bluuebunny/crossref_metadata_2025 huggingface dataset:
Re-evaluation of the role of trainee psychiatrists in secluding general adult psychiatric patients
Authors: Okhai M. F. , McLaren P. M.
Published: October 2008

The seclusion of general adult psychiatric patients is still a common nursing Intervention of questionable therapeutic benefit. It is often initiated as a last resort to maintain safety where there are staff shortages. Historically concerns over the abuse of this procedure led to the Involvement of medical staff to oversee or monitor the procedure and this practice has become fossilised in the seclusion policies of many trusts. This paper argues that the routine involvement of trainee psychiatrists in this procedure, for which they are rarely trained, is archaic, impairs inter-professional relationships and should be regarded as an inappropriate duty.
Dioclein – a new drug from an old plant
Authors: Dunn John
Published: October 2008

Preservation of the world's rainforests and other natural habitats can be argued for from several points of view. Maintaining biodiversity and preventing the ‘greenhouse effect’ are two commonly stated objectives. A less altruistic reason is that many of the floral species in such habitats remain unstudied and could yield new and important drugs to treat human diseases. Many of the drugs we use today are derived from plants or are their synthetic derivatives.
Child and adolescent self-poisoning: service-related characteristics
Authors: Nasr Ashraf , Vostanis Panos , Winkley Linda
Published: October 2008

This study presents the pattern of assessment and 6-month out-patient attendance of 54 children and adolescents who took an overdose over a 12-month period, and were assessed by a district child and adolescent psychiatry service. Attempts were precipitated by arguments (67%) or school-related stressors (19%). In 70.4% of cases, analgesic tablets were used. A psychiatric disorder was present in 51% of the cases. At 6 months, 13% of the patients were still attending for follow-up, while three children (5.5%) had taken a second overdose. Admission to a paediatric ward can facilitate the initiation of treatment. Child mental health services should aim at providing prompt assessment, good communication with other agencies, and follow-up arrangements, particularly with high-risk young people and their families
Safety and security: a survey of female psychiatric in-patients
Authors: Barlow Fiona , Wolfson Paul
Published: October 2008

Fifty-three female in-patients of a psychiatric hospital were interviewed to obtain their views on their own safety and security, and what improvements they would recommend. Most had experienced sexual harassment and a few had been victims of sexual assault. There was a reluctance to report incidents to staff. The majority felt that female-only wards would improve safety. Other recommendations included higher staffing levels, more staff awareness and vigilance, and single rooms with curtains on the doors.
A visits programme for forensic senior registrars
Authors: Akinkunmi Akintunde
Published: October 2008

As part of the academic programme for senior registrars in forensic psychiatry working in the North Thames Region, a series of visits to outside institutions of special relevance was organised. These visits form part of a larger academic programme which includes consultant tutorials, journal clubs and case conferences. Between May 1995 and October 1996 the author was the senior registrar in charge of organising the programme and this report is intended to share the experiences gained in visiting these other institutions.
The assessment and management of risk in psychiatry: can we do better?
Authors: Holloway Frank
Published: October 2008

This is the final contribution to a five part series on risk in psychiatry. Bowden (1997) has cast a bleak eye on the realities of making risk decisions about difficult and dangerous patients, identifying the essential subjectivity of these decisions and the cognitive distortions that psychiatrists can undergo to make them apparently easier; distortions that can blind the clinician to impending disaster. Morgan (1997) emphasised the limitations of a simplistic ‘risk factor’ approach to the management of potentially suicidal patients, concluding that the priority is the refinement of our basic clinical skills (and by implication deployment of successful treatments for our patients' illnesses). Prins (1997) analysed the particular difficulties faced by mental health review tribunals hearing the cases of Restricted patients. The perhaps unsurprising conclusion is that tribunals make bad decisions when presented with inadequate information (which begs the question why not adjourn and seek the information required before proceeding?). Roy (1997) has addressed a range of risks faced by Trusts and the clinicians who work for them. There is a clear demand that Trusts develop risk management strategies: of necessity these strategies will discourage inherently risky behaviour such as inadequate staffing of in-patient units and the devolution of inappropriate levels of responsibility to staff who are inadequately trained or supported.
Paediatrics in child and adolescent psychiatric training
Authors: Bradley Oonagh
Published: October 2008

The experience of a paediatric placement is described. Difficulties encountered mirror those experienced in liasion child psychiatry and the basis for this is dicussed. Early collaboration during specialist training of paediatricians and child psychiatrists can enhance the working relationships between the disciplines and the clinical skills of both.
Mental illness in Goa, India
Authors: Patel Vikram
Published: October 2008

While waiting for a delayed departure at Goa airport recently, I engaged in conversation with a fellow frustrated passenger who happened to be an American tourist. Upon discovering that I had spent eight months in Goa initiating a field study on common mental disorders in primary care clinics, she expressed amazement exclaiming “but surely there can't be mental problems in this place… it's so beautiful and everyone seems so happy!”. After a brief moment wondering whether my companion was joking, I realised that my work in Goa could in itself seem a bit of a joke to colleagues and friends who associated Goa with being a holiday destination. Not only is the view that living in an apparent paradise is somehow conducive to better mental health a smokescreen, I had come to realise that mental illness was a considerable problem in this coastal state. Perhaps this essay could be an opportunity to explain why.
Child abuse and neglect in sub-Saharan Africa
Authors: Famuyiwa O. O.
Published: October 2008

Child abuse could be defined from predominantly legal, clinical and research perspectives, and attempts at an integrative enunciation are fraught with over-inclusiveness. Meadow (1989) proposed that a child is considered to be abused if he or she is treated by an adult in a way that is unacceptable in a given culture at a given time. This definition usefully incorporates the essential issues including secularity and diversity of socio-cultural norms which often create controversy in case detection and are particularly relevant to the debate.
Injecting some audit into substance misuse services
Authors: Baxter Beelin , Green Stephen , Williams Olwen , Caan Woody
Published: October 2008

The former East Anglia Regional Health Authority initiated a 3-year project beginning in 1993. This aimed to introduce audit skills and to promote sustained audit activity across a diverse group of statutory and independent sector drug and alcohol agencies. Prior to this there had been little interest in audit for this area of care and no good models of practice were available from elsewhere in the NHS which could readily be adapted to the needs of the Anglian services. Eventually 24 agencies collaborated in this project, which introduced a system of reciprocal peer audit between the agencies which was supported by a dedicated facilitator, a programme of auditor training, and an Agency Audit Representative Group to prioritise topics for audit and to agree common standards. Progress was very slow to begin with. By May 1995, 12 agencies had completed an initial audit of 2–4 topics each from a regional menu of 12 priorities. One year later, 12 more services have undertaken such an initial audit and nine out of the original dozen (75%) have completed their first ‘audit cycle’ with a re-audit of the same topics. There has been an increase in the number of agencies meeting all the standards in their chosen topics, and in the number of topics where all standards are met, wherever those topics have been audited. Two new practice guidelines have also been developed by the agency representatives.
Psychiatric trainees' research experiences and activities in the Eastern region of Ireland
Authors: Quinn John , Meagher David
Published: October 2008

A questionnaire addressing various aspects of research activity was administered to 172 trainees in the Eastern region of Ireland. An 80% (n=138) response rate was achieved. While 98% of trainees regarded research activity as important, almost half rated their research opportunities as poor. The commonest reasons cited for doing research included c.v. enhancement, personal interest and consultant pressure. The most frequently reported problems in doing research were time allocation, funding and adequate supervision.
The psychiatrist, the patient, their relationship and the movies
Authors: Atkinson Jacqueline M.
Published: October 2008

Diagnosing a man who has travelled back from the future and who, in the present, speaks of the future as the past causes no problems: paranoid schizophrenia. Thus is Bruce Willis misunderstood in Twelve Monkeys (1995). Neither this, nor Brad Pitt as a patient with schizophrenia should distract us; once more we have a film in which a psychiatrist develops a dubious relationship with a patient. Despite evidence of the destructive impact on patients (Russell, 1993; Jehu, 1994), in films it has become almost normal.
Professional attitudes in the UK towards neuroleptic maintenance therapy in schizophrenia
Authors: Johnson D. A. W. , Rasmussen J. G. C.
Published: October 2008

Controlled trials show that about 80% of schizophrenic patients remain relapse free when given adequate neuroleptic maintenance therapy but this level of efficacy is not achieved in clinical practice. Guidelines for proper use of neuroleptics in relapse prevention were developed by a group of experienced psychiatrists – the ‘Consensus Group’ – in 1989. In this survey, the views of UK psychiatrists, GPs, CPNs and pharmacists involved in community care of schizophrenia were compared with the Guidelines.
Antipsychotic prescribing in light of the consensus statement of the College
Authors: Newton K. L. , Murthy R. , Qureshi J.
Published: October 2008

A retrospective survey was undertaken to evaluate the prescribing practices of medical staff in a District General Hospital in light of theConsensus Statementby the Royal College of Psychiatrists on the use of high dose antipsychotics (1993). Two per cent of 247 patients were prescribed a higher than recommended dose of antipsychotic. None of these cases had been prescribed ‘supra-BNFdoses of antipsychotic on a regular basis, but with the addition of ‘as required’ (PRN) medication the recommended dose was exceeded. In only one patient was the high dosage administered. A further analysis of these patients is made.
Community psychiatry in the RAF: an evaluative review
Authors: Hughes Julian C.
Published: October 2008

This paper offers a descriptive survey of RAF community psychiatry. It shows that most of the morbidity encountered in the community now served by RAF psychiatrists is at the ‘minor’ end of the psychiatric spectrum. It mostly requires supportive psychotherapy and the key worker is often the community psychiatric nurse. The study allows discussion of four related issues: the essential nature of military psychiatry; the future provision of community psychiatry to the RAF; psychiatric training and continuing professional development in the RAF; and the possibility of research.
Tardive dyskinesia – how is it prevented and treated?
Authors: Duncan Denise , McConnell Harry , Taylor David
Published: October 2008

Tardive dyskinesia (TD), literally meaning a late occurring, abnormal movement disorder, was first described by Schonecker in 1957, about five years after the discovery of chlorpromazine (cited in Kane, 1992). TD generally occurs after long-term antipsychotic therapy: Kane et al (1984) reported that the incidence was increased with each subsequent year of exposure to antipsychotics, starting with an incidence of 5% after one year of exposure and increasing by 5% each subsequent year. Certainly, the prevalence of TD has increased over the last 20 years, probably as the result of more patients being exposed to antipsychotics for longer periods.
An audit of drug management of acute behavioural disturbance
Authors: Robling Siri-Ann , Flynn Tom , Hunt Neil , Gregory Carol , McBreen Marie
Published: October 2008

The management of acute behavioural disturbance in psychiatric patients is an area that continues to require investigation, as it is potentially dangerous for both patients and staff. We conducted an audit of the management of these episodes, looking particularly at the drugs given, the doses and any polypharmacy. We also examined whether the issue of guidelines led to any changes in prescribing patterns. We found that we were prescribing appropriately and that the guidelines did lead to some shift toward safer prescribing.
Audit of out-patients on ‘higher dose’ antipsychotics
Authors: Taylor John R. , Cookson Ian B.
Published: October 2008

Standards developed from the Royal College of Psychiatrists' consensus statement on the use of high-dose antipsychotics were audited. The baseline survey and two completed audit cycles are described showing improvement in the monitoring and management of out-patients on higher dose depot antipsychotics. Initially the main problem was poor attendance at hospital appointments. Practice was changed by (a) medical staff becoming more assertive and visiting non-attenders at home; (b) a phlebotomist visiting patients at home. Deinstitutionalisation has relocated many patients with chronic psychoses into the community, but services, including the ancillary services, have sometimes been slow to follow. This audit found that the most effective change was the provision of services to patients in their own home.
Using the media during Mental Health Week
Authors: Kay Rob , Martin Barbara , Kelly Doreen , Stark Cameron
Published: October 2008

The mass media is an important source of public information on mental health issues. A two-page insert in 11 local Ayrshire newspapers was purchased to coincide with the Mental Health Weeks in 1994 and 1995. Using a quota sampling technique, 379 adults were questioned on their views and recollection of the insert in 1994, and a further 365 in 1995. It had been seen by 27% of 1994 respondents, and by 22% in 1995. Of these, 80% in each sample had read at least part. Local details were best remembered, and information on the nature of mental illness was regarded as the most helpful part of the insert. The newspaper articles provided a way of contacting a substantial proportion of the adult population of the area.
Impact on women who care for those with schizophrenia
Authors: Scazufca Marcia , Kuipers Elizabeth
Published: October 2008

This study examined the impact of caring on women who were primary care-givers to those with schizophrenia. From the 46 women and 21 men carers assessed for the study, women were considered primary care-givers more often than men (83% v. 57%). Higher levels of burden among women primary carers were associated with living with patients, and more hours in contact with them. Worse perception of patients' social functioning was associated with higher levels of burden. The findings of the study showed that women primary carers have particular needs, and services should consider how to provide support for them in their multiple roles, and over longer periods of time.
Counselling and support services for civil emergencies and major incidents
Authors: Nightingale Anne , Smith George , Scott David
Published: October 2008

Across the UK counselling and support services are being developed as an extension of emergency planning for major incidents, with the aim of offering psychological help in the immediate aftermath of a disaster. In Strathclyde, Social Work and Mental Health Services Jointly established Liaison Teams with the task of planning and preparing for a major incident. We describe the response of a Liaison Team to a serious bus accident and present reflections from a psychodynamic perspective on some of the factors which may bear on planning and delivery of services.
The Newcastle Clozapine Clinic
Authors: Tough Sandra L. , Wilcock Austin , White Sue , Hassanyeh Fuad
Published: October 2008

Over the six years since the introduction of clozapine to the UK, the number of people prescribed this medication and living in the community has steadily increased. Coordination of blood monitoring and dispensing of clozapine to people dispersed throughout a district can be problematic. In Newcastle-upon-Tyne a steering group of healthcare professionals was established to address this situation. The outcome was the establishment of the Newcastle Clozapine Clinic. This paper describes the development of this service, which has improved administrative efficiency and given the opportunity to develop associated new services for people in the city with enduring mental health problems.
Concerns about the children of psychiatric in-patients – what the parents say
Authors: Stormont Fiona , Craig Tom , Atakan Zerrin , Loader Peter , Williams Cindy
Published: October 2008

There is an increasing body of research literature investigating the effects of parental mental illness on children. This study investigates the views of psychiatric in-patients on consequences of their admission to hospital and their mental illness for their children. The results suggest that the parents do not readily acknowledge that their children have problems, and that interventional approaches require good liaison between adult mental health services and child-focused agencies.
Psychiatric services in Myanmar a historical perspective
Authors: Khin-Maung-Zaw
Published: October 2008

Myanmar, until recently known as Burma, is a developing nation in south-east Asia. Burmese kings and emperors ruled this land until 1885, when it fell into the hands of the British. It gained its independence in 1948. Burma has a mainly agricultural economy and has a rich fertile soil. At one stage in the post-war history Myanmar was renowned as ‘the rice bowl of the world’. It is blessed with abundant natural resources such as teak and precious stones. Myanmar covers a land area twice that of the British Isles with a population of around 42 million.
A glossary of television-related symptoms in psychosis
Authors: Smyth M. G.
Published: October 2008

Although the attribution of psychotic symptoms to the television is widespread, there is little literature on the subject and one might surmise that the issue is considered so mundane as not to merit further interest.

In so far as ‘reality’ is a critical problem in psychosis, television can constitute a particular source of confusion. ‘Reality’ can be fudged by this medium for us all, with editing, propaganda, and the spectrum of front line live reports, ‘real life’ re-enactments, and drama.
Knowledge of the Edinburgh Postnatal Depression Scale among psychiatrists and general practitioners
Authors: Aitken Peter , Jacobson Robin
Published: October 2008

The aim was to examine the impression that both general practitioners and psychiatrists have a low level of awareness and knowledge of the Edinburgh Postnatal Depression Scale (EPDS), have little experience in its use, and would not feel confident in giving advice on issues arising from its use by health visitors.
Use of high dose antipsychotic medication
Authors: Yorston Graeme , Pinney Alison
Published: October 2008

An audit of antipsychotic prescribing was carried out on community and in-patient samples. A novel method of expressing total daily antipsychotic dose as a percentage of the British National Formulary maximum recommended dose was used. Of 226 patients who had been prescribed antipsychotics, 16 (7%) were found to be on high closes. Their medical notes were examined to ascertain whether the Royal College of Psychiatrists guidelines were being followed. Recommendations on ways in which practice could be improved were made and a re-audit was carried out. The number of patients receiving high doses fell to 6 (3%) out of 206.
Patients with learning disability at Kneesworth House Hospital
Authors: Brooke Deborah
Published: October 2008

This paper reports a retrospective case note study of all patients with learning disability and challenging behaviour admitted to Kneesworth House Hospital between 1986 and 1991 (n=70), describing their demographic and clinical characteristics. The subjects had high levels of psychiatric morbidity, in addition to learning disability. Patients whose stay was relatively short, or who were discharged to community placements, were not able to be differentiated on clinical grounds, suggesting that the provision of local facilities determined the length of the admission. There is a need for more regional and sub-regional services for this group with multiple long-term problems.
Involvement of users and carers in the training of psychiatrists: making it happen
Authors: Crawford M. , Davies S.
Published: October 2008

Despite the widespread belief that the involvement of users and carers in the training of psychiatrists would provide a valuable addition to the training process, it is clear that many trainees do not receive this input as part of their current teaching. This article explores some of the questions and concerns that all those parties involved have raised and draws on the experience of users, carers and psychiatrists to address some of these issues and promote the further development of this practice.
The odd couple: the partnership of J. C. Bucknill and D. H. Tuke
Authors: Beveridge Allan
Published: October 2008

On the opening page of Daniel Hack Tuke's 1892Dictionary of Psychological Medicine, is a statement which reads:

Dedicated to John Charles Bucknill, M.D. Lond. F.R.C.P., F.R.S., Late Lord Chancellors Visitor in Lunacy, First Editor of the ‘Journal of Mental Science’, and an early and strenuous worker in the field of psychological medicine.
Substance misuse in a chronic psychosis population Prevalence and staff perceptions
Authors: Brown Steve
Published: October 2008

Aims and method

This paper describes the prevalence of substance misuse in a population with chronic psychosis and compares the results with staff estimates. Keyworkers were interviewed using validated questionnaires.

Results

The prevalence rate of substance misuse was higher than in the general population but significantly lower than staff estimates. Staff had little specific training or experience in treating substance misuse.

Clinical implications

Substance misuse is a significant problem among patients with chronic psychosis. Service providers should ensure than staff working with these patients are adequately trained in the management of this problem.
Mental health legislation is now a harmful anachronism
Authors: Szmukler George , Holloway Frank
Published: October 2008

Two recent developments have served to highlight the contradictory and discriminatory nature of UK mental health legislation, and indeed all ‘mental health’ acts. These are the Court of Appeal ruling in L. v. Bournewood (1997) and the increasing use of coercion in an attempt to alleviate society's fears of the dangers posed by the mentally ill in the community (Holloway, 1996). At the same time, a third development, the proposal for a Mental Incapacity Act, and the consequent Government Green Paper (Lord Chancellor's Department, 1997) Who Decides provides a framework rendering mental health legislation redundant.
Monitoring patients on high-dose antipsychotics
Authors: Barber Joan M. , Connaughton Jennifer , Wright Morag
Published: October 2008

Aims and method

Following the publication of the 1994 Consensus Statement on the use of high-dose antipsychotic medication, we identified our high-dose patients and undertook an audit of the recommended physical investigations. The patients were identified by scrutiny of prescription records. Data were collected retrospectively at six-monthly intervals for four audit cycles. Results were fed back to clinicians at the hospital journal club.

Results

The percentage of patients identified in the high-dose category fell from 35 to 23% over 18 months. Electrocardiograph monitoring of the group increased from 5 to 63%. Other tests showed a similar improvement. A very small number of abnormal results was shown. There were no untoward cardiac events.

Clinical implications

Introduction of the standards of physical monitoring advised in the Consensus Statement has implications of cost to the NHS to be balanced against risk avoidance for patients. The number of abnormalities detected in our population was low. Changing prescribing behaviour in response to reported abnormal findings proved unexpectedly slow and a new system was required.
Proposed change in service delivery and stress among nursing staff
Authors: Shah Ajit , De Tamal
Published: October 2008

Aims and method

The impact of major organisational change in a psychogeriatric service was examined in a naturalistic and opportunistic study, which was prospectively conducted.

Results

A positive association between the organisational change of the proposed closure and relocation of a psychogeriatric ward and stress among the nursing staff as measured by the General Health Questionnaire was demonstrated.

Clinical implications

Policy-makers, purchasers and providers need to consider the implication of such stress and develop strategies to minimise stress prior to any major policy change.
Influence of mailing strategies on response to questionnaires
Authors: Newton Kate , Stein Samuel M. , Lucey Clare
Published: October 2008

Aims and method

A prospective study was undertaken to evaluate the effect of a stamped addressed envelope, as compared to a non-stamped but addressed envelope or no envelope, on response to a mailed questionnaire. The correlation between questionnaire response and subsequent attendance at the first appointment was also studied.

Results

The overall response rate was 26% of 176 families offered first appointments at a local child psychiatry service. Families provided with a stamped addressed envelope were more likely to return their questionnaire and those families who returned the questionnaire were more likely to attend their first appointment.

Clinical implications

The return of patient questionnaires has significant clinical and resource implications. Only essential questionnaires should be sent out to referred families as nearly three-quarters will not be returned. The return rate can be enhanced by providing a stamped addressed envelope but, if questionnaires are not returned within 10 days, the likelihood of return is minimal. As more than half of the families who failed to return the questionnaire also failed to attend their first appointment, questionnaires can be used as a measure of motivation and likelihood of attendance as well as a source of clinical information.
New drugs and the NHS: square pegs and a round hole
Authors: Taylor David
Published: October 2008

Drug development in psychiatry has famously been something of a stop–start process. First, there were no truly effective psychotherapeutic agents, then, in the 1950s, phenothiazines, monoamine oxidase inhibitors and tricyclics all appeared in the space of a few years. Then, virtually nothing: no substantial developments for 25 years. In the mid–1980s the first selective serotonin reuptake inhibitors appeared, heralding a new era in psychopharmacology. Then, in 1990 clozapine was re-introduced, to be followed by other atypical antipsychotics and by drugs such as donepezil and acamprosate for entirely new indications. In addition, research into antidepressant therapy has produced new agents with varied modes of action and new strategies for the treatment of refractory depression.
Survey of community mental health teams
Authors: Mauthner Natasha , Naji Simon , Mollison Jill
Published: October 2008

Aims and method

The aim of the study was to describe community mental health teams (CMHTs) working In Scotland. Interviews, a focus group, and a postal questionnaire survey of Identified CMHTs were carried out.

Results

Of the 53 teams identified, 42 (79%) completed questionnaires. The average team size was 11 people. Community psychiatric nurses were in all teams, social workers and psychiatrists were in most, but psychologists were in only half. Needs assessments occurred in only 17% of teams. Fifty-one per cent of teams had open referral systems, and 38% of referrals comprised people with long-term mental health problems. Fifteen per cent of referrals were considered by teams to be inappropriate.

Clinical implications

Ambiguities about appropriate structures, patient groups and interprofessional and inter-agency working require further consideration and evaluation if CMHT care is to be optimally effective.
Autonomy and automatons: managed care in the USA
Authors: McKenzie Kwame
Published: October 2008

Managed care is a phrase on the lips of every US psychiatrist. Some believe that this revolution in health care has brought US doctors kicking and screaming into the age of ‘cost-effective’, ‘evidence-based medicine’ (Mechanic, 1997). But most psychiatrists I interviewed from Boston, San Francisco and New York, thought it had transformed them from autonomous professionals to automatons.
Treatment in the community in the absence of consent
Authors: Dyer J. A. T.
Published: October 2008

Because of the nature of some mental illness, care and compulsion in psychiatry are not always antithetical. However, it is no longer acceptable to link compulsory treatment almost exclusively to compulsory hospitalisation. Treatment should occur in the least restrictive environment possible. This paper looks at experience of extended leave of absence in Scotland, and in England and Wales before 1986, at the recent evidence for an increased risk of violence and homicide in schizophrenia and the danger of a backlash against community care if it is perceived as unsafe, and makes suggestions in relation to research and to provision for treatment in the community in the absence of consent.
Improving treatment adherence among patients with chronic psychoses
Authors: Sair Anjum , Bhui Kamaldeep , Haq Shujina , Strathdee Geraldine
Published: October 2008

This paper presents the literature on compliance as an ideology and then examines strategies to improve patient outcomes if non-compliance is identified as undermining the treatment regimen. We present strategies used by our team in a south London rehabilitation service for the severely mentally ill.
General hospital services for those who carry out deliberate self-harm
Authors: Hughes Tom , Hampshaw Susan , Renvoize Edward , Storer David
Published: October 2008

The Royal College of Psychiatrists has published national guidelines for services for those who carry out deliberate self-harm. This study aimed to discover whether these recommendations are being followed. We conducted a semi-structured interview with a professional from the accident and emergency service and one from the specialist service at each of 16 hospitals in the former Yorkshire Regional Health Authority. The findings are that services are not adhering to the guidelines. The production of guidelines without an adequate implementation strategy is ineffective. The Department of Health should endorse the College guidelines, and produce an implementation strategy to secure the involvement of purchasers and providers.
Hallmarks of a secure psychiatric service for women
Authors: Kaye Charles
Published: October 2008

Dissatisfaction with current psychiatric services provided for women in secure health environments is described. Mention is made of recent improvements in the special hospitals. A set of key criteria is suggested to judge the effectiveness of services wherever provided.
Cost comparison of zuclopenthixol acetate and haloperidol
Authors: Hyde Clive E. , Harrower-Wilson Colina , Ash Paul E.
Published: October 2008

This prospective, sequential study compared the costs of using haloperidol or zuclopenthixol acetate for rapid tranquillisation. In the first phase, all 16 patients admitted to our psychiatric intensive care unit requiring rapid tranquillisation received haloperidol; in the second phase, all 26 such patients received zuclopenthixol acetate. Mean overall costs per patient were substantially lower in the zuclopenthixol acetate group than the haloperidol group, mainly because special nursing was used much less in the zuclopenthixol acetate group. All nursing staff preferred to use zuclopenthixol acetate rather than haloperidol. Zuclopenthixol acetate could potentially reduce the need for special nursing and produce valuable cost savings.
Quality day care services for people with severe mental health problems
Authors: Foulds Georgina , Wood Helen , Bhui Kamaldeep
Published: October 2008

This paper describes the process of involving mental health service users in the planning and running of a community service. PACT (Psychiatric Assertive Outreach and Continuing Care Team) is based in south London and provides care for people who have severe and enduring mental health problems. We present an approach based on three years of intensive collaboration with service users. Community services will only become effective if they respond to need and develop new partnerships with people in contact with them. People require the opportunity to experience new ways of becoming involved at all levels of service provision and, therefore, efforts need to be made to develop a variety of opportunities for people to put forward their views. This takes time and determination by all involved.
Early discharge summaries
Authors: Walker Shona A. , Boehlhoff Gisela A. E. , Eagles John M.
Published: October 2008

An earlier survey of general practitioners in Grampian established their priorities for information they wished to learn from early discharge summaries on psychiatric patients. This survey resulted in changes to the format of the early discharge summary. An audit of information provided before and after these changes found significant improvement in 7 out of 10 items regarded by general practitioners as being of greatest importance.
‘The Health of the Nation’, suicide and the general hospital doctor
Authors: Elwood P. Y. , De Silva P.
Published: October 2008

Records were obtained of all suicide and open verdicts in York (n=127) between 1990–1994 inclusive. Those with no past or current contact with psychiatric services were identified (n=67). The extent and nature of this group's general (i.e. non-psychiatric) hospital contact in the months prior to death was established. Thirteen per cent (9/67) of these received general hospital input in the month before death with eight out of the nine aged over 65. Five of the 67 suicides showed evidence of depression. General hospital practitioners are in a position to make a small but important contribution in reducing the suicide rate.
‘Military Munchausen's’: assessment of factitious claims of military service in psychiatric patients
Authors: Baggaley Martin
Published: October 2008

Thirteen per cent of referrals of ex-servicemen to a military psychiatric centre for the treatment of combat-related post-traumatic stress disorder (PTSD) in a 12-month period have proved to be factitious. A simple classification of factitious combat-related PTSD into those with no military service and those with military service but with false claims of combat is described. The possible causes of this behaviour are discussed and a guide to the detection of factitious claims for psychiatrists without military experience is given.
Users' movement and the challenge to psychiatrists
Authors: Cohen Mark
Published: October 2008

In recent years the psychiatric users' movement has become more prominent and powerful. In this article aspects of the movement and some of the resultant challenges to psychiatrists are described. Psychiatrists are often regarded by users as resistant to its development. The author argues that psychiatrists may benefit from a creative engagement with this process of change.
Patent applications and neurotic concerns: further explorations in the Patent Office
Authors: James David V. , Gilluley Paul L.
Published: October 2008

It is a commonplace of clinical practice that those with obsessional disorder, or with obsessional features to a psychotic illness, often develop concerns about cleanliness and contamination, some with a focus on everyday bodily processes. In a search of the Patent Office for psychotic ideas (James & Gilluley, 1997), it became apparent that patents reflecting concern about bodily functions were strongly represented in the patent collection. These stood out from patents concerning innovation in conventional medicine or medical appliances, and some of them had the flavour of the more bizarre ideas on the subject put forward by patients in our psychiatric practice. It was decided to explore the collection of the Patent Office further, with a view to surveying the range of such patents and examining their relation to the times in which they originated. The procedure used was the same as in our previous article.
Chronic fatigue syndrome in children and adolescents
Authors: Richards Josephine , Smith Frank
Published: October 2008

General practitioners in a south London health authority were sent a questionnaire about their experience and views concerning the treatment of childhood chronic fatigue syndrome. Most thought childhood chronic fatigue syndrome had a significant psychological component, but opinion was divided over referral to a psychiatrist. The involvement of self-help organisations was supported but the place of rest and exercise unclear. The optimum primary care management of childhood chronic fatigue syndrome needs to be established.
Admission of the homeless mentally ill in the UK
Authors: Commander Martin , Odell Sue
Published: October 2008

The reduction in psychiatric beds over the past few decades has coincided with burgeoning homelessness in the UK. What effect has this had on the provision of in-patient care to this neglected section of the population? Admissions of people of ‘no fixed abode’ in Birmingham were compared for the years 1961–1964 and 1995–1996. Both the number of admissions and duration of in-patient episodes had decreased and many patients continued to receive no aftercare. Solutions to the problem of homelessness among the severely mentally ill must address failings in hospital as well as community services.
Inner-city general practice population of people with schizophrenia
Authors: Blair Grant , Deaney Carl
Published: October 2008

A survey of people with schizophrenia in an inner-city general practice was undertaken to identify levels of social disability, service receipt and patterns of care received. Contacts with general practitioners, psychiatrists, community psychiatric nurses and social workers were quantified, and the nature of the contacts assessed. Overall social disability for the group was marked (mean Health of the Nation Outcome Scales (HoNOS) rating 55.5). There was a correlation coefficient of +0.899 between the numbers of agencies involved and the overall HoNOS scores suggesting appropriate targeting of care. While there were few differences in the HoNOS ratings of the various contact subsets, there were significant differences in the extent of agencies contact with patients, the greatest number of contacts being in general practice. Limited information sharing, the absence of a formal shared care plan and sectorisation of services are thought to obstruct more effective general practice involvement in care.
Mental health in rural areas: experience in south Cambridgeshire
Authors: Smith A. J. , Ramana R.
Published: October 2008

Mental health morbidity is perceived as being predominantly urban based. Little is known about the health of the UK's rural residents. This paper summarises existing knowledge of rural health and social indicators. There is a relative dearth of information in this area making the application of urban-based (and biased) factors perhaps unreliable. Some rural areas have levels of deprivation similar to urban areas, even using urban-biased factors, though they encounter specific problems of service provision and accessibility. Currently, there seems to be no valid method of measuring rural deprivation and comparing it with urban deprivation. We highlight this inequality by describing discrepancies in day care provision between urban and rural areas.
Management of cognitive impairment of vascular origin
Authors: Dennis Michael , Boyle Ann
Published: October 2008

A postal questionnaire concerning the management of cognitive impairment of vascular origin was completed by 88 psychogeriatricians and 100 geriatricians. Aspirin was considered an important part of management, and clinically indicated with: a history, or clinical signs of stroke; computerised tomography (CT) scan changes suggestive of cerebrovascular disease; and atrial fibrillation. Advanced dementia was seen as a contraindication for treatment. Eighty per cent of responders indicated they would institute antihypertensive therapy in an elderly patient with a history of raised blood pressure and cognitive impairment. The median lower limit of systolic blood pressure requiring treatment was 160 mmHg, with a treatment target blood pressure of 150 mmHg.
Socio-economic deprivation and admission rates to secure forensic psychiatry services
Authors: Coid Jeremy W.
Published: October 2008

Annual admission rates from the North-East Thames Region to maximum- and medium-secure forensic psychiatry services demonstrated a highly significant correlation with social deprivation measured at district health authority level using the Jarman UPA 8. There were specific associations with the number of unemployed persons, overcrowded households, and persons from ethnic minorities in the districts studied. There was a 10-fold difference in treated prevalence rates across the region, indicating that certain purchasing authorities may be seriously underfunded to meet the needs of their catchment area populations for secure forensic psychiatry services. Further research is required into the nature of the association between admissions to these services and social deprivation. It is readily apparent that a new formula is required for the allocation of resources in the face of such wide disparities in demand from different geographical locations.
Access to health records: psychiatric patients and patients with diabetes compared
Authors: Jha Arun , Bernadt Morris , Brown Ken , Sawicka Elizabeth , Stein George
Published: October 2008

This study was undertaken to assess whether psychiatric patients respond more adversely to reading their own records than non-psychiatric patients. Seventy-three psychiatric out-patients and 84 out-patients with diabetes were posted their main clinical summary with a questionnaire about it. For seven of the eight questions, more than 70% of both patient groups gave favourable ratings. However, the psychiatric patients gave significantly less favourable responses than the patients with diabetes on five of the eight questions. Fourteen of 73 (19%) psychiatric patients were upset by reading the clinical summary about themselves compared with four of 84 (5%) patients with diabetes.
Making hospitals safe for patients
Authors: Millington Amos , Carnwath Tom , McGuinness Ted
Published: October 2008

“It may seem a strange principle to enunciate, as the very first requirement of a hospital, that it should do the sick no harm” (Nightingale, 1859).

The principle is less strange today than when it was first proposed, but making hospitals safe for patients is no easier. Stepping aside from one danger, one may fall into the path of another. Legionella risks can be avoided by higher water temperatures but this in turn introduces a risk of scalding. Security measures can protect the individual and work space but may compromise fire safety. This paper describes a similar problem of conflicting safety measures and its unfortunate consequences.
Psychiatry and the movies: Men in Black
Authors: Naylor Steven , Wilkinson Andrew
Published: October 2008

This family blockbuster film is about aliens given asylum on earth on condition they follow certain rules. Basically these are to live in a stated place, to allow access to the Men in Black and to remain in human disguise while in public places so as to not frighten the natives. The heroes are human secret agents who monitor the well-being of the aliens and ensure that they abide by their conditions of residence. Striking parallels with recent mental health developments are evident, particularly to at-risk registers and supervised discharge orders. This paper discusses these similarities and their possible consequences referring to events in the film to illustrate relevant points.
Changing minds: every family in the land
Authors: Crisp A. H.
Published: October 2008

Records of ill people being stigmatised exist over the centuries, especially individuals with mental disorders and related mental health problems. Ingredients of such stigmatisation include a belief that such disorders are often self-inflicted and resistant to change. Also, the perceptions that those with them are dangerous and present major difficulties in social interaction (Hayward & Bright, 1997). Such stigmatisation then takes many behavioural forms, including abuse and social distancing. These same disorders are common and, overall, they comprise the largest group of health problems in the country today. For a century or more the public has been protected by the existence of mental hospitals. With their closure and the emphasis now on community care, public concern seems to be mounting and stigmatisation of those afflicted worsening.
Consultant psychiatrists' opinions and experience of CPD
Authors: Williams Chris , Sims Andrew , Sensky Tom
Published: October 2008

A postal survey was carried out on a random sample of Fellows and Members of the Royal College of Psychiatrists in the United Kingdom or Eire in order to investigate current Continuing Professional Development (CPD) practice and the impact of resources and funding for CPD. One hundred and thirteen of 264 anonymised questionnaires were returned (43%). Most respondents considered CPD should be mandatory for consultants, for educational supervisors, for eligibility for the Certificate of Completion of Specialist Training and for election to the Fellowship of the College.
Maudsley Community Item Sheet
Authors: Corrigall Richard J. , Nikapota Anula
Published: October 2008

The Bethlem Royal and Maudsley Hospitals Item Sheet system for registering clinical data generated by psychiatric assessments is long established, with a proven track record as an instrument of scientific research. However, its use has not spread beyond the originating institution, despite being available in the public domain for many years. To address this problem we have designed a modified version of the Item Sheet. The new system has been simplified and improved to facilitate the use of this research aid in child guidance clinics and similar settings.
User views of two psychiatric day hospitals
Authors: Holmes Guy , Dawson Olivia , Waltho Dominic , Beaty Jenny , Newnes Craig
Published: October 2008

This report describes one of the largest published surveys of users' views of services, with 287 users returning a 34-item questionnaire and 80 people interviewed about their views and satisfaction with services provided by two psychiatric day hospitals. The combination of questionnaire and interview methodologies provided data such as an overall satisfaction score (which was relatively high) and satisfaction scores with specific aspects of the service, as well as highlighting specific problems and providing recommendations on how to make improvements.