming feeling, however, has been that it has been a time-consuming way of formalising good practice, and that the time spent filling in the forms would be better spent talking to the patients. I have always felt uncomfortable listing needs and solutions with the patient and ‘the team’, because it seemed reductionist, but I thought that this was my idiosyncratic response, and that I should get on with it. Recently, however, there was a near disaster with a patient which served to strengthen my reservations.
The role of the speciality tutor in the training of junior doctors in psychiatry
Authors: Hughes Patricia
Published: October 2008

“The Speciality Tutor is a psychiatrist working in the fields of child and adolescent psychiatry, psychotherapy, forensic psychiatry, learning disability, psycho-geriatrics, or the dependencies (drugs and alcohol), who is regarded as the tutor for the organisation of training in that speciality in the Region. There is one tutor for each Region.” (Royal College of Psychiatrists, 1996)

The speciality tutor is recognised but not appointed by the College. He or she may be appointed by the University, the Regional Post graduate Education Committee, or by a local committee, for example, the local Division of Psychiatry. The appointment, however, must have the agreement of colleagues (Royal College of Psychiatrists, 1996).
Negative views of the mother after childhood sexual abuse
Authors: Feigenbaum Janet D.
Published: October 2008

In childhood sexual abuse cases, the non-abusing parent (usually the mother) is often seen as colluder, helpless bystander or victim. These negative views may be based on misconceptions about incestuous families and can lead to treatment bias and neglect of the other ‘victims' of abuse. Mental health professionals and support agencies should ensure that the needs of the non-abusing parent are met as well as those of the victim and perpetrator.
NEWPIN: an opportunity for positive change
Authors: Gurr Myra , Hansen Anne
Published: October 2008

The work of NEWPIN was pioneered in the London Borough of Southwark in 1982. It was influenced by the rising child abuse figures, which were higher than the national average, and the low take-up of ante- and postnatal services in the district. A study of mothers with young children in Camberwell (Brown & Harris, 1978) had revealed that there was a high incidence of maternal depression within the group. This also influenced the direction NEWPIN was to take.
HoNOS v. GP opinion in a shifted out-patient clinic
Authors: Taylor John R. , Wilkinson Greg
Published: October 2008

This study compared the mean change in the total Health of the Nation Outcome Scales (HoNOS) with the general practitioners' (GPs) assessment of clinical improvement and satisfaction, in a shifted psychiatric out-patient clinic. The total HoNOS fell significantly between the first and last appointment, suggesting that it was sensitive to change even in patients with a lower level of morbidity. There was a weak association between change in the total HoNOS and the GPs' assessment of clinical improvement (r=0.4; P=0.06), and a trend towards a greater HoNOS fall in patients that the GPs assessed as having improved clinically (5.3) compared with those the GP thought had not changed (2.5), but this difference was not significant (95% Cl, 6.6 to −1.1). There was no evidence of a relationship between change in HoNOS and GP satisfaction, and no trend towards a greater fall in the HoNOS in cases where the GP was satisfied, despite a lack of improvement being the commonest reason given by GPs for dissatisfaction. The results suggest that the fall in total HoNOS relates to some degree with GPs' own assessment of clinical improvement in their patients, and that the HoNOS may be regarded as useful by GP fundholders.
Sharing medical records: comparison of general psychiatric patients with somatisation disorder patients
Authors: Goddard Nick , Bernadt Morris , Wessely Simon
Published: October 2008

The responses of somatisation disorder (SD) patients to reading their main clinical summary were compared with those of general psychiatric patients, to assess whether the sharing of information and psychiatic opinion might help in the management of SD. Overall the SD patients responded favourably on 8 out of 11 measures; 28 of the 30 (93%) thought it was a good idea to have read the summary and 26 (87%) thought it had provided helpful information. Significantly more of the SD patients (57% compared with 27% of the general psychiatric patients) had their concerns about undiagnosed illness increase as a result of reading their clinical summary.
Survey of young offenders in a regional secure unit
Authors: Lengua Cesar , Handy Sumy , Dhariwal Avi
Published: October 2008

The management of young offenders by specialist psychiatric adolescent forensic services is currently the subject of considerable debate at the Royal College of Psychiatrists and at the Department of Health. It is important to know what has been done in dealing with this very important group of vulnerable young people. This study aims to delineate how medium secure units become involved with this group and what happens to them.
Costs of physical health care for self-injuring patients
Authors: Swinton Mark , Smith Sarah
Published: October 2008

Self-injury is a major clinical problem on the women's wards at Ashworth Hospital. Ashworth Hospital is one of three special hospitals within England and Wales that provides assessment, treatment and rehabilitation for those legally detained patients under the Mental Health Act (1983) who suffer from a mental disorder and require conditions of special security because of their dangerousness. There is extensive literature on the psychological aspects of serf-injury. However, since patients with self-injury present with damage to the body, it is surprising that there is little information on the physical health care and associated resource costs of this behaviour.
Members of a community mental health team
Authors: Lucas Benjamin
Published: October 2008

The aim was to find out if professions differed in their contributions to the workload of two multi-professional community mental health teams. Both teams aimed to provide community mental health care in London, targeting those with severe mental illness and using the care programme approach. Junior psychiatrists had fewer contacts than other professionals but medical staff tended to contribute more to assessments. Community mental health nurses tended to have the most contacts. Community mental health team planners should be aware of inter-professional differences when designing teams.
Characteristics of in-patients without psychosis
Authors: Dowson Jonathan H. , Sussams Pamela , Grounds Adrian T.
Published: October 2008

In a study of a population over 13 months, ratings were made from medical records of adults who were admitted to short-stay, non-secure (acute) psychiatric beds. Of 197 patients, 126 fulfilled DSM-IV criteria for specified psychoses; 57 of the 71 remaining non-psychotic patients had a history of repeated self-harm, or threats of self-harm, and/or a substance-related disorder. Both these behaviours can be a manifestation of, and be associated with, personality disorder. It was considered that personality disorder made an important contribution to the psychopathology in the non-psychotic patients. The findings suggest a need to evaluate the alternative to in-patient care in a standard acute unit for such patients.
Improving resuscitation skills in psychiatric hospitals
Authors: Winston Tony , Drybala Gary
Published: October 2008

There is currently concern that junior psychiatrists lack adequate skill in cardiopulmonary resuscitation. However, little attention has been given to the equally important issues of nurse training, organisation and the provision of equipment and drugs which are appropriate to psychiatric wards. This paper describes the work of the Leicestershire Mental Health Services Resuscitation Committee and makes suggestions as to how these problems may be approached.
Lithium monitoring in hospital and general practice
Authors: Ryman Ann
Published: October 2008

A survey of the current practice of lithium monitoring in a general hospital and the general practices it serves revealed erratic and infrequent assessments of serum lithium levels and also of renal and thyroid function. General practitioners, who in this study monitor approximately a third of the patients on lithium, performed worse than psychiatrists, but in neither case was there cause for complacency.
Boléro unravelled: a case of musical perseveration
Authors: Cybulska Eva M.
Published: October 2008

Maurice Ravel (1875–1937), a musician of the highest order, died in a state of dementia. A genius of orchestration, a successful experimenter in musical forms and styles; he was at his best when given to composing small-scale constructions. His musical miniatures combine an extraordinary expressiveness with an unparalleled, almost mechanical precision. The latter quality provoked Stravinsky into calling him a “Swiss clock-maker of music”.
Bibliographic databases in psychiatry: an overview
Authors: Mitchell Alexander J. , Martin Clare , Preston Ian
Published: October 2008

Literature searching has been revolutionised by the desktop computer. Today it is almost inconceivable to be without the tools to efficiently and comprehensively examine the medical literature. However, as this biomedical literature grows ever more vast, researchers and clinicians need to know which of the many biomedical and psychiatric databases will best cover their particular area of interest. No databases can cover everything. It is necessary to select the most appropriate source of information for the task at hand and for a literature review this will usually entail the use of multiple methods of data collection. In this brief review databases of particular interest to psychiatrists are discussed.
The dispensable psychiatrist
Authors: Kellett John
Published: October 2008

Changes in the organisation and delivery of psychiatric services are likely to increase the stigma of mental illness, reduce the role of the psychiatrist, and inhibit recruitment of the best medical students. The value of close integration with the district general hospital and medical school is stressed. The future of psychiatry will be in doubt if this is ignored.
Psychiatrists and the learning disabilities health service
Authors: Cooper Sally-Ann , Bailey Nicola M.
Published: October 2008

A study of all trusts in England and Wales providing specialist health services for people with learning disabilities attracted an 83.9% response rate. Considerable variation exists with regard to the quantity of services. The relationship between the learning disabilities psychiatrist and National Health Service learning disabilities bed-numbers and learning disabilities health professionals from other disciplines is explored. An appropriate balance needs to be kept in these ratios to reduce stress and burnout.
Current views of solicitors on psychiatric court reports
Authors: Marchevsky David
Published: October 2008

This survey evaluates current views of non-medical professionals on the style of court report writing. A random sample of 120 solicitors who worked in the criminal field in London participated in this survey. The usable return was 72%. Up to 76% favoured changes in standards of report writing because of problems concerning clarity of style and use of jargon. The majority objected to reports being prepared by non-consultant psychiatrists.
Care needs of people with mental illness and aggression
Authors: Stevens Andrew , Gooder Pamela , Drey Nicholas
Published: October 2008

People with violent or dangerous behaviour represent a considerable health care burden. The health needs of this group have been considered a priority in recent years. Both health commissions and psychiatrists need to know the numbers of patients that they are responsible for and whether their needs are being met. The appropriateness of placement was used as the measure of need for this study.
Antipsychotic medication in learning disability Impact of audit and evidence-based medicine on quality of prescribing in a community assessment treatment unit
Authors: Cooray Sherva E. , Tolmac Jovanka
Published: October 2008

Aims and method

Antipsychotic medication, an effective treatment modality in the management of psychiatric/behaviour disorders in people with learning disability, is often criticised because of poor clinical practice. Rational and judicious use, subject to evidence-based guidelines and systematic monitoring, is mandatory. A five-year clinical audit programme on the quality of prescribing for this clientele was undertaken.

Results

Significant quality improvement with minimal resource consumption was demonstrated.

Clinical implications

Clinical audit facilitates high-quality prescribing: pragmatic and economic, it can easily be integrated into routine clinical practice.
Investigation of depot neuroleptic injection site reactions
Authors: Jones Julie C. , Day Jennifer C. , Taylor John R. , Thomas Christopher S.
Published: October 2008

Aims and method

A cross-sectional survey was performed on 318 patients receiving depot medication. The presence or absence of a depot site reaction was recorded by psychiatric nursing staff on a standardised form.

Results

Seventeen per cent of patients were found to have clinically significant depot site reactions. Such reactions were associated with increased frequency of injection and increased total volume of depot administered in the previous 12 months. The severity of a depot site reaction was unrelated to the concentration of depot preparation administered.

Clinical implications

Depot site reactions may be reduced by maximising the interval between injections and using low volume (highly concentrated) preparations of depot neuroleptic medication.
Old age psychiatrists' views on continuing in-patient care
Authors: Wattis John , Macdonald Andrew , Newton Paul
Published: October 2008

Aims and methods

The aim of this study was to elicit views from UK consultants in old age psychiatry concerning changes that were taking place in long-term care for older people with mental illness (especially dementia) and their views on a draft consensus statement produced by the Faculty for Psychiatry of Old Age on behalf of the College. A postal questionnaire was circulated as part of a wider survey of 472 consultants and a single postal reminder was sent to non-responders.

Results

Two hundred and forty-two (51%) consultants responded. Nearly nine out of 10 respondents were in favour of continuing NHS consultant-supervised long-stay beds and three-quarters of them preferred a return to national numerical guidelines for bed numbers, though at a level approximately half of previous guidelines and provision. This was accompanied by a view that such beds should no longer be ‘for life’ with over three-quarters of respondents supporting discharge if, for example, behaviour problems resolved. If Government policy continued to support ‘eligibility criteria’ rather than guidelines, 60% were in favour of national rather than local criteria. There was very strong support for the draft consensus statement (now published in modified form as College Policy) and the ‘eligibility criteria’ it contained. Agreed criteria for waiting times in acute beds for continuing NHS, nursing home or residential care were not widely used.

Clinical implications

Consultants want to continue to be responsible for some longer-term care and efforts should be made to develop the role of NHS longer-term care within the 'spectrum of services' provided for older people with psychiatric disorder, perhaps by acting as local ‘centres of excellence’ in dementia care as well as by providing services for patients with the more difficult behavioural problems. The more widespread use of ‘agreed waiting times' for patients in acute beds requiring longer-term care should be explored.
Practical training in the administration of ECT
Authors: Barnes Richard , Kingsley David
Published: October 2008

Aims and method

Electroconvulsive therapy (ECT) Is widely used In Britain and in most cases is administered by junior doctors. Many are inexperienced in its administration and the variety of machines available makes acquiring experience difficult. This report discusses a unique training programme involving a specially constructed ‘dummy patient’.

Results

This allows trainees to experience the practical administration of ECT and also learn in detail about the working of the ECT machine and the interpretation of electroencephalograms prior to giving treatment to patients.

Clinical implications

We believe this training device will have a significant positive effect on the way junior doctors are trained in ECT.
Psychiatric training and the Caiman reforms Survey of third year senior house officers
Authors: McCallum Seonaid , McGilvray Lisa , Bennie Peter , Whyte Sue
Published: October 2008

Aims and method

All third year senior house officers (SHOs) training in psychiatry in Scotland were canvassed by a postal questionnaire. They were asked about their views on training and the impact of the Caiman reforms in psychiatry.

Results

Results showed that 33% of trainees were not receiving one hour of consultant supervision per week. The quality of teaching in day release programmes was rated as average or poor by 75%. Three-quarters had not seen a copy of A Guide to Specialist Registrar Training, but had a good knowledge of the changes it proposed. Most were satisfied with their clinical training but expressed concerns about the Caiman reforms.

Clinical implications

The loss of the registrar grade has extended the time trainees spend as SHOs and there was concern that there would be a loss of breadth of training. We intend to repeat the survey in mid–1999, by which time the Caiman changes should be fully operational in psychiatry.
Hidden high-dose antipsychotic prescribing: effects of p.r.n. doses
Authors: Milton John , Lawton John , Smith Mark , Buckley Ann
Published: October 2008

Aims and method

The Royal College of Psychiatrists' Consensus Statement on “The use of high-dose antipsychotic medication’ suggests only fully qualified psychiatrists (MRCPsych) should recommend the prescribing of high-dose antipsychotic treatment. We observed changes in anti-psychotic prescribing in two surveys of psychiatric in-patients conducted eight and 32 months after publication of the Consensus Statement.

Results

Overall mean chlorpromazine equivalent doses of antipsychotic drugs reduced between the surveys. When p.r.n. (as required) prescribing (usually done by junior doctors) is included, mean potential doses and numbers of patients who might receive ‘high-doses' increases substantially, although the reduction between surveys in total mean dose and proportion of patients on high-dose antipsychotic medication is preserved, and the actual use of p.r.n. medication was low (4–5% of p.r.n. prescriptions).

Clinical implications

We recommend the development of local guidelines for junior staff concerning antipsychotic drug prescribing, regular monitoring of p.r.n. medication by consultants, and pharmacists' involvement in reviews of patients prescribed high-dose antipsychotic medication.
Prescriptions, licences and evidence
Authors: Healy David , Nutt David
Published: October 2008

Aims and method

There is considerable confusion at present among clinicians as regards the appropriateness of prescribing off-licence. Because of the nature of the registration process it is likely that a considerable proportion of prescribing will always be off-licence. This paper seeks to clarify when it is appropriate to prescribe off-licence. We convened a workshop on behalf of the British Association for Psychopharmacology involving clinicians and regulators from a variety of countries to explore this issue both generally and for specific childhood and learning disability clinical situations. Recent statements from the defence unions and consumer groups were also scrutinised.

Results

Across senior clinicians and regulators from a number of European countries and North America there is a consensus that prescribing off-licence is a necessary part of the art of medicine.

Clinical implications

Current advice to clinicians on the issue of off-licence prescribing can sometimes overemphasise the hazards and neglect the benefits that may stem from appropriate off-licence prescribing. Good prescribing involves specifying treatment goals and monitoring outcomes and it is more important to share this with the patient than it is to communicate the licensed status of the drug being prescribed.
Use of antipsychotics by child and adolescent psychiatrists
Authors: Slaveska Karmen , Hollis Chris , Bramble David
Published: October 2008

Aims and methods

A postal questionnaire of Trent Region's consultant child and adolescent psychiatrists was used to investigate the two-year period prevalence rates of antipsychotic medication prescription, and the ICD–10 psychiatric disorders it was used to treat.

Results

The response rate was good (92.3%) and 78% of respondents had prescribed antipsychotic medication for a range of conditions over the period, albeit very infrequently. Antipsychotics were used for a range of psychotic and non-psychotic disorders. The older antipsychotic agents (thioridazine, chlorpromazine and haloperidol) comprised the bulk of prescriptions. Newer, atypical, antipsychotics were prescribed only four times over the period and no patients in residential in-patient units received this form of treatment.

Clinical implications

These results highlight a pressing need to address antipsychotic prescribing in children and adolescents and, especially, the role of new antipsychotic drugs.
Changes in practice of ECT: a follow-on study
Authors: Trezise Kate
Published: October 2008

Aims and method

A retrospective case note study examining the effects of increased supervision on practice of electroconvulsive therapy (ECT).

Results

Increasing the level of supervision of ECT sessions was associated with patients receiving on average almost two fewer treatment applications per course of ECT.

Clinical implications

The risk of treatment is reduced because patients receive fewer anaesthetics, and they may be discharged home sooner. Such improvements in ECT practice should be relatively easily achievable in many ECT clinics.
Appraisal of meta-analysis
Authors: Chakraborty Apu , Warner James P. , Blizard Robert
Published: October 2008

Aims and method

Prompted by a clinical question, we critically appraised a meta-analysis of neuroimaging in our evidence-based journal club.

Results

The results of the meta-analysis suggested differences in ventricular size and sulcal width between controls and people with schizophrenia and mood disorders. However, we were unable to answer the question that prompted this exercise.

Clinical implications

Although the evidence-based medicine approach facilitates appraisal of complex articles, some clinical questions are not yet answerable.
Mental health review tribunals
Authors: Muth Zena
Published: October 2008

The power and responsibility of mental health review tribunals are set out in section 65 et seq. of Part V of the Mental Health Act 1983. Tribunals are independent judicial bodies which were first established under the Mental Health Act 1959. They are charged, when requested, with reviewing the cases of patients compulsorily detained under the provisions of that legislation.
Assessment of psychiatric teaching: examining examinations
Authors: Livingston Gill , Cox Stuart , Katona Cornelius , Robertson Mary
Published: October 2008

Aims and method

The study set out to consider whether the ‘end-of-firm’ examination in psychiatry fulfils its goals by examining the internal consistency of the end-of-firm examination and final medical board examination and the correlation between these examinations' scores and sub-scores. Students who failed their end-of-firm examination were followed to monitor their progress at final medical board examinations.

Results

One hundred and eighty students sat end-of-firm examinations and final medical board examinations. All the components of the end-of-firm examinations and the final correlated significantly with the total mark. The psychiatric essay was less well correlated with the final mark but correlated well with total essay marks. Students who failed their end-of-firm psychiatry examination at first attempt received extra tuition and only two failed finals.

Clinical implications

Essay writing ability may not carry over into high performance in other areas tested and may be a test of other skills. Extra tuition benefited failing students whose results fell outside the pattern of prediction. Thus the end-of-firm examination may be a useful tool if acted on to prevent student failure.
Twenty-eight years of liaison psychiatry at a general hospital
Authors: Carson A. J. , Dawson H. , Marshall D. , Stafford K.
Published: October 2008

Aims and method

A questionnaire was used to measure physician satisfaction with the unit and comparison of referral numbers and diagnoses with 1967, when the unit was new, and in 1985 when it was re-audited.

Results

Despite physicians' satisfaction with the service, the referral rate remains unchanged.

Clinical implications

Liaison psychiatry should not concern itself with trying to increase referral rates. Research into patient outcome should be a priority and guide its future direction.
Psychiatric training in Italy
Authors: Whitney Lucia , Bruce Janet
Published: October 2008

We visited Italy in 1995 as part of a National Health Service management learning network. We visited Florence, Prato and Arezzo in Tuscany; before moving on to Rome and Milan. L.W. had completed psychiatric specialist training in Italy, prior to doing so in England.
Audit cycle on young people presenting with self-harm
Authors: Lockhart Elaine
Published: October 2008

The first part of this audit looked at the demographics of young people presenting to Monklands Hospital and the quality of their assessment. Precipitating factors and past psychiatric history were enquired of in the majority of cases but there was a dearth of information regarding alcohol/drug use and family history. A checklist was devised with the aim of improving the quality of these assessments. The second part of the audit cycle completed one year later revealed considerable improvement in all categories. It is hoped that this will be maintained by displaying the checklist in the accident and emergency department and continuing to include teaching about this vulnerable population to all new medical and nursing staff.
Research by senior registrars in psychiatry
Authors: Williams Christopher J. , Curran Stephen
Published: October 2008

All higher trainees in psychiatry are required to spend one day a week in research or further study. A cross-sectional postal survey was used to investigate how senior registrars use their allocated research time, and to identify specific difficulties that prevent successful research being carried out. The instigation of the specialist registrar grade offers the chance to improve trainees' involvement in research. This has implications for the design and implementation of postgraduate teaching on research in psychiatry.
Training and employment in New Zealand
Authors: Kisely Steve
Published: October 2008

This article is one of a series dealing with training and employment in countries overseas, previous articles have covered Australia (Kisely, 1993) and Canada (Kisely & Jones, 1996). This paper updates an earlier report on New Zealand which was published five years ago (Timney, 1991). In particular it highlights important recent changes to registration procedures which will affect doctors wishing to go to New Zealand, for either temporary work experience or permanent settlement.
Climbing Mount Everest: tackling the media at a regional level
Authors: Harrison Tom
Published: October 2008

Regional Public Education Officers of the Royal College of Psychiatrists are strategically placed to influence and improve the coverage of mental health issues in the media. Their role needs to be enhanced and clarified, and a proposal is being put forward in the College to achieve this. One possible way of working locally is illustrated through the work of West Midlands Insight, which demonstrates the value of working with a wide group of people, including those who have experienced mental ill health.
Weapon carrying: an important part of risk assessment
Authors: Perry David W. , Cormack Irene D. , Campbell Colin , Reed Alison
Published: October 2008

Over the past 20 years, with the closure of psychiatric hospitals, there has been a greater emphasis on treatment of the seriously mentally ill in the community. Recently, there have been untoward incidents involving psychiatric patients leading to increasing public concern over this policy. Steps to reduce this concern have included the care programme approach, the supervision register and the community supervision order. Each requires some form of risk assessment to be carried out prior to their implementation, although there is little guidance on what areas should be covered.
Tattoos, scars, body adornment and dishevelment in an acute psychiatric population
Authors: Williams Kelwyn
Published: October 2008

Ninety-six successive acute psychiatric admissions were assessed with regard to dress, level of hygiene, the presence of tattoos, bodily piercing/decoration and surface marks of self-harm. These features were also examined in relation to ICD–10 category diagnosis. One-third were described as ‘dishevelled’, 21% ‘unclean’, 7% had multiple pierced ears and 3% other pierced body parts. Sixteen per cent had tattoos, rising to 34% in the F10–19 (substance misuse) category, and 15% had scars of self-harm. People with schizophrenia and related disorders were more likely to present in an unclean state. Those with personality disorders were no more likely to bear the scars of self-harm, tattoos or body piercing.
Genetics of human behaviour
Authors: Moncrieff Joanna
Published: October 2008

Ascribing human behaviour to the influence of genetic factors is a reductionist idea that inappropriately applies the explanations of physical science to the human social world. The result is that the designation of some behaviour as deviant is disguised as objective science. The high profile of genetic research means that we must be alert to the potential social consequences of this type of reasoning.
Implementing psychotherapy guidelines: putting a logbook into practice
Authors: Maloney Chris
Published: October 2008

The integration of medical/‘biologial’ and psychological approaches to the human mind is unique to psychiatric training. There have been past tensions between the two views, but the ability to integrate them is increasingly recognised as an indispensable contribution of our profession to mental health care as a whole.
Psychiatric involvement in an Edinburgh hospice
Authors: Mitchell John R.
Published: October 2008

Palliative care is a growing speciality. The terminally ill suffer high levels of psychiatric morbidity. The involvement of one senior registrar in setting up a liaison psychiatry service to a Marie Curie Hospice in special interest sessions is described. A liaison-consultation model developed and 29 referrals are described over six months.
Consultation—liaison in an old age psychiatry service
Authors: Loane Ruth , Jefferys Peter
Published: October 2008

This retrospective study looks at the outcome of 71 consecutive liaison referrals. Placement was noted at three-month follow-up and further use of medical, psychiatric and social services, compliance with clinical management and recommendations was also measured. Nearly half the patients had dementia and about half had a functional disorder. In 90% of referrals the recommendations were followed. At three-month follow-up 17% had died, 26% had further medical hospital admission, 39% had moved into a continuing care facility (residential/nursing home), and over half had further contact with the old age psychiatry services.
Opiate users' views on decriminalisation of drug use
Authors: Ahmed A. G. , Salib Emad
Published: October 2008

In this study we explored the views of 245 opiate users attending a regional drug dependency unit about decriminalisation of drug use and their perception of the consequences of free availability on themselves and society. Contrary to expectation, opiate dependent individuals were not in support of decriminalisation but favoured controlled availability.
How nurses' attire affects elderly psychiatric patients' ability to recognise them
Authors: McCreedy Hugh Joseph , Bentham Peter William
Published: October 2008

The ability of elderly patients to identify a nurse wearing a uniform as opposed to mufti was investigated together with the effect of administrator attire on the Abbreviated Mental Test score (AMT). Thirty-six out of 71 patients identified a nurse wearing mufti increasing to 59/71 when wearing uniform (P < 0.005). Patients rated by a uniformed nurse had significantly higher mean AMT scores (6.1) than when rated by a nurse in mufti (5.6) (P < 0.01), and this also had a significant effect on the sensitivity in predicting an organic diagnosis.
Drug treatment of personality disorder
Authors: Tyrer Peter
Published: October 2008

For many involved in the management of people with personality disorders the title of this article may appear to be a contradiction; drugs may alter mental state but intrinsically seem unlikely to alter personality. Nevertheless, drugs are available for treating personality disorders (even though none of them are licensed for these conditions). So it is hardly surprising that there is now a considerable body of literature on the subject which has recently been extensively reviewed (Stein, 1992) but which has attracted more attention since personality disorders have achieved greater prominence in all parts of psychiatric practice.
Contemporary community psychiatry
Authors: Cox John L.
Published: October 2008

When invited to give the Maxwell Jones lecture as part of the Fiftieth Anniversary Celebrations of the Henderson Hospital I was pleased and honoured, as well as somewhat surprised. I welcomed the opportunity to pay tribute to an outstanding social psychiatrist and to reflect on a decade of turbulent change within mental health services.
Development of liaison psychiatry
Authors: Guthrie E.
Published: October 2008

A survey was undertaken to establish the current state of liaison psychiatry in England, Scotland and Wales. Eighty-six consultants were identified who carry out specific work in liaison psychiatry, 43 of these consultants hold either full-time or half-time posts in liaison. Sixteen new posts in liaison (full-time equivalent (FTE) or half-time equivalent (HTE)) have been created in the past two years. Half of these were entirely new posts and half have been created by consultants already in a general psychiatry post renegotiating their contracts. Some specialist registrar schemes have no training slots in liaison psychiatry and others have training slots in liaison psychiatry which are supervised by a trainer who is not in a FTE/HTE liaison post. A national database is required to track expansion in liaison psychiatry and training at specialist registrar level needs to be developed.
Gloucester Clozapine Clinic
Authors: Macpherson Rob , Sarkar Sarbani Prasad , Medina-Galera Juan L. , Anstee Bryan
Published: October 2008

Twenty-four patients in the Gloucester rehabilitation service were considered suitable for clozapine treatment between January 1993 and May 1996. Five patients consistently refused to start clozapine and four patients (21%) discontinued clozapine, usually due to side-effects. Eight patients showed ‘some positive response’ and seven ‘good positive response’, of the 15 still taking clozapine. High rates of side-effects, but low readmission rates were found in this group. Putative reasons for the low discontinuation rates and apparent success of clozapine treatment in Gloucester include the wide experience engendered in the single consultant-led rehabilitation team, and the better coordinated, uniform approach to managing problems through the Clozapine Clinic.
Senile squalor: Plyushkin's not Diogenes' syndrome
Authors: Cybulska E.
Published: October 2008

Some names appear to stick to syndromes or diseases like a proverbial glue, regardless of their total inappropriateness. Gross self-neglect in old age characterised by domestic squalor, social withdrawal, apathy, tendency to hoard rubbish (syllogomania) and a lack of shame was originally reported by Macmillan & Shaw in 1966 and subsequently ‘christened’ by Clark et al as Diogenes∗ syndrome in 1975. Post (1982) preferred the term ‘senile recluse’ and argued that this is not a syndrome but merely an end stage of personality disorder. It was usually extremely difficult to help these patients, as one's care and goodwill often met with hostility and blunt refusal to cooperate (Cybulska & Rucinski, 1986). More recent studies, however, have shown a strong association of this condition with frontal lobe dysfunction (Orrell & Sahakian, 1991), thus giving a psychiatrist of old age a somewhat firmer basis for action.
The Bellelli family
Authors: Shillitoe R. W.
Published: October 2008

Edgar Degas (1834–1917) is perhaps best remembered for his pictures of women bathing and of ballet dancers. The awkward posing, the physical unattractiveness and the voyeuristic viewpoints that are characteristics of many of his later works have given him a reputation for misogyny. A lesser known aspect of Degas' work concerns portraiture. In the earlier part of his career he painted many portraits of his family and friends which are remarkable for their psychological insights as well as their technical and compositional mastery. One of the finest is the portrait of the Bellelli family which he started in Florence in 1858 and appears to have worked on intermittently until 1867. Its large size (200 x 250 cm), the length of time in execution and the number of preparatory studies all point to its significance in the artist's eyes. Despite this, scholars doubt that it was ever exhibited during Degas∗ lifetime and was discovered with considerable surprise in his studio following his death (Boggs, 1994).
How to appraise an article on therapy
Authors: Warner James P. , Blizard Robert
Published: October 2008

This first of a series of articles intended to guide clinicians through the evidence-based process assesses the published evidence for drug therapy in Alzheimer's disease. A Medline search identified a randomised, controlled trial of donepezil. Although this trial appeared to have a reasonably sound methodology, we had some doubts about the treatment effect and applicability of the results.
So who wants to be a consultant general psychiatrist
Authors: Milton John
Published: October 2008

This study addresses the perception among senior trainees that the lot of a consultant general psychiatrist is currently not a happy one and that transition from training to consultant grade can be difficult. Reasons for this are explored and alternatives suggested that might make the move from senior/ specialist registrar to consultant general psychiatrist a more rewarding and attractive proposition.
Irish psychiatric absconders: characteristics and outcome
Authors: Walsh Elizabeth , Rooney Siobhán , Sloan Darina , McCauley Patricia , Mulvaney Fiona , O'Callaghan Eadbhard , Larkin Conal
Published: October 2008

Absconding constitutes a significant clinical problem, leading to high levels of anxiety among staff. Ninety-five psychiatric in-patients who absconded from an Irish hospital over a period of 12 months were reviewed retrospectively. Absconders were significantly more likely to be single and compulsorily detained with a diagnosis of schizophrenia or personality disorder when compared to the remaining hospital population for that year. Common destinations included the public house and home, with most returning of their own volition within 24 hours. The rates of self-harm and violence against others are recorded.
Role of commissioners in promoting clinical effectiveness in everyday psychiatric practice
Authors: Hargreaves Sally
Published: October 2008

In a nutshell, commissioners (i.e. health authorities) have a statutory responsibility to buy the best health care for a defined population with a defined amount of money. They also have a broader, but less well-defined, responsibility for health, as opposed to health care. There is no doubt that health care has a relatively small influence on health compared with deprivation, housing and unemployment, but in reality the majority of effort of commissioners focuses on health care.