bluuebunny/crossref_metadata_2025 huggingface dataset:
1. Rehabilitation psychiatry
Authors: Black Dawn , Guthrie Elspeth , Bridges Keith
Published: May 2008

The career paths of many trainees in psychiatry are influenced by their experience of a six month SHO/registrar training post in a particular speciality. Not all trainees, however, may be aware of the training requirements for a specialist consultant post, career prospects and most importantly of the practicalities of working on a day to day basis as a specialist consultant or a consultant with special interest or responsibility. Furthermore, some SR trainees may have a limited choice of placement in a SR training scheme and with the diminishing availability of pure general psychiatry consultant posts, a year's training at senior registrar level may determine a trainee's whole career.
Implementing Caring for People? Draft guidance circulars from the Department of Health
Authors: Holloway Frank
Published: May 2008

Throughout the 1980s concern mounted over the provision of health and personal social services. As a result of inflation, an expansion in demand and technical advances, the increasingly expensive hospital services became more and more obviously threadbare, while the perceived failures of the community care movement were widely canvassed. As the decade ended the Government embarked on two bold initiatives aimed at increasing the efficiency, effectiveness and accountability of health and social care. These proposals, set out in the White Papers Caring for People (HMSO, 1989a) and Working for Patients (HMSO, 1989b), have now become law in the National Health Service and Community Care Act 1990. Another paper (pp. 641–645) somewhat critically reviews Caring for People from a psychiatric perspective (Holloway, 1990). At the heart of the ‘reforms’ is an attempt to create the conditions of a market. To achieve this a sharp distinction is to be drawn between the purchasers of care (Health Authorities, Local Social Services Authorities and Family Health Services Authorities) and service providers, with whom the purchasers will let contracts. It is envisaged that eventually a plethora of providers will compete within a “mixed economy of care”, becoming ever more efficient.
Support and stay: an innovative community service for the elderly confused
Authors: Whitby Paul , Rule Joan , Joomratty Jill
Published: May 2008

In the psycho-geriatric field there is great concern that as the number of elderly people in the population rises so the number of those suffering from dementia will increase. Services are already stretched and innovatory changes are needed to ensure that this large group of people receive adequate care.
The development of a community support service for the chronically mentally ill in an inner city health district
Authors: Colgan Stephen , Bridges Keith
Published: May 2008

Community support teams are an important component of services for the chronically mentally ill who do not need to remain in hospital. In the autumn of 1989 the Department of Psychiatry in Central Manchester established a small team with a remit to develop such a service. The team is made up of four nursing staff (a charge nurse, staff nurse, SEN and a nursing auxiliary) with additional support provided by two occupational therapists, a clinical psychologist, consultant psychiatrist and senior registrar in rehabilitation psychiatry. This paper will briefly describe some of the experiences and problems that the service has encountered so far and some of the solutions that have been explored.
Is the role of regional secure units changing?
Authors: Smith Jeanette , Parker Julian , Donovan Martin
Published: May 2008

Regional secure units are a relatively new facility for the treatment of mentally disordered offenders and difficult to manage patients. Their role is still evolving. Previous studies have described details of referrals and admissions to such secure units (Higgins, 1981; Gudjonsson & Mackeith, 1983; Offen & Taylor, 1985; Faulk & Taylor, 1986; Bullard & Bond, 1988). To date, however, no studies have examined changes of practice in RSUs over time. The purpose of the present study is to examine changes in the admission characteristics of patients admitted to the Butler Clinic, regional secure unit for Devon and Cornwall since it opened in 1983 to the present time.
Forensic psychiatry – a tale of two systems
Authors: Boast Neil
Published: May 2008

During registrar training I had the privilege of working in the interim secure unit at Friern Hospital in London. To gain further experience in the field of forensic psychiatry, I secured (if that is an appropriate term), a post as trainee psychiatrist at James Nash House, centre for forensic psychiatry, Adelaide, South Australia. This article compares the legal and health care frameworks in England and South Australia relevant to mentally abnormal offenders. The two units are described and differences in facilities, patient populations and working practices are discussed.
The case of the disappearing doctor
Authors: Collinson Susan
Published: May 2008

Edinburgh. She had recently taken up a locum tenens at the Royal Free Hospital in Gray's Inn Road in place of one of the resident staff who was away on holiday. The Lancet records that she was “seen in the hospital and about the wards up to noon on Saturday 15th (August), but since then nothing has been seen of her nor had anything been heard of her up to Thursday morning. We trust that before the paper is in our readers' hands Miss Hickman's whereabouts and safety will be made known to her father, with whose anxiety in the situation we sympathise deeply”. By 29 August nothing had been heard, though Miss Hickman's sudden and apparently motiveless disappearance had by then attracted a great deal of public interest. She had been a brilliant student, attending the London School of Medicine for Women, where she had consistently gained Honours and Prizes. Her first job was as Junior House Surgeon at Clapham Maternity Hospital. Her independent life-style (there was still controversy surrounding the practice of medicine by women) and the lack of motive for her disappearance led to a range of theories and explanations being brought to bear upon the mystery. The Lancet (29 August) suggested that Miss Hickman's disappearance “may be due to that curious condition of mentality which leads to ‘automatic wandering’ – a condition that is perfectly familiar to psychologists” and recommended to the reader a paper by Dr W. S. Colman, lecturer in forensic medicine. Entitled ‘A Case of Automatic Wandering lasting Five Days’, it described in detail two episodes of prolonged automatism. On each occasion, the patient had ‘woken up’ after a period of days, many miles from home.
Medical audit in a Scottish psychiatric service
Authors: Fenton George W. , Ballinger Brian R. , Ballinger C. Barbara , Naylor Graham J.
Published: May 2008

Psychiatry is unique in already being subject to statutory external audit through regular visits to psychiatric hospitals and units by the Hospital Advisory Services and Mental Health and Mental Welfare Commissions. These organisations do comment on aspects of the standard and quality of care. Reports of their findings undoubtedly facilitate change. By their programme of repeated visits they are in a position to observe the implementation and outcome of altered patterns of practice brought about by their reports. The Codes of Practice being prepared by the Mental Health Commission (England and Wales) and Mental Welfare Commission (Scotland) is another step that will significantly influence clinical practice. Finally, the Royal College of Psychiatrists' postgraduate training scheme accreditation exercise, like those of the other Royal Colleges and Faculties, has had an impact on quality of clinical care through its policy of gradually increasing the standard of postgraduate clinical training requirements. Locally based audit clearly complements these external exercises and local psychiatric services are now expected to organise systems of regular internal audit as are the other clinical disciplines (Department of Health, 1989).
Characteristics of patients in a psychiatric follow-up clinic
Authors: Shah A. K. , Lynch S.
Published: May 2008

Out-patient clinics are widely used to asssess and treat patients. In psychiatric practice, out-patient clinics are used both to assess new referrals and follow up existing patients. More than three-quarters of psychiatric out-patient attendances are for follow-up (DHSS, 1984). With modern emphasis on community psychiatry, the role of out-patient clinics may become less prominent and more refined. Very little appears to have been published on the subject of psychiatric follow-up clinics.
The absconder and the Hospital Order
Authors: Kaul Adersh , Whittaker Maggie
Published: May 2008

The Mental Health Services have been accused of providing a ‘soft option’ to offenders and this charge is highlighted in cases where the mentally disordered offender absconds (hereafter called the absconder) from the hospital. Society just about manages to accept the disposal of disturbed offenders to hospital, which it sees as providing at least some limited incarceration, but in the event of an offender absconding the whole dilemma of offenders considered to be in need of treatment is thrown into question. The Responsible Medical Officer (RMO) is concerned with issues of treatment, public safety and his/her responsibility to the Courts and society; and thus finds himself/herself in the conflicting roles of a doctor and an agent of social control. This paper attempts to address some of the issues surrounding the areas of the rights of the patient, the dilemma faced by the clinicians and the rightful use of the powers of the doctor and of the State in relation to Hospital Order and the absconder.
The Dutch approach to services for drug misusers
Authors: Fleming Philip M.
Published: May 2008

The Dutch have a tradition of tolerance and pragmatism in the fields of social policy, and nowhere is this better illustrated than in their policy and practice in the field of drug misuse. Indeed often exaggerated accounts of Dutch ‘liberalism’ are promulgated, and articles in the press have suggested a backlash is now occurring in Holland to these ‘progressive’ policies (Williams, 1989). The award of a Council of Europe Fellowship gave me the opportunity to spend two weeks in the Netherlands in October 1989, visiting drug services and talking to a wide range of people with responsibilities for such services. I was particularly interested to see how the Dutch were responding to the challenges of HIV infection in drug users (Fleming, 1989).
The nuts and bolts of writing papers: Number 3. Style and grammar
Authors: Footring Ralph
Published: May 2008

Let's face it, if you're writing about validating a rating scale, not many people are going to be glancing at the last page of the paper to see how it ends. The aim is not for the reader to go away breathlessly saying “I couldn't put the Journal down this month”. The principal consideration is to convey the information as clearly and concisely as possible. An efficient way of doing this is in the passive tense, but do not feel limited by this classic style. If you enjoy writing, why not let a little personality through? There is probably more room for this in papers that are not tied to methods and results sections, but if you have a chance to throw in a bit of personal style, why not let rip … tell ‘em good. Which brings me to the next point.
Trends in recruitment of new long-stay male schizophrenics
Authors: Todd Norman A. , Bennie Ernest H. , Cooper A. F. , McKane Joseph P. , Watt Linda J.
Published: May 2008

In 1973 a survey was carried out of male schizophrenic patients who had become long-stay residents in Leverndale Hospital, Glasgow, ‘long-stay’ being defined as having been continuously in hospital for more than three years (Todd et al, 1976). The patients were recruited from a four year cohort of admissions in the years 1967 to 1970 inclusive. In the following years there have been many changes in the provision of facilities and in clinical practice. In some countries, such as Italy, the USA and England, there has been a strong drive to reduce long-stay populations along with the closure of some mental hospitals. In Scotland the process has been much more gradual, possibly reflecting the differences in preexisting provisions and patterns of care.
‘The Blues’ and psychiatry: Symptomatology and therapy in song lyrics
Authors: Jelley Matthew
Published: May 2008

In the wee midnight hours, long ‘fore the break of day In the wee midnight hours, long before the break of day When the blues creep upon you and carry your mind away.
A pre-planned assessment sheet: a suggested aid for the MRCPsych examination
Authors: Vincenti G. E. P.
Published: May 2008

A useful part of the MRCPsych residential revision course at the University of Surrey in Guildford is the mock clinical examination. One of the peculiarities of the mock examination for the Membership course which I attended was that all examinees interviewed patients in one large hall. I found it intriguing to observe the note-taking techniques of my equally nervous colleagues. It seemed to me that there was little organisation in the way candidates wrote down the information acquired from their interviews. Most people left the hall clutching a jumble of disjointed sheets of paper to start a scrambled five minutes of hasty preparation before presenting the case. Much of this precious time was then spent attempting to decipher and organise their notes, when clearly it would have been better employed in thinking and trying to anticipate likely questions.
16 thoughts on getting that paper published!
Authors: Wilkinson Greg
Published: May 2008

(1) Authors may be divided into three classes – shooting stars, planets, and fixed stars. Arthur Schopenhauer: Parerga und Paralipomena, 1851 How brightly should you shine, and for how long? At appointments committees lists of publications are becoming increasingly important as proxy measures of candidates' abilities and potential. As competition for posts becomes fiercer, number and quality of publications are likely to assume even greater importance when similarly qualified individuals are being compared. We may bemoan this trend but in the absence of other more valid indicators of worth and from the point of view of self-interest it would be prudent to acknowledge it and to support it.
On measuring the changes in psychiatric care systems: results in an urban area (Vienna)
Authors: Rudas Stephan
Published: May 2008

Vienna, a city with a population of 1.5 million, as well as being the capital of Austria is also one of its nine provinces. Care for the mentally ill in Vienna, as elsewhere, was for decades either misguided or poor. The large mental hospitals in the city were seriously overcrowded and understaffed. In the extramural sector, there was an enormous deficit in out-patient and complementary facilities.
A psychiatric clinic for the single homeless in a primary care setting in Inner London
Authors: Joseph P. L. A. , Bridgewater J. A. , Ramsden S. S. , El Kabir D. J.
Published: May 2008

It is well recognised that there is an increased psychiatric morbidity, in particular psychosis, personality disorder and substance abuse, among the single homeless (Lodge Patch et al, 1971). The reasons for this are complex. There is evidence that these people are mentally ill before becoming homeless and that their illness may be a cause of their homelessness. In a study of newly presenting patients at the DHSS Reception Centre in Camberwell, London, Tidmarsh & Wood found that 87% of those with mental illness had been staying recently with their families just before their first hospital admission, suggesting that mental illness may have led to homelessness in these patients (Tidmarsh & Wood, 1972). Although direct evidence is scant in the UK, it is felt that the closure of long-stay psychiatric hospitals could lead to some of their in-patients becoming homeless.
Consumer satisfaction with a psychiatric out-patient clinic
Authors: Sheikh A. Jawad , Meakin Christopher
Published: May 2008

NHS out-patient clinics remain a major point of contact between psychiatrists and their patients. There are several advantages to this setting for consultation: it is time efficient, there is usually easy access to case records and contact with other disciplines and services is often available. With the current trend towards community care, increasing use of out-patient facilities is likely as home visiting becomes impractical and, moreover, may be undesirable for some patients.
Clinical audit — a proposal
Authors: Ferguson Brian
Published: May 2008

The best form of psychiatric audit would probably entail carrying out detailed structured interviews of mental state throughout treatment programmes in order to measure clinical effectiveness. In practice this is clearly impossible for busy routine services and will probably be confined to research initiatives. A number of units have attempted to carry out clinical audits subjectively but that clearly has the limitation of bias.
Psychiatric training at the Maudsley Hospital: a survey of junior psychiatrists' experiences
Authors: Fahy Thomas A. , Beats Barbara
Published: May 2008

A majority of psychiatrists embark on their careers by entering an SHO/registrar rotation where they can expect to receive a broad based training in the principles and practice of their chosen specialty. These posts should provide the trainee with an opportunity to observe and emulate high standards of clinical care as well as fostering academic interests and research skills. The Royal College of Psychiatrists recognises the importance of these years by monitoring the standard of posts and by examining trainees at the end of this period.
Medical audit and mental health care
Authors: Glover Gyles R.
Published: May 2008

The recent prominence of medical audit in psychiatry is due in large measure to the place given to the subject in the government's White Paper Working for Patients (DoH, 1989a). However, medical audit existed before the White Paper and covers a broader scope than the White Paper proposes. Thus in considering the introduction of audit into the mental health services it is important not to allow the White Paper to narrow the field of view.
An evaluation of general practitioners' knowledge and satisfaction of a local child and family psychiatric service
Authors: Markantonakis Aristos , Mathai John
Published: May 2008

Although childhood psychiatric disorders are commonly seen in general practice, only a few children in the community eventually gain access to professional help (Rutter, Cox, Tupling et al, 1975; Bailey, Graham & Boniface, 1978). Whether a child is referred or not depends on various factors connected with the child and family (Garralda & Bailey, 1988) and others such as what the GP expects from the referral. Whether GPs know of what the child psychiatric services in the area have to offer might also be expected to effect referral. We know that there is a general dissatisfaction with written communication between general practitioners and specialists in terms of the quality on the communication and usefulness to both groups (Pullen & Yellowlees, 1985; Kentish, Jenkins & Lask, 1987).
A peep at Polish practice
Authors: Hayes Helen J.
Published: May 2008

In June 1989, while the Polish people took part in their first free elections for 40 years, I spent a busy day in the company of Dr CY, an English-speaking Polish psychiatrist, visiting state psychiatric facilities in the Gdansk/Gdynia region and sitting in on consultations in Dr Y's private clinic in Gdansk.
Freud and Wagner-Jauregg: a historiographical study
Authors: Whitrow Magda
Published: May 2008

It is ironical that of the two greatest Austrian psychiatrists, Freud and Wagner-Jauregg, Freud is now a household name throughout the world, whereas Wagner-Jauregg is hardly known outside German-speaking countries. Yet his work brought him the highest honours not only in his own country and was crowned by the award of the Nobel prize in 1927. The reason for the reversal of their reputations is not far to seek. The Nobel prize was awarded to Wagner-Jauregg for his malaria treatment of general paralysis of the insane (GPI), a severe and fatal form of neurosyphilis, which saved untold thousands of lives. Today GPI is rarely seen because syphilis can now be successfully treated with antibiotics. Wagner-Jauregg also did pioneering work into the relationship between thyroid deficiency and cretinism, which in those days was still in a speculative state, but his name is hardly ever mentioned in this context. He had the misfortune to publish in journals with a more restricted circulation than those in which the results of Schiff's and Kocher's work appeared.
Media for Mental Health
Authors: Ramsay Rosalind
Published: May 2008

Broadcast media can powerfully influence the way we view the world. Journalists drawn to sensational news items do not necessarily portray the real situation they are describing. Often they strengthen belief in stereotyped images, such as the ‘mad axeman’. Yet they have the potential to foster greater public understanding of mental illness and a more responsible attitude to sufferers.
Compulsion in psychiatry: blessing or curse?
Authors: Koryagin Anatoliy
Published: May 2008

It is common knowledge that psychiatric patients sometimes need to have compulsory measures applied to them for the safety of themselves and of others.
Psychosurgery
Authors: Freeman Hugh
Published: May 2008

Drilling holes in someone's skull and destroying parts of the brain is the kind of scenario dreamt up by anti-psychiatrists. That it can happen in practice - and once happened on a fairly large scale - remains a matter of sensitivity for the public image of psychiatry, notwithstanding that there are still cogent reasons to retain leucotomy in its armamentarium. So any presentation of this subject on the mass media needs to be done with the greatest responsibility, and should convey an accurate message.
Out-patient referrals of major depression to psychiatrists in central Liverpool
Authors: Green Ben , El-Hihi M. Amin
Published: May 2008

Psychiatric clinics see 4% of all hospital referrals by general practitioners (GPs), but the literature contains surprisingly little about the referral behaviour of, and the patients referred by, GPs to psychiatrists (Wilkinson, 1989). We describe an analysis of the Royal Liverpool Hospital psychiatric out-patient clinic which serves a deprived inner city population of 125,000 people and its GPs.
The white coat and the liaison psychiatrist
Authors: Wear Alan N.
Published: May 2008

Medical care in general hospitals is a collective activity and liaison psychiatrists may become part of this process. Cornerstones of successful management are co-operation with colleagues and ‘teamwork’, although these elusive goals are not always achieved. A shared uniform is one possible solution to improve this teamwork, the white coat being the livery of the hospital doctor. Furthermore, patients may appreciate a uniform. One survey of 200 North American general hospital in-patients showed the white coat to be surprisingly popular (Dunn et al, 1987); 65% of those replying wanted to see their doctor in a white coat. But the white coat is often unpopular with doctors and perhaps a more relevant question is whether it makes any difference to patient behaviour.
Emergency and liaison psychiatry
Authors: Gourdie Alison , Schnieden Vivienne
Published: May 2008

The post of Emergency and Liaison Registrar in the Bloomsbury Rotation was created in 1988 to provide a psychiatric service at University College Hospital, London, in the Accident and Emergency (A&E) Department and to the A&E Ward for assessment of deliberate self harm (DSH) cases. It incorporated existing commitments of liaison to the UCH wards and provision of urgent psychiatric assessments. The service had previously been shared among a number of psychiatric staff. The registrar can thus be seen as a ‘central pivot’ within the District Psychiatric Services.
Medical audit: basic principles and current methods
Authors: Robinson Michael
Published: May 2008

Dr Michael Robinson, of the London School of Hygiene and Tropical Medicine, dealt with more general aspects and Dr Ann Gath, Registrar of the College and Chairman of the Medical Audit Working Party, with aspects of particular relevance to psychiatry.
Prescribing by psychologists?
Authors: Birchwood Max , Crammer J. L.
Published: May 2008

Observers of the American Psychological Association's enthusiastic support for the gathering momentum to accredit psychologists with prescribing privileges will detect professional and economic motives among others: the same can also be said of the AMA's campaign to stop it. Health care in the USA is underpinned by a business culture in which psychologists and psychiatrists operate widely as independent practitioners in the open market place. The prestige value and pecuniary advantages to American psychologists would not be insignificant. Also, since health care insurance companies purchase separate psychological and medical treatment for their customers, it would be to their economic advantage for these treatments to be embodied in one individual. Thankfully, pressures on this scale have yet to reach these shores. Nevertheless, serious consideration should be given to establishing a grade of prescribing psychologist in the NHS if it can be shown to raise the overall quality of care; if prescribing could be done appropriately and safely; and if this did not detract from the quality of psychological intervention.
A document prepared for the South Manchester District Health Authority
Authors: Goldberg David , Gater Richard
Published: May 2008

Most common mental disorders - becoming anxious, distressed or depressed - are dealt with by family doctors. In order to be able to understand the situation in South Manchester, we start by comparing figures for all mental disorders here with the situation in the country as a whole (Table I). The figures in the vertical columns are like Russian dolls: each figure below is contained within the figure above it!
The physical examination in psychiatry
Authors: Hughes Stephen
Published: May 2008

There are many studies in the medical literature attempting to confirm the value of a comprehensive physical examination in the psychiatric in-patient population. An appraisal of the literature and review of psychiatric admissions in a large teaching district offers some evidence to the contrary.
Mental health services in Romania
Authors: Radhakrishnan G.
Published: May 2008

Since the demise of the Ceaucescu regime in Romania, the media has been presenting a grim catalogue of life in Ceaucescu Romania. Even as these stark images were unfolding, Bristol MENCAP, independent of the national organisation, was putting together a package of humanitarian aid directed, predominantly in the first instance, to orphanages in and around the city of Cluj-Napoca in the province of Transylvania, Romania. Our department has close links with the National Executive of MENCAP and we were approached by Bristol MENCAP to undertake a fact-finding mission on the current state of professional services for the mentally handicapped in general, and that of the Department of Psychology at Cluj-Napoca University in particular.
Clinical audit effects a reduction in routine prescribing of benzodiazepine hypnotics
Authors: Childs Peter
Published: May 2008

The Edith Morgan Centre is a 60-bedded acute psychiatric in-patient unit on a DGH site, now open for three and a half years, following the closure of a nearby psychiatric hospital.
The development of psychiatric education in the United Kingdom
Authors: James F. E.
Published: May 2008

Although there was some specialist interest in teaching psychological medicine in the 18th century, it was the Asylum Acts of 1808 and 1845 which made the subject a speciality and was responsible for drawing attention to the need for undergraduate and post-graduate training. By 1827 Alexander Morison was giving lectures on insanity in Scotland, to be followed by Dr W. A. F. Browne who, in 1836, was giving a series of lectures at the Montrose Asylum which he repeated at the Crichton Royal Hospital in 1851. Dr D. Skae of Morningside Asylum also gave lectures and clinical demonstrations on insanity from 1846. Edinburgh students benefited from teaching in insanity by Thomas Laycock, professor of medicine following his appointment in 1851 (Crichton Browne, 1851).
Reading about Wisdom
Authors: Culliford Larry
Published: May 2008

What follows is derived mainly from the traditions of Taoism, Confucianism, Buddhism, Zen and Hinduism. Not every reader would wish me to concentrate on Eastern and for the most part ancient sources. Please note firstly however that contemporary translations and modern commentaries from the Western viewpoint are now relatively common. Secondly, I can write with more authority on the texts with which I am most familiar; and that, simply, is how things came about.
High Elms: a hostel ward which closed after four years
Authors: Staufenberg Ekkehart , Bridges Keith
Published: May 2008

Long stay patients who continue to require 24-hour nursing care can be divided into two main groups: those who need to remain in hospital and those who could receive their care outside hospital. The Hostel Ward, with a multidisciplinary team providing input to individualised rehabilitation programmes, has been conceived as a possible solution to providing care for the second group. Some of its clinical, social and economic benefits have been reported (e.g. Hyde et al, 1987) and there now seems to be increasing agreement about its potential value within the range of rehabilitation services needed by a health district for people with chronic psychiatric illnesses (Abrams, 1988). However, it is still a relatively new concept and as the experience of this type of service may vary from one district to another, further reports of its utility and limitations are still needed (Garety et al, 1988).
Psychiatry of the elderly and geriatric medicine
Authors: Sandler Martin
Published: May 2008

The West Midlands Senior Registrar Rotational Training Scheme in General and Geriatric Medicine has established links with the Senior Registrars in Psychiatry of the Elderly and their trainers. Reciprocal attachments to one another's specialty are encouraged and expected, much along the lines of the Royal College of Psychiatrists and British Geriatrics Society recommendations. This has been gratifyingly successful: the attachments have proved very satisfactory in themselves and have led to joint research and to friendships, some of which may form the basis of harmonious and constructive working relationships in years to come.
Terminator 2, Judgment Day
Authors: Footring Ralph
Published: May 2008

Scientific Editor, British Journal of Psychiatry

How would you feel about a sequel to One Flew Over the Cuckoo's Nest, set in the present? I am writing about the next best thing: Terminator 2, subtitled Judgment Day, sequel to the 1984 film Terminator, both starring Arnold Schwarzenegger in the eponymous role. Terminator 2, reputedly the most expensive film ever made, was released last August. Guild, its distributor, expect the film (certificate 15) in the UK to gross £17 million and to be seen by 6 million people, with a similar audience when it is released on video.
Child psychiatry and the law
Authors: Stone Frederick H.
Published: May 2008

It is a great privilege to be asked to give this memorial lecture. There must be few in this audience who do not know the name of Jack Kahn, if only from his classic writings on school refusal. To many of us, however, he was a dear friend as well as a rather special colleague. I seem always to have known Jack, although in fact I probably first met him in the middle ‘60s at just such a residential conference as we are having now, on that occasion in Harrogate. This was in the days of the RMPA. Jack was chairman of the Child Psychiatry Section and the guiding spirit behind the organisation of that particular conference. I recall particularly the concluding session on the Saturday morning when to our surprise (although we would be less surprised to-day) the presentation was not by one of our members or distinguished guests but by a local dramatic society who presented us with one scene from a play which Jack, as master of ceremonies with his customary skill and flair, used as the catalyst for an exciting large group discussion.
Beautiful Dreamers. A Rediscovery of Love and Compassion (Blue Dolphin Film Distributors)
Authors: Freeman Hugh
Published: May 2008

The National Film Board of Canada has a highly honourable record of making or promoting movies which would have been unlikely to survive through the millstones of commercial production. Although the credits of most films are of such Byzantine complexity that it is virtually impossible to work out who was responsible for anything, ‘Beautiful Dreamers’ seems to have resulted from a partnership between the Board, other public bodies, and commercial companies, and since a story set in a Canadian mental hospital in 1880 does not strike one as immediately bankable, that may have been just as well.
7. Substance misuse
Authors: Black Dawn , Guthrie Elspeth , Merrill John
Published: May 2008

The speciality of substance misuse has expanded way beyond the treatment of alcoholism and drug addiction as incorporated in the now defunct term ‘addictions’. ‘Substances’ include the illegal (e.g. heroin and amphetamines), socially acceptable (e.g. alcohol and tobacco), medically prescribed (e.g. benzodiazepines) and household products (e.g. glue and lighter fuel). ‘Misuse’ covers that use of substances which has resulted in or may lead to physical, psychological and social problems.
Huddersfield (West) crisis intervention team: four years follow-up
Authors: Punukollu N. Rao
Published: May 2008

The Huddersfield crisis intervention team began crisis intervention work after visiting well-established crisis intervention centres and reviewing the literature. In Huddersfield health district there are four adult psychiatrists, each covering a sector of about 54,000 population. At the time of the establishment of the crisis team, the health district was not sectorised. Since 1 February 1989 the district has been sectorised into four parts and the Huddersfield Crisis Intervention Team covers the Huddersfield West Sector
Antidepressant prescribing in general practice – how long can this go on?
Authors: Kerr Michael P.
Published: May 2008

Present guidelines for the prescribing of antidepressant medication, with particular reference to the duration of treatment, are unclear (BNF, 1989). Evidence suggests that continuation of treatment for at least six months is valuable in the prevention of relapse of the acute illness (Mindham et al, 1975). Other workers have demonstrated a prophylactic effect similar to lithium over a three year period in patients with unipolar depression. There is, however, a paucity of information about the benefits (or lack of benefits) of longer term maintenance treatment. This study focuses on a population of a type which has been previously studied elsewhere – of patients in general practice receiving long-term (greater than one year) antidepressant medication. The implications of this to the psychiatrist and general practice–psychiatry liaison are discussed.
Searching for the cause of Alzheimer's disease
Authors: Harrison Paul J.
Published: May 2008

Becoming demented is something people dread most about growing old; the image of a confused and wandering elderly person is a powerful and distressing one. Alzheimer's disease is the commonest cause of dementia, affecting 500,000 people in Britain alone. It is a progressive and presently incurable brain disease, causing great suffering and imposing an enormous burden on health resources. As a result, a large research effort is under way to find out what causes the disease, since a cure is only likely to emerge once the disease is understood. This research is wide-ranging and diverse, as the complexity of Alzheimer's disease requires many lines of enquiry if the puzzle is to be solved. At one extreme, the research focus is upon large groups of elderly people who are being followed up to see what features predict and herald the onset of dementia. At the other, individual genes, molecules and brain cells are under detailed investigation. Some of the latter studies have given important clues as to the cause of Alzheimer's disease, and these are briefly mentioned here.
Multidisciplinary crisis intervention service – a registrar's experience
Authors: Lewin J.
Published: May 2008

Recent years have seen a steady move from a hospital based psychiatric service into a community orientated one. Mental health carers and psychiatrists need to be trained in order to be able to meet the changing demands placed upon them (Lancet, 1985).
Editorial registrars
Authors: Groves Trish
Published: May 2008

The most heavily thumbed publication in a typical hospital mess is the classified advertisement supplement of the British Medical Journal. Wishful thinking often takes readers straight to the back – for promises of sun and fun in foreign climes – or to the front for other forms of escape. It was there, at the front, that I spotted an intriguing invitation to try medical journalism for a while. Within a few weeks I had finished my psychiatry rotation and started at the BMJ as an editorial registrar, wondering what on earth I had done.
The role of the doctor in the Mental Health Review Tribunal
Authors: Woolf P. Grahame
Published: May 2008

This paper draws upon over 30 years experience of Tribunals as RMO, medical member and independent psychiatrist.
The forensic psychotherapist: dying breed or evolving species?
Authors: Adshead Gwen
Published: May 2008

My paper deals with the provision of psychotherapy services for forensic patients and the training available to the would-be forensic psychotherapist. Psychotherapy in the context of this paper refers to psycho-analytically based psychotherapy, either individual or group, and not to behavioural or cognitive models. In addition, two aspects of psychotherapy should be borne in mind: supportive psychotherapy in the context of ongoing therapeutic relationships (e.g. patients suffering from chronic mental illness) and mutative psychotherapy, which aims to change some aspect of the person. Both aspects are important in the practice of forensic psychiatry, perhaps especially the latter.
The early years
Authors: Floate Susan , Williams Margaret Harcourt
Published: May 2008

By 1841, advances in communication and education, coupled with an increasing number of medical staff attached to mental asylums, made the idea of a formal grouping of such asylum staff a viable proposition. Although, as the following paragraphs indicate, such a group took many years to become established, the body whose early years are described briefly here, is the direct ancestor of the Royal College of Psychiatrists.
Psyche
Authors: James F. E.
Published: May 2008

The Greek origin of the word psyche (breath) is well-known but psyche also referred to life as action or as soul, some special force or spirit which entered living creatures. It was as soul or spirit that psyche was adopted into the English words psychology and psychiatry but its exact semantic status is a knotty affair.
Who owns research?
Authors: Eastwood M. R.
Published: May 2008

Once upon a time there were clear-cut career pathways for ambitious doctors, what are now called ‘inside tracks’. Forward-looking people in the UK, for example, realised early that in order to become a consultant or professor in a teaching hospital, it was essential to be well qualified and published. In psychiatry, this meant proof of being truly renaissance with qualifications in medicine, psychiatry and research. How this was achieved was up to the individual. At places like the Maudsley Hospital people often arrived bristling with degrees. About half the entrants had passed College exams or had research doctorates. During psychiatric training the others went for the extra qualifications. They had to; otherwise they would not make it to senior registrar. Some characters practised brinkmanship and passed the MRCP on the umpteenth occasion. Thereafter things varied, with some moving into personal analysis (no degree) and others into wet and dry laboratory research. Many eschewed both and headed for clinical work. There was a period, perhaps between 1945 and 1975, although the limits are arguable, which was halcyon. Medical trainees were actually committed to research. There were twin pathways; the scholarly going to the MRC unit or the Chair and the entrepreneurial to the teaching hospital consultant job and Harley Street practice. The teaching hospital wallahs needed about ten papers to be acceptable. An engaging feature of the system was that the pay was not particularly discrepant between researchers and clinicians. The somewhat subfusc role of researchers was, in any case, redressed in the mid 1960s and parity achieved. Amazingly, then, it was possible to have a career in research without losing money. To what did it all add up? In modern parlance, was it cost-effective and efficient? Did the clinicians with their ten papers or the MRC medical scientists give value for money? After all, with what can they be compared?
20th century composers
Authors: Jones Mark
Published: May 2008

At the turn of the century, opera was leaderless after the heady days of Verdi and Wagner. Puccini emerged as the new voice of Italian opera, where realism, or verismo, was the way forward. But verismo could never be the answer to the operatic dilemma that faced the latest composers, since it only gave a musical dimension to a stage painting of ‘life as it is’, without reference to underlying psychodynamics — I personally have never thought Puccini much of an intellectual. Beautiful his music may be, but as thinking pieces of theatre they are devoid of real challenges. Their appeal and potency lies, to a great extent, in Puccini's obsession with needless suffering.
Improving psychiatric day hospital attendance - a Liverpool intervention study
Authors: Ridley G. T. , Clare K. , Dewey M. E. , Davidson I. A.
Published: May 2008

In spite of the somewhat disordered development of day care for the mentally ill, the Psychiatric Day Hospital (PDH) has become accepted as an essential element in the mental health services. Several recent studies have defined a role for the PDH in the management of more acute psychiatric disorders (Creedet al, 1989), and this is likely to become increasingly important with the continuing reduction in the availability of in-patient facilities.
Who needs an adolescent unit? A referrer satisfaction study
Authors: Gowers Simon , Symington Ron , Entwistle Ken
Published: May 2008

Despite the recommendations of the Health Advisory Service report Bridges over Troubled Waters (1986), there has not been any dramatic growth in adolescent psychiatry as a sub-speciality. The HAS report highlighted the largely unmet special needs of this age group, the rising risk for mental illness with increasing age in adolescence, and the need for effective liaison between professional disciplines working with this age group. Nevertheless adolescent services increasingly perceive themselves as under threat from political initiatives and continue to fight their corner (e.g. Wells, 1989).
Some problems in the management of residents in psychiatric hostels in Western Australia
Authors: Buchan Terry
Published: May 2008

In the wake of legislation overseas, Western Australia promulgated a new Mental Health Act in 1966, paving the way for the establishment of private psychiatric hostels in the community and the discharge from mental hospitals of many chronically ill, long-stay patients.
Physical illness associated with depression in the elderly in community based and hospital patients
Authors: Dover Stephen , McWilliam Christopher
Published: May 2008

The co-existence of physical and psychiatric illness in so much of the elderly population poses diagnostic and therapeutic problems for psychiatrists, geriatricians and general practitioners alike, with the presence of physical illness strongly influencing and sometimes limiting the options for treatment of the psychiatric illness. Recognition of this has resulted in the Section of Old Age Psychiatry of the Royal College of Psychiatrists recommending that senior registrar training in old age psychiatry should include a one month attachment to an approved geriatric medicine unit.
Disability Working Allowance
Authors: Steadman Philip
Published: May 2008

Disability Working Allowance (DWA) is for working people who have an illness or disability that puts them at a disadvantage in getting a job.
Fraud and misconduct in medical research Summary of the report of the Royal College of Physicians
Authors: Ferguson Brian
Published: May 2008

In February 1991 the Royal College of Physicians produced a report entitled ‘Fraud and Misconduct in Medical Research’. Most of the cases documented have come from the United States but by the end of 1988 five cases had been formally reported in Britain. One of these was a financial fraud perpetrated by a psychiatrist who worked in a district general hospital in the Northern Region and who forged data for a drug company. He was subsequently reported to the General Medical Council by the Association of the British Pharmaceutical Industry and had his name removed from the medical register. Informal investigations, however, suggest that fraudulent research might be more widespread and as a result the Royal College of Physicians established a working party to look at this issue in detail. They recommended that a twin track approach of prevention and thorough management of complaints of misconduct be adopted. The report was kindly forwarded to the Research Committee of the Royal College of Psychiatrists which felt that a summary of these recommendations should be widely published among researchers in psychiatry.
The psychotherapy clinical seminar at the Maudsley Hospital
Authors: Clark Andrew
Published: May 2008

The open psychotherapy clinical seminar at the Maudsley Hospital is a weekly teaching event in which psychiatric trainees can present a case from their general psychiatric work to a forum chaired by a consultant psychotherapist. The seminar has a history stretching back to the 1960s when Heinz Wolff, Henri Rey and Murray Jackson taught in the Maudsley Psychotherapy Unit. The seminar is currently chaired by Nicholas Temple. It draws on a tradition of teaching psychotherapy which owes much to the pioneering work of Michael Balint. The psychotherapy training seminar which he developed is well described in the appendix to The Doctor, his Patient and the Illness (Balint, 1957). A trainee presents a case with particular emphasis on his or her feelings about the patient. The trainee's counter-transference is used as the raw material for the seminar's discussion of the patient. Balint adopted this method for teaching psychotherapy to a variety of professionals including social workers, general practitioners, and medical students. As Pedder (1986) pointed out, it is a model which has been very influential in British psychotherapy training.
The Sultanate of Oman: an experiment in community care
Authors: Burjorjee Rustom , Al-Adawi Samir
Published: May 2008

An experiment in community care, training Omanis with bachelor degrees in social work, psychology and education to act as psychiatric care givers in the community, is currently being developed in the Sultanate of Oman. This experiment is based on the Alma-Ata declaration to achieve Health For All by the Year 2000 (WHO, 1978) and WHO aspirations to move psychiatric care back into the community (WHO, 1990), and the fact that in many developing countries psychiatric care has remained on the fringe due to lack of resources and manpower.
Community mental health services in Malaysia
Authors: Salleh Mohd. Razali
Published: May 2008

The need to confine and restrain psychotic patients at the turn of the last century saw the building of a few large asylums which soon became overcrowded with the growth of the population. These asylums were the only service available to the mentally ill until 1959 when the trend to decentralise began with the building of general hospital psychiatric units.