bluuebunny/crossref_metadata_2025 huggingface dataset:
An Error of Judgement: a play about the sexual abuse of people with learning disability
Authors: Crichton John H. M.
Published: October 2008

In recent years, psychiatrists have become much more aware of the sexual abuse of adults with a learning disability. Having struggled with such a case, which raised challenging problems of law, ethics and management (Crichton, 1997), I turned to the literature to help inform me about the subject. There I found helpful statistics from recent surveys, but sometimes such material fails to convey the true nature of what is a distressing and painful subject. To my astonishment I discovered that at a local theatre there was to be a performance on this very theme: An Error of Judgement I had heard of the Strathcona Theatre Company, a touring company of eight learning disabled professional actors who, with the assistance of two directors, devise the original plays they perform, but I had no idea of what the evening was going to be like.
The mental state we are in: morale and psychiatry
Authors: Thompson Chris
Published: October 2008

In this lecture I will ask: is morale poor among doctors? If it is (and let us for a moment assume that it might be), why is it that? If it is worse recently then is the deterioration an inevitable part of the process of rapid change in the National Health Service (NHS)? Is it, on the other hand, remediable?
Consultant psychiatrists' views on the supervision register
Authors: Lowe-Ponsford Francesco L. , Wolfson Paul , Lindesay James
Published: October 2008

A questionnaire on attitudes to the supervision register, about one year after its introduction, was sent to all consultant psychiatrists identified as working in the National Health Service South Thames Region. A response rate of 72.3% was obtained. Half of the respondents felt that the supervision register was not likely to reduce the risk of violence to the public by mentally disordered people and a quarter was unsure. Just over half felt confident in predicting violence, and over half felt that they had been reasonably trained to do so. Most had not changed their practice in admitting or discharging patients, or in the use of the Mental Health Act. There were criticisms of the register, for example: lack of resources needed to implement it, increased paperwork, stigmatisation of patients and the lack of a formal appeal mechanism. Fifty per cent felt the register should be abolished, only 25.5% felt it should not be.
Preliminary evaluation of supervised discharge order in the South and West Region
Authors: Mohan Damian , Thompson Chris , Mullee Mark A.
Published: October 2008

Six months after the introduction of the Mental Health (Patients in the Community) Act 1995, this study shows that the new legislation has been implemented in its first six months of existence. Lack of resources and increased paperwork are identified by some doctors as reasons for their reluctance to proceed with implementation of supervised discharge. Patients who were placed on supervised discharge were found to be mostly young, mentally ill patients previously detained under Section 3 of the Mental Health Act 1983, as yet, the 1995 Act does not appear to have been implemented in the after care of ‘forensic’ patients or those with mental impairment.
Sexual adverse effects with new antidepressants
Authors: Mir Shameem , Taylor David
Published: October 2008

Sexual dysfunction is a widely recognised adverse effect of many psychotropic agents. Older antidepressants such as monoamine oxidase inhibitors and tricycles, particularly clomipramine, are known to engender sexual adverse effects. In depression, this problem is exacerbated by the occurrence of impotence and lowered libido as part of depressive illness itself. We examined evidence relating to more recently introduced antidepressants: selective serotonin reuptake inhibitors, moclobemide, venlafaxine, nefazodone, mirtazapine and reboxetine. We reviewed published trials and case reports collated from searches of Medline, PsychLit and Micromedex from 1985 to December 1997, and contacted manufacturers of new antidepressants and requested information from them.
R. D. Laing revisited
Authors: Beveridge Allan
Published: October 2008

In Scotland's National Portrait Gallery, there hangs the only portrait of a 20th century Scottish psychiatrist to have been commissioned by this pantheon to the country's great and good. The subject of the painting is, of course, R. D. Laing, who was not only Scotland's most famous psychiatrist, but, for a brief period in the 1960s and early 1970s, the most famous psychiatrist in the world. He was the world's first media psychiatrist, and his books sold in millions and were translated into more than 20 languages.
Users' needs and satisfaction with a community-based mental health service
Authors: Ralston George , Beesley Sarah , Bogue John
Published: October 2008

There has been an increasing move to involve consumers in the assessment of health services. Needs assessment and consumer satisfaction of a recently setup community mental health team is described.
Benzodiazepine prescribing in a psychiatric hospital
Authors: Summers J. , Brown K. W.
Published: October 2008

Using a case note study, this paper presents a longitudinal survey of the effect of psychiatric inpatient care on benzodiazepine prescribing. Standards were proposed to assess the quality of this prescribing. Based on these standards, the study shows inappropriate use of benzodiazepines. Following admission, there was an increase in the number of patients prescribed benzodiazepines and in the number of benzodiazepines prescribed. Of the benzodiazepines withdrawn, most were contrary to the proposed standard. The quality of drug history showed little emphasis being placed on rationalising benzodiazepine prescribing. The issue of how benzodiazepines should be handled during psychiatric admission is discussed.
Allocation of referrals within a child and adolescent mental health service
Authors: Roberts Sophie , Partridge Ian
Published: October 2008

Long waiting lists are a common problem in child and adolescent mental health services. We describe how referrals to the service in York are considered and allocated by a multi-disciplinary team. The criteria for allocation to different professionals and specialist teams are described and data representing a snapshot of referrals and response rate over a three-month period presented, showing that most referrals are seen within two months. We postulate that consideration of referrals in this way is an effective and efficient way of running a service.
Use of the Care Programme Approach register by an inner-city old age psychiatry team
Authors: Wallace Jeremy , Ball C. J.
Published: October 2008

The Care Programme Approach and its accompanying register were introduced in response to difficulties encountered in a young adult population. This paper describes the use of the register by an old age psychiatry service who do not routinely accept ‘graduate’ patients. Few patients had a diagnosis of dementia and most had psychiatric histories in excess of 10 years.
Implications of urban drift on health care resources in inner London
Authors: Montgomery A. J. , Parshall A. M.
Published: October 2008

All 34 patients admitted from a central area of London over a 10-week period were identified. The 25 (73%) who were subsequently interviewed were questioned about their whereabouts at various points in the past. Eleven (44%) of the interviewed patients had arrived in the area within one month prior to admission, nine (36%) within the last week. Seven (28%) of the total were identified as not being the responsibility of the local authority. Patients who have recently arrived provide a significant proportion of the clinical workload in this area.
The other end of the couch
Authors: Jones K. S.
Published: October 2008

In 1979, I wrote a personal paper on psychiatry viewed from retirement (Jones, 1979). Six years later Wounded Healers included a chapter by me (Phoenix, 1985). In the first I was coy about the nature of my ‘personal crisis’; in the second, I could pseudonymously be frank. Now, at 76, my further account appears above my own name.
Against a high-risk strategy in the prevention of suicide
Authors: Kapur Navneet , House Allan
Published: October 2008

Standard approaches to the prevention of suicide have concentrated on the rigorous assessment and management of suicidal risk. Using deliberate self-harm as a specific example, we discuss the relative merits of this ‘high-risk’ strategy and compare it with a population-based preventive strategy. We conclude that a combined approach offers the best hope for reducing the rate of suicide, although it may not fit easily with medical models of care.
Social and clinical characteristics and outcomes
Authors: Gilleard Chris , Lobo Ros
Published: October 2008

This paper describes the social and clinical characteristics of patients who attended a mental health promotion drop-in clinic that was set up in a primary care group practice. From consideration of the characteristics of the patients, the problems they presented with and the results of the consultations, we argue that there is a viable role for mental health promotion as a form of primary prevention of mental health problems, distinct from an extended treatment or therapeutic role. It is open to question whether the particular way we delivered the service is necessary to achieve such an objective and we draw attention to some of the constructive criticisms the primary health care team made at the final evaluation of the project.
Co-occurrence of Gilbert's syndrome and psychosis
Authors: Mahdi A. S. , Elameer M. S.
Published: October 2008

Idiopathic unconjugated hyperbilirubinaemia (Gilbert's syndrome) is a common benign disorder that, when seen in association with psychiatric illnesses, often leads to the inappropriate withholding of psychotropic medication. We describe three cases with Gilbert's syndrome and psychosis in which diagnosis of Gilbert's syndrome was delayed. This led to unnecessary investigations, further relapses and increased admissions to hospital. We emphasise the need for psychiatrists to be more aware of this benign condition.
Self-diagnosis and attitude change through the ‘information super highway’
Authors: Ayonrinde Oyedeji , Michaelson Simon
Published: October 2008

The Internet provides information on virtually any subject. This is readily accessible to the public, although of variable quality. The Internet also plays an important role in contemporary psychiatry with the dissemination of information on disorders, research and clinical practice. Our patients may have access to mental health web-sites, consulting electronic sources when making decisions that affect their health. The implications of patient power on the Internet are discussed.
The supervision register: 19 months after its introduction
Authors: Hindler Charles
Published: October 2008

Aims and method

To examine whether, 19 months after its introduction, the goals of the supervision register have been met. A matched case-control study of patients on the supervision register and Care Programme Approach was conducted.

Results

Cases and controls demonstrated similar socio-demographic characteristics, primary diagnoses and community psychiatric care. The supervision register group were more likely to use concurrent alcohol and/or illicit drugs (P=0.001) or suffer with an accompanying personality disorder (P=0.0001), and were less likely to have experience of a long-term relationship (P=0.003). Nineteen months after registration, the supervision register group were more likely to be violent to others (P=0.002) or involved in serious threatening behaviour to others (P=0.0007). Relapse of mental illness was the only significant predictor of future violence in the supervision register group (P<0.01).

Clinical implications

Patients with a history of violence to others were found to be appropriately placed on the supervision register but continued to demonstrate aggressive behaviour after registration, indicating that the goal of the supervision register to prioritise most appropriate care and treatment for this group of patients has not been met.
Police training for the management of dangerous patients
Authors: Logsdail Stephen , Ellis Kevin
Published: October 2008

When we call on the police, we can anticipate every officer will have received a basic level of training, which is given at the start of his/her career. This takes place at one of the National Police Training Centres within the UK. Over 10 weeks, new officers are taught self-defence, safety, communication and handcuffing skills. After this they transfer to a local force training centre, where the national training is put into the context of local policies and procedures, using local equipment. The officer works as a probationer for two years before final basic qualification is accepted.
Mental Health Act Code of Practice
Authors: Parkin Andrew
Published: October 2008

The revised Code of Practice to the Mental Health Act 1983 (England and Wales) was published on 1 March 1999 (Department of Health & Welsh Office, 1999), and came into force on 1 April 1999. This code of practice replaces the previous one (Department of Health & Welsh Office, 1993) in providing guidance to professionals undertaking duties under the Mental Health Act 1983. The Mental Health Act uses the term ‘patient’ irrespective of age. However, Section 10 (2) of the Act sets out the right of 16– and 17–year-old people to determine their own admission. Section 10 states:
Over-occupancy in London's acute psychiatric units – fact or fiction?
Authors: Audini Bernard , Duffett Richard , Lelliott Paul , Pearce Alison , Ayres Catherine
Published: October 2008

Aims and method

Inner London psychiatric services face particular pressures. One measure of this is over-occupancy of acute psychiatric beds. Seven census-based surveys were conducted between June 1994 and January 1999 to quantify and monitor problems of inner London acute psychiatric bed provision. The censuses involved 14 inner London mental health services with a combined catchment population of approximately three million. Measures included levels (and changes over time) of occupancy, detention under the Mental Health Act, prolonged hospital stays and ward violence.

Results

‘Minimum’ occupancy levels for the combined services were above 100% at all census points. Occupancy level fell from 122% to 112% between the first and seventh census. This was associated with an increase in bed numbers of 2.5 per 100000. Levels of detention were consistently at around 50% and violent incidents were high at all census points.

Conclusions

Current provision of acute beds remains insufficient to meet service demand. To meet the 85% ward occupancy level recommended by the Royal College of Psychiatrists a further 14 beds or community alternatives per 100000 population would be required.
Effect of treatment in an active rehabilitation hostel on the need for hospital treatment
Authors: Macpherson Rob , Butler Julian
Published: October 2008

Aims and method

To describe the work of the ‘Vron’, a seven-bed active rehabilitation hostel which has operated in Gloucester for the last 15 years. Such units have been acknowledged as a successful alternative to hospital care for patients with severe mental illness, but nationally are grossly under-provided.

Results

Demographic details, admission and discharge data were described for all 103 patients admitted over a 12–year period up to January 1996. Duration of hospital treatment fell from mean 105.8 days one year before and 138.0 days two years before admission to the Vron to: mean 28.6 days one year after and 57.1 days two years after discharge from the Vron. The change was highly significant for both one and two year analyses.

Clinical implications

Residential rehabilitation, provided as part of a comprehensive rehabilitation service, was effective at reducing requirement for hospital care. Clinical approaches which contributed to this success were described. The results point to the value of a range of residential hostels, which can through skilled deployment effectively target individual needs for a wide ranging, heterogeneous population.
Electroconvulsive therapy in Wales
Authors: Duffett Richard , Siegert Drew Ridley , Lelliott Paul
Published: October 2008

Aims and method

The use of electroconvulsive therapy (ECT) was surveyed over the first six months of 1996 in Wales. Data on the indications for ECT and clinical outcome were collected in the first three months.

Results

The computed annual rate was 22 patients treated with ECT per 100 000 population. Women constituted 71% of those receiving ECT (236/321). Eighty-three per cent had an affective disorder, and 80% had failed to respond to previous treatments. Only 33% of patients had been prescribed more than one class of antidepressant and only 25% had received augmentation with lithium or an alternative drug before being given ECT.

Clinical implications

ECT is mostly used after a failure of patients to respond adequately to a course of antidepressants.
Criteria for appointment to observer and examination panels and overseas examinations
Authors: Tyrer Stephen P.
Published: October 2008

The procedure for nomination to the MRCPsych Board of Examiners was recently published in Psychiatric Bulletin (Tyrer, 1999). These have led to enquiry by Members and Fellows of the College about the criteria for appointment to other Committees and Panels that are under the aegis of the Examinations Department. Following discussion at the Examinations Sub-Committee the criteria for appointment of psychiatrists to the Panel of Observers, the Panels concerned with the development of questions for the Multiple Choice Papers in both Parts of the MRCPsych Examinations, the Critical Review Paper and the Essay Paper in Part II of the Examination and for Overseas Examiners, are indicated below.
Evidence-based medicine, user involvement and the post-modern paradigm
Authors: Laugharne Richard
Published: October 2008

Working in general psychiatry requires us to live with tensions. We have to live with the tension between the paternalism of compulsory admissions and advocating the autonomy and rights of people with a mental illness. A further tension is exacerbated by two movements of recent years, evidence-based medicine and user involvement. These are broadly to be welcomed, but will ultimately bring psychiatry further into the conflict between the ‘modern’ and ‘post-modern’ views of the world.
When all else fails
Authors: Pereira Stephen , Beer Dominic , Paton Carol
Published: October 2008

Aims and method

A small minority of treatment-refractory patients who could benefit from treatment with clozapine, refuse to comply with blood tests or oral treatment. Treatment with clozapine can be enforced under the Mental Health Act.

Results

An aide memoire was developed locally to guide clinicians through the process of enforcing clozapine treatment.

Clinical implications

It is possible to enforce treatment with clozapine under the Mental Health Act and so offer a valuable treatment option.
Commentary: the risks of enforcing clozapine therapy
Authors: Barnes Thomas R. E.
Published: October 2008

Pereira et al's paper (1999, this issue) is to be welcomed in that it highlights an area of clinical decision that requires a careful balance of short- and long-term risks and benefits in the individual patient. In this (necessarily) brief commentary I will concentrate on this aspect, and leave aside any ethical and medico-legal considerations.
High-dose antipsychotic treatment in clinical practice
Authors: Tyson Philip J. , Mortimer Ann M. , Wheeler Jason A
Published: October 2008

Aims and method

A trust-wide audit of antipsychotic prescription was conducted in order to investigate the prevalence of high-dose treatment in a population with schizophrenia and assess compliance with Royal College of Psychiatrists' guidelines on the use of high doses. Details of antipsychotic medication were recorded and in cases of high-dose treatment compliance with the College's guidelines was assessed.

Results

Sixteen out of 361 patients (4%) were receiving high-dose medication. At re-audit this figure fell to four patients (1%). High-dose treatment comprised of a combined depot and oral medication in most cases. There was poor compliance with the College's guidelines.

Clinical implications

The study stresses the importance of monitoring patients on high-dose antipsychotics, particularly when taken in combination.
Perceived role of psychiatrists in the management of substance misuse a questionnaire survey
Authors: Day Edward , Arcelus Jon , Kahn Ashraf
Published: October 2008

Aims and methods

A postal questionnaire sent to all psychiatrists working in four NHS trusts in and around Birmingham was used to survey the number of new cases of drug and alcohol misuse identified in the previous month and the degree of postgraduate training in the management of such cases. Attitudes and beliefs about substance misuse problems were also elicited.

Results

A response rate of 70% was achieved across six sub-specialities in psychiatry and four levels of training. Of the 143 respondents, over half had identified at least one new case of alcohol (61%) or drug misuse (55%) in the previous month. Approximately half of the sample admitted to having received no training in management of substance misuse cases in the previous five years (45% alcohol 50% drugs). There was general agreement about the potential management role of the doctor in the field, but less consensus on whether the clinician had a responsibility to intervene in such cases. A clear discrepancy was demonstrated between psychiatrists' perceptions of the evidence supporting various treatments and the actual evidence base.

Clinical implications

The study highlights the pressing need for training psychiatrists at all levels and in all sub-specialities in the management of substance misuse.
Attitudes of the general population to psychiatric and physical illness
Authors: Lawrie Stephen M.
Published: October 2008

Aims and method

The attitudes of members of the general population to people with psychiatric and physical illnesses were examined. We took a random sample of 280 members of the general population listed in the phone directory and sent them a brief clinical vignette about a neighbour with either schizophrenia, depression, diabetes or no illness.

Results

Only 103 (41%) of the surveyed general population responded. Some unsolicited comments revealed negative attitudes from a small number of subjects. There were, however, no statistically significant differences in general attitudes to sufferers of psychiatric and physical illnesses suggestive of discrimination against the former. Indeed, respondents showed a general tendency to be more supportive of a neighbour with any illness than to those without. In a sub-analysis, however, those who knew someone with schizophrenia were significantly less likely to be sympathetic towards them.

Clinical implications

We have not detected any general stigmatisation of those with psychiatric disorders, but our results may be attributable to response bias. Discrimination against those with psychiatric disorder may be limited to a relatively small sector of society or may only be manifest in relatively close relationships.
Regional review of psychiatric training
Authors: Herzberg Joe , Fergus Karen , Paice Elisabeth
Published: October 2008

Aims and method

To investigate whether psychiatry training in North Thames met standards set by the Royal College of Psychiatrists and North Thames Deanery. Visits to individual sites to inspect the training programmes and facilities were carried out. A speciality-specific trainee survey (paper questionnaire) was carried out and results from a general trainee satisfaction survey (electronic survey units) are given.

Results

We visited all 43 sites. The 207 psychiatry trainees completed the speciality-specific questionnaire (response rate 40%) and 2947 trainees completed the general survey (response rate 71%) of which 280 responses were from psychiatry trainees. Trainees in psychiatry expressed greater satisfaction with their training than trainees in other specialities. However, we identified deficiencies in suitability of general practitioner posts, safety issues, electroconvulsive therapy supervision, access to multi-disciplinary training and consultant supervision.

Clinical implications

Although trainees in psychiatry were generally satisfied with their training, the educational and safety standards set by the Royal College of Psychiatrists and the North Thames Deanery were not always met.
Desmond Kelly: in conversation with David Tait
Authors: Tait David
Published: October 2008

Desmond Kelly's decision to enter psychiatry was finally settled while dining with the late Dr William Sargant at his club. After National Service he returned to St Thomas' to do his MD and, after six months at the Maudsley Hospital spent a year at Johns Hopkins, Baltimore on a Nuffield Fellowship. His consultant career began with 10 years at St George's where, in addition to extensive teaching and committee duties, he published over 50 papers and his book Anxiety and Emotions. He then became Medical Director at Roehampton Priory Hospital.

He established links between the Priory and Charing Cross, University College London and St George's. These links with medical schools culminated in accreditation by the Royal College of Psychiatrists. In 1992 he became a Visiting Professor at University College London. Dr Kelly's involvement with issues in addition to his clinical and management responsibilities have included the College's ‘Defeat Depression’ campaign. He is currently Patron of ‘The National Depression Campaign’, its successor.

It is his involvement in independent practice, however, which sets him apart. His leadership grew from Medical Directorship of a single hospital to becoming Group Medical Director of a score of hospitals throughout the UK, with a seven-fold increase in bed provision and a steady development of specialist services. During this time he became a Board Member of the parent company and was also Chairman of the group for five years.

Desmond Kelly retired this year.
Psychiatry in Sri Lanka
Authors: Kuruppuarachchi K. A. L. A. , Rajakaruna R. R.
Published: October 2008

Sri Lanka is a developing country situated in the Indian ocean with a population of about 18.5 million. Its education and health care services are free in the state sector. Psychiatric services are mainly confined to the units in the general hospitals and two large mental hospitals situated in Angoda and Mulleriyawa (suburbs of Colombo) at the moment. However the institutional care is gradually changing and many professionals are aware of the importance of community care. There are a few reasonably organised community centres available at present.
[no title]
Authors: McCloud Annie
Published: October 2008

Sir: Thompson's article on the internet and suicide (Psychiatric Bulletin, August 1999, 23, 449–451) is a timely and welcome addition to the slowly growing literature on the internet and health. However, she could possibly have developed further positive ways of approaching the influence of the internet. Attempting to shut down, or restrict access to internet sites dealing with suicide is likely to be difficult to enforce in practice and may inadvertently block access to sources of positive help. It is important to stress the potential benefits of support online. The vast majority of online informants of my current thesis in medical anthropology on chronic fatigue syndrome and internet use reported that it provided a lifeline in the face of prejudice and lack of sympathy for family and desertion by friends. There is a vast untapped potential for NHS trusts and bodies such as Mind, or the Royal College of Psychiatrists to set up websites, moderated newsgroups and Internet Relay Chat (IRC) services to provide more therapeutic approaches to suicide and mental illness than those described by Thompson.
Nagy Riad Bishay
Authors: Salib Emad
Published: October 2008

Dr Bishay was born on 25 August 1936 in Sohag, Egypt, the first of six children of Coptic Christian parents from Upper Egypt. After an illustrious school career he moved to the capital to study medicine at the University of Cairo, obtaining his MB ChB in 1958. He worked as a general practitioner in various Egyptian military hospitals for the next four years and obtained his Diploma in General Medicine in 1964. He continued to work in military hospitals for two further years as a physician.
A time to keep silent and a time to speak
Authors: Zigmond A. S.
Published: October 2008

The final report of the Scoping Study Committee (Richardson Committee) reviewing the Mental Health Act 1983 is eagerly awaited. All psychiatrists, either individually or through the College, had an opportunity to express their views on what changes in legislation are needed and to comment on the draft proposals (Scoping Study Committee, 1999). Many psychiatrists did neither. Yet to use modem terminology, psychiatrists are one of the major ‘stakeholders' of mental health legislation. A valuable way of ascertaining colleagues' views in a structured way is by surveys of the type conducted by Buchanan & Gunn (1999, this issue). Given that the Richardson Committee has yet to publish proposals for ‘Part III’ the survey is timely. The response rate is, of course, very important and one is left wondering why a third of the general and community psychiatrists did not respond. Work load, burn-out or lack of familiarity with Part III of the Act are possible explanations.
Letter to the Secretary of State for Home Affairs
Authors: Tomison Arden R.
Published: October 2008

Dear Mr Straw, I awoke on Monday 19 July to the news that you were publishing a Consultation Paper to explore the possibility of introducing preventive detention for people with severe personality disorders. In your interview on radio that morning you seemed very determined to be sure that such legislation was introduced in the expectation that incarceration of the 200 people with severe personality disorders who would be subject to such detention, would somehow enhance public safety.
Model job description for consultant child and adolescent psychiatrists
Authors: Littlewood Stephen , Dwivedi Kedar N.
Published: October 2008

In June 1997, the Royal College of Psychiatrists published an occasional paper entitled Model Consultant Job Descriptions. The Faculty of Child and Adolescent Psychiatry Regional Representatives considered that further guidance was required to assist those writing job descriptions and for Regional Representatives assessing the job descriptions in consultation with Regional Advisors, on behalf of the Royal College. Hence, this Faculty document which may additionally be helpful for those contemplating applying for consultant posts.
Increasing the cross-fertilisation of ideas between training schemes
Authors: White David
Published: October 2008

Sir: I have had the opportunity, as the specialist registrar representative on a Child and Adolescent Psychiatric Special Advisory Sub-Committee team, to visit a different child and adolescent training scheme than my own. This was a very interesting experience both with regard to the process of the visit and seeing how another scheme functions. It also exposed me to new ideas about training. I strongly support the view expressed by Laurence Sheldon (1994) that approval visits should be open for any interested specialist registrar and recommend other trainees to consider offering themselves for approval visits.
Doctors in distress
Authors: Rees Lesley
Published: October 2008

Sir: As we near the end of the twentieth century it can be hard to believe that members of the medical profession might find themselves in need. As a profession we are reasonably well paid and jobs are relatively secure. We have the NHS Pension Scheme and we can take out insurance policies which, at first sight and at a price, appear to cover most eventualities.
Bruce Ricketts
Authors: Selley Carry
Published: October 2008

His formative years were spent in the Malvern Hills, Worcestershire, an area which always held a deep affection for him and played a part in his musical development. Another strong influence on him was the Quaker school he attended there. Anyone who knew Bruce can vouch for his strong sense of right and wrong and the importance of each individual. His work for organisations, such as St Dismas in Southampton and the Samaritans was invaluable. A man respected by so many, could do much for such worthy, charitable organisations who work with those often just on the edge of psychiatric services.
Experience in group analytic psychotherapy
Authors: Rees Harvey
Published: October 2008

The Royal College of Psychiatrists classifies group psychotherapy as required experience for psychotherapy training as part of general psychiatric training (Grant et al, 1993). This is defined as group experience in in-patient and/or out-patient settings, with an experienced co-therapist and/or supervision. Previous surveys estimate that the percentage of trainees gaining such experience ranges from only 9% (Arnott et al, 1993) to 58% (Hwang & Drummond, 1996). The limited duration of psychiatric training does not allow experience in all types of psychotherapy and trainees must therefore be selective in respect to their own training, depending on what is available.
CHEAF (Child Health and Education Assessment Forum): a multi-disciplinary powwow for children
Authors: Williams Christine , Wright Barry , Smith Rob
Published: October 2008

It has been recommended that child and adolescent mental health services operate on four tiers (NHS Health Advisory Service, 1995). Tier three represents specialist teams, where professionals work together to provide specialist services. Since additional resources have not been forthcoming to support such developments, existing teams frequently restructure themselves in order to operate in this way. One way of rationalising existing resources effectively is to establish interagency links so that multi-disciplinary working is not limited by professional boundaries. This can occur across as well as within teams.
Psychiatrists' attitudes to maintenance drug treatment in depression
Authors: Jackson Graham A. , Maciver Ishbel
Published: October 2008

Aims and method

The recurrence rate of major depression can be decreased by the use of maintenance drug treatment. This paper describes a survey of Scottish psychiatrists' attitudes to prescribing maintenance therapy. Questionnaires were sent to all Scottish psychiatrists at consultant and associate specialist grade.

Results

It is evident that there are major differences in prescribing practices. How patients are managed would appear to depend on to whom they are referred.

Clinical implications

Psychiatrists do not appear to be practising evidence-based medicine in this context. There is perhaps a need for greater consensus on the prevention of recurrence.
A follow-up study of people with severe mental illness treated by a specialist homeless team
Authors: Odell Sue , Commander Martin
Published: October 2008

Aim and method

To follow up homeless people with psychoses treated by a dedicated team; changes in accommodation, risk behaviour, mental state and psychiatric care were examined.

Results

Service uptake improved as did symptomatology and residential stability. However, substance use and criminality continued to be prevalent and a minority remained homeless.

Clinical implications

Specialist psychiatric teams are a valuable adjunct to mainstream services in areas with high levels of homelessness.
Psychiatric morbidity in patients referred for individual psychotherapy within and outwith the NHS
Authors: Mitchell John R. , Freeman Chris P.
Published: October 2008

Aims and method

Demographic and medical characteristics of waiting list patients for National Health Service (NHS) psychotherapy, non-NHS psychotherapy or NHS general adult psychiatry were compared by postal questionnaires.

Results

One hundred and eighty-three subjects replied. High rates of psychiatric morbidity were reported in both psychotherapy populations but general psychiatric referrals were more disturbed, taking more psychotropic medication than non-NHS psychotherapy but not NHS psychotherapy subjects. The biggest referral source to non-NHS psychotherapy was general practitioners.

Clinical implications

Non-NHS psychotherapists should be able to recognise severe mental illness and have a basic understanding of psychotropic medication and psychiatric services.
Psychotherapy and old age psychiatry
Authors: Garner Jane
Published: October 2008

Aims and Methods

This report was prepared as the basis for wider consultation within the Old Age Faculty and the College. Some literature and practice is reviewed and practical suggestions made for the future in this area.

Results

Although older patients are less likely to be refused for psychological intervention attitudes are slowly changing.

Clinical implications

The clinical implications of this development include a greater consideration of the unique emotional life of each of our patients and an improved understanding of our reluctance to engage in psychotherapeutic work with older people.
Role and responsibility of the speciality tutor
Authors: Garner Jane , Ong Yong Lock
Published: October 2008

Aims and method

In order to identify the role and responsibility of the speciality tutor, the tutors' post in old age psychiatry was compared across two regions.

Results

The role was narrow; but different in the two regions depending on training programmes.

Clinical implications

Tutors in all faculties should have an expanded and standardised job description, separate from the role of the regional representative, in order to strengthen the input of the specialisms to training at all levels.
How to pass the MRCPsych examination
Authors: Cormac I. , Marston G.
Published: October 2008

Membership of the Royal College of Psychiatrists is the main qualification needed to progress from the basic training grade (senior house officer) to higher professional training (specialist registrar) in psychiatry. The Collegiate Trainees Committee (CTC) recognises that the MRCPsych examinations may generate anxiety in candidates and require a large investment in time and personal resources. The examinations are competitive, with approximately 50% of candidates passing on each attempt. It is worthwhile preparing well the first time, by planning in advance and understanding the critical factors for success. This article aims to help trainees preparing for the MRCPsych examination.
Sources of stress, psychological distress and burnout in psychiatrists
Authors: Guthrie Elspeth , Tattan Teresa , Williams Edwina , Black Dawn , Bacliocotti Himant
Published: October 2008

Aims

To assess the degree of psychological morbidity and burnout in 138 psychiatrists in three Manchester teaching hospitals.

Results

The results for senior house officers (SHOs), registrars, senior registrars and consultants were compared. The overall response rate was 76.8%. There was no significant difference in psychological morbidity between the three training grades, but SHOs and registrars reported significantly higher levels of burnout than either senior registrars or consultants. Dealing with violent patients was stressful for all psychiatrists, no matter what the grade.

Clinical implications

Factors related to job stress in psychiatry need to be addressed. In particular, the provision of safer working environments needs to be considered for psychiatrists at all levels of training.
First psychosis liaison unit family education programme
Authors: Morris Eric , Harris Catie , Nolan Lynley
Published: October 2008

Aims and methods

This study presents an evaluation of an education programme for families whose relative has experienced a first episode of psychosis. Participants attended a five-week programme and were asked to rate their level of knowledge and confidence in managing the illness before and after the education sessions.

Results

Two consecutive groups of relatives (n=9; n=11) attended the programme. Comparison of knowledge and confidence ratings before and after the education sessions demonstrated significant levels of change at the final session for both groups.

Clinical Implications

Education for relatives of people experiencing psychosis for the first time is an important component in community management. Such education improves the knowledge and confidence of relatives in coping with the illness, possibly leading to a more accepting and less stressful family environment reducing the risk of relapse and promoting the psychological health of the patient.
Making sense of child and adolescent mental health services
Authors: Stallard Paul , Potter Robert
Published: October 2008

Aims and method

A prospective audit of the 425 referrals made to a community child and adolescent mental health service over a three month period was undertaken. Standardised data were collected about the referrer, reason for referral problem chronicity and complexity, service response and first appointment attendance.

Results

The service is currently seeing less than one in five of the children conservatively estimated to require specialist mental health services. The majority of those referred were appropriate, identifying multiple problems of longer than six months' duration presenting within a complex context.

Clinical implications

The results have provided commissioning authorities with a clear specification of the current service. This can inform decisions about resource reallocation, prioritisation and future service development. Clinicians feel that the complexity of their work is now understood and various audit projects and initiatives have been established in order to explore alternative ways of responding to referrer demands.
Accuracy of references in psychiatric literature: a survey of three journals
Authors: Lawson L. A. , Fosker Ruth
Published: October 2008

Aims and method

The prevalence of errors in reference citations and use in the psychiatric literature has not been reported as it has in other scientific literature. Fifty references randomly selected from each of three psychiatric journals were examined for accuracy and appropriateness of use by validating them against the original sources.

Results

A high prevalence of errors was found, the most common being minor errors in the accuracy of citations. Major citation errors, delayed access to two original articles and three could not be traced. Eight of the references had major errors with the appropriateness of use of their quotations.

Clinical implications

Errors in accuracy of references impair the processes of research and evidence-based medicine, quotation errors could mislead clinicians into making wrong treatment decisions.
The management of cylindrical battery ingestion in psychiatric settings
Authors: Hindley Nick , Gordon Harvey , Newrith Chris , Mohan Damian
Published: October 2008

Aim and method

To describe physical sequelae of cylindrical battery ingestion and their management by description of recent cases and literature review.

Results

X-rays should be performed to determine the position and integrity of the battery. In the absence of abdominal symptoms, immediate surgical opinion may not be indicated.

Clinical implications

Conservative management of battery swallowing is frequently possible.
Medical students' perspective of maximum security psychiatric care
Authors: Thomson Lindsay D. G. , Gray Colin M. , Humphreys Martin S.
Published: October 2008

Aims and method

This study describes the effects of teaching medical students in a maximum security psychiatric setting. A questionnaire was distributed to students (n=210) at the beginning and end of their third year.

Results

Following the visit to the State Hospital significantly more students understood that maximum security psychiatric facilities are part of the National Health Service; that some serious offenders may require hospitalisation rather than imprisonment; that not everyone detained in such surroundings is actively violent or dangerous, or permanently detained. Twenty-three students considered forensic psychiatry to be a possible career option.

Clinical implications

This study demonstrates that early exposure, even to such a specialised area of practice, can enhance the prospects of future recruitment. Attracting motivated, able and interested doctors is important in improving patient care.
Psychiatry in Bermuda
Authors: Marlowe Karl
Published: October 2008

Bermuda has one psychiatric hospital, which is organised along a programme model; an acute programme, a rehabilitation programme, a child and adolescent programme, a substance misuse programme and a learning disability programme. Bermuda has good resources and the majority of staff are trained in British hospitals. There has been a shift away from the stigma of mental hospitals towards a more community-oriented mental health service.
Psychiatric features of new variant Creutzfeldt-Jakob disease
Authors: Will R. G. , Stewart G. , Zeidler M. , Macleod M. A. , Knight R. S. G.
Published: October 2008

Aims and method

New variant Creutzfeldt–Jakob disease is a novel prion disease of humans that may be causally linked to bovine spongiform encephalopathy. Psychiatric symptoms occur in the early stages of the illness and may be difficult to distinguish from the symptoms of more common psychiatric disorders. Cases of new variant Creutzfeldt–Jakob disease are identified through the national surveillance system. Information on psychiatric features has been obtained by review of case notes and, in the majority of cases, by interview of relatives by a member of the surveillance staff.

Results

Thirty-five cases of new variant Creutzfeldt–Jakob disease have been identified in the UK and detailed information on the clinical features and investigations is currently available in 33 of these cases. All but one of the cases exhibited prominent early psychiatric symptomatology, but the diagnosis of an underlying neurological disease was not possible in the majority of cases until the development of neurological symptoms and signs. Early indications of an underlying neurological disorder included cognitive impairment, persistent sensory symptoms or limb pain and, in a minority, gait imbalance, dysarthria or visual symptoms. Limited evidence suggests that investigations such as electroencephalogram or brain imaging are unlikely to provde useful diagnostic information during the ‘psychiatric’ phase of the illness.

Clinical implications

The early recognition of an underlying neurological disorder may be impossible in the early psychiatric phase of new variant Creutzfeldt–Jakob disease, but the suspicion of this diagnosis may be raised by the occurrence of associated neurological symptoms. The development of early diagnostic markers is an important objective.
Survey of suicides in the Fife region of Scotland
Authors: Douds Fergus , Bridges Vicky
Published: October 2008

Aims and methods

Suicides in the Fife region were investigated over a two-year period. The timing of the final contact with general practitioners and psychiatric services was ascertained. Data were collected from procurators fiscal records, general practices, and where applicable, psychiatric records.

Results

There were 74 suicide victims during the study period. Forty-six per cent of suicide victims saw their general practitioner in the month before death, and 55% had a history of previous contact with psychiatric services, although only 27% of this group saw a psychiatrist in the month before death.

Clinical implications

Clinical audit of suicide is an important task for psychiatric services. Practitioners must continually assess risk and attempt, where possible, to reduce risk factors.