bluuebunny/crossref_metadata_2025 huggingface dataset:
Belgrave Square in the 19th century
Authors: Williams Margaret Harcourt
Published: October 2008

The district of London known today as Belgravia was developed in the 1820s. Previously it was called the Five Fields and was a rural area between Westminster and the village of Knights-bridge. Hay, herbs and vegetables are said to have been grown here and it was considered a difficult and dangerous area to cross on the journey to the west of London.
Psychology of compulsory detention
Authors: Beveridge Allan
Published: October 2008

The compulsory detention and treatment of patients against their will is unique to psychiatry. It is arguably the most stressful event in psychiatric practice, both for the doctor and for the patient, and yet, although much has been written about the details of mental health legislation (Clare, 1980; Fennell, 1995), very little has been said about the psychological impact that this procedure has on either the doctor or the patient (exceptions are Mills, 1962; Rogers et al, 1993). This paper will examine the emotional factors involved when a patient is deprived of his or her liberty, and will take as its point of reference the Scottish Mental Health Act.
NHS beds for people with learning disabilities
Authors: Bailey Nicola M. , Cooper Sally-Ann
Published: October 2008

A questionnaire was completed by 135 of the 161 (83.9%) National Health Service (NHS) trusts who provide specialist health services for people with learning disabilities in England and Wales. From these, cumulative frequencies were calculated to describe the current level of provision of NHS beds. Results vary in different parts of the country, but the majority of NHS trusts provide assessment and treatment admission beds, long-stay beds (including those NHS trusts who have completed their resettlement process) and respite care beds. A half of NHS trusts directly manage NHS day places. The high response to questionnaires indicates the current high level of interest in this issue.
Psychiatrists' attitudes to physical examination of new out-patients with a major depressive disorder
Authors: Mitchell A. C. , McCabe E. M. , Brown K. W.
Published: October 2008

This survey examined Scottish psychiatrists' attitudes to physical examination and appropriate investigations in the routine assessment of new out-patients with a major depressive disorder. A discrepancy exists between current opinion towards and actual practice of physical examination in the assessment of new out-patients with depression. Numerous obstacles to performing investigations were identified including lack of time, inadequate consulting rooms, lack of equipment and lack of chaperon. The many obstacles identified are considerable but not insurmountable. Missed diagnoses may have adverse consequences for patients as well as medico-legal implications.
Characteristics of referrals to a mental health service for young people in care
Authors: Butler Julet , Vostanis Panos
Published: October 2008

This paper describes the characteristics of referrals to a new direct access child mental health service for young people in the care of the local authority, during the first six months (n=32). Consistent problems emerged within four areas: their histories within the care service (n=18, 56% had had at least one more previous placement); their individual experiences of abuse (n=23, 72%) and the lack of mental health support provided to redress this; their overall poor educational status; and the psychopathology evident at the time of referral (n=29, 91% had ICD–10 diagnoses, mainly mixed depressive conduct disorders).
Documentation of vascular risk factors in vascular dementia
Authors: Rao Rahul
Published: October 2008

The diagnosis of vascular dementia may often be made on the basis of structural neuroimaging, this may not always be reliable. In view of this, a retrospective study of 30 case notes with diagnosis of vascular dementia was undertaken to examine the documentation of vascular risk factors and presence of cerebrovascular disease. Specific recommendations were then made for the future case note documentation. Nine months later, 10 case notes were examined to assess the impact of the recommendations. A noticeable improvement in the documentation of most risk factors was observed. The wider implications of these findings are discussed.
Psychiatric aspects of trauma care: survey of nurses and doctors
Authors: Alexander David A , Atcheson Susan F
Published: October 2008

This study reports on how 139 nursing and 42 medical staff in trauma units viewed psychiatric aspects of trauma, their training and the impact of their work upon them. Insufficient attention was paid in their units to the psychiatric aspects of trauma. There were important gaps in staff knowledge relating to the diagnosis and prevalence of post-traumatic stress disorder, and to the use of night sedation. Nearly all staff favoured providing information regarding post-traumatic psychiatric reactions for relatives, but nearly half had reservations about giving such information to patients. Job satisfaction was reported by most, but their emotional and training needs were generally not met.
Use of hypnotic drugs in a learning disabilities hospital
Authors: Kon Y. , Jackson M. , Banerjee R. , Robertshaw B. , Dunne F.
Published: October 2008

A one-day audit in a learning disabilities hospital revealed 15 patients (9.4% of the hospital population) on hypnotic medication. Guidelines were then developed for the use of hypnotic drugs. An audit of hypnotic drug usage was repeated for the 12-month period of 1994 which revealed that five patients were started on hypnotics.
Fall and rise of the movie ‘psycho-killer’
Authors: Byrne Peter
Published: October 2008

The Glasgow Media Group, through a combination of media watching and group interviews, has confirmed the importance of media representations of mental illness, with its finding that negative images can outweigh even an individual's direct experiences in this area (Philo, 1996). In one recent summary, Philo concludes: “the results show clearly that ill-informed beliefs on, for example, the association of schizophrenia with violence can be traced directly to media accounts” (Philo, 1997). The origins and strength of this association can be traced to cinema, where powerful images of violent ‘insanity’ endure today. In a questionnaire of 487 people who had a family member with severe mental illness, 85.6% identified “popular movies about mentally ill killers” as the largest single contributor to the stigma of that illness (Wahl & Harman, 1989).
Chronic fatigue syndrome in childhood: seven-year follow-up study
Authors: Khawaja Shakil S. , Van Boxel Pieter
Published: October 2008

This study explores the outcome and longer-term sequelae of suffering chronic fatigue syndrome in childhood. Ten such children, ranging from 10 to 16 years of age at diagnosis, were followed up into adulthood, an average of seven years. Most were completely well or markedly improved (seven of nine). Only children fully engaged in therapy made a total recovery. However, respondents felt medical staff did not believe their symptoms and that rehabilitative strategies were unhelpful. No physical or mental illness was subsequently diagnosed to account for the original symptom presentation. Childhood sufferers maintained the same pattern of symptoms as adults. Depressive symptomatology was present in two cases. The overall longer-term prognosis for children suffering chronic fatigue syndrome is good. A successful doctor-patient relationship is essential to improve compliance with management plans.
Detection and awareness of child sexual abuse in adult psychiatry
Authors: Goater Nicky , Meehan Karena
Published: October 2008

We investigated the detection and awareness of child sexual abuse by examining case notes. Child sexual abuse was recorded in 4.7% of cases. There was no evidence that enquiry about child sexual abuse or detection of the problem had increased in recent years, and recording of the details of abuse was rare. Victims received more psychological help and less medication than others. We conclude that awareness of the issue has not increased. Previous findings about child sexual abuse are rarely used in evaluation, and diagnosis and drug treatment may be overlooked in some victims.
Establishing a specialist eating disorders team
Authors: Roberts Sophie , Foxton Toni , Partridge Ian , Richardson Greg
Published: October 2008

Child and adolescent mental health services operate at four tiers. An eating disorders service is a tier 3 function and in the usual absence of specific funding has to operate from within current resources. The operation of an eating disorders team within a wider child and adolescent mental health service has significant advantages. The operation of such a team is explained and the advantages discussed.
Electroconvulsive therapy practice in north-west England
Authors: Benbow Susan M. , Tench David , Darvill Simon P.
Published: October 2008

This study surveyed north-west consultant psychiatrists regarding their clinical electroconvulsive therapy (ECT) practice. A postal questionnaire was sent to all consultants identified by contacting north-west hospitals. Most respondents were in favour of using ECT, primarily for depressive psychosis. Bilateral ECT, twice weekly, was the preferred means of administration. Practice was similar overall to Pippard and Ellam's findings in their national survey. Prior to the latest College ECT guidelines, there had been little change in clinical ECT practice in the north-west since Pippard and Ellam's national survey.
Guardianship in Oxfordshire: hits and misses
Authors: Gordon Catherine
Published: October 2008

This is a follow-up of 24 cases of guardianship orders, and demonstrates how they can be used in practice for complex cases and highlights practical problems with the process of guardianship. Results showed that orders were generally applied to elderly females with dementing illness living alone. Many orders resulted in a move to residential care where the orders were often left to lapse within six months. Occasionally orders needed continuous renewal and here the process was often haphazard and disorganised. However, guardianship was used to coordinate and facilitate multi-disciplinary care. Difficulties have since been identified and improvements in organisation are discussed.
Medical staffing crisis in psychiatry
Authors: Jenkins Rachel , Scott Jan
Published: October 2008

This article summarises the findings of a National Health Service Executive, Royal College of Psychiatrists', National Association of Health Authorities and Trusts, and Trust Federation working group on medical staffing in mental health, which reported to ministers in summer 1996 and was launched at a conference in November 1996 jointly with the College. Although primarily focused on England and Wales, it is clear that similar problems exist in other parts of the United Kingdom and the Republic of Ireland.
The whirligig of time
Authors: Ryle Anthony
Published: October 2008

Had I been invited to write a professional ‘Prospect’ when I qualified almost half a century ago, rather than this retrospect, it would have contained no reference to psychiatry or psychotherapy. Glimpses from the long stone corridor of Frien Barnet into vast bare wards inhabited by patients in striped hospital clothing (or has memory conflated this with images of Belsen?) and demonstrations of cases of, rather than of people with, echolalia or mania or ‘general paralysis of the insane’ (dementia paralytica), which were my student introduction to psychiatry, were aversive rather than attractive. But many of the values and attitudes which have shaped my later attitudes to psychiatry were already evident, rooted in the belief that the most destructive war in history should prepare the way for a juster world, and influenced by my father's enthusiastic advocacy of the National Health Service (NHS) and by his move from clinical to social medicine, a move through which he sought ‘to study the ultimate as well as the intimate causes of disease∗.
Setting up a new old age psychiatry service
Authors: Kirby Michael , Cooney Colm
Published: October 2008

The views of general practitioners (GPs) on the priorities for a new old age psychiatry service were obtained. Most GPs identified dementia patients with behavioural or psychiatric disturbance as being the greatest priority for an old age psychiatry service. There was less consensus on the priorities for delivery of the service, but hospital-based services such as in-patient and day hospital facilities remain high on the GPs' priority list. There was a widely-based desire for results of assessments to be communicated by telephone, followed later by letter. These findings have been taken into account in the development of our new service.
Initial seizure threshold in bilateral electroconvulsive therapy
Authors: Dykes Sheena R. , Scott Allan I. F.
Published: October 2008

The extent to which electrical dose exceeds the seizure threshold is an important determinant of the efficacy of electroconvulsive therapy (ECT) but seizure thresholds have not before been evaluated using an ECT machine made in the UK. In this study seizure threshold was empirically titrated at the outset of bilateral ECT given to 100 consecutive depressed patients treated with an Ectron Series 5A ECT machine. No patient received anti-epileptic drugs. Men and women under 30 years of age (n=14) had low thresholds and men of 60 years or more (n=3) had high thresholds. Seizure thresholds varied at least threefold among other groups, suggesting that empirical titration may be desirable for most patients treated by bilateral ECT.
Psychiatric assessment and diversion schemes: problems associated with brief court reports
Authors: Chambers Clare , Gill Jane
Published: October 2008

Mental health professionals are becoming increasingly involved with the criminal justice system through their work in psychiatric assessment and diversion schemes. Preparation of reports for the courts requires knowledge of the legal system. Those preparing such reports need specific training for this work.
HoNOS in long-stay patients with learning disabilities
Authors: Ashaye Olakunle , Mathew George , Rigby Elizabeth
Published: October 2008

This study, assessed 63 older, long-stay, learning disabled patients, the Health of the Nation Outcome Scales (HoNOS) highlighted the expected problems in areas of cognition, physical illnesses or disabilities, relationships and activities of daily living. No significant changes were observed in the problems assessed using the HoNOS over a six-month period in this group of patients with relatively stable health problems and needs. HoNOS proved to be useful in identifying some expected problems. However, further studies are needed to assess its sensitivity to changes secondary to improvement or worsening of problems along with wider use to see if its brevity allows it to give sufficient detail on the problems of persons with learning disabilities.
Continuing Professional Development
Authors: Morgan Gethin
Published: October 2008

Soon after I retired from my clinical academic post I agreed to become Director of Continuing Professional Development (CPD) for a period of two years, in the hope that I might be able to play a part in ensuring that it becomes firmly established and accepted by psychiatrists as a whole. Having now completed one year as Director, it is gratifying to find the scheme accepted by so many. Nevertheless, I need to discuss what is perhaps the most pressing of all problems which I face. It concerns the various difficulties which have impeded full recruitment into the scheme.
Assessment of respite needs for carers of persons with severe mental illness
Authors: Malcolm Katy , Rowlands Paul , Inch Heather
Published: October 2008

Respite needs for carers of persons with severe mental illness were assessed using a semi-structured inverview. Very few carers were currently using respite facilities. The need for respite was widespread, although largely unmet. Carers shared clear and definite ideas concerning the layout of a good respite service.
Adolescents referred following overdose
Authors: Davies Gillian , Ames Samantha
Published: October 2008

Services for adolescents who overdose remain variable in the UK despite College guidelines. The problem is significant in terms of the demand placed on services, the level of distress it represents and the high eventual mortality rate. This study was undertaken to gain an understanding of the local picture with a view to improving service provision. The study revealed a high level of psychiatric morbidity, considerable drug and alcohol misuse and paracetamol as the most commonly taken substance. The findings supported Hawton's classification into three distinct groups, confirming it as a simple but useful system. This may provide a means of screening adolescents who overdose to improve service delivery to those most in need within the resources available. The possible role of the primary child and adolescent mental health worker is discussed.
Psychiatric out-patients' views on talking about sex
Authors: Crawford M. J. , Shaw T.
Published: October 2008

Despite widespread acceptance that the sexual history is an important part of psychiatric assessment, concern continues to be raised that such questions are often neglected. It has been suggested that one reason for this is the belief of staff that patients do not want to discuss sexual matters. The response of 65 out-patients to a questionnaire concerning their attitudes and expectations to being asked questions about sex is reported. The majority of patients expected there to be some inquiry about sexual matters. While detailed enquiry was not anticipated, patients stated that most questions would not make them feel uncomfortable. This study does not support the view that patients are reluctant to give a sexual history.
Importance of acknowledging racial and cultural differences
Authors: Coll Xavier
Published: October 2008

It is important to explore and interpret the dynamics of cultural differences and racism in clinical work. Race and culture often play a significant role in any psychotherapeutic relationship. Vignettes and clinical narratives are used to illustrate that they can be a useful vehicle for the expression of transferences, demonstrating how basic concepts of psychotherapy apply to cross-cultural interactions.
Dutch lessons in forensic psychiatry
Authors: Balakrishna Jeyabala
Published: October 2008

Dutch forensic psychiatry provides services for mentally disordered offenders which centre around a legal measure called the TBS order. Specialised units deal separately with assessment and treatment. The system appears to work in the context of a small and wealthy country and a criminal justice system which differs from the English system. This paper describes the key features of the secure units, examines the conceptual issues and complications of the Dutch system, and considers lessons for psychiatric and legal approaches to the problem of psychopathy in Britain, in particular the new hybrid order.
Psychiatrist Fellows of the Royal Society
Authors: Bewley Thomas
Published: October 2008

The Royal Society is the oldest scientific society in Great Britain and one of the earliest in Europe. It is usually considered to have been founded in 1660, though a nucleus had been in existence for several years before that date. From Charles II's reign onwards, British Governments have constantly appealed to the Royal Society for advice in connection with scientific undertakings. The Society elects some 32 Fellows annually, who have been proposed by six or more existing Fellows. Foreign Members, not exceeding 50 in all, may be selected by the Council from among “men of the greatest scientific eminence” abroad. From this it can be seen that Fellows of the Royal Society are among the most distinguished scientists in the country. It is not widely known that several psychiatrists have been Fellows of the Royal Society.
Section 17 of the Mental Health Act
Authors: Milton John
Published: October 2008

From 1 April 1996 mental health legislation was expanded to include provision for “supervised discharge” under the Mental Health (Patients in the Community) Act 1995. However, the use off Section 17 (s17) off the Mental Health Act has always provided an option for an extended leave. This retrospective case note study examines 10 years of practice off s17 use and focuses on characteristics off those patients recalled. Increases in s17 applications represented equivalent increases in admissions and overall sections, although numbers off patients actually recalled had fallen significantly. Patients recalled after discharge were generally middle-aged men with a long history of schizophrenia, on s3, who relapse quickly due to treatment non-compliance.
Supervised discharge order: the first year in the South and West Region
Authors: Knight Anna , Mumford David , Nichol Bob
Published: October 2008

Information was collected from responsible medical officers (RMOs) in the South and West Region who had used the new supervised discharge order (SDO) (Section 25a) during the first year of its operation. Twenty-nine patients were placed on a SDO by 19 consultants. Most patients suffered from schizophrenia. In a third of cases, medication was stipulated as a requirement, although this is not legally permissible. RMOs commented on the time-consuming process of applying for a SDO and felt it had limited value because of the lack of sanctions.
Selected characteristics of people on long-term sick leave
Authors: Rose Suzanna , Taylor Pamela J.
Published: October 2008

All personnel within one UK emergency service who had been identified during a six-month period as having been on sick leave for eight consecutive weeks or more were identified. Those consenting were interviewed once using both a semi-structured questionnaire and standardised instruments. There were three main objectives: to discover the nature of the presenting problem in terms of illness or injury, the extent to which psychological problems presented and the relative importance of general and/or traumatic stressors. The resulting sample of 17 people accounted for 2–3% of the workforce. Fifteen agreed to take part and 13 to full interview. of the 14 who completed the Hilton Drinking Behaviour Questionnaire 10 exceeded the threshold consistent with problem drinking. The reason for sick leave in all these cases was recorded as physical injury only.
Attendance at child psychiatric clinics
Authors: Ubeysekara A. , Cox N.
Published: October 2008

A study of 41 families who failed to attend their first appointment at a child psychiatric clinic is described. The study was prospective over a period of one year and the families were interviewed personally; 14.9% failed their first appointment. Improvement of the child's symptoms during the waiting period, anxiety about seeing a psychiatrist/social worker, financial difficulties and the invitation to the family to attend were common reasons given for non-attendance. Another important factor was that families were ill-prepared by the referrers.
Appraisal of an article on prognosis
Authors: Lester Marc , Warner James P. , Blizard Robert
Published: October 2008

Prompted by a clinical question, an article on prognosis in anorexia nervosa was appraised using evidence-based guidelines. Although problems with the validity and generalisability of the study were identified, this article yielded useful information. We conclude that it is not possible to address all clinical questions using the evidence-based framework.
Inconsistencies in risk assessment
Authors: Harwood Paul , Yeomans David
Published: October 2008

An audit of case notes and a survey of in-patients was carried out to evaluate risk assessment on an in-patient ward. We found considerable inconsistencies between the risk assessment records in medical and nursing notes. A systematic survey found higher levels of risk than either set of notes, but combining the notes improved the quality of risk assessment compared to the survey. We suggest three key areas for action to improve risk assessment.
Delayed response to abnormal lithium results is no longer necessary
Authors: King J. R. , Birch N. J.
Published: October 2008

A survey of one year's lithium results for a hearth district of 170 000 disclosed unacceptable delays in checking abnormally high values. Only 17% of moderately elevated levels were rechecked within a week. The problem was most marked with patients monitored in general practice, but one particularly high result in a patient monitored in psychiatric out-patients remained unchecked for over three weeks as a result of poor communication between general practitioner and psychiatrist. A trial of an on-the-spot monitoring service using new technology has simplified procedures and reduced to zero the number of results taking over a week to check.
Ideas of flight
Authors: Maher C. , Murray D.
Published: October 2008

As staff on the acute psychiatric unit at St Ita's Hospital had recently become aware of an increasing number of referrals from Dublin airport, a retrospective analysis of case notes of such patients admitted from 1987 to 1994 was undertaken. Twenty-three patients were admitted over this period, the majority arriving from the UK. Mania was the admission diagnosis in 11 patients, schizophrenia in eight, unipolar depression in two, and schizoaffective and personality disorder in one case each. All but two had a past psychiatric history. Seventeen had Irish friends or relations; five of these acting upon ‘Ireland-related’ delusions. Ten patients required temporary certification. The mean duration of hospitalisation was 19 days and the total 433 days. All patients were repatriated, nine being transferred directly to psychiatric hospitals, with the relatives eventually bearing the cost of transport in all but one.
Assessment and certification of neurosurgery for mental disorder
Authors: Langley G. E.
Published: October 2008

The views expressed are based on experiences of a second opinion appointed doctor and refer to neurosurgery for mental disorder. Here the general issues are sharpened by the necessity to certify informed consent and the likelihood of the alleviation or the prevention of deterioration. In an age of evidence-based medicine the criteria by which these issues are judged are critical and need to be generally agreed. The evidence needed in clinical reports and in certification is considered from theoretical and practical viewpoints and suggestions are made in reference to treatment at both new and established centres.
Violence in the community: study of community mental health teams
Authors: Eastwood Nigel , Pugh Robert
Published: October 2008

The experience of violence towards members of community mental health teams was explored using a questionnaire. Response rates were 97%. The number of staff experiencing various types of violence was greater than in previous studies. Staff were generally well-informed about the theoretical issues and had sensible attitudes towards the risk of violence. Appropriate training was found to be lacking and other Department of Health and Social Security recommendations were not being followed. These included information about whereabouts of staff, and mechanisms for communication. We recommend that training issues are addressed locally and that safe theory should be translated into safe practice which is regularly monitored.
Care programming and service change in a psychiatric sector
Authors: Feeney Sean , Onyett Steve , Lindsay Kevin
Published: October 2008

The effects of service expansion and change (including Joint working with social services) following the provision of a community mental health centre and the introduction of care management were examined by auditing service activity. Data were collected on service provision to 20 randomly selected patients who met the local criteria for care management, and also on the general level of service activity as judged by service contacts for all disciplines. Compared to the baseline period, face to face contact with care-managed patients increased six-fold. There were more home contacts, a wider range of professional contacts occurred, and a greater variety of types of treatment provided. A substantial (though not statistically significant) reduction in day hospital attendance was seen over the period studied. The number of service contacts for non-care-managed patients also rose. The introduction of care management was simplified by changes in service organisation. Increased resources were needed to both implement care management and provide an adequate service to the remainder of patients. Both aspects of the service functioned efficiently in parallel.
Writing letters to patients
Authors: Thomas Phil
Published: October 2008

Recent changes in the law and mental health policy have forced psychiatrists and other mental health professionals to review the traditional cloak of secrecy that surrounds record keeping and letter writing. This paper establishes what proportion of patients attending a psychiatric out-patient clinic are interested in receiving letters from their psychiatrist. Those who are interested tend to be better educated, whereas those who are not interested are much more likely to have an ICD–10 diagnosis of schizophrenia. Overall, there appear to be high levels of satisfaction with the nature of the letters received. The significance of these findings is discussed in relation to the difficulty of engaging people with the most severe and enduring forms of mental health problems as active participants in the process of care.
Olanzapine in practice
Authors: Taylor David , Drummond Siobhan , Pendlebury Joanne
Published: October 2008

Prescription charts including a prescription for olanzapine were evaluated for 202 patients from 15 National Health Service trusts. In patients prescribed olanzapine for less than six weeks, the mean dose was found to be 12.4mg/day but 56% of patients were prescribed olanzapine as the sole antipsychotic. For patients prescribed olanzapine for longer than six weeks (when dose titration and drug crossovers were assumed to be complete) the mean dose of olanzapine was 15.8mg/day and 64% received olanzapine as the sole antipsychotic. A substantial proportion of patients were prescribed concurrent anticholinergic drugs (but relatively few when on olanzapine alone). Olanzapine was used in doses higher than the standard dose recommended by the manufacturers, often in combination with typical antipsychotics. Such practices increase costs and, at least in the latter case, very probably adversely affect outcome. Studies are needed to evaluate the relative effectiveness of commonly used antipsychotic regimens in naturalistic settings. In the absence of these, olanzapine should be used as the sole antipsychotic and patients should be property assessed on lower doses before dose increases are undertaken.
Comparison with attendance at child medical and surgical clinics
Authors: El-Badri Selim M. , McArdle Paul
Published: October 2008

A widespread perception exists that attendance at child psychiatry clinics is especially poor. The reported rate of non-attendance at a child psychiatry outpatient clinic is 61%. However, other child health clinics also suffer a high rate of non-attendance. In this paper we examine the hypothesis that rates of non-attendance are higher in child psychiatry than In other child health out-patient clinics.
Anti-bullying policy in child and adolescent psychiatric units
Authors: Sommers Stephanie , Whitney Lucia
Published: October 2008

Bullying is a common problem. There has been much written on the subject, mainly relating to schools. In this study a questionnaire was sent to 66 child and adolescent psychiatric units in the UK, 50 (75%) were returned. The units were surveyed on frequency of bullying, whether an anti-bullying policy was in place and whether difficulties had been encountered setting up the policy. An anti-bullying policy was present in only 10% of units. Further research is needed on bullying and appropriate and effective methods of dealing with it on child and adolescent psychiatric units.
Nature and extent of dental pathology and complications arising in patients receiving ECT
Authors: Beli Nita , Bentham Peter
Published: October 2008

This study aimed to describe the prevalence of dental pathology in patients receiving electroconvulsive therapy and to prospectively determine the incidence of dental complications arising during treatment. Of 30 subjects, 93% complained of a dry mouth and 83% were taking drugs with anticholinergic properties. A third wore dentures and the dentate population had a mean of 15 decayed, missing or filled teeth. Oral hygiene and periodontal condition was poor with one-third requiring scaling and 30% complex periodontal treatment. Temporomandibular pain followed 44% of treatments, and minor buccal lesions occurred in 22%. Greater emphasis must be placed on dental care, and guidelines are suggested to improve practice.
Butterflies, fractals and psychiatry
Authors: Reid Steven
Published: October 2008

In this paper concepts related to the field of non-linear dynamics and chaos theory are discussed, and their relevance to psychiatry is considered.
Trainees' assessment and management of mental illness in adults with mild learning disabilities
Authors: Sayal Kapil , Bernard Sarah
Published: October 2008

Recommended changes in services for adults with mild learning disabilities are likely to have training implications. A case vignette study examined the effect of coexistent mental illness and learning disability on trainees' clinical assessment and management. Mental illness was more likely to be diagnosed in those with a mild learning disability than in a control group who had no learning disability. Despite this, the learning disability group was less likely to receive treatment. Service and training issues are discussed.
The detective, the psychiatrist and post-modernism
Authors: Beveridge Allan
Published: October 2008

The similarity between the work of the fictional detective and that of the psychiatrist has often been remarked. Both Marcus (1984) and Shepherd (1985) have compared the technique of the archetypal sleuth, Sherlock Holmes, with that of Sigmund Freud. The sage of Baker Street attempted to solve criminal cases by finding links between items in the external world, such as footprints, bloodstains or broken locks, while Freud tried to make sense of the mysteries of the mind by making connections between events in the inner world, such as dreams, thoughts and desires. Both attempted to provide an all-encompassing explanation of seemingly disparate phenomena. Over the years, the literary descendants of Holmes have become increasingly similar to psychiatrists, because, as well as attending to the external events, they also take account of the individual psychology of the criminal and the social context of the crime.
Workhouse or asylum: the nineteenth century battle for the care of the pauper insane
Authors: Myers E. D.
Published: October 2008

Throughout the 19th century some 20–25% of all known pauper lunatics in England and Wales were accommodated in workhouses. Early on, the lunacy commissioners considered that all pauper lunatics should be admitted to asylums and were highly critical of the conditions under which they were kept in workhouses. As the century progressed the lunacy commissioners were forced to compromise because of the lack of space in asylums and diminishing confidence in the results of asylum treatment. By the end of the century the lunacy commissioners were reconciled to the accommodation of feeble-minded, imbecile, idiot, chronic psychotic and demented paupers in workhouses, but held to the view that the acute pauper insane should be admitted to asylums.
Dilemmas of a psychiatrist in a developing country
Authors: Malik Sa'ad B.
Published: October 2008

It was in early 1984 when, after receiving my basic postgraduate training in the UK, I returned to my home country, Pakistan. As I began to settle down in my professional work I soon realised that I was facing problems on more than one front. Whereas some of these I have been able to overcome with time, others remain largely unresolved. Psychiatrists from the developing world who receive their training in the West and subsequently return to their home countries may be facing similar dilemmas. Here I would like to share some of my own.
Jung at heart
Authors: Clarke Rick
Published: October 2008

I was wandering through the ward clutching an auroscope in search of a patient suffering from severe psychological and behavioural problems who was complaining, inter alia, of a blockage in her ears. I encountered her consultant, a Jungian, who when informed of my purpose, responded that this was the most important development in years as it meant she was ready to listen!
Public education: 12 years on
Authors: Hart Deborah , Phillipson Jill
Published: October 2008

One of the main objectives of the College's Charter is “to promote public education”. The Public Education Committee, which was established in 1986, and is now a Special Committee of Council, has been actively promoting media coverage of College policy, materials for the general public, new research and information about good practice in psychiatry. A large part of the work of the Public Education Committee involves media activity, such as regular press releases, press conferences and responding on a daily basis to the growing number of media enquiries from all over the world.
The College: an analysis of members' views
Authors: Kendell R. E. , Duffett R.
Published: October 2008

Aims and method

In November 1997 a questionnaire was sent to a large random sample of members, fellows, affiliates and inceptors living in the UK or the Republic of Ireland.

Results

One thousand four hundred and seventy-six completed questionnaires were available for analysis, a response rate of 63%. The College was complemented for raising standards of education and training in psychiatry and criticised for not trying hard enough, or failing, to influence the policies of the Department of Health. A high proportion of respondents highly valued the British Journal of Psychiatry and Psychiatric Bulletin but few made use of the library. A high percentage of Irish, Welsh and Scottish members, and of members of the five smaller faculties, participated in and expressed their appreciation of the activities of the College.

Implications

Whatever its other failings the College is not dominated by general psychiatrists and their interests, or by London-based psychiatrists. It is surprisingly successful at involving Scottish, Welsh and Irish psychiatrists, and members of the smaller faculties, in its activities. To some extent, however, the faculties are thriving at the expense of the English divisions.
HoNOS: a cautionary tale of their use in a rehabilitation service
Authors: Chaplin Robert , Perkins Rachel
Published: October 2008

Aims and method

Health of the Nation Outcome Scales (HoNOS) were piloted in 248 patients with serious persistent mental health problems. Staff were trained by a cascade approach and rated patient outcome after six months.

Results

There was poor interrater reliability between nurses and psychiatrists/psychologists. Outcome measured by HoNOS often contrasted with clinical experience.

Clinical implications

HoNOS were not a reliable or valid measure of outcome. The scales are now completed only under supervision.
Profile of staff grade psychiatrists
Authors: Blower Aileen
Published: October 2008

Aims and method

Staff grade psychiatrists working in Scotland were surveyed by postal questionnaire in order to determine their demographic profile, career aspirations and experience of the grade.

Results

A heterogeneous group of doctors was identified, from a variety of professional backgrounds, and with a range of ambitions. Respondents generally held a favourable view of the grade, but expressed concern over perceived lack of opportunities for training, education and career progression. This is despite considerable recent efforts by the College to include non-consultant career grades in its programme for Continuing Professional Development.

Clinical implications

There remains scope for imaginative development of the grade. In particular, staff grade psychiatrists might benefit from a more individualised approach to, and support for, all areas of their professional development. Such ‘mentoring’ may be especially beneficial for staff grades in Scotland, for whom geographical, as well as professional isolation, can be problematic.
Sweets, newspapers and analgesics: patients' purchases from hospital shops
Authors: Somerfield David
Published: October 2008

Aims and method

The study was undertaken to examine over the counter drug sales from hospital shops. One hundred hospital shops were sent a questionnaire asking for details of drugs sold and any policy to prevent sales to patients.

Results

Seventy-three shops replied, 20 of which sold medication. Most had policies which would allow sales to patients. Three shops had sold medication which was subsequently used for self-poisoning by in-patients.

Clinical implications

Hospital managers and clinicians should ensure hospital shops have effective policies to prevent medication sales to patients.
Specialised in-patient psychiatric service for women
Authors: Kohen Doro
Published: October 2008

Aims and method

To describe one of the first psychiatric services in the inner-city especially designated for female psychiatric patients with severe mental illness.

Results

The referral system, the staffing levels and the admission criteria have been established following needs of the patients, especially young women with perinatal problems and women from ethnic minorities.

Clinical implications

This single gender acute psychiatric ward has received welcome attention from mental health professionals and management at every level, and it is hoped that further discussion will help to clarify future policies and guidelines on all aspects of this venture.
Bridging the psychotherapy divide
Authors: Monaghan Mary T. , Moorey Stirling
Published: October 2008

Aims and method

All consultant psychotherapists should be sufficiently familiar with the three major branches of psychotherapy, to appropriately match therapy with their assessment of the patients' needs. This requires that specialist registrars training in psychotherapy acquire skills in psychodynamic/interpersonal, cognitive-behavioural and systems-based therapies.

Results

While acknowledging the benefit for the trainee of being familiar with more than one model of psychotherapy the practicalities of incorporating different models in to training is likely to be problematic, at least initially, for both trainees and trainers.

Clinical implications In this article the experience of a senior registrar who completed a training in psycho-analyticpsychotherapy prior to gaining experience in cognitive-behaviour therapy is examined from the perspective of both the trainee and cognitive-behavioural trainer.
Collegiate Trainees' Committee: guidance for trainees having interpersonal problems with their educational supervisor
Authors: Cormac Irene , Marston Geoffrey
Published: October 2008

In many psychiatric rotations, trainee psychiatrists usually move every six months between educational supervisors (consultant trainer). These moves may entail geographical relocation and nearly always involve an emotional relocation for the trainee. Trainees need to acclimatise quite rapidly to different methods of working, training style and expectations from each individual trainer.
Mental Health Act reform
Authors: Turner Trevor , Salter Mark , Deahl Martin
Published: October 2008

Psychiatrists have been complaining about mental health legislation for over a century (Smith, 1891), usually in terms of the delays engendered, paperwork and bureaucracy, and the impositions on clinical practice. As a result they have gained more powers, and perhaps much-needed status within the medical profession, to the concern of some commentators (e.g. Fennell, 1996). Thus, the ‘triumph of legalism’ (Jones, 1993) of the Lunacy Act 1890 was modified by the Mental Treatment Act 1930, whereby outpatients and voluntary patients were encouraged and ‘asylums' became ‘mental hospitals'. Then came the radical change of the Mental Health Act (MHA) 1959, making compulsory detention an essentially medical decision and removing the routine of the courts, but retaining a theme of requiring ‘treatment in hospital’. The Mental Health Act 1983, however, was a touch anti-medical, since it strengthened the role of the approved social worker (ASW) and enhanced the importance of a patient's consent to treatment. “The primacy of the medical model and the paramountcy of the psychiatrist are certainly subject to greater limitations and external review”, was the opinion of William Bingley, then Mind's Legal Director, now Chief Executive of the Mental Health Act Commission – reviewing the Act in its early days (Bingley, 1985).
Treatment of the mentally ill in the Federal Republic of Germany
Authors: Röttgers Hanns Rüdiger , Lepping Peter
Published: October 2008

Aims and method

The legal provisions concerning the admission to hospital, holding powers and compulsory treatment of the mentally ill in Germany are illustrated. The essential legal concepts are compared to the situation in Great Britain.

Results

Whereas British law gives key powers to multi-professional decision-making and relatives, German law requests formal court decisions even in routine cases. This reflects a different understanding of individual rights and their protection. German mental health law is motivated by the experiences of the totalitarian national socialist regime. It tries to protect patients' rights by restricting physicians', hospitals' and family members' Influence. British law, on the other hand, assumes that experts as well as family members act benevolently in the patient's Interest, prefers less formal mechanisms and expresses more trust in professional ethics.

Conclusion

Further research is desirable to analyse the situations in other countries and to determine which of these approaches is the most adequate from the point of view of the mentally ill. This is even more important in view of further European integration which will undoubtedly touch these questions and accelerate a convergence in medico-legal issues.
Is specialist registrar training in cognitive therapy effective?
Authors: Moorhead Steve , Scott Jan
Published: October 2008

Aims and method

This paper describes the characteristics and outcome of the first 20 patients seen by a newly appointed specialist registrar in cognitive therapy. The outcome of the first (cases 1–10) and second (cases 11–20) cohorts were evaluated to assess if training had any impact on clinical effectiveness.

Results

Comorbidity was common, but more patients improved following the intervention (effect size=0.64–1.34). The 25% therapy drop-out rate was comparable with previously reported rates. Four out of five patients who dropped out had Cluster B personality disorders. The two cohorts showed similar baseline characteristics, but the second cohort showed improved outcome (effect size of training=0.89–1.04) and had a significantly shorter course of therapy (P=0.02).

Clinical Implications

Specialist registrar training in cognitive therapy provides experience in treating a wide variety of mental disorders. The routine collection and analysis of clinical and psychometric data helps identify training effectiveness and training needs. The data demonstrate that training was associated with improved patient outcomes.
Options for part-time training
Authors: Garrard Olga
Published: October 2008

As we approach the new millennium, more doctors are seeking part-time training, in all specialities and grades, with the demand outnumbering the opportunities (Goldberg, 1997; Clay, 1998).