bluuebunny/crossref_metadata_2025 huggingface dataset:
The use of St John's Wort in the treatment of depression
Authors: Maidment Ian
Published: September 2002

Aims and Method

To assess and update the data on the use of St John's Wort as an antidepressant. A Medline search was conducted for the period January 1985 to December 1999. The search included other aspects of the usage of St John's Wort, such as side-effects, mechanism of action and drug interactions.

Results

While two overviews and four clinical trials have recently been published, there is little data comparing St John's Wort against therapeutic doses of standard antidepressants.

Clinical Implications

St John's Wort is generally well tolerated, and an effective antidepressant. The current evidence indicates that it is less effective than standard antidepressants for severe depression. While some of the available data suggests equivalent efficacy as subtherapeutic doses of tricyclic antidepressants in mild to moderate depression this requires further confirmation. One recently published paper suggests that St John's Wort has equivalent efficacy to fluoxetine in mild to moderate depression. The appropriate therapeutic dose needs clarification.
Six years' experience in Oxford
Authors: Rose Nicholas
Published: September 2002

Deaths of patients under psychiatric care, especially if they are in-patients, have been the subject of a number of retrospective studies (Copas & Robin, 1982; Morgan & Priest, 1991; Modestin et al, 1992; Roy & Draper, 1995; Proulx et al, 1997). They have also been a particular focus of the National Confidential Inquiry (Appleby et al, 1999) as well as many individual inquiries. In contrast, little has been published on how individual psychiatric departments and trusts might best review and learn from local deaths or ‘near misses' of patients under their care. In particular, there is no well publicised or widely accepted model for routinely examining such occurrences.
What do inner city general practitioners want from a child and adolescent mental health service?
Authors: Weeramanthri Tara , Keaney Francis
Published: September 2002

Aims and Method

We surveyed 25 general practitioners (GPs) on their needs from their local child and adolescent mental health services (CAMHS) to improve liaison and inform service development.

Results

Most GPs refer to specialist services. Only a quarter deal with problems themselves. The top priority was easy and quick access to services. The most popular topics for GP training were interactions between teenagers and their parents, child abuse and eating disorders. No GP had formal training in child and adolescent psychiatry and further training was a low priority.

Clinical Implications

Such a survey has helped to develop a closer partnership between GPs and their local CAMHS using a service–response model. It has raised concerns about the under-identification of child mental health problems. It has informed CAMHS of the service and training needs of local GPs.
Triage in emergency psychiatry
Authors: Morrison Audrey , Hull Alastair , Shepherd Beryl
Published: September 2002

Aims & Method

Psychiatric emergencies constitute a large proportion of psychiatric referrals, with the response to this need therefore of great importance. The impact of the introduction of a telephone triage system on such factors as speed of response, assessment site, outcome and the personnel performing the assessment is examined within the context of closing of a 24-hour open access emergency system. Information was gathered from all emergency referrals, with 80 subjects randomly chosen and studied in depth.

Results

The triage system afforded a greater flexibility of response, and the involvement of more experienced clinicians. It did not reduce the overall referral or admission rates.

Clinical Implications

Triage was found to be an effective method of introducing flexibility of response to emergency referrals while encouraging continuity of patient care.
In-patient neuropsychiatric brain injury rehabilitation
Authors: Lazaro Fernando , Butler Rob , Fleminger Simon
Published: September 2002

Aims and Method

To discuss the service offered by an in-patient neuropsychiatric brain injury rehabilitation unit. To examine the demographic details of patients admitted to the unit. To find the commonest reasons for referral.

Results

The notes of 78 patients admitted to the unit, over a two-year period, were examined. Seventy-three per cent were male and the mean age was 45 years. Seventy-five per cent of admissions had a severe brain injury. Two-thirds of the patients were admitted within six months of their injury. The most common reasons for referral were memory difficulties (n=61), verbal aggression (n=31) and temper control(n=25).

Clinical Implications

In-patient neuropsychiatric brain injury rehabilitation units offer management of patients referred with a wide range of cognitive, behavioural, functional and physical problems.
Psychiatrists suffer from stigma too
Authors: Persaud Raj
Published: September 2002

Psychiatry is a complex enterprise, requiring the longest training period required of any mental health profession. Yet doctors are playing a declining role in deciding health care policy. It is almost as if while acknowledging they would rather see a doctor than anyone else when seriously ill, lay public and politicians also prefer practically any alternative, other than a physician, when determining who should decide how health care is delivered.
Anorexia nervosa: service consumption and outcome of local patients in the Leicester service
Authors: Palmer R. L. , Gatward N. , Black S. , Park S.
Published: September 2002

Aims and Method

A retrospective case note study provided data on the service consumption and outcome of treatment for a cohort of adult anorexia nervosa sufferers treated in a specialised secondary service.

Results

A cohort of 106 patients was studied. Only just over a quarter were ever admitted. Of a subset of 78 patients, first seen before 1994, nearly one-fifth failed to engage in treatment. Those who were admitted spent on average a total of 10 months in hospital, were in touch for four years and had over 100 therapy sessions. The majority who were treated solely as out-patients remained in touch with the service on average for over two years.

Clinical Implications

Services for anorexia nervosa sufferers need to plan for prolonged contact with their patients and high rates of service consumption.
Driving in Somerset
Authors: Kolowski Stefan Jan , Rossiter Jackie
Published: September 2002

Aims and Methods

The number of drivers on our roads with dementia is likely to increase as the elderly population grows. We performed a retrospective analysis of patients referred to our Memory Clinic in Taunton who were still driving despite a high suspicion of dementia.

Results

Twenty per cent of the patients were still driving at the time of their assessment. Ten per cent had a diagnosis of Alzheimer's disease and 10% mild cognitive impairment. The patients and/or carers stated that the patient had not been told to stop driving and none of the referral letters documented any advice about driving.

Clinical Implications

Referrers should advise all patients with possible dementia to refrain from driving until assessment by a specialist team is completed. They should be informed of the risk of medico-legal consequences if they continue to drive.
Psychiatric training in two different EU countries: Denmark and the UK
Authors: Hansen Lars K. , Thomsen Anders F.
Published: September 2002

The undergraduate medical education in Denmark consists of six-and-a-half years of (mainly) academic studying. A combination of sabbatical years and late-starters pushed the average age of the medical candidate to 30 in 1998. Well over 50% are women.
Intranets - ‘safe surf’
Authors: Hicks Trevor , Stubbs Ben , Briscoe Martin
Published: September 2002

The last 10 years has seen a phenomenal growth in the internet which is currently used by over 200 million people around the world, including 12.5 million in the UK (NUA, 2000). This rapid growth is set to continue and by the end of the year most of Britain's 24 million mobile phone users will be able to access the web through the latest generation of telephones (Daily Telegraph, 6 January 2000). This growth in popularity stems from the internet's ease of use and the huge amount of information from around the globe that can be accessed 24 hours a day. Success has, of course, brought problems and the internet has been criticised for being slow, for containing inaccurate and even dangerous material and for being a home to viruses waiting to attack unwary surfers.
Locked doors or sentinel nurses?
Authors: Adams Bob
Published: September 2002

Towards the end of 1998 we decided to introduce a facility to lock the doors of the acute psychiatric wards at Bootham Park Hospital, York. At first sight this would appear to be a retrograde step for modern psychiatric care in the UK. But this was a reasoned and planned move which has resulted in improved care for patients overall.
Implementing the Royal College of Psychiatrists' guidelines for the practice of electroconvulsive therapy
Authors: Brookes Guy , Rigby John , Barnes Richard
Published: September 2002

Aims and Method

To implement the Royal College of Psychiatrists' guidelines for the practice of electroconvulsive therapy (ECT) and measure the impact of such implementation on the quality of treatment. Treatment of ECT for periods of six months before and after implementation of the guidelines were studied. The effect on producing adequate treatments and the actions taken by the administrating doctor were noted.

Results

Once the guidelines were in place there was a slight improvement in the proportion of treatments considered therapeutic and the doctor was more likely to take appropriate action following an inadequate treatment. However, it was also clear that despite the guidelines being available they were not followed in a significant number of instances.

Conclusions

Implementation of the guidelines is not easy and there needs to be considerable effort to ensure they are used. When they are followed there is an improvement in the practice of ECT.
Trainee views on active problems and issues in UK psychiatry
Authors: Wilson Rowan , Corby Catherine L. , Atkins Maria , Marston Geoff
Published: September 2002

Aims and Method

A questionnaire sent to trainees in three regions of the UK asked them which current issues they felt were most important in psychiatry. Comments were invited of ways to improve the UK practice of psychiatry.

Results

Trainees from each of the regions were concerned about inadequate resourcing, public expectations, manpower and quality of training. Solutions to these problems were collated.

Clinical Implications

The opinion of trainees reflects the recent initiatives undertaken by the Royal College of Psychiatrists to improve recruitment and retention. Consultants and trainees have similar concerns, which need to be addressed and monitored at a local and national level.
Mental illness and the media
Authors: Bolton Jim
Published: September 2002

Stigmatising opinions about mental illness are more common among young people than older people (Yarney, 1999). Whether the media should carry responsibility for this was the subject of the College's 13th Christmas Lecture for Young People. Over 300 school children gathered in central London to take part in a debate on the role of the media in the portrayal of mental illness. Alison Lowe introduced the debate by illustrating how common mental illness is. She invited everyone to look at the eight people sitting around them before adding, “In your lifetimes at least one of you will see a psychiatrist”.
Euthanasia in Nazi Germany
Authors: Madden J. S.
Published: September 2002

The 11th International Congress of the World Psychiatric Association (WPA) was held in Hamburg during August 1999. The most memorable feature of the successful event was not the presence of 10 000 psychiatrists from 96 countries, nor their 6000 papers, nor the elegance of the rebuilt city, but a poignant exhibition prepared by the German Society for Psychiatry, Psychotherapy and Neurology. The presentation, titled ‘In Memoriam‘, described the wartime extermination within Germany of 180 000 psychiatric patients. The killers were their psychiatrists.
Use of serotonin antagonists in the treatment of neuroleptic-induced akathisia
Authors: Maidment Ian
Published: September 2002

Akathisia is a distressing movement disorder associated with neuroleptic medication. Patients complain of a feeling of inner restlessness (Barnes, 1989). The characteristic signs include constant moving when seated, rocking from foot to foot and pacing (Adler et al, 1989). Neuroleptic-induced akathisia (NIA) is usually an acute reaction, but a chronic akathisia can occur after prolonged treatment with neuroleptics (Fleischhacker et al, 1990). It has been suggested that chronic NIA is related to tardive dyskinesia, and that like tardive dyskinesia it is difficult to treat (Blaisdell, 1994). Reducing the neuroleptic dose may ease the symptoms (Barnes, 1989). Other options include using an atypical neuroleptic, which may cause lower rates of akathisia (Poyurovsky et al, 1999). Biochemical and pharmacological evidence has indicated the importance of serotonin in controlling movement (Bersani et al, 1986). Serotonin antagonists, particularly mianserin, ritanserin and cyproheptadine, have been used to treat NIA. This article reviews the published trials and case reports retrieved by a Medline search from January 1985 to August 1999.
Prevalence and patterns of substance misuse in schizophrenia
Authors: Condren Rita M. , O'Connor John , Browne Roy
Published: September 2002

Aims and Method

To identify the prevalence and patterns of substance misuse in patients with schizophrenia in a catchment population in Dublin, and to compare this with that of a control group from general practice. Ninety-nine patients and 75 controls were interviewed using a semi-structured technique. Urine samples were obtained from all patients and controls were analysed for illicit substances.

Results

Prevalence of illicit substance and alcohol misuse was similar among patients (illicit substances, 45%; alcohol, 33%) and controls (illicit substances, 43%; alcohol, 25%). Patterns of substance misuse were similar, apart from ecstasy, which was used more commonly by controls. Discrepancies were found between histories of drug use and urinalysis.

Clinical Implications

Illicit substance misuse in patients with schizophrenia may mirror usage in the general population, rates of misuse reflecting cultural factors rather than illness and patterns of misuse reflecting geographical variations in the availability of drugs. A combination of screening methods is more effective than the use of a single source of information.
Questions patients ask psychiatrists
Authors: Llewellyn-Jones Sian , Jones Gill , Donnelly Peter
Published: September 2002

Aims and Method

To identify the questions patients most commonly ask their psychiatrist. For 200 consecutive psychiatric patient consultations, answers to the invitation, “Do you have any questions you wish to ask me?” were recorded along with diagnosis. The most frequently asked questions were noted and compared across patient groups.

Results

Most patients wanted to know when medication could be reduced or stopped. Some patients asked for more medication. Concerns about side-effects and fitness to drive were also common. A high proportion of patients (21–57%) asked no questions.

Clinical Implications

Psychiatrists must be prepared to answer questions effectively on the necessity and benefits of long term medication. These may be useful facts to include in a patient information leaflet. Side-effects of medication should also be taken seriously. Many patients lead impoverished social lives, with low levels of interpersonal interaction. This may be a barrier to participation in the clinical interview, and diminish the likelihood of posing questions.
Substance misuse problems in Russia
Authors: Fleming Philip , Bradbeer Tim , Green Anita
Published: September 2002

We visited St Petersburg in the autumn of 1999 as the guests of Professor Leonid Shpilenya, Director of the city's addiction services, and Dr Olga Khvognova, Director of Nurse Training, College Number Three. This was part of an exchange programme financed by the Know How Fund – Health Sector Small Partnerships Scheme (Russia). Two of the authors (P.F. & A.G.) have been involved in these exchanges for a number of years. The current project is a joint one, involving medical and nursing staff (Green et al, 2000).
Does involuntary out-patient treatment work?
Authors: O'Reilly Richard L.
Published: September 2002

There has been considerable debate in the UK in recent years about the propriety of using various forms of ‘involuntary out-patient treatment’ for some individuals with serious mental illness (Eastman, 1995; Dyre, 1998; Burns, 1999; Moncrieff & Smyth, 1999; Sugarman, 1999). While most jurisdictions in the US have statutes that support involuntary out-patient treatment (Torrey & Kaplan, 1995), its use remains controversial (Slobogin, 1994; Diamond, 1995; Torrey, 1997). Involuntary outpatient treatment was originally proposed as a solution to the ‘revolving door syndrome’ (Geller, 1996). It has also been recognised, however, that it may provide a solution to the clinical and ethical dilemmas of allowing individuals who are incapable of making treatment decisions to discontinue treatment, with predictable deterioration to the point where they may harm themselves or others (Geller, 1990). This paper provides a review of controlled studies that have examined whether involuntary treatment in the community is effective.
Out of area hospitalisations – the view from current routine statistics
Authors: Glover Gyles R. , Bindman Jonathan
Published: September 2002

AIMS and Method

To examine what current routine statistics could show about the extent to which patients are admitted to hospital beds ‘out of area’, a quality indicator proposed in the National Service Framework.

Results

Available data record that, on average, at least 6.9% of acute general psychiatry admissions in the English NHS happen outside the normal catchment area arrangement of a patient's health authority. However, deficiencies in the calculation – arising from lack of data, mainly about private sector admissions – and the absence of a central registry of NHS trust catchment areas suggest this is a substantial underestimate.

Clinical Implications

The most useful way for this issue to be examined is from year to year for individual trusts.
The impact of olanzapine on attitude to medication and quality of life in schizophrenia
Authors: Stallard James , Joyce Eileen
Published: September 2002

AIMS and Method

This study aimed to compare the subjective quality of life and attitudes to medication between groups of patients with schizophrenia taking either olanzapine or traditional antipsychotic medication.

Results

The two groups were matched for age, gender, length of illness and antipsychotic group demonstrated more extrapyramidal side-effects (EPS) and akathisia. Within this group, those with EPS scored lower on the affect balance scale of the Lancashire Quality of Life Scale than those without. More patients in the olanzapine group reported that medication was taken to prevent symptoms returning.

Clinical Implications

These results lend support to the hypothesis that the presence of EPS impairs quality of life and suggest that olanzapine therapy may improve patients' attitudes to medication.
From pillar to post – a study of younger people with dementia
Authors: Williams Tim , Dearden Anthony M. , Cameron Ian H.
Published: September 2002

AIMS and Method

A health needs assessment was undertaken to evaluate current provision and to help inform the future development of services for people under the age of 65 years with dementia in Leeds.

Results

The prevalence rate for early onset dementia in Leeds was found to be 42 per 100 000 aged 30–64 years, and 78 per 100 000 aged 45–64 years. Four main gateways for specialist investigation and care were identified and 38 referral pathways were identified in total. Carers had difficulties accessing information and services and they, along with the patients, valued, in particular, both the coordinated service provided by the specialist early onset dementia team and the dedicated day care facility available in Leeds.

Clinical Implications

Younger people with dementia can have very different needs to older people. The prevalence rate and the experiences of carers and patients clearly justifies the existence and further development of a specialist early onset dementia service. Such a service should provide a single gateway to coordinated service provision and ensure continuity of care. It should provide sufferers and carers with information, advice and expertise.
Ambiguity in Section 136 of the Mental Health Act 1983
Authors: Ogundipe Laofe , Oyebode Femi , Knight Amanda
Published: September 2002

AIMS and Method

To investigate the interpretation of Section 136 of the Mental Health Act 1983 by Section 12(2) approved doctors and to describe a pathway that facilitates early assessment of people detained under Section 136. We surveyed a random sample of Section 12(2) approved doctors in the West Midlands.

Results

A response rate of 70% was achieved. Approximately 65% believe that it would be illegal to transfer a person under Section 136 from the police station to a further place of safety, such as hospital. Thirty-five per cent believed that this could be done legally or were unsure.

Clinical Implications

Ambiguity still remains about the legal interpretations of the provisions of Section 136 of the Mental Health Act 1983, which needs to be rectified.
A brighter future for in-patient wards
Authors: Appleby Louis
Published: September 2002

During April came one of the most important announcements on mental health care since I set up shop at the Department of Health. Thirty million pounds of new money is to be spent on refurbishing in-patient units, starting in this financial year. It is an acknowledgement that some of our wards are bleak and shabby, unsuitable for the care of distressed or disturbed people.
The limits of responsibility
Authors: Bristow Michael
Published: September 2002

While attending a rancorous and ill-tempered meeting of the Hackney Community Health Council in 1985 it was brought home to me that psychiatry was different from other branches of medicine. Not in the sense that it was the only one that dealt with intangibles, we all know that X-rays, scans and the like are far less precise than their purveyors let on. But it seemed that the mental health professionals and the groups that represented the clients, relatives and users of the service couldn't agree on a single thing, not even whether people were ill in the first place. It was difficult to imagine, say, the British Diabetic Association and a group of Endocrine Clinic staff knocking verbal lumps out of each other in this way even though diabetes and schizophrenia have a good deal in common.
Structured psychiatric assessment schedules – treating the case notes and the patient
Authors: Lyons Declan , Amos Mark , Mathew V. M.
Published: September 2002

Aims and Method

We surveyed the usefulness of a structured method of recording history and mental state examinations with a treatment plan in terms of conveying information about diagnosis and management, compared with informal methods of recording data. A survey of admission records by nursing and medical raters was followed by introduction of a standardised assessment format for use by trainees and a re-audit. Initial psychotropic medication was also scrutinised.

Results

The assessment schedule improved clarity of diagnosis for the medical and nursing raters alike, but improvement in management plan quality was mainly apparent for the medical rater. The audit also exposed widespread use of hypnotic agents.

Clinical Implications

It is suggested that structured assessment schedules facilitate adherence to good standards of clinical practice and may benefit trainees undertaking professional exams as well as having a multi-disciplinary and medico-legal relevance.
HoNOS–ABI; a clinically useful outcome measure?
Authors: Coetzer R. , Du Toit P. L.
Published: September 2002

Aims and Method

Outcome measurement has become increasingly important in brain injury rehabilitation. Health of the Nation Outcome Scale-Acquired Brain Injury (HoNOS–ABI) is a new outcome measure targeting psychiatric and other sequelae of brain injury. Forty patients' scores on three outcome measures and other ecologically valid markers of outcome were compared.

Results

Significant correlation coefficients between HoNOS–ABI and two other outcome measures were found. Post-injury employment status correlated with HoNOS–ABI rating. Although there was a significant increase in need for psychiatric intervention following brain injury, this did not correlate with HoNOS–ABI ratings.

Clinical Implications

HoNOS–ABI may be a useful additional measure of outcome following brain injury, specifically identifying the often missed psychiatric sequelae of a brain injury.
The public's knowledge of psychiatrists: questionnaire survey
Authors: Williams A. , Cheyne A. , MacDonald S.
Published: September 2002

Aims and Method

One objective of the Royal College of Psychiatrists' stigma campaign is to improve the public's knowledge about psychiatric illness. There has been little work in the UK on the public's knowledge of the training of psychiatrists and the treatments they use. Using a questionnaire, we compared a sample representing the general population (n=223) with a sample attending psychiatric outpatients (n=67) to assess their level of knowledge.

Results

Half of the general population sample did not know that psychiatrists were medically qualified, and 80% underestimated the length of psychiatric training. There was variable knowledge of the conditions treated by psychiatrists and treatment methods used, with the outpatient group having better knowledge of drug treatments.

CLINICAL IMPLICATION

If the general public do not know about the training and expertise of psychiatrists, this is likely to limit their willingness to seek treatment for mental illness.
Service innovations: an Australian approach to community care – the Northern Crisis Assessment and Treatment Team
Authors: Carroll Andrew , Pickworth Jane , Protheroe David
Published: September 2002

The recent White paper, Modernising Mental Health Services, recommended the provision of home treatment teams for acute mental illness (Department of Health, 1998). Such services are not widespread in the UK and have been the subject of recent debate (Smyth et al, 2000). In Australia, multi-disciplinary teams providing 24–hour community assessment and treatment of psychiatric emergencies have been in place now for over a decade, and form the cornerstone of the public mental health service.
Consultant advisers in every service
Authors: Appleby Louis
Published: September 2002

Shortly after taking up my appointment as National Director for Mental Health, I convened a working group of consultant psychiatrists to consider how to involve psychiatrists more in the current process of changing mental health services. This was in recognition of the fact that, while psychiatrists are central to modernising services, their skills and experience are insufficiently used. It is one of the most frequent complaints that I hear from clinicians.
Making work schemes work
Authors: Grove Bob
Published: September 2002

The past 5 years have seen dramatically increased interest among users, professionals and the Government in enabling people with mental health problems to gain employment. Many new projects have been started, with a range of different approaches including supported employment, training and placement, transitional employment, social firms and cooperatives. There are a number of reasons for this increased interest.
Additional clinical experience (ACE) modules in psychiatric specialities for general practice registrars
Authors: Tarbuck Andrew F. , Rumball Daphne , Jones Stephen M.
Published: September 2002

As part of training for general practice, approximately 40% of junior doctors will undertake a senior house officer (SHO) post in psychiatry (Ratcliffe et al, 1999). The majority of such posts will be within general adult psychiatry. As a result of this general practitioner (GP) trainees often receive little exposure to old age psychiatry or child and adolescent psychiatry. Similarly, although trainees will inevitably gain some experience of substance misuse associated with mental illness, there is little opportunity to develop skills in addressing primary substance misuse disorders and there is a clear need to develop better skills in the recognition and management of psychiatric comorbidity (Commander et al, 1999).
Electroconvulsive therapy – attitudes and practice in New Zealand
Authors: Strachan John A.
Published: September 2002

Aims and Method

The clinical practice of electroconvulsive therapy (ECT) by New Zealand psychiatrists was surveyed by questionnaire. This paper compares the findings with national and regional surveys conducted in Great Britain, and considers the influence on clinical practice in New Zealand of the Royal College of Psychiatrists' ECT Handbook.

Results

ECT has the same level of support from psychiatrists in New Zealand as in Britain, but is less frequently used. Modern brief pulse machines are used by 16 of 19 (84%) services from which data were received. The ECT Handbook was the most nominated source of information on ECT. Most (87%) respondents were aware of at least one set of ECT guidelines. However, these have apparently failed to influence some important aspects of practice. In particular, many medical conditions are still perceived as absolute contraindications.

Clinical Implications

The Royal College of Psychiatrists and the Royal Australian and New Zealand College of Psychiatrists need to place even greater emphasis on the importance of training in ECT for both trainees and qualified psychiatrists, and on the promotion of approved guidelines.
Pain clinics, a new role for psychiatrists
Authors: Wallace John , Panch Gnanie
Published: September 2002

Aims and Method

The aim of this study was to find out the extent of psychiatric involvement in pain clinics and also clarify the treatment approaches taken for the significant psychiatric comorbidity reported in these clinics. A questionnaire survey was conducted, by a psychiatrist and an anaesthetist, of the 31 pain clinics in the Greater London area.

Results

Psychiatric involvement in the management of patients with chronic pain is extremely limited, despite the extensive psychiatric morbidity associated with these patients (response rate, 74%). The majority of surveyed pain clinics wish to provide a multi-disciplinary approach to these patients, utilising the skills of a psychiatrist for both assessment and management. Only a small minority of pain clinics, however, have sufficient access to a liaison psychiatry service that could provide the broad multi-disciplinary approach and the psychiatric treatment options that they believe chronic pain patients require.

Implications

The involvement of psychiatrists in pain clinics is very limited. Increased involvement is desired and would likely lead to an improved profile of pain clinics, a more realistic and comprehensive treatment approach and, in turn, enhanced patient care.
The Disability Living Allowance Advisory Board
Authors: Lucas Richard
Published: September 2002

A recent article in the Psychiatric Bulletin reviewed how disability and incapacity benefits operate, the structure of the Benefits Agency, and the role that doctors played within the structure (Killoughery, 1999). The article was concerned with three benefits: Disability Living Allowance (DLA); Severe Disablement Allowance; and Incapacity Benefit. Linked to the planned introduction of DLA in April 1992, the Disability Living Allowance Advisory Board (DLAAB) was set up in September 1991. I describe here the nature, functions and activities of the Board.
A survey of psychiatrists' and nurses' views of mental health advocacy
Authors: Lacey Yvonne , Thomas Philip
Published: September 2002

Aims and Method

Advocacy is assuming an increasingly important role in the delivery of mental health services, but many psychiatrists feel threatened by it. This study was performed to ascertain how much doctors and nurses know about advocacy and their attitudes towards it. We interviewed five senior house officers, five staff nurses and four community psychiatric nurses (CPNs) to examine their understanding, experience and opinions about advocacy. A full-time advocate was also interviewed to establish his views about how well staff understood his role.

Results

In general there was poor understanding of the background and training of advocates, and their Code of Practice. There were also important differences in the way in which different groups of staff saw advocacy, with CPNs having the best understanding. Experiences of advocacy were positive and it was seen as being helpful both for clients and staff, despite fears that advocates might work to their ‘own agendas'.

Clinical Implications

There is a need to improve psychiatrists' understanding of what advocacy is, through the involvement of advocates and service users in their training. This would help to allay their anxieties about the role of advocates.
What to do when a patient commits suicide
Authors: Hodelet Nicola , Hughson Mark
Published: September 2002

A patient has committed suicide. You are his/her doctor. You're faced with the emotional impact this has on yourself, your colleagues, the patient's family and your other patients. You must report the suicide to your hospital authority and to the coroner (or procurator fiscal in Scotland). If you're very unlucky, you may be the focus of media attention. You have the prospect of a coroner's (or fatal accident) inquiry, a hospital inquiry and perhaps copycat suicides or para-suicides among your other patients. What are your obligations, where do you turn for help and can anything positive come from the experience?
Suicide in schizophrenia – how can research influence training and clinical practice?
Authors: Raymont Vanessa
Published: September 2002

Suicide has consistently been the most common cause of premature death in schizophrenia. A large 5-year World Health Organization study consisting of the follow-up of 1056 patients exhibiting psychotic symptoms found the most common cause of death in those with schizophrenia was suicide (Sartoriuset al, 1986). In their review of the subject Caldwell and Gottesman (1990) found that 9–13% of patients with schizophrenia eventually commit suicide. At least 20–40% make suicide attempts (Meltzer & Fatemi, 1995) and 1–2% go on to complete in their attempt within the next 12 months (Meltzer & Okayli 1995). Therefore, suicide in schizophrenia has long been a major area of concern and research efforts.
Residential care homes for the mentally ill
Authors: Kinane C. , Gupta K.
Published: September 2002

Aims and Method

This study describes residents in seven care homes, reviews their usage of mental health services and evaluates cost implications of psychiatric health care provision.

Results

The patients are predominantly male with multiple diagnoses who are receiving psychiatric health care, but in general lack structured rehabilitation services. Forty-seven per cent of the residents moved into the trust catchment area in order to occupy the placement.The cost associated with the provision of differing models of out-patients care varies considerably.

Clinical Implications

These vulnerable residents are costing the mental health service relatively little, although the total cost to society is higher.This study points to the necessity of multiagency planning for 'new long-stay' patients.
Evidence-based journal clubs and the Critical Review Paper
Authors: Dhar Rajeev , O'Brien Aileen
Published: September 2002

The Critical Review Paper (CRP) has been part of the MRCPsych Part II examination for only two sittings and is still fairly uncharted territory. As two people who have separately sat the two papers, we examine whether evidence-based journal clubs (EBJCs) are useful preparation for the exams. We make an argument for changing the format of journal clubs to make them more relevant to the exam, as well as to promote the development of evidence-based practice.
A review of the treatment options for clozapine-induced hypersalivation
Authors: Cree Adrian , Mir Shameem , Fahy Thomas
Published: September 2002

Aims and Method

To develop and introduce an evidence-based drug treatment protocol for clozapine-induced hypersalivation, a review of published literature relating to clozapine-induced hypersalivation and its treatment was undertaken in March 2000. The databases searched were Medline, EMBASE and PsychLit, from 1966 to the present.

Results

This paper reviews the evidence of the benefit of using antimuscarinic agents, adrenergic antagonists and adrenergic agonists. There is alack of good-quality controlled-trials, with most papers reporting aseries of uncontrolled cases dependent on subjective measures of improvement reported by the patients. However, the published literature suggests a benefit for all of the drug categories reviewed. The most effective treatment may be acombination of terazosin and benzhexol.

Clinical Implications

Clozapine-induced hypersalivation is not only an embarrassing problem, but can be difficult to treat. An evidence-based prescribing protocol will encourage the use of those drugs found to be the most effective in treating this problem. It will also offer alternatives if acertain treatment is ineffective or intolerable.
The role of users of psychiatric services in service development – influence not power
Authors: Campbell Peter
Published: September 2002

Any review of service user involvement must acknowledge the progress that has been made in recent years. In the early 1980s service users were usually passive recipients of their own care and treatment and had little or no collective involvement, even in voluntary organisations that claimed to be speaking on their behalf. The few independent service user groups that existed were marginalised and lacked significant resources. In 1985 the House of Commons Social Services Select Committee Report on Community Care (1985) complained about the difficulty “of hearing the authentic voice of the ultimate consumers of community care”.
Assaults and threats on psychiatrists
Authors: Davies Stephen
Published: September 2002

Aims and Method

To determine the annual rates of assaults and threats to psychiatrists, describing the situations and staff involved, using a retrospective postal questionnaire of 139 doctors working in South Wales.

Results

Over the year, 17% of respondents reported one or more assaults (of these, 42% were assaulted more than once) and 32% reported one or more threats. The most junior senior house officers (SHOs) were significantly more likely to have experienced an incident, regardless of the individual's gender or attendance at a course in managing aggression. Most assaults (61%) were committed by patients from general adult psychiatry, and half occurred during urgent assessments. Eighteen (58%) of the assailants were known to have previously assaulted amember of staff, and this information was known to the doctor before the assault for 16 (88%). Five (16%) of the assailants had been drinking alcohol prior to the assault. Twenty-nine (78%) of the assaults were documented in the case notes and 6 (19%) were reported to management.

Clinical Implications

Some staff (in particular, inexperienced SHOs) are at greater risk, and efforts should be made to identify and help these individuals and/or grades to deal with aggression. All psychiatric staff should be trained to manage violence. Staff should be encouraged to report incidents to management, so that employers can identify and address problem areas.
Reform of the Mental Health Act 1983: the Green Paper
Authors: Zigmond A. S.
Published: September 2002

The profession awaits the Government's White Paper on a new Mental Health Act (MHA) with trepidation. At the time of writing, the closing date for consultation on the Green Paper (Department of Health, 1999a) has passed. None the less, discussion and lobbying must continue.
Survey of psychotherapy training for psychiatric trainees in South-West England
Authors: McCrindle David , Wildgoose Joanna , Tillett Richard
Published: September 2002

Aims and Method

A telephone questionnaire to assess psychotherapy training in the 12 psychiatric training schemes in South-West England was conducted in April 1999. The findings were compared with the 1993 guidelines recommended by the Royal College of Psychiatrists.

Results

Only one scheme was achieving the standards set by the College guidelines. The majority of trainees in this region were not receiving adequate psychotherapy training.

Clinical Implications

Psychotherapy training for psychiatric trainees needs urgent review in South-West England.
Oral health of psychiatric in-patients
Authors: Mirza Ilyas , Day Rachel , Phelan Michael , Wulff-Cochrane Victor
Published: September 2002

Aim and Method

The aim of the study was to get an estimate of oral health needs of in-patients on acute general adult wards in an inner-city psychiatric unit. Information was collected by means of a cross-sectional survey with patient interviews and a brief oral examination.

Results

A significant majority of patients had carious teeth, inflammation of gums and oral plaque. A majority of patients complained of pain during the preceding 3 months and problems with teeth.

Clinical Implications

Oral health of patients admitted to an acute psychiatric unit is worse than compared to the general population. There appears to be a need for basic dental health education and easy access to dental care on psychiatric wards.
A Masters degree in Business Administration by distance learning
Authors: Leonard Feargal
Published: September 2002

There is a recognition that doctors require management skills and many are now studying for formal qualifications in management. This article describes a Masters degree in Business Administration (MBA) with the Open University.
Individual appraisal for senior medical staff
Authors: Khalil Salwa , Parry Elizabeth , Brown Nick , Oyebode Femi
Published: September 2002

There is public concern about medical errors. In Britain, the Bristol Inquiry is the paradigmatic example that focuses professional and public attention on the safety of medical interventions. In the US the Institute of Medicine's recent report To Err is Human: Building a Safer Health System (1999) was widely seen on both sides of the Atlantic as confirming what most already feared, that medical interventions were accompanied by unacceptably high levels of preventable harms (Barach & Small, 2000). The response to these public concerns has been multifold. In the UK clinical governance was introduced in April 1999, principally to focus attention on continuously improving the quality of clinical care. At the same time, the arrangements for the registration of doctors by the General Medical Council (GMC) was under review and there was an expectation that NHS trusts would bring consultants, who hitherto had been regarded as independent practitioners outside any supervisory system or arrangement, within an appraisal system. It has become clear that this appraisal system will be a component part of the GMC's revalidation of doctors (GMC, 2000). What is clear is that these varying systems are designed to restore public trust by providing an open process, which has the confidence of the profession, management and public alike. In this paper we aim to discuss the historical development of appraisal as a system for reviewing the performance of individual practitioners, suggest a method for appraising senior medical staff and finally to discuss the limitations and problems inherent in the introduction of such a system.
The use of operationalised criteria for inclusion on a Care Programme Approach register
Authors: Phipot M. , Hales H. , Sheehan B. , Reeves S. , Lawlor M.
Published: September 2002

Aims and Method

To determine the rates at which clinical teams within one NHS trust placed older people on a Care Programme Approach (CPA) register and to examine the degree to which clinicians' use of the register conformed to trust policy. Two retrospective case notes surveys were carried out 6 months apart within a completed audit cycle.

Results

Consultant teams varied considerably in their application of the CPA policy. Feedback to clinicians after the first survey had a variety of effects on subsequent use of the CPA register.

Clinical Implications

Health service policies exist to reduce variation in clinical practice and to ensure minimum standards. Clinical audit may be a useful tool in identifying irrational variation within the framework of clinical governance.
High dose neuroleptics – who gives them and why?
Authors: Wilkie Alcuin , Preston Neil , Wesby Roger
Published: September 2002

Aims and Method

Neuroleptic medication is often used in excess of the BNF maximum. The purpose of this study was to examine the relationship of neuroleptic dose to patient, prescriber and environmental factors, by using a cross sectional ‘snapshot’ study of psychiatric in-patient prescriptions combined with a retrospective case note survey.

Results

It was found that certain consultants prescribe higher doses of neuroleptics than others. Patients with a history of aggression had a nine and a half times higher chance of being prescribed higher doses of neuroleptics. Patients with a greater than 5-year history of neuroleptic prescription received higher doses.

Clinical Implications

High neuroleptic prescription is related more to patients' past reputation and prescriber differences than to patients' current behaviour.
Memoirs of a press officer
Authors: Hart Deborah
Published: September 2002

My first encounter with the media was about 17 years ago when Marjorie Wallace turned up at a College meeting. As the conference organiser, I was told by the then secretary of the College, Natalie Cobbing, to ensure that Marjorie was not admitted, as our meetings were closed to the press. In fact, the fear of God was instilled in the staff at that time about the press – no staff were to talk to the media. Disobedience could be seen as a sackable offence. Ironically, Marjorie Wallace is now an Honorary Fellow of the College in recognition of the work she has done in mental health, both as a journalist and campaigner.
Senior house officer training in liaison psychiatry – are College guidelines being implemented?
Authors: Surlinson S. , Guthrie E.
Published: September 2002

Aims and Methods

To determine whether the College guidelines in liaison psychiatry are being implemented, a survey of training opportunities at senior house officer (SHO) level was undertaken. A detailed postal survey was conducted in January 2000. Information was collected about the number and nature of SHO liaison psychiatry posts from a wide range of sources.

Results

Nationally, 45.5 SHO posts in liaison psychiatry were identified. These were unevenly distributed, with a high number in London. Only five posts were available to general practitioner trainees. Nine regions anticipated an increase in training opportunities. Regional liaison representatives had incomplete knowledge of the availability of liaison training opportunities in their region.

Clinical Implications

The College guidelines to incorporate liaison experience into all training schemes have not been implemented. In four regions no training opportunities were identified whatsoever. A national database is needed to monitor training opportunities and inform further development of training posts.