bluuebunny/crossref_metadata_2025 huggingface dataset:
Attitudes to developments in community psychiatry among general practitioners
Authors: Stansfeld Stephen
Published: May 2008

As general practitioners (GPs) are clinically responsible for the majority of recognised psychiatric morbidity in the community, they have an important role to play in deciding the shape of new community psychiatric services. This paper reports the results of a self-completion postal questionnaire survey of Harlow GPs' views on how community psychiatric services should be developed. Harlow is a mature new town (population 79,521: 1981 census) north east of London, served by a typical DGH department of psychiatry with in-patient wards and a day hospital, outreach services being provided largely by community psychiatric nurses (CPNs). GPs work in group practices in purpose-built health centres.
New mental health legislation in Japan
Authors: Sakuta Tsutomu
Published: May 2008

In Japan the Mentally Disordered Persons Supervision and Protection Law (1901) and the Mental Hospital Law (1919) used to be the main laws for mentally disordered people. Subsequently, the Mental Hygiene Law came into force in 1950 but was criticised as it had restrained admitted patients and the provisions for procedures for the release of patients were inadequate. The purpose of the old law was to give medical treatment and custody to mentally disordered persons and to maintain and improve the mental health of the nation. In the revised law, enacted in July 1988, acceleration of social rehabilitation of mentally disordered persons and promotion of their well-being were added.
American Psychiatric Association
Authors: Morris Michael
Published: May 2008

The 1991 annual meeting of the American Psychiatric Association (APA)∗ one of the world's most influential psychiatric organisations with a membership of over 35,000, and an annual budget of $24 million, was attended by over 12,000 persons from all over the world. (The cost of the meeting itself was about $2.5 million). Over 230 workshops and symposia were presented together with lectures from distinguished researchers, video presentations, debates and 600 posters. With up to 25 concurrent sessions, it was impossible for any one individual to attend more than a fraction of the programme. The theme, chosen by outgoing president, Dr Elissa Benedek, Professor of Child Psychiatry at Michigan, was ‘Our Children - Our Future’.
International Symposium on Eating Disorders
Authors: Reiss David
Published: May 2008

Wednesday, 17 April 1991, advertised on the Paris Metro as ‘la première journée de la minceur’ was, by an appropriate coincidence, also the morning Professor Philippe Jeammet welcomed over 800 participants from 34 countries to this bilingual conference at which 298 papers and posters were presented. In 1859 Louis Marcé, described by Dr Joseph Silverman as the “forgotten man of anorexia nervosa”, wrote the first description of the syndrome. Today anorexia nervosa is common, expensive and life threatening, responsible for an estimated 200 British deaths every year.
A new discharge summary
Authors: Smith Susan , Trotter Carol
Published: May 2008

A good discharge summary is an important part of in-patient psychiatric care. It should provide a useful prècis of the admission in the hospital notes, and also provide the general practitioner with details needed for the immediate and longer term management of the patient after discharge.
The one-day census in clinical audit
Authors: Lelliott Paul , Strathdee Geraldine
Published: May 2008

Psychiatric care is delivered by a wide range of workers (psychiatrists, hospital nurses, community psychiatric nurses, occupational therapists, psychologists, social workers, counsellors and general practitioners) who work as teams with some patients and as individuals with others. Health authority resources for psychiatric care are widely distributed among facilities both hospital-based (wards, day hospitals, out-patient departments, social work departments, occupational therapy departments) and community-based (community psychiatric nursing departments, community mental health centres and facilities funded jointly with social services and voluntary agencies).
Higher training in old age psychiatry: a survey of senior registrars' experiences
Authors: Beats Barbara , Bagley Gerard , Banks Victoria , Cronin Patricia , Opdebeeck Goedele
Published: May 2008

If high quality services are to be provided for the elderly mentally ill throughout the country it is now recognised that specialist teams are needed, led by adequately trained old age psychiatrists (Wattis et al, 1981).
From pulsating brains to paranoid psychoses
Authors: Doody Gillian
Published: May 2008

The recent technological explosion in the advancement of brain imaging, resulting in MRI, SPECT and PET scanning, has served to further blur the interfaces of neurology, neurosurgery and psychiatry. As proposed by Reynolds (1990), the traditional divergence of classical neurological science and psychiatry, originating from Cullen's description of ‘neurosis’, is currently changing to convergence and in many areas coalescing.
Services for the severe mentally ill – a planning blight
Authors: Hirsch S. R.
Published: May 2008

The College has become increasingly concerned about the failure to achieve what has for many years been a reasonable policy for the chronic mentally ill. This paper will outline the significant effect that the blight in provision of services for this group of patients has had on mental health services as a whole, the extent of the shortfall and the effect on the patients themselves.
Psychiatrists' experiences of trust status hospitals
Authors: Persaud Rajendra , Bullmore Edward , Dare Christopher
Published: May 2008

It is over a year since the Government introduced its reforms of the NHS and, despite surveys of consultant attitudes to these changes (Whitfield et al, 1989; Delamothe, 1990) and numerous letters to journals from those working in Trusts, there has been no attempt to systematically investigate the experiences of consultant psychiatrists working in NHS trusts. This information would be of use to those contemplating whether to countenance trust status for their own hospitals and those yet to make up their mind about their attitudes to the reforms.
Academic departmental meetings via video link: the Welsh experience
Authors: Mallett Paul , McGuffin Peter
Published: May 2008

The problem of geographical dispersion is common in clinical academic departments. Often there is a main departmental base in a teaching hospital with various smaller units either elsewhere on the same campus or based in other hospitals in the same city. In addition, staff may do their ward work, out-patient clinics and their associated clinical teaching scattered over a number of sites. Although these arrangements usually have some effects on departmental cohesion, problems can usually be overcome with a little effort and the traditional means of ensuring communication and developing common policies in teaching, research and service development has been to hold regular departmental meetings.
The reconstruction of psychiatric services after the liberation of Kuwait
Authors: Aref Mohammed Aly
Published: May 2008

In this paper I describe my experience of restructuring psychiatric services after the Iraqi invasion. It is difficult, if not impossible, to find words to describe the frustration, bitterness, sorrow and disappointment in seeing the collapse of a service that had been built up by the strenuous efforts of psychiatrists.
‘Mentally Incapacitated Adults and Decision Making’: implications of the Law Commission consultation paper for old age psychiatrists
Authors: Benbow S. M. , Jones R. , Rands G. , Wattis J. P.
Published: May 2008

Old age psychiatrists' main concern with regard to incapacity is with patients with dementia. Dementia is predominantly a disorder of old age, probably affecting over half a million people in the UK, and it inevitably affects decision-making capacity. The 1983 Mental Health Act does not appear to have been framed with particular consideration for this group and it is vital that any new laws pay special attention to people with dementia.
Severe persistent mental illness
Authors: Liddle Peter F.
Published: May 2008

Many patients with persistent mental illnesses enjoy a better life in a community setting than would be possible in a long stay mental hospital. Furthermore, the available evidence indicates that most such patients get better while living in the community. Unfortunately, community care has not served all patients well. Much of the difficulty can be attributed to lack of resources. However, there is also a tendency by planners to underestimate the severity of patients' disabilities. A realistic appraisal demands a detailed examination of the problems of patients whose needs have not been met by community care. One important issue is that of patients who fall through the net of community care and another is that of patients who have not but nonetheless have not survived in the community. This paper addresses the question of the needs of this latter group.
Section 5(2): who acts as the consultant's nominated deputy?
Authors: Cooper Sally-Ann , Harper Ruth
Published: May 2008

Section 5(2) of the Mental Health Act, 1983 allows for the detention of an informal in-patient, should he/she wish to leave hospital but be considered a danger to him/herself or others if allowed to do so. The 72 hour period of detention allows time for a completed assessment for application for admission under Section 2 or 3 of the Act; it is not intended to replace this fuller assessment. The 1983 Mental Health Act introduced new provisions with regard to Section 5(2). The equivalent Section 30 of the Mental Health Act 1959 did not provide for a nominated deputy to act on behalf of the registered medical practitioner in charge of the patient's treatment (RMP). The nominee must exercise his/her own clinical judgement but, as indicated in the Code of Practice (1990), must contact the nominating doctor or another consultant to discuss the need for Section 5(2), before implementing it. The nurses' holding power, Section 5(4), was also a new provision in the 1983 Act.
“-isms” and psychiatry: the threat of single issue politics
Authors: Charlton Bruce G.
Published: May 2008

Single issue political movements (such as feminism, anti-racism, Marxism, homosexual liberation, animal rights etc) have been a major characteristic of the post-1960s radical scene in the United States and Western Europe. While such movements typically start out doing a good job, it is my assertion that they have now reached the point of posing a serious threat to medicine at large, and to psychiatry in particular.
The contribution of Henry Maudsley to the Institute of Psychiatry
Authors: Rosen Ismond
Published: May 2008

I am grateful of the honour the President and the College has bestowed on me in accepting the presentation by Lundbeck Pharmaceuticals of my bronzes of Henry Maudsley and Erwin Stengel, as part of the 150th Anniversary Celebrations. Special thanks are due to Professor Hugh Freeman for his assistance in this regard.
Section 48: an underused provision?
Authors: Exworthy Tim , Parrott Janet M. , Bridges Paul K.
Published: May 2008

Section 48 of the Mental Health Act, 1983 (MHA) permits the Secretary of State to authorise the removal to hospital of an unsentenced prisoner who is ‘suffering from mental illness or severe mental impairment of a nature or degree which makes it appropriate for him to be detained in a hospital for medical treatment and that he is in urgent need of such treatment’. (Mental Health Act, 1983). Its common usage in the past has been in transfers of unsentenced prisoners from prison to hospital.
General practitioners' referrals for compulsory admission under the Mental Health Act, I: comparison with other GP mental health referrals
Authors: Sheppard Michael
Published: May 2008

Although the work of general practitioners (GPs) with mental illness generally, particularly in relation to minor mental illness, has been extensively examined, there has been practically no work devoted to the role of GPs in assessment for compulsory admission, either under the 1959 or 1983 Acts. The notable exception is the work of Bean (1980), who is, in some respects, highly critical, accusing them of showing little interest in patients, referring at times inappropriately, committed to the rhetoric rather than reality of care and of knowing little or nothing of the law they were supposed to be using. Bean's work is, however, a study of the 1959 Act, and no research exists on the 1983 Act which now governs section assessments. This neglect of GPs is surprising, in view of the severe consequences of compulsory admissions (sections) and research on the use of the 1983 Act already available on other participating professionals (Sheppard, 1990; Rogers, 1989). GPs are likely to be professional instigators of section assessments as well as involved in the assessment itself.
Patients repeatedly admitted to psychiatric wards
Authors: Evans Mavis , Rice David , Routh Christina
Published: May 2008

Many admissions to general adult psychiatric beds occur as emergencies, either due to social crisis or relapse of psychiatric illness. Other admissions are planned to arrest or reverse deterioration in mental state. Length of stay varies from days to months depending on reason for admission and adequacy of support in the community. Rapid readmission or failed discharge, defined as readmission within three months, has been linked with multiple previous admissions and personality factors (Jones, 1991).
A mental health consultation to colleagues
Authors: Jaffa Tony
Published: May 2008

From time to time I am asked to help colleagues from other disciplines with interprofessional issues. Here is an example. To avoid identifying the workers concerned, names have been changed and some details omitted.
‘When is a pervert not a pervert?’
Authors: Crown Sidney
Published: May 2008

The title seems chosen to catch the eye. This it does, but as being perjorative. In contemporary writing about sexual variations only psychoanalysts and a few psychotherapists retain the term ‘perversion’; others have abandoned it as stigmatising.
DSM–IV and culture: is the classification internationally valid?
Authors: Littlewood Roland
Published: May 2008

Although relatively neglected in Britain, the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders has been widely adopted in both Western and non-Western countries (Spitzer, Williams & Skrodol, 1983). The descriptive and multiaxial approach used in DSM-III (1980) and in its revised edition DSM-III-R (1987), together with the introduction of specific criteria for allocating each diagnosis, would seem particularly useful when comparing psychopathologies across societies. In addition to Axes I, II and III (Clinical Syndromes, Developmental and Personality Disorders, Physical Disorders and Conditions), the Manual has two more obviously ‘social’ axes – (IV) Severity of Psychosocial Stressors and (V) Global Assessment of Functioning.
Assessment of deliberate self-harm on medical wards
Authors: Blacker C. V. R. , Jenkins R. , Silverstone T.
Published: May 2008

In 1984, the Department of Health and Social Security issued guidelines, based upon the recommendations of a working party of the Royal College of Psychiatrists, on the management of patients admitted to hospital following acts of deliberate self-harm (DSH). Unlike the 1968 Hill report (which recommended that all such patients should be assessed by a psychiatrist before discharge) the new guidelines placed the responsibility for psychosocial assessments on the admitting medical team.
Smoking among psychiatric in-patients in Southampton
Authors: Corby Claudia , Barraclough Jennifer
Published: May 2008

Smoking accounts for 15–20% of all British deaths (Royal College of Physicians, 1983). Smoking-related diseases incur considerable cost to the NHS and smokers' materials cause 39% of accidental hospital fires (Batten, 1988).
Old age psychiatry and mental handicap
Authors: Pearson N. , Smithies J.
Published: May 2008

We report on the first two years of a novel, controversial approach in East Dorset where consultants in old age psychiatry have taken on the consultant responsibility for patients who have mental handicap. We discuss our experience as it may be of interest to others where there are problems recruiting consultants in the psychiatry of mental handicap.
Seminars in social psychiatry in Romania
Authors: Wilkinson Greg , Gask Linda , Henderson John
Published: May 2008

For more than a decade there has been no opportunity for formal post-graduate training in psychiatry in Romania. In February 1992, as part of a World Health Organization (Regional Office for Europe) initiative, we travelled to Romania as WHO temporary advisers to give seminars on: (i) the role of primary health care services in providing mental health care; and (ii) the development of community-based services for the mentally ill and disabled. Our seminars were designed to complement the biological and clinical elements of a developing psychiatric training programme.
Worldwide help for survivors of torture
Authors: Ramsay Rosalind
Published: May 2008

Developments on the world political scene over the last year have had far-reaching effects on the lives of ordinary people in areas such as the Middle East and Eastern Europe. For the International Rehabilitation and Research Centre for Torture Victims (RCT) in Copenhagen these changes have led to a huge increase in calls on its service. In 1991, the continuing opening up of Eastern Europe made it possible to reach out to new countries where support is needed to establish centres offering training in RCT's treatment methods and information about torture, while the Gulf War created more urgent demands on its resources.
The use of antidepressants by British child psychiatrists
Authors: Bramble David J. , Dunkley Simon D.
Published: May 2008

The controversy concerning psychotropic drug use in children has waged over several decades. The recent trend in treatment has moved towards problem-orientated, eclectic and flexible approaches to disturbed children and their families, away from specific “pure” therapy models. Erstwhile over-use of medication in certain conditions, for example psycho-stimulants in hyperactive children in the USA (Werry et al (1980), has handicapped the development of paediatric psychopharmacology.
Computerised psychiatric case registers in Britain
Authors: Wood Stephen , Elphick Martin , Sinclair Mike
Published: May 2008

Case registers can provide useful data for research and service planning, but the older manually maintained registers were expensive and required special accommodation, staffing and support. Turning raw data into useful information was a laborious process and most systems could not accommodate ad hoc reports. Partly as a result of these shortcomings, and partly because of spending cuts, a number of case registers were closed in the 1980s (for example, see Hassall, 1991).
Why occupational therapy?
Authors: Sheikh A. Jawad , Boultan Debbie
Published: May 2008

Occupational therapy as a discipline (Finlay, 1988) has grown and matured with time. It has moved away from an ill-defined, imprecise and informal discipline to one which, while treating the patient as a whole being, nevertheless attempts to identify an individual's unique problems and treats them through purposeful activity. It strives to attain the qualities of a holistic, goal-orientated objective process.
The quality issue
Authors: McClelland Roy
Published: May 2008

“It is essential that discussion about the quality and effectiveness of care are reintroduced into the centre of the debate as they are, in the end, the more important dimensions of NHS performance” (Maxwell, 1984).

While the term quality is not much used explicitly in clinical medicine in general and mental health services in particular, quality is implicit in much that guides us. Indeed it is at the very foundations of our health care practice – the ethical codes with their emphasis on beneficence, non-malevolence, respect for autonomy, justice and fairness.
A plea against over specialisation in forensic psychiatry
Authors: Mendelson Eric F.
Published: May 2008

The optimal system for delivering forensic psychiatric care has yet to be established. At an early stage, Gunn (1977) drew attention to the differing models of a ‘parallel’ service and an ‘integrated’ approach. Only with the integrated system do forensic patients pass to ordinary NHS facilities when they no longer require security or other specialist expertise. The debate can be extended into whether forensic services should be provided by regional units, by district services, or by a mixture of both. Indeed, the Royal College of Psychiatrists (1988) recognised that in addition to a regional service led by a fully trained forensic psychiatrist, secure care can be provided at a district level by consultants who have sufficient training to hold posts with a special responsibility. Furthermore, managers are understandably keen for as much as possible to be provided by their own district services.
The effect environmental change has on the frequency of violent incidents
Authors: Rusius C. W.
Published: May 2008

Violence is an important consideration in the management of psychiatric patients. Probably one in ten psychiatric patients assault staff (DHSS, 1988), although this may be an underestimate (Lion et al, 1981). Fellow patients are assaulted less frequently (Nobel & Rodger, 1989). Several factors have been associated with violent behaviour in patients: suffering from schizophrenia, delusions, hallucinations (Noble & Rodger, 1989); being young, compulsorily detained and an increased use of temporary nursing staff (James et al, 1990).
Antidepressants and murder
Authors: Edwards J. Guy
Published: May 2008

A 44-year-old man was treated with amitriptyline by his general practitioner for ‘mild depression’. Shortly after starting treatment he was said to have become ‘beserk’; he hit his wife and a family friend with an iron bar and attempted to sever their heads with a kitchen knife. He was found guilty of manslaughter on the grounds of substantially diminished responsibility and sentenced to life imprisonment.
Attitudes of child psychiatrists to electroconvulsive therapy
Authors: Parmar Ranjana
Published: May 2008

Electroconvulsive therapy (ECT) has long been recognised as an important method of treatment in adult psychiatric disorders, especially severe depression. However, in spite of increasing concern about the occurrence of depressive disorders among the young (Klerman, 1988), very little is known about the use of ECT in children and adolescents. Indeed the published literature on ECT in this age group consists almost entirely of case reports (Bertagnoli & Borchardt, 1990). This paper is concerned with an important determinant of such practice, the attitudes of child and adolescent psychiatrists.
Schizophrenia: the problems for the family
Authors: Sargeant Rhona J.
Published: May 2008

The relatives of people with schizophrenia are a group who have much to offer professional carers and other relatives. They have a huge store of knowledge, often gained painfully by trial and error, about the problems involved in caring for sufferers from schizophrenia.
Psychiatry and the new NHS
Authors: Harrison Judy
Published: May 2008

The NHS and Community Care Act 1990 has been described as the biggest shake-up to the NHS since its inception. Most psychiatrists will by now be familiar with the new arrangements for community care, but what are the implications of the structural changes in the NHS for psychiatry?
Psychogeriatricians and general practitioners: a national survey
Authors: Banerjee Sube , Lindesay James , Murphy Elaine
Published: May 2008

Recent changes in the provision of health and social care in the UK such as the institution of a purchaser/provider system and regular screening of the elderly by GPs are of importance to the relationship between primary health care teams (PHCT) and psychogeriatricians. These changes have clarified the necessity for sensitivity by psychogeriatric services to the needs of GPs and commissioning authorities.
Social morbidity of a long-stay mental hospital population with chronic schizophrenia
Authors: Milne Steven , Curson David , Wilkie Alcuin , Pantelis Christos
Published: May 2008

As part of the shift towards community care, a number of the large mental hospitals throughout the United Kingdom have now closed and many more are due for closure. In a review of deinstitutionalisation, Thornicroft & Bebbington (1989) concluded that the run-down of hospitals was outstripping the provision of new community facilities. Between 1974 and 1984 the mental hospital population fell by 25,000. However, the increase in residential places provided by local authorities and by the private and voluntary sectors totalled only 3,000. Inadequate planning and provision could give rise to discharged patients facing the prospect of isolated, segregated and impoverished lives with a high likelihood of homelessness and recurrent admission.
Notes on the Lundbeck Teaching Fellowship to Bulgaria 1991
Authors: Storer David , Holman Dorothea
Published: May 2008

In 1991 the Royal College of Psychiatrists awarded two overseas teaching fellowships. Tom Harrison and Alexandra Espejo described their visit to Chile in the March 1993 Psychiatric Bulletin. We were asked to visit Bulgaria to teach liaison psychiatry in both child and adolescent and adult psychiatry.
Black marks for Black Daisies
Authors: reviews Brice Pitt
Published: May 2008

I've had difficulty in writing this review. I initially caught the last half of Tony Harrison's ‘docudrama’ about Alzheimer's disease shown at the outset of Alzheimer Awareness Week in July and hated it. My heart sank at the Brechtian device of putting the dialogue to the tune of a hymn (in this case the carol ‘In the Bleak Midwinter’), and I found the approach to the three ‘star’ patients chosen for the film from those in Whernside ward, High Royds Hospital, sentimental and patronising.
In defence of multidisciplinary teams in child and adolescent psychiatry
Authors: Cottrell David
Published: May 2008

Early in 1992, two articles were published on the subject of multidisciplinary teams in child and adolescent psychiatry. In the first, Mathai (1992) challenges the “accepted multidisciplinary model” as being “unworkable”. He comments that in many teams an appearance of multidisciplinary working can hide covert conflicts and goes on to propose that all referrals should be made to the consultant psychiatrist who will then decide to whom these referrals should be allocated within the team.
Special Interest Group
Authors: Thompson C.
Published: May 2008

In June 1987 Council approved the establishment of Special Interest Groups.
Fire risk: assessment and management in long-term psychiatric patients
Authors: Phelan Michael , Fisher Nigel
Published: May 2008

Many mental disorders are associated with an increased risk of fire setting. As a result, its assessment and management is an important part of the management of people with psychiatric disorders. As more patients are managed in the community, away from the protection of high levels of hospital staff and fire regulations, such assessments are vital to ensure appropriate and safe placement. The presence of fire regulations in hostels offers only limited protection. Further, as residences with four people or less are not subject to fire regulations, assessment by psychiatric staff may have to extend to the fabric of the placement. Despite psychiatric hostels tending not to accept patients who are ‘a fire risk’, figures suggest that fires in hostels are common. One health authority reported 26 fires in hostels over 12 months (Moxom, personal communication).
Training in liaison psychiatry
Authors: House A. O. , Creed F.
Published: May 2008

It is generally agreed that training in liaison psychiatry should be available at SHO/registrar grade, but the College's guidelines are not specific about what it might entail. As a result it is difficult for approval visitors to decide whether a particular post on a rotational training scheme truly provides liaison experience. At times so-called “liaison experience” amounts to no more than participation in a duty-rota for visiting a general hospital to undertake the assessment of cases of deliberate self-harm.
The psychiatric probation clinic
Authors: Collins Paul , Ball Hadrian , Costello Ann
Published: May 2008

Liaison with the various agencies which deal with mentally abnormal offenders is one of the prime roles of the forensic psychiatrist (Royal College of Psychiatrists, 1988). The probation service is a key agency in this regard. The importance of such collaboration has once again been highlighted with the clear message that the care of the mentally abnormal offender is improved as a result (DOH/Home Office, 1991). However, the provision of a satisfactory psychiatric consultation service to probation clients who have been remanded on bail can be problematic. Much of the work of forensic psychiatrists is institutionally based. Non-attendance rates at hospital based out-patient clinics are high (Bowden, 1978). However, general psychiatrists have found that psychiatric clinics based in general practitioners' surgeries are more acceptable to patients than hospital clinics (Tyrer, 1984). The probation office as a community base for forensic psychiatrists is a valid equivalent.
Too high a hurdle? the use of pre-assessment questionnaires in psychotherapy
Authors: Eynon Terri , Gladwell Stephen
Published: May 2008

Up to one third of patients referred for psychotherapy fail to attend for their first appointment (O'Loughlin, 1990). Psychotherapy assessments are usually allocated a considerable portion of uninterrupted time, and an unexpected non-attendance wastes significant clinical resources. A variety of strategies have been used to ensure that assessors are not left waiting for a patient who never comes. One method is to send out forms which must be completed and returned before a first appointment date is given. In O'Loughlin's study, in which a similar questionnaire to that detailed in this paper was used, it was suggested that sending a pre-appointment questionnaire reduced the default rate.
Time for a trainees' charter?
Authors: Davies Steffan
Published: May 2008

The Patients' Charter was introduced in 1991 (DoH, 1991). Although much maligned at the time and since, it has had positive effects. Much criticism was directed at the lack of resources to implement its generally laudable aims, e.g. reduced waiting times, and it was often dismissed – along with the Citizens' Charter as a whole – as a Tory pre-election stunt. The positive effects were to increase the awareness among patients and health professionals of standards to be aspired to. Personal experience has shown that awareness of the Patients' Charter extends to some of the most psychiatrically disabled patients in Nottingham. All doctors are aware of the Charter and many express regret that a Doctors' Charter of patient responsibilities does not also exist.
Resettlement and community care: ‘The Mental Hospital as an Institution’ revisited
Authors: Huxley Peter
Published: May 2008

For almost four decades social policy has been directed at the closure of old mental hospitals and the resettlement in the community of large numbers of patients. Research into resettlement shows that, on the whole, individual needs are recognised, service responses are reasonably well planned, and that individual welfare has not deteriorated, at least in the short-term (Knapp et al, 1992; TAPS, 1993). Furthermore, those who receive services under the resettlement schemes are said to be better served than those who receive routine care on discharge from hospital (Allen et al, 1992).
The clinical team: ideology, power, boundaries and the patient
Authors: Green Chris
Published: May 2008

Over the last 20 to 30 years, the team, multidisciplinary, approach to psychiatry has become firmly established. Proponents would argue that it is essential that a patient has the benefit of the different knowledge bases, skills and approaches, which come from the various professionals forming the clinical team. Using the common Gestalt concept, one might hope that a well-functioning team would exceed in its therapeutic effectiveness the sum total of the skills of its individual members. Such a team should be able to communicate well, draw freely from particular skills of members and be able to adopt a consistent approach in its relationships and interventions with patients. This, however, is not always the case. In my experience, it is not uncommon for clinical teams to suffer from unresolved conflicts between their members. Such conflicts can diminish the team's overall potential and make difficulties in adopting a consistent approach with patients. When conflicts are severe, the clinical team can sometimes exacerbate, through its own chaotic element, the disturbances in the minds of its patients. In this extreme, patients may be pulled into staff conflicts and used to augment one side or another of a particular staff difference. This paper argues that for the clinical team to endeavour to reach its maximum potential, there has to be a reasonable degree of resolution and agreement around three ‘constructs’ of potential conflict: ideology, power and boundaries.
Experience of a psychiatric trainee by a general practitioner
Authors: Oates Christopher
Published: May 2008

When the idea was first proposed to our practice that we should have a doctor from the York Psychiatry Rotation attached to our practice as a trainee we were all enthusiastic. As the start date approached and it became more obvious that I, as the trainer without a trainee for the six months in question, would be responsible for him I became a little more apprehensive. What if he wore strange clothes? What if he upset all the patients? What if he exposed all my ignorance on matters psychological? When I first spoke to Simon he mentioned that he had not done any acute proper medicine since house jobs, five years previously; I do not know who was more apprehensive – him or me. In the event, of course, I feel the placement was successful and I hope that Simon came away learning a lot about general practice and a significant amount of psychiatry in a different setting.
Compulsory treatment in the community in Scotland: ten questions and answers
Authors: Chiswick Derek
Published: May 2008

A recent report by the Royal College of Psychiatrists (1993) on community supervision orders refers to the use of extended leave in Scotland. The legal basis for this practice is uncertain, and some explanation is required.
Who is watching them? A study of the interpretation of the observation policy in a mental health unit
Authors: Hodgson Christine M. , Kennedy Joanne , Ruiz Paloma , Langenbach Michael , Moorhead Steve , Junaid Ola
Published: May 2008

Observation levels are widely used in the management of acutely disturbed psychiatric patients (Shugar & Rehaluk, 1990). Although clinicians are involved in decisions about observation levels, there is rarely any specific training and very little formal structure to the decision making process. We report a survey of the views and knowledge of clinical staff regarding observation levels. Questionnaires were sent to all the nurses of the six acute psychiatric wards in the Nottingham Mental Health Unit, and all the doctors involved in the care of patients on these wards.
Practice of ECT guidelines in the UK v. the USA
Authors: Upadhyaya Ajay K.
Published: May 2008

Electro-convulsive therapy (ECT) is a safe and effective treatment for some psychiatric disorders, but its mechanisms of action remain unclear. In the last decade ECT seems to have enjoyed a resurgence of research interest and some recent findings have raised exciting possibilities of making it a more rational and targeted treatment.
ECT: a patient-friendly procedure?
Authors: Riordan Denise M. , Barron Philip , Bowden Melanie F.
Published: May 2008

Electroconvulsive therapy is widely seen by the public as a barbaric and outmoded form of treatment. Even within groups of health care professionals, ECT does not have a ‘good press’. Most research into the area of patient attitudes to ECT has been retrospective and often considerably so, and is therefore unlikely to illustrate patients' feelings about a course of treatment at the time it took place (Freeman & Kendell, 1980; Kerr et al, 1982). The only prospective study is that by Malcolm (1989). This showed a low level of understanding of treatment and a high level of anxiety both before treatment and afterwards, but, despite this, a high level of compliance with ECT therapy.

Our aim was to re-examine these findings in order to find a way of improving the experience of ECT.
Attitudes towards depression
Authors: Vize Christine M. , Priest R. G.
Published: May 2008

The Royal College of Psychiatrists in association with the Royal College of General Practitioners and other relevant organisations launched the Defeat Depression campaign in January 1992. The objectives of the campaign are to reduce the stigma associated with depression, to assist general practitioners and other health care professionals in the recognition and treatment of depressive illness, and to increase public awareness of the extent and treatability of depression.
North East Division: Joint Conference with Clinical Psychologists: A Personal Reaction
Authors: Martin Ian C. A.
Published: May 2008

This conference, under the title ‘Psychological and Psychiatric Perspectives in Mental Health’, was held at the University of Durham on 28 September 1977. I suppose that among the regular attenders of clinical symposia there can be few who, with the passing years, do not have cause to adjust their levels of expectation. Our earlier attendances at meetings may have carried hopes for blinding revelations of new educational horizons, but as time goes by one is more than grateful if the slightest snippet of a new idea escapes from the formal proceedings, and one looks most eagerly towards the byways of ‘between session’ encounters for the greatest personal, professional—and vocational—revivals. This is a premise which some may regard as cynical but I believe is simply realistic.
Using Library Resources
Authors: Picken Fiona Mackay
Published: May 2008

The whole object of using a library is to obtain wanted material and information. Libraries are in a constant state of evolution, and local facilities have improved, in some cases dramatically, but on the whole the situation is still far from adequate.
Psychiatric Testimony—Who Can Give it and When?
Authors: Brahams Diana
Published: May 2008

In November 1980, two men, Mackenny and Pinfold, were convicted at the Old Bailey on several counts of murder which were of a particularly callous and brutal nature. They were sentenced to life imprisonment. In the preceding December (1979) another man, Childs, had pleaded guilty to all the murders with which Mackenny and Pinfold had been charged, and which he alleged had been carried out with them together. He turned Queen's evidence, and it was his testimony that was crucial and central to the Prosecution's case against Mackenny and Pinfold.
The Management of Deliberate Self-Harm
Authors: Kennedy Peter
Published: May 2008

These departmental guidelines at last revise advice of the 1968 vintage—that all parasuicides should be admitted to hospital and assessed by a psychiatrist. Of course this was never achieved, nor even attempted in many areas. It is a welcome set of new recommendations, therefore, which will help ensure that what actually happens is done well. It is great credit to undergraduate medical teachers that such confidence can now be expressed in newly qualified doctors carrying out these psychosocial assessments. It recognizes that suitably trained nurses and social workers can assess and manage aftercare of these patients quite competently.
Kisspeptin Can Stimulate Gonadotropin-Releasing Hormone (GnRH) Release by a Direct Action at GnRH Nerve Terminals
Authors: d'Anglemont de Tassigny Xavier , Fagg Lisa A. , Carlton Mark B. L. , Colledge William H.
Published: May 2008

The G protein-coupled receptor GPR54, and its peptide ligand kisspeptin (Kp), are crucial for the induction and maintenance of mammalian reproductive function. GPR54 is expressed by GnRH neurons and is directly activated by Kp to stimulate GnRH release. We hypothesized that Kp may be able to act at the GnRH nerve terminals located in the mediobasal hypothalamus (MBH) region. To test this hypothesis, we used organotypic culture of MBH explants challenged with Kp, followed by RIA to detect GnRH released into the cultured medium. Kp stimulation for 1 h induced GnRH release from wild-type male MBH in a dose-dependent manner, whereas this did not occur in MBH explants isolated from Gpr54 null mice. Continuous Kp stimulation caused a sustained GnRH release for 4 h, followed by a decrease of GnRH release, suggesting a desensitization of GPR54 activity. Tetrodotoxin did not alter the Kp-induced GnRH release, indicating that Kp can act directly at the GnRH nerve terminals. To localize Gpr54 expression within the MBH, we used transgenic mice, in which Gpr54 expression is tagged with an IRES-LacZ reporter gene and can be visualized by β-galactosidase staining. Gpr54 expression was detected outside of the median eminence, in the pars tuberalis. In conclusion, our results provide evidence for a potent stimulating effect of Kp at GnRH nerve terminals in the MBH of the mouse. This study suggests a new point at which Kp can act on GnRH neurons.
Effects of Substitution and High-Dose Thyroid Hormone Therapy on Deiodination, Sulfoconjugation, and Tissue Thyroid Hormone Levels in Prolonged Critically Ill Rabbits
Authors: Debaveye Yves , Ellger Björn , Mebis Liese , Visser Theo J. , Darras Veerle M. , Van den Berghe Greet
Published: May 2008

To delineate the metabolic fate of thyroid hormone in prolonged critically ill rabbits, we investigated the impact of two dose regimes of thyroid hormone on plasma 3,3′-diiodothyronine (T2) and T4S, deiodinase type 1 (D1) and D3 activity, and tissue iodothyronine levels in liver and kidney, as compared with saline and TRH. D2-expressing tissues were ignored. The regimens comprised either substitution dose or a 3- to 5- fold higher dose of T4 and T3, either alone or combined, targeted to achieve plasma thyroid hormone levels obtained by TRH. Compared with healthy animals, saline-treated ill rabbits revealed lower plasma T3 (P = 0.006), hepatic T3 (P = 0.02), and hepatic D1 activity (P = 0.01). Substitution-dosed thyroid hormone therapy did not affect these changes except a further decline in plasma (P = 0.0006) and tissue T4 (P = 0.04). High-dosed thyroid hormone therapy elevated plasma and tissue iodothyronine levels and hepatic D1 activity, as did TRH. Changes in iodothyronine tissue levels mimicked changes in plasma. Tissue T3 and tissue T3/reverse T3 ratio correlated with deiodinase activities. Neither substitution- nor high-dose treatment altered plasma T2. Plasma T4S was increased only by T4 in high dose. We conclude that in prolonged critically ill rabbits, low plasma T3 levels were associated with low liver and kidney T3 levels. Restoration of plasma and liver and kidney tissue iodothyronine levels was not achieved by thyroid hormone in substitution dose but instead required severalfold this dose. This indicates thyroid hormone hypermetabolism, which in this model of critical illness is not entirely explained by deiodination or by sulfoconjugation.
The Role of Activin A and Akt/GSK Signaling in Ovarian Tumor Biology
Authors: Do Thuy-Vy , Kubba Lena A. , Antenos Monica , Rademaker Alfred W. , Sturgis Charles D. , Woodruff Teresa K.
Published: May 2008

Elevated activin A levels in serum, cyst fluid, and peritoneal fluid of ovarian cancer patients suggest a role for this peptide hormone in disease development. We hypothesize that activin A plays a role in ovarian tumor biology, and analyzed activin-mediated pro-oncogenic signaling in vitro and the expression of activin signaling pathway molecules in vivo. Activin A regulation of Akt and GSK, and the effects of repressing the activities of these molecules (with pharmacological inhibitors) on cellular proliferation were assessed in the cell line, OVCA429. Activin A activated Akt, which phosphorylated GSK, repressing GSK activity in vitro. Activin A stimulated cellular proliferation and repression of GSK augmented activin-regulated proliferation. To validate in vitro observations, immunostaining of the βA-subunit of activin A and phospho-GSKα/β (Ser9/21) was performed, and the correlation between immunoreactivity levels of these markers and survival was evaluated in benign serous cystadenoma, borderline tumor, and cystadenocarcinoma microarrays. Analysis of tissue microarrays revealed that βA expression in epithelia did not correlate with survival or malignancy, but expression was elevated in stromal cells from carcinomas when compared with benign tumors. Phospho-GSKα/β (Ser9/21) staining was more intense in mitotically active carcinoma cells and exhibited a polarized localization in benign neoplasms that was absent in carcinomas. Notably, lower phospho-GSKα/β (Ser9/21) immunoreactivity correlated with better survival for carcinoma patients (P = 0.046). Our data are consistent with a model in which activin A may mediate ovarian oncogenesis by activating Akt and repressing GSK to stimulate cellular proliferation.
Androgen Deprivation by Activating the Liver X Receptor
Authors: Hoon Lee Jung , Gong Haibiao , Khadem Shaheen , Lu Yi , Gao Xiang , Li Song , Zhang Jian , Xie Wen
Published: May 2008

Prostate cancer is the most commonly diagnosed and the second leading cause of cancer death in men. The androgens-androgen receptor signaling plays an important role in normal prostate development, as well as in prostatic diseases, such as benign hyperplasia and prostate cancer. Accordingly, androgen ablation has been the most effective endocrine therapy for hormone-dependent prostate cancer. Here, we report a novel nuclear receptor-mediated mechanism of androgen deprivation. Genetic or pharmacological activation of the liver X receptor (LXR) in vivo lowered androgenic activity by inducing the hydroxysteroid sulfotransferase 2A1, an enzyme essential for the metabolic deactivation of androgens. Activation of LXR also inhibited the expression of steroid sulfatase in the prostate, which may have helped to prevent the local conversion of sulfonated androgens back to active metabolites. Interestingly, LXR also induced the expression of selected testicular androgen synthesizing enzymes. At the physiological level, activation of LXR in mice inhibited androgen-dependent prostate regeneration in castrated mice. Treatment with LXR agonists inhibited androgen-dependent proliferation of prostate cancer cells in a LXR- and sulfotransferase 2A1-dependent manner. In summary, we have revealed a novel function of LXR in androgen homeostasis, an endocrine role distinct to the previously known sterol sensor function of this receptor. LXR may represent a novel therapeutic target for androgen deprivation, and may aid in the treatment and prevention of hormone-dependent prostate cancer.