bluuebunny/crossref_metadata_2025 huggingface dataset:
A brief computerised discharge summary in old age psychiatry: general practitioner reactions
Authors: Wattis J. P. , Protheroe David
Published: May 2008

In an attempt to provide data for medical audit, to standardise the information on discharge letters and to speed communication, a computerised discharge form was introduced for a catchment area of 20,000 people over 65 years. The programme, based on a surgical audit programme using DBASE II, was developed by one of us to run on an Amstrad PCW. This produced a discharge summary on a standard layout which gave the date of admission, the patient's name, date of birth and address as well as the consultant and GP's name. The patient's diagnosis (according to ICD-9), and a list of disciplines and facilities involved in follow-up preceded brief notes on history and progress. Date of discharge was followed by a list of medication and a space for ‘other information’. All this was contained on one side of A4 paper.
The Responsible Medical Officer and Mental Health Review Tribunals
Authors: Langley G. E.
Published: May 2008

The RMO who is well informed about his patient, and conversant with the law in respect of the particular problems that the case presents, has little to fear from Tribunal proceedings. Nevertheless to have to write reports and insert, into a busy timetable, often at short notice, a sometimes lengthy Tribunal is an irritation which can have an adverse effect on both knowledge of the case and on objectivity.
The approval of psychiatric training schemes in 1988
Authors: Sims A. C. P.
Published: May 2008

The objects and purposes of the constitution of the Royal College of Psychiatrists in 1971 included to “advance the science and practice of psychiatry” and “to promote study and research” (Supplemental Charter and Bye-Laws, 1989).
Mental health services in Nicaragua: Ten years of revolution
Authors: Harris Alison , Shefer Tammy
Published: May 2008

Nicaragua is celebrating ten years of revolution since the overthrow of the 45 year long Somoza dictatorship∗. In this time, the Sandinista government has attempted to construct a more democratic society with considerable achievements in the area of health, welfare and education. Indeed, health care has been a priority in spite of severe economic difficulties caused by the United States economic blockade and by the need for defence against the war waged by the counter-revolutionaries (the Contra).
Who owns the brain?
Authors: Eastwood M. R.
Published: May 2008

As usual, I bought my wife Vogue magazine for Christmas. It always serves well as, in North America parlance, a ‘stocking stuffer’. This year it had further value as it highlighted the brain. A well-known psychiatrist, Nancy Andreasen, set out to inform America about modern psychiatry (Andreasen, 1990). The article is entitled ‘Brave New Brain’ with the subtitle being ‘Modern Psychiatry has Left the Couch for the Laboratory’. She takes the reader through neuro-imaging, molecular genetics and psycho-pharmacology. It is an elegant synopsis and worthy of someone who had a doctorate in English before she took up medicine. Importantly, however, she prefaced her serious material with a mock-comic story about a conversation she had had with someone at a New York hospital recently. She was phoning about the retrieval of a brain for research and the ingenuous person at the hospital just could not put the idea of psychiatry and brains together. Another sad tale of psychiatric breast-beating? Those of us who trained in psychiatry in Britain a generation ago might give a wry smile. After all, biological psychiatry was all that we ever knew. When I entered the Maudsley in 1964, part of the orientation for registrars consisted of going to the laboratories. A mouse was popped into a jar containing liquid nitrogen, it went rock hard and the group was advised that freezing the neurotransmitters in that way was the royal road to solving problems.
Opening of the Norah Fry Research Centre
Authors: Raghuraman V.
Published: May 2008

A new centre to study the needs of people with learning difficulties (mental handicap) was opened at the University of Bristol on 1 February 1990.
Computer communications in psychiatry: literature searching and bulletin boards
Authors: Littlejohns Carl S.
Published: May 2008

Much of the information generated in the practice of psychiatry is manipulated by microcomputer. Program packages allow text to be structured and viewed before it is printed, information to be filed so that it can be accessed from several parameters, and columns of figures to be manipulated and displayed graphically.
Don Giovanni
Authors: Jones Mark
Published: May 2008

In the second of this occasional series, Mark Jones looks at Mozart and his 1788 masterpiece, Don Giovanni, and interviews Tom Sutcliffe, opera critic of The Guardian, about his views on this problematical work and its portrayal on the stage.
Common Law and the ‘Code of Practice’ - a commentary
Authors: Jelley Matthew
Published: May 2008

The decision of the Law Lords in May 1989 that allowed the sterilisation of a woman with serious mental handicap (F. v. W. Berkshire H.A., 1989) is arguably the single most important legal development in relation to psychiatry in the last 30 years. It has far-reaching implications beyond the field of mental handicap and will affect the practice of all psychiatrists. The Law Lords used the appeal to consider “the startling fact that there is no English Authority on the question whether as a matter of common law (and if so in what circumstances) medical treatment can lawfully be given to a person who is disabled by mental incapacity from consenting to it” (Lord Goff). Quite clearly this encompasses a large part of psychiatric practice and promised to clarify much of the controversy surrounding consent and the incompetent patient. The decision that they reached has now been incorporated into the Code of Practice of the Mental Health Act 1983 which was approved by Parliament in December 1989. The effects of this are of huge importance, and it has extensive consequences for all psychiatrists and their patients by simplifying the legal aspects of treatment. The most surprising aspect of this whole issue, therefore, is the silence that has surrounded both the original decision by the Law Lords and the subsequent publication of the Code of Practice. The only reference to these in The British Journal of Psychiatry, or its sister journal, Psychiatric Bulletin, has been a brief letter outlining some implications of the Lords' decision (Lovett, 1989). This is doubly surprising as the Royal College of Psychiatrists has shown considerable interest in this debate, not least by publishing a book about it! (Hirsch & Harris, 1988). The purpose of this paper is to provide a background to the Code of Practice and to clarify certain issues surrounding the Common Law.
The future of community psychiatric nursing: some research findings
Authors: Tyrer Peter , Gelder Michael
Published: May 2008

A workshop organised by the Research Committee of the College took place on 20 November 1989, in which 14 invited delegates from nursing, psychiatry and general practice presented and discussed the implications of recent research developments in community psychiatric nursing. Papers were given by Helen Hally, Chairman of the Community Psychiatric Nurses Association, on recent developments in the workload of community psychiatric nurses. Dr Joseph Connolly presented the preliminary findings of the ‘Daily Living Project’ at the Maudsley Hospital in which comprehensive community care is given primarily by community psychiatric nurses. Professor Brandon outlined some of the difficulties in obtaining data on the working practices of community psychiatric nurses arising from a study in Leicester and this was followed by an account by Dr Alastair Wright, a general practitioner in Glenrothes, Fife, of the typical psychiatric workload of a general practitioner and the ways in which community psychiatric nurses may be of value in treating this without the necessity of referral to psychiatric care.
Rehabilitation psychiatry: description of a provincial setting in Zimbabwe
Authors: Sidandi Paul
Published: May 2008

Psychiatric services in Zimbabwe are, by African standards, relatively sophisticated and are modelled on the British system. A new patient is assessed using the Maudsley history-taking format modified to suit local situations, and a mental state examination. A physical examination and routine investigations follow. X-ray facilities and basic laboratory work-up such as haematology and microscopy are available at Provincial level. EEG, ultrasonography, echoencephalography, CT scanning and serum anticonvulsant levels are available in Harare and Bulawayo.
Postgraduate teaching in the Department of Psychiatry, University of Keele
Authors: Barrett K.
Published: May 2008

Keele received its Charter as the University College of North Staffordshire in 1950. The first Vice Chancellor was Lord Lindsay, formerly the Warden of Magdalen College, Oxford. In the pre-war years Lindsay was a frequent visitor to the Potteries, presenting lectures within the Workers Education Association. He was unusual as an Oxford don not only in this respect but also in his approach to university education. He was closely involved in the development of the Modern Greats degree at Oxford and had strong views on the need for a broad liberal university education. Keele was founded on this principle as a teaching university offering a four year degree, the foundation year requiring students to study arts, sciences and humanities. At its inception the university was housed in a Victorian stately home, Keele Hall, and several ex-army huts. For the first decade of its life a “community of scholars” ethos was strongly emphasised and academics as well as students were required to live on campus. There were weekly small group student seminars involving academics from the three different disciplines. The academics look back on these seminars fondly, although it is not clear whether the students derived the same enjoyment from these interdisciplinary talking shops.
William Cullen's bicentenary
Authors: Kendell R. E.
Published: May 2008

William Cullen (1710–1790) was the greatest teacher of clinical medicine in Britain in the 18th century. He was born in Hamilton in Lanarkshire and began his career in Glasgow where he held the chair of chemistry and was one of the founders of the medical school. In 1755 he moved to Edinburgh with its already flourishing medical school and its new hospital, the Royal Infirmary, and there he held in succession the chairs of chemistry, the institutes (theory) of medicine and the practice of physic. Together with Alexander Monroe he made Edinburgh the most famous medical school in the Western world and students came from far and wide to be taught by him – from England, Scotland and Ireland, from the Americas and the West Indies and from the Continent. Like Boerhaave, his reputation rested mainly on his gifts as a teacher and it is clear that his students idolised him. Benjamin Rush, the founder of the first medical school in the New World in Philadelphia, America's first psychiatrist and one of the signatories of the American Declaration of Independence, wrote of him that “It is scarcely possible to do justice to this great man's Character either as a scholar, a physician, or a Man”.
Psychiatry in Prague: some personal impressions
Authors: Kerr Alan , Peck Edward
Published: May 2008

The sudden collapse of the communist order in Czechoslovakia and the formal installation of the new government in June 1990 has led, inter alia, to a fundamental reappraisal of mental health care. On a visit to Prague in September 1990 the system under the 40-year-old communist regime was still largely intact but clearly about to undergo major changes. Among the reform proposals made by a working group of the Ministry of Health and Social Affairs of the Czech republic are practices familiar to western psychiatrists: mental health care and specialist liaison in primary care settings; formal specialisation within psychiatry into general adult psychiatry, psychogeriatrics, child and adolescent psychiatry, psychotherapy; psychiatric units in general hospitals; community care with restructuring of funding away from the mental hospital budget and devolution to districts. More “humanisation” of psychiatry is envisaged, with choice of consultant, increased competition between doctors and legal definitions of involuntary treatment (Potucek et al, 1990). Voluntary organisations, existing until recently only underground, will be encouraged as also will be counselling services. Dementia, and drugs and alcohol misuse, are seen more as social service than medical issues. Of particular interest is a proposal to separate mental health funding from the rest of the health care budget.
Non attenders at a marital and sexual difficulties clinic
Authors: Huws R.
Published: May 2008

The Marital and Sexual Difficulties Clinic at Sheffield offers out-patient treatment that is usually based on a modified Masters & Johnson method. This consists of behavioural techniques, notably sensate focus, used within a psychoanalytic background.
Measuring levels of behavioural disturbance in long stay patients
Authors: Beer Dominic
Published: May 2008

Large mental hospitals are gradually being emptied. Patients return to the community. But often their prospective carers have little idea of what to expect when they arrive. Hospital staff often cannot give information regarding how disturbed patients might be.
A psychiatrist with beds: evolution and evaluation of socio-therapy on an acute admission ward
Authors: Cox John L.
Published: May 2008

There is a serious flaw in much current thinking about the development of ‘community’ psychiatry because of the failure to consider the function of admission wards and to resource them adequately. Excessive emphasis is placed on the value of non-hospital psychiatry with an implication that psychiatrists can manage patients adequately without beds (see Dean & Gadd, 1990). Although I have not met a consultant who literally believes this to be true, the managerial consequences of this attitude leads to in-patient units being yet further under-resourced, and so becoming more disturbed and having lowered morale. Yet in Better Services for the Mentally Ill (HMSO, 1975) the District General Hospital In-patient Unit was regarded as a main component of a comprehensive psychiatric service. Clinical experience does suggest that without an effective admission ward the management of patients in the community, including those with intractable mental illness, is unsatisfactory and sometimes totally impossible.
Psychiatry, the law and the media
Authors: Blom-Cooper Louis
Published: May 2008

When the Liverpool Daily Post, its sister paper, the Liverpool Echo, and the Daily Mail published inflammatory material about a restricted patient at Park Lane Special Hospital (now Ashworth (North) Special Hospital) their editors were strongly warned by the House of Lords that they would be well advised to exercise greater care in future, that they did not overstep the mark and find themselves in contempt of court. The newspapers won their appeal because the law allowed them to report the fact that a restricted patient had applied to a Mental Health Review Tribunal for his discharge, the date and place of the hearing of the application and any order made discharging the patient, absolutely or conditionally. But the law does not give the papers carte blanche to comment on a case in order to mount a campaign of public protest against the patient's release.
The need to consider quality of life as an outcome of antidepressant therapy
Authors: Morris Jenny
Published: May 2008

Depression is a very common disorder. It has been estimated that 20% of all women and 13% of all men will develop depression at some time during their lifetime, although much of the depression which exists in the community is unrecognised and untreated. Approximately 75% of the female population and over 50% of the male population attend their general practitioners at least once with a psychiatric complaint, of whom 70% of the women and 34% of the men have a depressive episode. While treatment for some patients will be successful following the acute phase of the depressive episode, it will generally take at least three months and in some instances six months or more to treat an episode. The risk of relapse following treatment is high, affecting approximately 50% of patients treated; furthermore, there is no evidence to suggest that those patients being treated for their first episode of depression are less vulnerable to relapse following response to treatment than those who have suffered previous episodes of depression.
The experience of psychiatrists managing Chinese patients in Merseyside
Authors: Li D.
Published: May 2008

The Chinese community in the UK has existed since the latter half of the 1800s and traditionally has been perceived as insular and self sufficient (Lynn, 1982). In the 1960s and ‘70s, there was a large influx of Chinese into the UK to work in catering businesses. Many of the children of this generation were born in this country; with this group now in their early adulthood, there is more integration into the indigenous population. However, there is still an impression that Chinese psychiatric patients are under-represented in the services, but as yet, there has been little psychiatric research carried out among the Chinese in the UK. This study examined briefly the level of contact with, and difficulties encountered in, managing Chinese patients by psychiatrists in Merseyside.
What has happened to patients from long-stay psychiatric wards?
Authors: Double D. B. , Wong T. I.
Published: May 2008

Evidence bearing on the issue of what happens to patients from long-stay psychiatric wards in Britain is scarce. The results of a particularly well-planned resettlement programme may not be representative of the outcome from general policies of discharge from all psychiatric hospitals. The present study was undertaken in Sheffield to find the whereabouts of patients from long-stay wards after eight years, a longer period than usually studied previously. The expectation was that difficulties in tracing patients could be overcome with sufficient time and effort.
Patients' access to their psychiatric notes: a review
Authors: Jones Jeffrey R.
Published: May 2008

Recent legislation, the Access to Health Records Act (1991), which came into force in November, will mean that patients will be able to apply for access to their written case file. This law will not be retrospective, and notes written before this date will not therefore fall under the scope of the act. Similar legislation has already been passed enabling access to Social Services case files (Access to Personal Files Act, 1987). The legislation follows increasing pressure for consumer rights in various areas and follows similar developments allowing access to health records in other countries.
Experts
Authors: Appleby Louis
Published: May 2008

The voice on the other end of the line said, “I understand you're an expert on trepanation.” I said I knew next to nothing about it. That, replied Radio Stoke, didn't matter. Could I just repeat what I had told The Guardian?
MCQs: a suggested study technique
Authors: Smyth Marcellino G.
Published: May 2008

The MCQ has now become firmly established as an integral part of post-graduate psychiatric examinations. In my experience a number of trainees have particular difficulty with MCQ tests such that they find them threatening, and in some cases a repeated stumbling block to the advancement of their careers. A minority within this group may consider the MCQ test to lie in the realm of the arcane and mysterious and find themselves subject to repeated worry and frustration. While advice on techniques for answering is plentiful (sample textbooks and manuals on examination technique) I am not aware that there has been any focus to date on study technique. I would like to suggest a personal approach for MCQ study (based on successful application) which I believe fully integrates MCQ with general psychiatric study and emphasises the potential of ‘MCQ thinking’ in refining ones overall psychiatric knowledge.
The first nine months of a community mental health team: a study of communication and attitudes
Authors: Cardno A. G. , Simpson C. J.
Published: May 2008

Community orientated mental health services are rapidly developing in Britain today, and as part of this development many community mental health teams (CMHTs) are being established. This study looks at some of the relationships between members of one CMHT and local primary health care team members and social workers, with particular emphasis on communication between these various professionals.
How much do patients on lithium know about their medication?
Authors: Delany Norma
Published: May 2008

Lithium is a drug used extensively in psychiatry for the treatment of depression, acute mania, and the prophylaxis of recurrent affective disorders. Lithium also has a place in the management of schizoaffective disorders and has been suggested for aggression and alcoholism. The side-effects, dangers of toxicity, and need for monitoring are well documented and should be considered before starting anyone on lithium. Likewise patients should be adequately informed of the benefits and hazards of treatment.
Instant lithium monitoring
Authors: King J. R. , Phillips J.D. , Judge R. , Armond A. D. , Corbett J. A. , Birch N. J.
Published: May 2008

Lithium therapy for affective disorders has been estimated to result in savings of hospital beds in the National Health Service of £23 million each year. In order to maintain and justify this saving we must invest to provide careful monitoring of serum lithium concentrations in patients living in the community. In recent years the advent of lithium clinics has done much to improve the compliance and safety of lithium therapy (Masterton et al, 1988), but we believe that there may be scope for further improvement both in the service to the patient and in encouragement of the patient to comply.
Psychiatrists and public dramas – a personal experience
Authors: Marshall Philip D.
Published: May 2008

It has long been felt that there sometimes occur certain dire situations, often involving the police, where our special experience has been felt to be valuable. I am unsure how well established this claim is but wish to describe one recent occasion when I was called upon in this way, in the hope that it might help others in deciding what they might have to contribute.
Training on the Regional Brain Injury Rehabilitation Unit: six months registrar experience
Authors: Lewin J.
Published: May 2008

There is an increasingly large population of those who are chronically disabled as the result of brain injury (Jennett & Macmillan, 1981). These injuries can be the result of trauma, infections, tumours, hypoglycemia, anoxia or other damaging conditions. The large majority of rehabilitation units cater for physical problems only. However, it has been recognised that patients with brain injury often develop behavioural disorders during the early recovery phase and in a few cases these persist (Eames & Wood, 1989).
Interview skills training
Authors: Warwick Hilary M. C. , Everall Ian P.
Published: May 2008

The importance of interview skills in psychiatry cannot be underestimated, and the acquisition of adequate interview skills must be one of the foremost aims of training. The College requirement that MRCPsych candidates must interview the patient in front of the examiners (in both parts I and II) rightly stresses the fundamental importance of interview skills in clinical practice. Maguire (1982) has questioned the adequacy of standard methods of training psychiatrists (usually reporting and discussing interview findings with a senior colleague) in interview skills. In a study of medical students, he has shown that audio/videotaped observation of interviews with feedback is superior to traditional methods (Maguire et al, 1978). Gask et al (1988) demonstrated that use of group video feedback training was effective in improving psychiatric skills in a group of general practitioners. Rutter & Cox (1981) published a series of studies examining the effects of interview style on the quality of factual information obtained and the emotional response elicited. Such work has generated interest in interview skills training and specialised courses are now run in some centres.
A short series of short pieces (with questions)
Authors: Culliford Larry
Published: May 2008

The ancient texts which survive speak highly of mystery. It is not only inevitable for the human mind to find fascination in mystery. Mystery is at the heart of things. Through wisdom it may be penetrated. We are taught acceptance of mystery, to meditate upon it; to relax and find comfort there, inspiration, succour, confidence.
Psychiatric referral letters from the 17th century
Authors: Howard Robert , Foerstl Hans
Published: May 2008

The 17th century saw the transfer of Bethlem from its original monastic site to more spacious accommodation at Moorfields in 1676, the development of an organised admissions system, and the establishment of an admissions register in 1683. The register contains often no more than the patients' names and the dates of their admission and discharge. Examinations of the admission register for the period 1684–1700 however, reveals 20 cases in which the entry is a copy of a warrant for admission in the form of a letter from the referring authority.
Medical audit quality of note-keeping
Authors: Markantonakis Aristos , Weir I. K.
Published: May 2008

Recently there has been an increasing awareness of the need for medical audit. Medical audit in the health service is not a new thing across the Atlantic. Many centres accept it as a normal part of health management. The findings of audit are made known to the individuals who have been audited with the aim that this would produce future improvement. Hence it is an effective way of increasing efficiency and highlighting inefficient and costly procedures. There is debate as to who should be doing the auditing. General practitioners have been suggested as being in the ideal position to be able to audit specialist services such as psychiatric services (Ferguson, 1990). GPs can be approached by questionnaire to gain their views as to the level of satisfaction on things such as communication, availability and usefulness of referral to a local specialist service (Markantonakis & Mathai, 1990).
Medical out-patients with non-organic disorders
Authors: David Anthony
Published: May 2008

It is hard to believe that this coming together of the Royal Colleges of Physicians and Psychiatrists to discuss the patients that so often bounce back and forth between the specialists was the first of its kind.
The Mental Health Act and its agencies – are they working together?
Authors: Tyrer Stephen P. , Jerram Timothy C.
Published: May 2008

The 1983 Mental Health Act gave increased responsibility to the Mental Health Act Commission and the Mental Health Review Tribunal to ensure safeguards in the treatment and detention of patients compulsorily admitted to hospital. Although most are agreed that the civil rights of patients admitted to hospital against their will are better protected under the new Act, some psychiatrists are irritated by the necessity to involve these bodies in what they regard as primarily clinical management. The North-East Division of the Royal College of Psychiatrists believed that debate on this issue might benefit both psychiatrists and others involved and this topic was chosen for the Annual Meeting of the Division in York on 28 September 1990. The meeting attracted other mental health care professionals and of the 144 participants almost one-third were not psychiatrists, but mainly social workers and psychologists. The sessions were chaired by the President of the College and Professor Donald Eccleston.
Dumfries
Authors: McCreadie R. G.
Published: May 2008

My work has four main strands – patient care, membership of the unit management team, clinical research and the College. At different times I can, or have to, place greater or lesser emphasis on any one of these areas – the result is a job virtually devoid of routine. Let me tell you about each area. I hope by doing so you will also learn a little about what is going on in psychiatry north of the border. You will know we arrange things rather differently from the rest of the United Kingdom.
Self-referral admissions
Authors: Gee Martin , Craddock Nick
Published: May 2008

Little is known about those patients who bypass their GP and self-refer directly to hospital. There have been studies of referrals to emergency clinics (Lim, 1983; Haw et al, 1987; Kehoe & Newton, 1990) and to community centres (Hutton, 1983; Boardman & Bouras, 1989). All these studies found that more men self-referred than women. Hutton (1985), Boardman & Bouras (1989) and Kehoe & Newton (1990) found that self-referrals often had a non-psychiatric precipitant and rarely required acute psychiatric intervention.
An audit of research activity among trainee psychiatrists
Authors: Junaid Ola , Daly Rachel
Published: May 2008

Productivity in research is now an almost mandatory requirement for trainee psychiatrists. There is an increasing awareness among psychiatric trainees of the necessity to participate in and indeed publish research in order to ensure career progression (Junaid & Staines, 1990). This paper describes the research activity of psychiatrists in the training grades, during the year October 1988 to September 1989.
Community ward rounds (T. Burns (1990) Health Trends, 22, 62–63)
Authors: Pullen Ian , Shepherd Simon
Published: May 2008

It is interesting to observe just how much (or little) psychiatric services adapt to changing circumstances. The progressive move to community care, with the resettlement of seriously ill patients outside hospital and the avoidance of admission for many acutely ill patients, has shifted the focus of the psychiatric team away from its traditional institutional base – or rather the focus should have shifted. Yet it is probable that many psychiatrists, while paying lip service to the needs of patients in the community, have not altered their weekly routine. Hospitals, and the security they represent, retain their magnetic attraction for many staff. But with the growing number of out-patients and chronically disabled patients being supported by team members outside hospital, how should the multidisciplinary team respond?
Multidisciplinary involvement in hospital discharge: a regional survey of current practice in general adult psychiatry
Authors: Cowan Colin
Published: May 2008

The multidisciplinary team approach is considered by the Royal College of Psychiatrists to be a valuable instrument in modern psychiatric practice (Rawnsley, 1984). In addition, it is assumed by the 1983 Mental Health Act in Section 117 concerning joint Health and Social Service responsibility for statutory aftercare and in Sections 57 and 58 where consultation with other disciplines by the second opinion doctor is required. The benefits of this way of working include a broader perspective in care provision, consistency of approach, continuity of care, and improved communication between disciplines (Pollock, 1986).
A local research course for trainees in psychiatry
Authors: Delany Norma , Thompson Chris
Published: May 2008

Trainees in psychiatry are encouraged to become involved in research during their training (Sims, 1988). As Crisp (1990) points out, research skills are basic to a number of attributes such as problem solving abilities, consultation skills, self-audit, and the audit of others. Both the College and senior registrar appointment committees seem to value some research experience as it demands persistence, as well as the ability to think both creatively and logically. The College does provide a research option for the MRCPsych Part II, but this is only chosen by a minority of candidates. In addition the College runs its own course. Nevertheless, many trainees find it very difficult to know how to set about research unless they have previous experience or their job specifically involves research.
The Edinburgh Declaration and education in psychiatry in the 21st century: a review (H. J. Walton, [1991] Journal of the Royal Society of Medicine, 84, 153–158)
Authors: Farmer Anne
Published: May 2008

Despite publication in the Lancet (1988), the initial impact of the Edinburgh Declaration was probably not apparent to many outside the world of academic medical education when it was first published in 1988. In particular the implication for psychiatrists involved with teaching was hardly recognised by the profession at that time. Thus, this review by Professor Walton is a timely reminder of the Declaration's importance.
Psychiatry in Australia: economic and service delivery aspects
Authors: Andrews Gavin
Published: May 2008

In 1987 there were 1,428 psychiatrists in Australia, 8.8 per 100,000 population (Burvill, 1988), 55% identified as in private practice and 45% in public sector practice. Let us be clear about terms. Public sector practice means that each week you receive a salary from the public purse whether you have seen one or a hundred patients. Private practice means that you are paid on a piece-work basis, also largely from the public purse (national health insurance or Medicare), but the income (at about $100 per hour) depends exactly on the number of hours spent with patients. On average, private psychiatrists in Australia gross about $150,000 per year, out of which they must pay practice expenses. The pay for public sector psychiatrists probably averages $70,000 to which, for the purposes of our calculation, we will add the cost of rooms, telephone and secretary provided by the hospital which at $30,000 brings the cost of a public sector psychiatrist to about $100,000 per year. If 45% of psychiatrists are in public practice then the averaged cost of a psychiatrist in Australia can be calculated as $127,500 per annum, and as there are 8.8 psychiatrists per 100,000 the cost, calculated on this simple basis, is $1.12 million per 100,000 population (Andrews, 1989).
Organising the MRCPsych Part II examination
Authors: O'Sullivan D. F. , Kennedy N. M. J. , Jenkins R.
Published: May 2008

The MRCPsych Part II examination takes place twice a year at a number of centres in Britain and Ireland. It comprises five components. Three are written exercises and the other two, a viva voce and a clinical examination, are practical assessments characterised by face-to-face interaction with the examiners.
A combined group and individual long-term out-patient clinic
Authors: Abrahamson David , Fellow-Smith Elizabeth
Published: May 2008

Complaints of delays at out-patient clinics are common; a Newham patient's complaint that she had not been kept waiting long enough was correspondingly puzzling but has subsequently proved very fruitful. Her explanation that discussions with other waiting patients and the OPD nurse were often more helpful than the interview with the doctor triggered the development of a clinic designed for fuller participation of patients and staff.
The Code of Practice and Parliamentary intention concerning short term treatment orders
Authors: Robin Ashley
Published: May 2008

The Code of Practice for the Mental Health Act, 1983 “has now passed through the necessary Parliamentary procedure” but may still be subject to amendment by Parliament, and in this context it is useful to consider the expressed intention of Parliament over the last 70 years in relation to short term treatment orders and the Code's current guidance on S.2 of the Mental Health Act 1983.
The portable computer in psychiatry: experience with a Z88
Authors: Littlejohns Carl S.
Published: May 2008

Managerial and administrative personnel are increasingly to be seen using desk-top computers. With medical staff, however, it seems to be commoner to find their computers sitting at home. This is likely to be because clinicians are essentially mobile in their working, and although the career structure dictates that publications are essential, there is no time-slot during the clinical day for such activity.
Usage of professional time: a case by case analysis
Authors: Clark Andrew , Chaudhry Sabia , Tayler Peter , Bhate Surya
Published: May 2008

Child and adolescent psychiatric services receive referrals from a variety of sources in addition to traditional medical channels. It is unknown whether this practice has implications in patterns of usage of time. Our hypothesis was that referrals from non-medical sources were likely to be more time-consuming than those from medical colleagues.
Who owns money?
Authors: Eastwood M. R.
Published: May 2008

In my medical year there was a student who had been in the RAF in World War II. After the war he worked for Beaverbrook and the Express newspapers and went on to become a publisher. He studied medicine, while a publisher, and then came the crunch. To be a publisher or a doctor? On the first day of house jobs he inadvertently drove his Jaguar into the consultant's reserved parking spot, which caused no amusement. To add to his disquiet he found that his salary of £35 per month, after income tax, and then surtax on top, only paid for his pipe tobacco and refreshments. The rest of us were less egregious and embarked upon life with even less fiscal fun. A bottle of Woodpecker Cider on Saturday night was nirvana. Was this really the reward for all that education? (Most specialists had at least 28 years of formal education: from starting at age four to leaving postgraduate school.) Like many before me, particularly Edinburgh graduates, I crossed the high seas, at the age of 32. My naval forebears would have been surprised that it took so long, especially my father, who went to sea at 14 in World War I. There were many surprises, not least of which was that of money. In a career sojourn, from the UK to Australia and finally Canada, over 18 months, there was a tenfold increase in income.
Why are the mentally handicapped still admitted to hospital?
Authors: Cooke Leila B.
Published: May 2008

The Stoke Park Hospital Group in Bristol has been providing a service to mentally handicapped people and their families since 1909. The nature and extent of the service has changed significantly between then and now, largely due to changes in Government policy, first laid out in the 1971 white paper Better Services for the Mentally Handicapped. The changing nature of the service was highlighted in Carter's paper in 1984, in which he examined all admissions to the Group over ten years. He found an increasing use of the hospitals for short-term care, particularly for those patients with a superimposed psychiatric disorder, and a continuing, albeit reducing, demand for long-term care for some patients. He concluded that the hospital would continue to have an important role to play in the evolving pattern of care.
The use of computerised tomography in mental handicap patients
Authors: Lekh S. K. , Puri B. K. , Singh I.
Published: May 2008

Since its inception (Hounsfield, 1973), computerised tomography (CT) has become an invaluable diagnostic and research tool, particularly in clinical neurology and neurosurgery. Clinically, CT has proved useful in differentiating between ‘functional’ and ‘organic’ psychiatric disorders where it is particularly helpful in the diagnosis of potentially treatable organic disorders. For example, Owens et al (1980) found clinically unsuspected intracranial pathology in 12 of 136 chronic schizophrenic patients examined by CT and Roberts & Lishman (1984) found diagnosis, management, and/or prognosis were influenced in approximately 12% of cases referred by psychiatrists for CT imagining.
Psychiatric clinics in homeless hostels – your flexible friend
Authors: Ferguson B. , Dixon Ruth
Published: May 2008

The increasing awareness that serious mental disorder is common among men residing in homeless hostels has acted as a fillip towards providing new services for this disadvantaged group. Conventional psychiatry frequently fails to meet their needs, not least because of the formality and inaccessibility of the contact. Detailed psychiatric history taking, for example, is often perceived as a barrier to communication with no intrinsic benefit for the homeless. Indeed psychiatrists often appear distant to hostel staff. The Salvation Army have gone so far as to suggest to the House of Commons Social Services Committee that community psychiatric nurses are effective because of their ability to mediate with consultant psychiatrists.
Alzheimer's disease – the experiences of national voluntary organisations
Authors: O'Shea Brian
Published: May 2008

I previously reported (O'Shea, 1989) on the experiences of national Huntington's disease (HD) organisations in Britain, Holland, Ireland, New Zealand, and the USA. The Australian experience was discussed later (Kapp, 1990; O'Shea, 1990). The earlier paper supported the contention (Black, 1988) that the medical profession in general was not supportive of HD voluntary groups. I also expressed concern that the lobbying of voluntary groups representing far more common disorders was “bound to dilute the impact that Huntington societies may have.”
Overseas doctors' training scheme
Authors: Adeniran R. A.
Published: May 2008

About a year after applying to come on the Overseas Doctors' Training Scheme (ODTS), I was offered a post. The letter arrived about two months before I was to start work in the UK; it contained pertinent information about my job, the training programme, and the community I would live in. The information and its early arrival enabled me to make adequate preparation for my trip.
Mental disorder and professional driving
Authors: Payne Simon , Lee Alan S.
Published: May 2008

Recently several cases have drawn our attention to problems associated with professional driving and mental disorder. All drivers are responsible for informing the licensing authority of any disability likely to cause them to drive hazardously. Medical Aspects of Fitness to Drive (Raffle (ed.), 1985) gives detailed guidelines to help doctors advise their patients. Those relating to ordinary licence holders appear intuitively correct and most psychiatrists would give similar advice without reading them. However, the guidelines for vocational drivers, especially holders of Public Service Vehicle (PSV) and Heavy Goods Vehicle (HGV) licenses, are more stringent because of the serious consequences when accidents occur. The guidelines follow those of the Royal College of Psychiatrists, revised in 1983.
One year after the NHS Bill: the extra-contractual referral system and Henderson Hospital
Authors: Dolan Bridget , Norton Kingsley
Published: May 2008

In 1991 we predicted the new contracting system introduced by the NHS Bill would reduce referrals to specialist units, particularly supra-regional units (Dolan & Norton, 1991), and that any resulting decline in patient numbers might lead to the suggestion that these resources were surplus to requirement and hence not viable in a market economy (Dolan & Norton, 1990).
The use of car telephones by psychiatrists
Authors: Henderson J. A. , Simpson C. J. , Mumford J. D.
Published: May 2008

As community services develop, medical staff are increasingly spending more time outside the hospital, despite the most severely ill patients still being in hospital. This may lead to junior medical staff and nurses feeling unsupported by the consultant. In addition, as more disturbed patients are kept out of hospital, the general practitioner and community health workers may require to contact the psychiatrist more often to talk about patients or to request urgent assessment. Therefore the importance of communication with consultants is increased both from the hospital and from the community while they are spending increasing amounts of time in their cars. In a discipline where communication is of paramount importance, a failure to meet this growing need would undermine the effectiveness of the service as a whole.
Cognitive therapy and Winnie-the-Pooh
Authors: Hosty Gary
Published: May 2008

“Here is Edward Bear, coming downstairs now, bump, bump, bump, on the back of his head, behind Christopher Robin. It is as far as he knows, the only way of coming downstairs, but sometimes he feels that there really is another way, if only he could stop bumping for a moment and think of it.”
The case of Aaron Kosminski: was he Jack the Ripper?
Authors: Lekh S. K. , Langa A. , Begg P. , Puri B. K.
Published: May 2008

The Whitechapel murders of 1888 attributed to Jack the Ripper were, like many of the crimes of multiple-victim killers, well-publicised, bizarre and dramatic (Lunde & Sigal, 1990). Although in the public mind at the time the murders of at least seven women in and around the Whitechapel district of London's East End were believed to have been carried out by Jack the Ripper. However, according to police and forensic evidence his victims, all prostitutes, numbered only five, beginning with Mary Ann Nichols, found murdered on 31 August 1888, and ending with Mary Jane Kelly, whose mutilated body was discovered on 9 November 1888.
Stress and working with addicts: a role for meditation?
Authors: Farmer R. , Ramsay Rosalind
Published: May 2008

Occupational stress is frequent among individuals whose work brings them into close contact with other people. One putative means of preventing or alleviating such stress is meditation (West, 1987). A six week course in meditation was recently held for staff in the Drug Dependence Service based at University College Hospital, London. The idea for the course came from the head of the unit who had personal experience of meditation. The course and its acceptability to staff are described below.
In conversation with Desmond McGrath
Authors: Healy David
Published: May 2008

Dr McGrath was born in Liverpool in 1922. He was Medical Director of St John of God Hospital from January 1955 until December 1991 and Consultant Psychiatrist, St Laurence's (Richmond) Hospital (Beaumont Hospital from 1987), Dublin from 1956 until 1988. He was a Foundation Fellow of the Royal College of Psychiatrists and was a member of Council from 1974 to 1979, a member of the Court of Electors from 1979 to 1982 and Chairman of the Irish Division from 1974 to 1977. He was a member of Council and Censor of the Royal College of Physicians of Ireland from 1980 to 1982 and Chairman of the Section of Psychiatry of the Royal Academy of Medicine in Ireland from 1973 to 1975. He was President of the Medico-Legal Society of Ireland from 1966 to 1968 and has served on the Fitness to Practice Committee of the Medical Council of Ireland since 1989 and the Mental Health & Neurology Committee of the Medical Research Council of Ireland from 1969 to 1991.
Death threats to psychiatrists
Authors: Owen John
Published: May 2008

Threats made by patients to harm, or even kill, their psychiatrists, may cause great stress to both the doctor and his or her family. This potential source of anxiety is seldom discussed by the profession and is a neglected area in the literature, perhaps indicating that denial is a common mechanism used to cope with any fear engendered by such threats.
Screening of the mental state of the over-75s in the community: what are GPs doing?
Authors: Mackenzie D. M.
Published: May 2008

The new general practitioners' contract requires the primary health care team to perform a yearly assessment of their patients of 75 and over. This includes an assessment of the ‘mental condition’. In a list size of 2,000, typically 130 fall within this age group. Screening does not have to be carried out by the doctor and as 90% are already seen at least once a year, there is scope for opportunistic screening. Nonetheless, screening increases the general practitioner's workload and while it improves the morale of elderly people, it may have little impact on medical and functional problems.