bluuebunny/crossref_metadata_2025 huggingface dataset:
The Third European Trainees Forum
Authors: Sheldon Laurence , Cornwall Peter L.
Published: October 2008

The Third European Trainees Forum met in Copenhagen in May 1995. Twenty-nine delegates from fourteen countries came together to discuss training issues in the European context. Newcomers representing France, Spain and Italy joined representatives from the United Kingdom, Ireland, Norway, Denmark, Sweden, Finland, Greece, Switzerland, Germany, The Netherlands, Belgium, and Portugal. As in previous years, the Forum addressed a number of specific training topics and discussed furthering links with other European psychiatric bodies.
The Centre for Mental Health Services Development
Authors: Moss Roger C. S.
Published: October 2008

The design of community-based mental health services to replace institutional patterns of service has proved a weighty responsibility for districts engaged in the task. A major challenge has confronted clinicians, planners and managers of change: to seize the not-to-be-repeated opportunity of redeeming the investment in outdated buildings; to revitalise forms of practice that have become increasingly divorced from the needs of those who use these services; and to set up valid systems of care which can stand the test of time.
Community interviewing: experiences and recommendations
Authors: Parkman Sue , Bixby Sara
Published: October 2008

Evaluation studios of community mental health services require the research, often in the form of interviews, to be carried out in private homes which poses a particular set of issues relating to the interview environment and the organisation of the work. This paper describes the experiences of interviewing patients, staff and informal carers as part of an evaluation study of the mental health services in two psychiatric sectors in South London and makes recommendations for more effective community based research.
Treatment decisions following assessment by multidisciplinary psychogeriatric teams
Authors: Lindesay James , Herzberg Joe , Collighan Gill , Macdonald Alastair , Philpot Michael
Published: October 2008

The psychiatric treatment decisions made by two multidisciplinary psychogeriatric teams in 100 new referrals were compared with those made by a group of psychiatrists following independent formal research assessments. There was satisfactory agreement between the team and research decisions with regard to psychiatric hospital admission, antidepressant treatment and neuroleptic treatment. Agreement was less good for psychological treatments.
Choosing death: the moral status of suicide
Authors: Oyebode Femi
Published: October 2008

Our moral conception of suicide is examined. It is argued that a neutral definition of suicide is difficult to achieve and that how we treat the Question of suicide shows what value we place on the sanctity of Me or on life as a means to other ends. The case is made that autonomy, the principle of self-governance, has acquired special importance in the modem world to me detriment of other ethical principles such as beneficence.
Ethical dilemmas in perinatal psychiatry
Authors: Ramsay Rosalind , Kumar Channi
Published: October 2008

This paper discusses ethical dilemmas that arise in parenting assessments on an in-patient Mother and Baby Unit with reference to one subject, a mother with schizophrenia who had been referred for a specialist opinion. The case raises ethical issues about the sometimes conflicting needs and wishes of mothers and their infants, and considers the requirements of the Children Act.
Training in public health medicine
Authors: Summers J. A. , Kehoe R. F.
Published: October 2008

This paper considers the possible relevance to psychiatry trainees of a period of training in public health medicine. The work of public health doctors is to identify ways of Improving the health of populations and to promote relevant change. It is of relevance to psychiatrists, who have to consider needs of whole catchment populations rather than Just of patients who seek help, and who have historically experienced difficulty in competing for resources. We discuss tasks that trainees might undertake during a brief public health attachment, the potential benefits of such an attachment and some of the practical considerations.
Survey of highly specialised psychiatric services
Authors: Beasley J. , Brockington I. F. , Crisp A.
Published: October 2008

It is in the nature of Health Services that there should exist a balance between the general and the specialised; between the treatment of common conditions with generally applicable techniques and the handling of more unusual diseases. Services which require scarce skills and treat less patients who need more time are expensive. In a cost-driven situation, these skills are likely to be constrained in favour of more generally applicable, lesser standards which are cheaper.
Should psychiatric trainees do research?
Authors: Williams Chris , Curran Stephen
Published: October 2008

Freeman (1992) advocated the setting up of a network of College Research Training Coordinators to provide practical assistance and supervision for trainees engaging in research for the first time. A recent debate held at a College Research Training Coordinators meeting in York under the Chairmanship of Dr Chris Freeman debated the motion “All trainees should undertake research”. This has stimulated us to think again about our own attitudes towards this question.
What makes you so special?
Authors: Punter Jale
Published: October 2008

I am foolish enough to believe that just because I was successful at my senior registrar appointment interview, my preparation was good enough and my wisdom worthy of passing on to the next generation of candidates!
The Sick Child
Authors: Kapp Elinor
Published: October 2008

The greatest unnameable fear for all of us who are parents is that of losing a child. We hear about it in others, we read about it in the papers and a cold chill touches us. The most common deaths are sudden in accidents but many parents have to cope with the long drawn-out trauma, alternating hope and fear, of sickness. No-one can ever know if or when or where they may experience the policeman at the door or the embarrassed compassion in the doctor's face.
Junior doctors and emergency tranquillisation of elderly, confused patients: a survey
Authors: Thacker Simon
Published: October 2008

This paper presents the results of a survey of Junior doctors' opinions concerning the emergency tranquillisation of acutely disturbed, confused elderly patients. Although the majority of respondents gave recommendations within current guidelines, there were large variations In drug dose, and the choice of psychotropic agent may have been determined more by availability than rational prescribing practice.
Personal finances for long-stay psychiatric patients resettled into the community
Authors: Fuhrmann Ross , Reeder Clare
Published: October 2008

It is important to ensure that the financial provision received by the long-stay psychiatric population is maintained as their care is relocated from hospitals to the community. A survey of the provision made by the 20 community homes to which Horton Hospital patients have been resettled was conducted. Comparison with the provision received by patients prior to resettlement revealed that the clothing allowance provided for patients without savings in Horton is often not maintained in the community and that resettled patients receive widely differing and frequently much smaller provision for clothing.
Is routine physical examination of psychiatric in-patients really necessary?
Authors: Porter Ian
Published: October 2008

Although there are some well recognised physical disorders such as intracranial lesions that can present with mental illness, many psychiatric conditions do not appear to be associated with underlying somatic complaints. However, a number of recent studies have shown that there are often high rates of concurrent medical conditions among acute psychiatric in-patients that were previously undiagnosed or unsuspected. The author illustrates this point by presenting two case studies in which a significant medical condition was only identified after physical examination on a psychiatric unit.
Antidepressant prescribing prior to suicide: role of doctors
Authors: Boer Harm , Booth Nick , Russell David , Powell Roy , Briscoe Martin
Published: October 2008

The pharmacological treatment of depression and the time elapsed since last seen by a doctor were investigated among 507 adults who subsequently killed themselves. The proportion of people consulting a general practitioner or psychiatrist prior to suicide was lower than reported by the British government in the Health of the Nation document. General practitioners prescribed relatively low doses of antidepressants. Nineteen out of the 115 people receiving antidepressants used the drugs to kill themselves. Our findings emphasise the importance of prescribing adequate doses of antidepressants and underline the need for safer prescribing.
Regional audit of depot neuroleptic usage in adults with learning disabilities
Authors: Gravestock Shaun
Published: October 2008

A previous survey (Gravestock, 1996) assessed factors associated with depot neuroleptic usage in 79 adults with learning disabilities using mainly community-based services. The data informed consensus standard setting and this audit focusing on 32 out of 79 original subjects. At two year follow-up, five subjects had been withdrawn from depots; there was a significant (P < 0.001) reduction in subjects' median depot dosage and reduced concomitant usage of oral neuroleptics and anticholinergics. The importance of completing the audit cycle and other psychotropic medication monitoring studies in community learning disabilities services are discussed.
A management course for senior registrars
Authors: Reder Peter
Published: October 2008

A course on management within a psychiatry training scheme contributes to senior registrars' preparation to become consultants. Sessions should impart factual knowledge and consider interpersonal components of the management process.
Special Interest Group for Neuroscience in Psychiatry
Authors: Goodwin Guy M.
Published: October 2008

The inaugural meeting of a Special Interest Group for Neuroscience in Psychiatry was held at the meeting of the College in Glasgow in 1995, chaired by Professor Stuart Checkley.

The following statement has been prepared for the group to announce its existence and stimulate discussion of its aims.

The mission of the group will be to promote the application of neuroscience to the core problems of aetiology and treatment in psychiatry. The term neuroscience encapsulates those aspects of anatomy, physiology, pharmacology, genetics and psychology which contribute mutually to an improved understanding of how the brain functions in health and disease.
An investigation of high lithium concentrations
Authors: Myers D. H. , Hallworth M. J.
Published: October 2008

The circumstances associated with high lithium concentrations detected by 23 district laboratories in the West Midlands during a 22 month period were investigated.
Prescribing for patients attending old age psychiatry day hospitals
Authors: Semple Margaret M. , Ballinger Brian R. , Irvine Elizabeth
Published: October 2008

A review of the drug treatment of 163 patients attending two old age psychiatric day hospitals showed that 29 received medication from the day hospital, 44 from general practitioners and 60 from both sources. Many of the patients' knowledge of their drug treatment was incomplete. Of those individuals interviewed, approximately equal numbers expressed a preference for day hospital and general practitioner prescriptions. The origin of the prescription did not bear any obvious relationship to subsequent admission to hospital or continued attendance at the day hospital.
Lithium and the thyroid
Authors: Paton Carol , Beer Dominic
Published: October 2008

The common thyroid disorders are all autoimmune in origin, with the lifetime risk of thyroid disease being 1–2%. Thyroid autoantibodies are present in 9% of the adult population and 12.7% of women, with the frequency rising steeply in women over 45 years of age (Myers & West, 1987). In addition, 20% of the over 60–year-olds have an abnormal (raised) thyroid stimulating hormone (TSH). The presence of both raised TSH and thyroid autoantibodies is associated with the development of clinical hypothyroidism at the rate of 5% per year (Myers & West, 1987).
Intensive case management: putting it into practice
Authors: Holloway Frank , Murray Morag , Squire Clare , Carson Jerome
Published: October 2008

The first 18 months of operation of a team providing high intensity case management is presented. A key-worker/co-worker system was adopted, with regular team meetings to review the progress of all clients. Low case-loads (10 clients per case manager) enabled the team to carry out detailed assessments of need, offer assertive outreach and crisis intervention and coordinate complex packages of community care. The case management team provided an accessible and effective service. However, not all patients appeared to benefit and the intensive nature of the work was very demanding on staff.
Cost-offset following specialist treatment of severe personality disorders
Authors: Dolan B. M. , Warren F. M. , Menzies D. , Norton K.
Published: October 2008

Service usage of 24 patients with a personality disorder was established for one year pre-treatment and one year post-treatment via a prospective survey of the patients, their original referrer and their general practitioner. The average annual cost of psychiatric and prison services (calculated from extra-contractual referrals (ECR) tariffs and Home Office data) was £13 966 pre-treatment compared to £1306 post-treatment, representing a cost-offset of £12 658 per patient per year. The average cost of the specialist admission was £25 641. Thus the cost to the Nation for treating these personality disordered patients in a tertiary treatment resource would be recouped within two years and represent a saving thereafter.
General practitioner and psychotherapist referrals to a specialist psychotherapy centre
Authors: Margison Frank , Stewart Alistair
Published: October 2008

General practitioners (GPs) were surveyed by questionnaire to determine their views on the indications for specialist psychotherapy and their estimates about the number of patients they thought should be referred. GPs had good awareness of the types of treatments available. There was close agreement between referring and non-referring GPs and with specialists on the indications for treatment. Estimates about demand for services showed that those who had not referred in the previous year estimated higher rates than those who had referred. GPs and specialists show good overall agreement on level of service and the indications for its use.
Guidance for presenters of short papers
Authors: Cottrell David
Published: October 2008

Short paper presentations are now a major feature of most medical conferences. While the exact timing varies it is not unusual to have only 10–15 minutes to present the results of research which may have taken years to plan, collect and analyse. Many doctors have not had any training in teaching or presentational skills, a fact which becomes readily apparent to those who have to hear them present at conferences.
Psychiatry in Jamaica
Authors: Hilton Claire
Published: October 2008

Jamaica has one large mental hospital. Recent developments in community care have reduced the number of in-patients. Most patients with serious psychiatric illness live in the community, supported by their families and nurses with some psychiatric training. Substance abuse is a major problem, and the suicide rate is reported to have risen recently.
The first twelve months of a community support bed unit
Authors: Thomas Philip , Greenwood Mike , Murray Ian , Kearney Gabrielle
Published: October 2008

The characteristics of clients admitted to a community support bed unit (SBU) serving an isolated, rural community were compared with those of clients from the same sector, admitted to a district general hospital (DGH) unit over the same period. There were few differences In the nature of the problems presenting to the two units, although there were more readmissions to the SBU, and more women tended to be admitted there. These results suggest that although the need for inpatient care remains for some patients, many who are currently admitted to such units can be managed in less institutional settings in the community. A support bed unit may play an important part in offering service users more choice about where and when they received help.
Psychosis and substance misuse comorbidity: ethical dilemmas
Authors: Macpherson Rob
Published: October 2008

This case demonstrates some of the complex practical and legal difficulties in managing patients suffering from comorbidity of substance misuse and psychosis. A discussion of the ethical issues includes references to absolutist and utilitarian ethical models. Ethical dilemmas in such cases often impinge directly on clinical management, and the paper argues that the success or otherwise of treatment is partly dependent on awareness of such factors.
Threatened eviction and hospital readmission from community homes
Authors: Gardner Justin , Pugh Robert
Published: October 2008

The outcome of 19 long-stay patients discharged from a large psychiatric hospital to staffed group homes managed by a voluntary organisation were compared with 11 patients discharged to a hostel ward managed by an NHS Trust. The former were found to have a higher rate of police involvement, readmission and threatened eviction. The study highlights the need for an integrated range of different residential facilities and the necessity for close monitoring of long stay patients discharged to more independent community settings.
Prevalence of hepatitis B virus in people with learning disabilities
Authors: Rajapakse D. , Ranasinghe R. N.
Published: October 2008

The prevalence of hepatitis B virus infection is thought to be higher in institutions for people with a learning disability than in the general population (Clarke et al, 1984). People with Down's syndrome are reported to be at higher risk than other learning disability groups. The prevalence of hepatitis B surface antigen (Hbs Ag) in Great Britain is in the order of 1 in 500 of the blood donor adult population (Department of Health, 1980). This rate is lower than those reported from countries in Europe, Africa and Asia. The present study was to identify those residents in an institution for people with a learning disability with a positive response to the test for Hbs Ag.
Working for the Mental Welfare Commission for Scotland
Authors: Morrison Rhona , Geddes John
Published: October 2008

In this article we describe a six-month attachment to the Mental Welfare Commission for Scotland undertaken as part of higher professional training. We discuss the training benefits of such an attachment, emphasising the valuable overview it provided of mental health policy and the use of guardianship and leave of absence.
The training of child psychiatrists in Thailand
Authors: Bartlet L. B. , Boonyaprakob Vanpen
Published: October 2008

In most Asian countries child psychiatry is still in its infancy and the few specialists operating in this field have received their training overseas, usually in Europe or the USA. There is a perceived need for more expertise in child mental health and the unsatisfactory solution often adopted is for psychiatrists trained in adult work to move in and learn from experience.
On learning from the patient: hearing voices
Authors: Warnes Ann , Strathdee Geraldine , Bhui Kamaldeep
Published: October 2008

This paper presents the coping strategies developed by one patient with 18 years experience of managing her own schizophrenic illness. The interventions which evolved gave her significant control over her illness. We report her experiences and emphasise that for some patients with treatment resistant schizophrenia, the patients themselves may have expertise in managing their symptoms.
Psychiatric intensive care units, a design for living
Authors: Dix Roland , Williams Kelwyn
Published: October 2008

The psychiatric intensive care unit (PICU) is now at the cutting edge of acute psychiatric care. Very little guidance has been produced to ensure that the PICU structure and design is able to meet the complex demands put upon it. The creation, development and relocation of a PICU has taken place within the Severn NHS Trust. We describe the experience gained from a recently commissioned unit together with a review of the relevant literature. Recommendations are offered for core features and design.
A survey of psychotherapy training among psychiatric trainees
Authors: Hamilton Ross J. , Tracy Diana
Published: October 2008

The Royal College of Psychiatrists has stressed that psychotherapy skills are seen as a core element of psychiatric practice. To formalise this a new set of guidelines for psychotherapy training as part of general professional psychiatric training was published in November 1993. Concerns have been expressed over the implementation of previous guidelines from 1986. We have surveyed the psychotherapy training experience in our area and have worked with the psychotherapy department to address the findings. The future of training in the psychotherapies and implementation of the most recent guidelines are considered.
Neuroleptic prescribing in an adolescent psychiatric in-patient unit
Authors: Lowe K. , Smith H. , Clark A.
Published: October 2008

The Royal College of Psychiatrists' consensus statement suggests that prescribing high dose antipsychotic medication in children and adolescents should rarely be necessary. Our objective was to study the prescribing of antipsychotic medication in a regional adolescent unit during a three-year period. We found that antipsychotic prescribing on this unit is common in psychotic disorders and often high closes are required. This is not in keeping with the recommendations of the consensus statement. Review of clinical practice on other adolescent units is needed, together with a more comprehensive evaluation of the outcome of psychotic disorders in this age group.
General practice and brief psychotherapy: a novel psychiatric training post
Authors: Scott Jonathan
Published: October 2008

Many psychiatrists now work successfully in the primary care setting. Although a primary care post might be considered to be a useful experience by most trainees, few undertake such an attachment, owing to lacked opportunities and concern that such a placement would delay career progress or be at the expense of psychiatric subspeciality experience (Burns, 1994). For general practice posts to be integrated into psychiatric training, these concerns need to be addressed. One solution has been a post shared with general psychiatry (Balmer, 1993). This paper describes an alternative approach, a post combining subspeciality experience in psychotherapy within the practice setting, with working as a general practitioner (GP) trainee.
All lost and in one day
Authors: Jolley David
Published: October 2008

November 30th 1995 saw old age psychiatry lose the active services of four men who have played heroic roles in creating and moulding the speciality.
Australia: getting there
Authors: Wilkie Alcuin
Published: October 2008

There have been two recent accounts in the Psychiatric Bulletin (Harrison, 1989; Kisely, 1993) which have given some practical advice about getting work in Australia. They did, however, rather gloss over the details. With clear memories of the difficulties of arranging a one year training post in Sydney, New South Wales (NSW) and having been approached by numerous mainly junior colleagues asking about details of arranging a similar trip, I am writing what I hope will be a useful and accurate “Getting your Australian visa and medical registration made easy” guide.
The evolution of psychiatric care – a spiral model
Authors: Sumathipala Athulo , Hanwella Raveen
Published: October 2008

The present trend towards community care with the continuing closure of the old Victorian institutions has given rise to much argument for and against community care. Incidents of violence by mentally ill patients against members of the public have resulted in some backlash against community care. There are fears of a return to the days of the institution. It is proposed that these changes can be predicted from a model that we have called the ‘spiral model’. An understanding of this model might help to prevent history from repeating itself.
Psychiatric emergencies: assessing parents of dependent children
Authors: Hatfield Barbara , Webster Jeni , Mohamad Hadi
Published: October 2008

Frameworks within which services are delivered to people with mental health problems neglect the specific needs of those with dependent children. These children have been identified as having risks to their development and well-being. A system of monitoring social assessments of mental health crisis is used to examine the characteristics of parents assessed in seven Local Authorities across 3 calendar years. Parents of dependent children are underrepresented, and are more likely to be women and to suffer from affective psychosis. Ethnic minorities are over-represented. Parents are less likely to be detained following assessment. Further work is needed to establish whether the needs of the family as a whole are addressed.
Dr Blake Marsh and the Blake Marsh Lectures
Authors: Day Kenneth , Jancar Joze
Published: October 2008

At the Council meeting of the Royal Medico-Psychological Association in November 1963 the Treasurer reported that “a handsome legacy of about £20,000 in shares had been made to the association by the late Dr Blake Marsh and arrangements are being made to take over these shares”. The actual amount was in fact a little over £23,500 – a considerable sum by today's standards. Numerous suggestions were made as to how this generous gift might be honoured including naming the Association's Bronze Medal after Blake Marsh but Council finally accepted a recommendation of the Education Committee “to found an annual lecture of a standing equal to the Maudsley Lecture on a subject connected with Mental Deficiency to be known by his (Dr Blake Marsh's) name” and this was ratified at the Annual Meeting in 1965.
Psychiatry: a risky business?
Authors: Holloway Frank
Published: October 2008

Following a series of well-publicised tragedies the Department of Health published guidelines on the discharge and aftercare of psychiatric patients (Department of Health, 1994). These guidelines stipulate that at the time of discharge from in-patient care the treatment team will have carried out a risk assessment, with the expectation that professionals will be criticised if things go wrong. Risk assessment is now a routine, if poorly understood, element of clinical practice. The allied concept of risk management, which lacks a simple definition but is “aimed at reducing the likelihood of harming patients during treatment, minimising trauma to those who are affected, and controlling the possibility of subsequent litigation” (Vincent, 1995), is much less familiar to clinicians. The Editor has commissioned a short series of articles that address the topic of risk in psychiatry, covering suicide, dangerousness, the exposed role of Mental Health Review Tribunals in the case of Restricted patients and a variety of professional risks. The aim is not to be didactic but to raise the level of debate about the risky business that psychiatrists are engaged in.
Australia – being there (in praise of general practice)
Authors: Wilkie Alcuin
Published: October 2008

“… the cardinal requirement for the improvement of the mental health services in this country, is … a strengthening of the family doctor in his therapeutic role.” – Michael Shepherd (1966).
Risk factors for acute psychiatric readmission
Authors: Dixon Mandy , Robertson Emma , George Mohan , Oyebode Femi
Published: October 2008

A retrospective case note study explored readmissions to an acute psychiatric in-patient unit within six months of discharge. The study aimed to calculate a hospital readmission rate, to investigate the timing of readmissions, and to identify risk factors associated with readmission. The readmission rate was 27% with the majority of readmissions occurring within three months after discharge, suggesting the need for investigation of such early readmissions. The three factors found to predict readmission were: discharge against medical advice, number of previous admissions, and living alone or with family rather than in care. Implications for hospital service planning are considered.
Monitoring of patients on high dose antipsychotic medication
Authors: Sillifant Kate , Muir Jacqueline , Crabb Mary , Read Stephen
Published: October 2008

In the light of recently published Royal College of Psychiatrists' guidelines on the use of high dose antipsychotic medication, electrocardiographic and blood investigations were performed on 11 patients with learning disabilities receiving such treatment. All patients had normal electrocardiograms (ECGs). Four patients had asymptomatic low white cell counts and mild anaemia was detected in three individuals. Three patients were hyponatraemic; liver function tests were essentially normal. Issues around routine monitoring of such patients are discussed.
Participating in the MRCPsych examinations: the patients' experience
Authors: Sloan Darina , Mannion Laura , Swanwick Gregory , O'Boyle James
Published: October 2008

Candidates' views regarding examinations in psychiatry have been highlighted in recent years. Few studies to date, however, have examined the views of the patients themselves toward the examination procedure. This study examines the knowledge and experience of a patient group participating in the College membership examinations. Providing patients with written information prior to the examinations significantly improves their knowledge and experience of the exam procedure.
Health economics in mental health. 2: Economic evaluation
Authors: Craig Neil , Stark Cameron
Published: October 2008

This paper is the second in a series explaining key concepts and techniques used in health economics in the context of mental health care. The paper describes the different types of economic analysis and the circumstances in which they should be used. It explains key aspects of the methods used in economic evaluation to measure costs and benefits. The purpose of the paper is not to enable clinicians to undertake economic analysis, but to familiarise them with the methods used in economic evaluation and to enable them to assess the rigour and results of published studies.
Staff perception on reduction of medication in patients with chronic schizophrenia
Authors: Thomas A. , Katsabouris G. , Bouras N.
Published: October 2008

This exploratory study assessed staff perceptions to the reduction of maintenance neuroleptic medication in patients with chronic schizophrenia living in a long-stay hospital. Ten in-patients were assessed at regular times over six months. In addition to the Brief Psychiatric Rating Scale (BPRS), data were obtained from nursing staff on patients' ward behaviour (Ward Behaviour Interview Schedule, WBIS), clinical global opinion (CGI) and staff reaction (SR) to the reduction of medication plan. The average decrease of BPRS and WBIS was not related to keyworker's clinical global impression. The SR increased against the reduction of medication over the study period (P<0.05). Staff perceptions in the treatment of patients with chronic schizophrenia and their possible influence on prescribed closes should be taken into consideration in addition to psychopathology and clinical symptoms.
Methods of registrar post allocation
Authors: Ramchandani Paul , Sayal Kapil , Kapur Navneet
Published: October 2008

Little is known about how posts are allocated to enable Individuals to experience a comprehensive pre-membership psychiatric training. A questionnaire survey of 26 teaching hospital training schemes was carried out. This concentrated on registrar training – post-Part 1 MRCPsych (now known as senior house officers since the Caiman changes). Four main methods of allocation, with varying degrees of trainee involvement, were identified. The amount of prior notice given of the trainees' next placement and perceived advantages and disadvantages were compared between the four methods. Implications for practice are discussed.
Evaluation of a client held record introduced by a community mental health team
Authors: Stafford Anna , Laugharne Richard
Published: October 2008

A client held record for patients with long-term mental illness was introduced by a community mental health team in east London. The record was evaluated by asking the opinions of 45 patients and examining how their client record had been used. Over 80% of the patients found the record and the information it contained useful, 74% of contacts were recorded in the booklet and the client held record had begun to be used by many professionals for purposes other than appointments and medication. A client held record can increase patient involvement in care and help communication between professionals.
Predictors of length of stay in day hospital patients
Authors: Shergill Sukhwinder S. , Ebrahim Irshaad , Greenberg Maurice
Published: October 2008

This prospective study assessed the importance off baseline clinical, socio-demographic and diagnostic variables on patient outcome at six weeks, and their relationship to total length of stay. It included all patients admitted to an acute day hospital in inner London over a one-year period, and used standardised rating scales. All scales improved after six weeks, but only improvement on the Global Assessment Scale (GAS) predicted the length off stay in those patients who were depressed. There was an increased length off stay in patients with a diagnosis off personality disorder and those admitted with a lower score on the GAS.
Psychosurgery: description and outcome study of a regional service
Authors: Snaith R. P. , Dove E. , Marlowe J. , Pemberton S. , Price D. J. , Rawson S. , Wright J. F. , Butler A. , Coughlan A. K. , Hird M. , Trigwell P.
Published: October 2008

The report indicates that a psychosurgery service can be established on a regional basis. The outcome study of the Yorkshire Regional Psychosurgery Service indicates that the treatment should retain a place in the treatment of patients who have failed to respond to other available approaches. For such patients (and their carers) life is a state of persisting torment. Some psychiatrists consider psychosurgery as a procedure not to be countenanced, or outmoded, but patients have a right to know what may be achieved by the treatment and at what cost in terms of possible failure to improve and adverse effects. An audit of the Regional Psychosurgery Service indicates a favourable result of the Intervention. All patients improved to some extent, some very remarkably, and no adverse effects were encountered.
Survey of locked facilities in Scottish psychiatric hospitals
Authors: Smith Alan
Published: October 2008

A postal questionnaire survey of intensive care units/ locked wards in Scottish psychiatric hospitals revealed a lack of structural security features (other than a locked door) and an absence of personal alarm systems for staff in a substantial minority of units. The main reasons for transfer to locked units were physical violence to others and absconding risk, and the commonest diagnosis was schizophrenia. Transfer of in-patients not detained under mental health legislation was not uncommon. Differences in practice with regard to the transfer process were evident. In Scotland local locked facilities play an important role in secure provision and further evaluative research is required.
Safety awareness among junior psychiatrists and provisions for their safety in the workplace
Authors: Chubb Helen
Published: October 2008

Violence in the workplace is of great concern to trainee psychiatrists. A questionnaire was devised to assess knowledge of safety Issues, and precautions available, among junior doctors. The results, which revealed gaps in provision of safety training and facilities in this area, have been forwarded to the relevant directorates with a view to setting standards suitable for audit review.
‘The Reading model’: an integrated psychotherapy service
Authors: Knowles Jane
Published: October 2008

This article describes the principles and structure, staffing and training of an integrated psychotherapy service for the people of West Berkshire and South Oxfordshire (Reading, Henley, Wokingham, Newbury and Didcot) a population of 530 000.

The service is integrated internally as a joint outpatient and therapeutic community service that can provide psychodynamic psychotherapy across a wide range of length, intensity and styles. Externally it is integrated with the general adult psychiatry service, referrers, social services and community mental health teams.
Psychiatry on the Internet: survey of an OCD mailing list
Authors: Stein Dan J.
Published: October 2008

Professionals and consumers have joined psychiatric support groups on the Internet. This paper reports on a survey of members of an obsessive-compulsive disorder (OCD) mailing list (OCD-L). Members, who were primarily patients with OCD, but included family members and professionals, were generally positive about the benefits of the list, finding it a useful source of information about treatment, and a helpful source of support. It is concluded that a useful component of the management of OCD may include Joining OCD–L or a similar Internet support group, as benefits seem to outweigh possible problems. Further study of other Internet psychiatric support groups, which may differ significantly from OCD–L, seems warranted.
Staff attitudes to a psychiatric hospital closure
Authors: Ardagh-Walter Nick , Naik Prakash , Tombs David
Published: October 2008

Many psychiatric hospitals in the UK have closed. Factors influencing staff morale around the time of a hospital closure will affect the functioning of that institution. This study surveyed staff anxieties, attitudes and expectations in a major psychiatric hospital three weeks prior to its closure. We found evidence of widespread denial despite energetic dissemination of information. There were also significant differences between staff groups. Our findings will have implications for the management of future hospital closures.

“We have to get it into our heads that a hospital is like a shell, a framework to contain certain processes, and when the processes are superseded, the shell must, most probably, be scrapped and the framework dismantled” (Enoch Powell, 1961).
Staff grade psychiatrists – a view from the inside
Authors: Blower Aileen , Lusman Diane
Published: October 2008

With the recent establishment by the College of ‘Affiliate’ status for non-member psychiatrists and continuing professional development (CPD) for ‘non-training’ grades, we though it timely to open a debate on the role, status and needs of staff grade doctors in psychiatry. Many of the issues that need to be addressed are common to staff doctors in all specialities. Following a brief description of the grade and how it is being used at present we will focus on education needs and career progression, drawing on recent debate in the medical literature and our own experience as staff grade psychiatrists in the West of Scotland.
Educational supervision sessions between consultants and trainees
Authors: Azuonye I. O.
Published: October 2008

The weekly educational supervision sessions between consultant psychiatrists and their trainees have emerged as a central pillar of psychiatric training. The College has set out, in various Statements on Approval of Training Schemes for General Professional Training for the MRCPsych, what it expects of these sessions: they should happen weekly, be devoted entirely to the needs of the trainee, and be applied to the development of the trainee's clinical skills as opposed to academic knowledge.
Nursery observation in the training of child psychiatry registrars
Authors: Etchegoyen Alicia , Stubley Joanne
Published: October 2008

This paper discusses a training opportunity based on an adaptation of the Infant Observation method. This is a much shorter module, of ten weekly visits.

We describe three training components: (a) an opportunity to learn directly about child development and to become familiar with children's verbal and nonverbal communications; (b) a direct experience of the emotional impact and strength of primitive feelings, both in the children and in the trainees themselves, and (c) learning to be a ‘non-participant’ observer. We believe that the ability to observe without intervention is extremely important in the development of clinical skids. We suggest that this is the cornerstone of the method and that it may have a wider application to the training of those in the caring professions, including psychiatrists, nurses and social workers.
Teaching cultural aspects of psychiatry
Authors: Peutz Margreet
Published: October 2008

This paper discusses a pilot teaching programme on cultural aspects of psychiatry undertaken as part of the academic programme of the Department of Psychiatry, Cambridge University. The aim of the programme was to stimulate thinking about psychiatric phenomena in a different, more culturally aware perspective. Feedback was collected from participants through an evaluation questionnaire following the series. More practical and experiential teaching of cultural psychiatry is needed.
Psychiatric beds attached to a community mental health centre
Authors: Boardman Jed , Hodgson Richard , Lewis Martyn
Published: October 2008

The loss of psychiatric beds associated with the closure of large psychiatric institutions creates problems for the community care of those with severe mental Illness. This paper describes the use and possible advantages of a non-acute in-patient unit attached to a Community Menial Hearth Centre in North Staffordshire which has prioritised Individuals with severe mental Illness.
Doses of carbamazepine and valproate in bipolar affective disorder
Authors: Taylor David , Duncan Denise
Published: October 2008

Carbamazepine and valproate are now well established treatments for bipolar affective disorder (BAD). Both drugs are used in the acute treatment of mania and, more frequently, as longer-term mood stabilisers. The British National Formulary (BNF, Vol. 32, 1996) provides information on the use of carbamazepine in the ‘prophylaxis of manic depressive illness' and suggests that the ‘usual range’ of doses is between 400 mg and 600 mg daily. No guidance on the use of valproate in BAD is given in the BNF because the drug is not licensed for this indication in the UK.
Two management courses for senior/specialist registrars
Authors: O'Brien Maureen , Sullivan Gary
Published: October 2008

The recent reforms to the MHS have resulted in a need for management training to be a part of higher professional training. The trend towards competition within internal markets requires that all doctors become managerially accountable for the quality and efficiency of their service (Waters, 1985). The beed for management training has been recognised by the Collegiate Trainees' Committee (CTC, 1990, 1995). Some training schemes offer no organised management training, and some provide training as a short course (Reder, 1996). Many residential management courses are available, providing one or two weeks of ‘Intensive training’. Inevitably, the amount of management theory and techniques which can be learned on such courses Is limited.
The conversion of Holloway Sanatorium
Authors: Knowles Jane
Published: October 2008

Holloway Sanatorium, named after the benefactor, Thomas Holloway, stands in beautiful grounds opposite Virginia Water railway station, Surrey.
Psychiatric admission for homeless people: the impact of a specialist community mental health team
Authors: Commander Martin , Odell Sue , Sashidharan Sashi
Published: October 2008

The difficulty in achieving good quality community mental health care for homeless people has received increasing attention during the last few years. Less consideration has been given to the provision of inpatient care. By comparing data collected before and after its inception, we examined the impact of a specialist community mental health team for homeless people on ‘no fixed abode’ admissions in Birmingham. Although the team was successfully involved in the admission and discharge process in a substantial proportion of cases, many admissions still took place out of hours and involved the police, while discharge was often against medical advice and occurred without follow-up. These findings and their implications for the provision of homeless services are discussed.
The role of carers in the information process in dementia
Authors: Rao Rahul
Published: October 2008

The role of carers is explored in the process beginning with the early detection of changes in cognitive function through to the diagnosis of dementia. Carers were not always aware of early cognitive decline before other family and friends. Forty-five per cent of initial diagnoses were made by GPs. In over 50% of cases, the sufferer had not been told their diagnosis by health professionals or carers. A quarter of carers wanted more information about dementia even after referral to specialist services. The importance of early referral and provision of sufficient comprehensive information about dementia are discussed.
Long-term medication in depot clinics and patients' rights: an issue for assertive outreach
Authors: Eastwood Nigel , Pugh Robert
Published: October 2008

This study investigated the knowledge and attitude of 100 patients about their depot neuroleptic medication. Patients were well informed about their medication, particularly those seen in depot clinics. Most patients were content with service delivery but 48% did not realise that they had a choice about receiving their treatment. This aspect of patients' rights should be addressed and demands sensitive management in the case of depot refusers, or when assertive outreach is planned. We suggest that such issues should be incorporated into an educational programme and discussed with patients when they are relatively well.
Beyond reason: art and psychosis
Authors: Chaplin Robert , Richards Josephine
Published: October 2008

It is unusual for an exhibition of unknown artists to open with critical acclaim and draw crowds to a major gallery. What is more remarkable is that few of the artists received formal tuition, none belonged to a movement or painted commercially and they did not expect their work to be seen by an audience. The artists were mentally ill people residing in asylums throughout Europe whose work was collected between 1918 and 1921 by the German psychiatrist and art historian Hans Prinzhorn (1886–1933).
Psychotropic medication in learning disabilities: audit as an alternative to legislation
Authors: Miller H. E. J. , Simpson N. , Foster S. E.
Published: October 2008

Clinical standards were compiled for prescription of psychotropic medication in adults with learning disabilities, and used in a community population for comparisons of current practice in two audit studies 12 months apart. Completing the audit cycle led to improved clinical practice and a rationalisation of prescribing practices. Improvements were achieved on all standards and the methods used to obtain them are discussed.
Negative political campaigning
Authors: Beecroft Nicholas
Published: October 2008

It seems to be increasingly taken for granted by politicians and commentators that it is more effective to attack one's opponent than to promote a positive vision in order to sway voters in an election campaign. This article examines the relevant evidence in the psychological literature to see if this belief is justified. This includes the evidence on information processing, emotion and the specific effects of negative campaigning.