bluuebunny/crossref_metadata_2025 huggingface dataset:
Attitudes towards community mental health care of residents in North London
Authors: Reda Sawsan
Published: October 2008

The closure of large psychiatric hospitals and the opening of community-based mental health facilities is a central part of British health policy for the care of people with mental illness. The North East Thames Regional Health Authority's (NETRHA) psychiatric hospitals closure plan started in 1985. As part of this a programme was established to assess the closure process (Leff, 1993). This study was carried out between 1988 and 1992 and was designed to study the reactions of the public to the hospital closure decision (Reda, 1993).
Readmissions from registered care homes
Authors: Abrahamson David , Leitner Natty , Sasan Sheena
Published: October 2008

Registered care homes have been developed in Newham, a deprived inner city borough of about 220000 population, by a number of different housing associations. Some of these provide the care component themselves while others purchase it from separate agencies. The formats of the homes also vary. Features common to all the provision include prolonged preparation of future residents in rehabilitation houses on the Goodmayes Hospital campus prior to taking up residence, particular attention to their compatibility and social networks, and regular individual reviews by a community rehabilitation team which also provides training and support to care staff.
The rise and fall of anti-psychiatry
Authors: Nasser Mervat
Published: October 2008

A review is made of the anti-psychiatric movement through its major protagonists, Lacan, Laing, Cooper and Szasz. The ideology was set to challenge the concept of mental illness and question the authority of the psychiatrist and the need for mental health institutions. The anti-psychiatric movement received a lot of attention in the 1970s but is now considered to be of the past and of likely interest to the psychiatric historian. However, the impact of the movement on current psychiatric practice requires further re-examination and appraisal.
Treatment of psychotropic-induced hyperprolactinaemia
Authors: Duncan Denise , Taylor David
Published: October 2008

Prolactin, a protein hormone synthesised and released by the anterior pituitary, promotes mammary tissue development and lactation and suppresses gonadotrophin secretion. Dopamine is the natural inhibitor of prolactin release and so standard antipsychotics, which block dopamine receptors, will cause prolactin levels to rise. This hyperprolactinaemia can lead to gynaecomastia, galactorrhoea, menstrual disturbances, a reduction in sperm count, erectile dysfunction, failure of ejaculation and reduced libido. Prolactin-related adverse effects are frequently encountered in patients on antipsychotics and are a cause of substantial morbidity.
The life of Leopoldo Fregoli
Authors: Yorston Graeme
Published: October 2008

The Fregoli delusion is one of a number of misidentification syndromes. It is characterised by a patient recognising a familiar person, usually seen as a persecutor, in various strangers who, although they do not show physical resemblance, are believed to be psychologically identical to the familiar person. It usually occurs in the context of a schizophrenic illness but has been reported in affective disorders and organic psycho-syndromes (Förstl et al, 1991). It was first described by the French authors Courbon & Fail in 1927, who used the term ‘Fregoli illusion’ after the Italian actor who enjoyed enormous popular success on the Paris stage at the time. It has also been called the ‘illusion of negative doubles'. However, as the psychopathology is a delusional interpretation of normal visual stimuli rather than an abnormal perception the terms Fregoli delusion or ‘delusional hyper-identification of the Fregoli type’ are preferable. The original case description has recently been translated and annotated (Ellis et al 1994) but there remains little background information available on the figure of Fregoli himself. Biographies have appeared in French and Italian but there are few English language references and this paper is intended to provide an account of the life and career of one of the most extraordinary entertainers in theatre history.
The refugees of Rwanda seen through the eyes of a psychiatrist
Authors: Rooke O. J.
Published: October 2008

Rwanda was the most densely populated country in Africa. It is two-thirds the size of Switzerland but contained a larger population (9 million people), growing by almost 40% every two years. Few square inches are left uncultivated. The Tutsi people (never more than 14% of the population) are said to have arrived in the 14th century ad, bringing with them a feudal and totalitarian system of government. There was significant intermarriage with the result that today the Hutu and Tutsi people share the same language, cultural beliefs and religions (predominantly Catholic). In reality the terms Hutu and Tutsi now more accurately describe caste than ethnicity (Delcros, 1994).
The magical mind
Authors: Culliford Larry
Published: October 2008

Magical thinking co-exists with rational, logical thought. It may be eclipsed by reason, but not extinguished. Magical thinking is an ever-present component of the mind's activity.
The Preliminary Report on Homicides in People with Psychiatric Illness
Authors: Boyd W. D.
Published: October 2008

The preliminary report on homicides committed by mentally ill people was published on Wednesday, 17 August 1994. The decision to present some of our findings ahead of the more comprehensive report to be published in 1995 was made by the Steering Committee after it became clear that some information coming from our collection of data might usefully be made more widely known. The media reaction which had followed individual cases over the previous months made it important to provide some perspective into the frequency of homicides by psychiatric patients, to indicate that the respondents to our questionnaire often saw these tragic episodes as unexpected and unconnected with shortage of services and to point to the finding that several of the cases showed that the individual patient had somehow removed himself or herself from supervision or from regular medication in the weeks or months before the homicide.
The stresses of peace-keeping
Authors: Palmer I.P.
Published: October 2008

Unlike NHS practice, Army psychiatry is an occupational psychiatric service. This is a description of my three visits to Bosnia-Hertzegovina (BHG) as the visiting Army psychiatrist during 1993.
GMC's guidance on confidentiality
Authors: O'Brien Jane
Published: October 2008

The General Medical Council have agreed that part of a letter which they wrote to a member of the College containing their current policy on confidentiality can be published in the Psychiatric Bulletin. This letter was written in response to a specific enquiry.
Leadership in the mental health service: what role for doctors?
Authors: Reed John
Published: October 2008

Policy and practice in the cart of people with a mental Illness has been changing radically for many years. This article draws attention to the Important role doctors can play in Influencing the development of central policies and to the need for leadership, including leadership by doctors, in developing a mental health service for the next century.
Patient access to psychiatric records: experience in an in-patient unit
Authors: Kosky Nick , Burns Tom
Published: October 2008

Forty of 46 consecutive admissions to a psychiatric inpatient unit were encouraged to read their admission notes and discuss them with the Junior doctor. The offer was withheld for two patients with organic impairment. Twenty-eight patients (including 12 on compulsory admissions) accepted the offer. The 12 who refused were characterised by overall lower educational attainment. Diagnosis raised only a few problems, prognosis and maintenance treatment being the focus of most discussions. There was no evidence of a deterioration in the quality of notes or therapeutic relationships as a consequence of access. Only in one case was the exercise judged ‘harmful’, but ‘useful or essential’ in 22. Possible benefits for both patients and doctor are explored.
The liaison model
Authors: Kraemer Sebastian , colleagues
Published: October 2008

This paper puts the case for accessible multidisciplinary mental health services for children and young people to managers, purchasers and GPs, in a framework of national and international statutes and guidance. The essential differences between the disciplines are explained, based on detailed advice from mental health colleagues in nursing, teaching, social work, psychology, child psychotherapy and child and adolescent psychiatry.
Consultant images
Authors: Cox John L.
Published: October 2008

At present there is a somewhat damaging ‘splitting’ occurring within the NHS ‘reforms’ – assisted by the media. Consultant psychiatrists, who are regarded as intrusive and paternalistic, administer treatments (mostly medication and ECT) to patients who are not consulted, and are generally thought to know what is best for themselves. General management, which overtly sets out to ‘change the culture’, appears to sustain this irrational harmful and pseudo confrontation.
The care of individuals with substance misuse problems detained in police custody
Authors: Ghodse Hamid , Stark Margaret , Lawrence Ralph
Published: October 2008

Substance misuse is a substantial and growing problem. Forensic physicians are increasingly being asked by the police to assess substance misusers' fitness to detained, the need for treatment and fitness for interview. Many substance misusers come into contact with the police either for drug offences or for offences committed to maintain their habit, such as shop-lifting and burglary, and a forensic physician will then be called under the guidance given in the Codes of Practice 1991 of the Police and Criminal Evidence Act 1984 (1991).
To be or not to be discharged: an ethical dilemma
Authors: Kotak Anita , Noore Faiz , Muthiah Kamal , Raffique Farooqh , Schmidt Ulrike
Published: October 2008

We describe the problems encountered in dealing with a ‘discharge refuser’ in the context of recent government guidelines on good practice in the discharge of mentally disordered people.
The role of psychiatry in genetic prediction programmes for Huntington's disease
Authors: Berrios G. E. , Marková I. S. , Gimbrett R.
Published: October 2008

Psychiatrists are becoming increasingly involved in the assessment of candidates for genetic testing for Huntington's disease (HD) in which their role ranges from diagnosing conventional psychiatric disorder to identifying ‘new odd behaviours'. They are also expected to predict dysfunctional response to test results (e.g. self-harm). This paper describes the psychiatric component of the Cambridge HD Clinic and its assessment protocols. Practical concepts, useful to the understanding of the clinical problems that may be encountered, are also discussed.
The pitfalls of dose titration as used in electroconvulsive therapy
Authors: Byrne P. O. , Farquharson R. G. , Schofield I. S.
Published: October 2008

Dose titration is the new colloquialism in ECT circles. The technique, as generally applied, assumes that current and the time for which it is passed, are equally important in the depolarisation of nerve cells. The units used to quantify its measurement, namely the milliCoulomb (mC) reflect this. We think this is misleading and suggest it ought not to be used as a parameter to describe a treatment regime. It is the aim of this communication to explain, in general terms, the physical parameters that control the current flowing in the patient's head, to suggest a more appropriate method to describe the treatment administered and outline the requirements of a good ECT machine.
Setting up a community support team for the severely mentally ill
Authors: Doyle Harry , Craig Tom
Published: October 2008

This article describes the process of setting up a community support team for the severely mentally ill, and the challenges this posed. As this method of service delivery has been infrequently described, it is hoped our experience may be instructive to others.
Daniel in the lion's den: attachment to a purchaser
Authors: Fry Richard
Published: October 2008

This article describes a part-time attachment to the public health department of a purchasing authority, during my senior registrar training in child psychiatry. This London purchasing authority was responsible for researching needs and priorities, planning services and drawing up and administering contracts for an area previously administered by several separate health authorities. In carrying out these tasks it worked in close collaboration with its local public health department, but was not directly linked to a Family Health Services Authority.
Trust and control
Authors: Culliford Larry
Published: October 2008

Where human relationships are concerned, issues of trust and control go together. Where professional relationships are concerned, these issues require special attention.
Sex with aliens: out of space or out of mind?
Authors: Klemperer Frances
Published: October 2008

Extraterrestrial kidnapping is in vogue. A dozen books are available that detail accounts by alleged victims. A telephone survey of almost 6000 Americans revealed that many reported ‘abduction by an alien’. BBC's Horizon programme sent Dr Susan Blackmore, psychologist and TV-troubleshooter for the paranormal, to investigate.
Patients taping staff
Authors: Stephenson Matthew
Published: October 2008

I would like to raise Issues about tape-recorded interviews by way of describing the recent admission to hospital of a man who began recording staff and patients.
A nurse-led psychiatric intensive care unit
Authors: Dix Roland
Published: October 2008

Severn NHS Trust has recently commissioned a psychiatric intensive care unit (PICU) which became operational on 18 July 1994. Although the number of PICUs is increasing and their services are greatly valued, they are often fraught with problems. A model for the development of PICU services is described. It includes admission criteria, overall clinical organisation of the PICU, discharge criteria and a discussion. The model described is based on the hypothesis that the primary role of the PICU is to deal with clinical nursing problems rather than medical problems. The discussion points out some of the instrumental components necessary for the successful development of PICU services.
Psychotherapy training in a community mental health team
Authors: Ogg Elaine C.
Published: October 2008

A one year training post at senior registrar level in psychotherapy in a developing community mental health team is described, not only for its relevance to training at all levels but also as an example of how general psychiatry and psychotherapy can work together to promote good psychiatric practice in a community team.
Stage hypnosis: a personal account of the Kilroy Programme
Authors: Trevelyan T. R.
Published: October 2008

Tom Trevelyan, describes his impression of a debate for which he was considered too reasonable.
Special care wards: are they special?
Authors: Zigmond Anthony
Published: October 2008

Over the past four years I have visited a number of special care wards (also known as locked/intensive care/secure wards) and interviewed many staff and patients, both as a Mental Health Act Commissioner and as a second opinion appointed doctor. It has been suggested to me that my observations may be of some interest. The points are not exhaustive nor are they research based. Before continuing I must also declare that I have no special knowledge or expertise in the care or treatment of patients in this setting.
The union of the vegetable: the ritualised use of hoasca tea
Authors: Labigalini Eliseu , Dunn John
Published: October 2008

In the Amazon rainforest there grow two plants: the mariri (Banisteriopsi caapi) and the chacrona (Psychotria viridis), which have been used by native Indians for hundreds of years to make an infusion. The infusion, known as ‘hoasca tea’, is no ordinary herbal brew but one with psychoactive properties. The leaves of these plants contain dimethyltryptamine (DMT), which has hallucinogenic effects, and beta-carbolines, which are monoamine oxidase inhibitors that prevent the degradation of DMT in the gastrointestinal tract. The preparation and consumption of these substances are legal in Brazil; although the Federal Council for Narcotics (CONFEN) states that they can only be used during recognised rituals.
Working with traditional healers in Harare
Authors: Patel Vikram
Published: October 2008

As an expatriate psychiatrist, working in a new culture has exposed me to the difficulties in practising my profession, and in particular, its limitations. In search of understanding common psychosocial distress in the communities we serve, I have sought to work with traditional healers in the high-density suburbs of Harare city.
Mental health needs of deaf and hearing impaired children and adolescents
Authors: Clark Andrew
Published: October 2008

Diagnosis and treatment of mental health problems in individuals suffering from deafness or severe hearing impairment poses particular challenges. This is recognised for adults by the provision of specialised services based in London, Birmingham and Manchester but for children and adolescents there is only a specialised out-patient service based at Springfield Hospital in London which has itself only been in existence two years. This day conference of invited hearing and non-hearing professionals held in Birmingham in October 1994 considered how appropriate services might further develop.
A workshop on Gentle Teaching
Authors: Piachaud J.
Published: October 2008

Gentle Teaching (McGee et al, 1987) has been described as a technique for working with people who have learning disabilities and severe behavioural disorders. I attended a two-day workshop from 25–27 May 1994 run by the Royal College of Nursing, Bexley MENCAP and Values Incorporated.
The Royal Medico-Psychological Association and the Royal College of Psychiatrists in Bristol
Authors: Wallis Geoffrey
Published: October 2008

The Royal Hotel overlooking College Green in Bristol accommodated members attending the Spring Quarterly Meeting of the Royal Medico-Psychological Association (RMPA) in May 1957 and the Annual Conference of the Specialist Section of General Psychiatry of the Royal College of Psychiatrists in May 1994. I was privileged to be there both times.
The case for catchment areas for mental health services
Authors: Thornicroft Graham , Strathdee Geraldine , Johnson Sonia
Published: October 2008

The establishment of mental health teams which take responsibility for small geographical catchment areas has been a fundamental element in the planning of community services in most Western European countries over the last decade. This idea is challenged in the companion paper in this issue of Psychiatric Bulletin which refers to catchment areas as a “relic of the past”. The case is put for catchment areas in terms of their planning, service delivery and quality advantages for the development of comprehensive inter-agency mental health services. In brief, it is argued that community mental health services are still in many areas poorly developed (Audit Commission, 1994; Faulkner et al, 1994), and that catchment areas are necessary but not sufficient for their fuller realisation.
A review of a facility for the admission of mothers with babies to psychiatric care
Authors: Semple M. M. , Ballinger C. B.
Published: October 2008

The advantages and disadvantages of a mother and baby facility as part of a general hospital psychiatric admission unit were explored. A questionnaire was sent to 60 women who had been admitted to the unit with their babies over a ten-year period asking about their psychological health following discharge from hospital, the welfare of their family and their opinion of the facility. A 37% response rate was obtained. The patients' case-notes were studied for information on various items and the results for the response and nonresponse subgroups were compared.
The stigma of psychiatric in-patient care
Authors: McCarthy Jennie , Prettyman Richard , Friedman Trevor
Published: October 2008

The differences in attitudes to their illness between selected groups of medical and psychiatric in-patients admitted to units on the same hospital site were investigated. Patients new to the services were asked about their willingness to disclose information about their admission to hospital and their diagnosis to family members, friends and people at work. Psychiatric patients were more likely to want to keep their admission and diagnosis a secret. They were also less sure of the nature of their diagnosis and the necessity of their admission. The results suggest that wider public education is needed to reduce the stigma of mental Illness.
Which is the safest antidepressant to use in epilepsy?
Authors: Duncan Denise , Taylor David
Published: October 2008

Seizures are a serious adverse effect of many antidepressants: most, if not all, tricyclics (TCAs) lower the seizure threshold, some atypicals (e.g. maprotiline) are known to cause convulsions and seizures have been reported to occur with all selective serotonin reuptake inhibitors (SSRIs). Opinions vary on which is the safest antidepressant to use in epilepsy.
The Cradle, Berthe Morisot
Authors: Kapp Elinor
Published: October 2008

This is the second in a short series of articles on portraits of children from the point of view of a child psychiatrist.
Writing an introductory handbook for trainees
Authors: Barnes Richard C. , Earnshaw Stephen M.
Published: October 2008

‘Induction days' are becoming more popular for trainees and are a useful way of communicating important local information to the new intake. The authors feel that a handbook given out during the induction can serve as an aide-memoire, and have provided a suggested layout which they themselves have used in preparing several such books.
Classical Greek tragedy and the inner world
Authors: Oyebode Femi , Pourgourides Christina
Published: October 2008

Femi Oyebode and Christina Pourgourides show how Greek tragedy tests established morality and helps an audience resolve its own emotional conflicts.
Shared experiences of mental health services in Verona and London
Authors: Perwanger Verena , Phelan Michael
Published: October 2008

Close links have developed between the Institute of Psychiatry at the University of Verona – a town in North-East Italy – and the Maudsley Hospital in South London. Reciprocal visits, exchanges and cooperation in clinical practice and research have led to interesting experiences and comparisons between the different cultural settings and mental health services. In 1993, one of us (MP) visited the South Verona Psychiatric Service for two weeks, and a year later VP spent six months attached to the South Camberwell Community Team and at PRISM (Psychiatric Research in Service Measurement), a research team at the Institute of Psychiatry. This paper records our impressions and observations during these visits. The two services are not representative of all services in the respective countries but the visits did give us the opportunity to consider details not revealed by formal comparative research studies.
Partnership in Practice: a multidisciplinary approach to quality improvement in primary health care
Authors: Phelan Michael
Published: October 2008

This one day seminar was arranged by the King's Fund Organisational Audit team (KFOA), to take a multidisciplinary view of quality improvement in primary care. Despite the title of the day all the speakers were general practitioners and managers, and input from other professional groups was limited to questions and comments from the audience of nearly 200.
What should we call patients with schizophrenia? a sociolinguistic analysis
Authors: Haghighat Rahman , Littlewood Roland
Published: October 2008

To avoid identifying patients with a class while classifying disorders, DSM-IV specifies that it will not use such expressions as a schizophrenic but instead will use the designation an Individual with schizophrenia. This review aims to explore the sociolinguistic connotations of various designations used for patients suffering from schizophrenia. An analysis of these designations from six perspectives, using conceptually different sociolinguistic paradigms, systematically supports the DSM-IV comment. Further research is required into the social impact of the language of psychiatry.
Uptake of welfare benefits by psychiatric patients
Authors: Slade Mike , McCrone Paul , Thornicroft Graham
Published: October 2008

The British benefit system provides for disabled people. However, disincentives within the existing system reduce uptake of benefit entitlements. The link between mental illness and poverty is now well known. If welfare benefits are essential for mentally ill people to function effectively in the community, then changes may be necessary to the current system. These changes include increasing the availability of accessible literature and information from both health and social services sources, further training for mental health staff, and the automatic evaluation of benefit entitlement by the Department of Social Security.
New trends in the health care provision for people with learning disabilities: a Welsh paradigm
Authors: Verma H. M.
Published: October 2008

The launch of the All Wales Strategy for people with learning disabilities in 1983 heralded an era of redressing the anomaly of 80% of resources being deployed in hospitals while the majority of people with learning disabilities lived at home (Welsh Office, 1983). Social services were given the lead responsibility to plan and co-ordinate services away from institutions towards community based facilities. In 1983, some 2,100 people with a learning disability were resident in hospitals and hostels; by April 1991 the number had fallen to just over 1,300. There was a concomitant development of services in the community with a rise in the number of adults living in ordinary accommodation from 170 to 1,000. The priorities for development of services in the second phase of the strategy were set out in the ‘Framework for Development’ from April 1992 (Welsh Office, 1993).
The new undergraduate curriculum: implementing the changes in Nottingham
Authors: Cantwell Roch , Brewin John
Published: October 2008

Substantial changes are taking place to undergraduate psychiatric curricula, in response to recent General Medical Council recommendations. The overall aim is to provide a training in core knowledge and skills that enables students to become competent junior house officers. These developments will inevitably affect clinicians' involvement in undergraduate teaching. How change is being implemented in Nottingham –and the success and challenges so far – is discussed.
Developing psychogeriatric services in Hong Kong
Authors: Pang A. H. T. , Lam L C. W. , Chiu H. F. K.
Published: October 2008

Hong Kong is an international trade and finance centre situated on the southern coast of China, offering a unique blend of Western culture and Chinese tradition. With a largely private primary health care system, psychiatric services here have been predominately hospital centred. Following the 1992 Government Review of Rehabilitation Program Plan (Secretary of Health and Welfare, Hong Kong, 1992) development of community-based services has become the major local issue. Psychogeriatrics is the first sub-speciality to have achieved major progress in this area. Such a development illustrates how local psychiatrists faced the challenge of applying Western models to suit an Oriental population with a different socio-cultural value system.
‘Med 3’ rock and blues band to Trieste
Authors: Bale Rod
Published: October 2008

On a recent visit to the UK, Dr Guiseppe Dell Acqua, a leading exponent of the Italian psychiatric reforms, heard the ‘Med 3’ band play and extended an invitation to visit Trieste and give a concert. ‘Med 3’, the name being an allusion to the medical certificate, were formed in 1992. A Mental Health Week was held in the City of Portsmouth that year. In association with the Arts Connection, a local organisation promoting the arts to a wide audience, and the Portsmouth Care Consortium who were organising the event, artists in many fields ran workshops for mental health service users. Guy and Emma Heape, session musicians, ran a workshop at the Social Service Mental Health Day Centre and it was so successful it led to a band being formed. The band achieved recognition by winning a Mental Health Task Force award in 1993. An invitation to accompany the band to Trieste was readily accepted.
The consultant's caseload: a working framework
Authors: Fagin Leonard , Hollander Doris , Weller Malcolm
Published: October 2008

Consultants psychiatrists have a limited time to offer their services. Current contracts, based on population norms, do not establish limits to consultants' workload. Reorganisation of service provision, rising demands and marked social differences in different localities have brought these population norms into question. What is the desirable workload for a consultant to ensure a decent level of care to patients? A model is proposed that specifically applies to whole-time consultants within a catchment area, and those working in adult general psychiatry. It will need to be adapted for other specialities. The figures given are estimates, which will need to be audited appropriately for refinement. It is hoped that such an analysis will facilitate the process of purchasing care for specific patient groups, and be a clearer way of identifying gaps in clinical service.
Attitudes of employers to the mentally ill
Authors: Manning Cressida , White Peter D.
Published: October 2008

Patients often ask psychiatrists for advice on how to answer questions about their health, when seeking employment. They fear not being employed if they declare that they have suffered from a mental illness. The attitudes of personnel directors of 200 randomly chosen public limited companies were measured. This confirmed significant reluctance, stigma and ignorance about employing and believing the mentally ill. Employers decided whether to employ someone by considering the fob description, the standard of previous work, whether the applicant was receiving treatment, previous time off sick, and the particular illness suffered. Those with depression were more likely to be employed than those with schizophrenia or alcoholism. The largest companies were significantly more likely to employ patients and were less likely to seek dismissal than the smallest. Employers would welcome more information about mental ill health. Potential employees should approach large firms and seek treatment.
“No Lion can him Fright”
Authors: Bennett Douglas
Published: October 2008

On 31 December 1992 Ben Silcock, a 27-year-old man, climbed into the lion's den at London Zoo where he was mauled by a lion. In the newspaper accounts it was evident that he suffered from schizophrenia. His father Bryan Silcock added that “he would sit up in his room smoking dope”. One national newspaper asked why people like Ben were not in hospital and his father blamed the health authorities for letting his son down.
Psychiatry in Pakistan (1947–1994): the balance sheet
Authors: Shafique M.
Published: October 2008

At the time of independence (1947) Pakistan with a population of 40 million had three asylum-like hospitals with a total of less than 2000 beds. The hospitals were prison-like and they provided custody with little care. Patients were mostly brought in chains. Detention and reception orders were used for admission as provided in law and the law was and continues to be the Lunacy Act of 1912. The common man referred to them as pagal-khanas (mad houses) or jail hospitals. The doctors appointed were mostly general duty doctors with no training and often no interest in psychiatry and their average stay was two to three years. In place of nurses there was a cadre of attendant staff, most of them illiterate, untrained and acting more like police sepoy or jail warder than nurse.
Attitudes of mental health workers to treatment in their own workplaces
Authors: Stephens John , Prunty Mark , Falkowski Wojciech
Published: October 2008

Recent questions have been raised regarding the development of policies by Trusts for the treatment of their locally resident staff outside the hospitals in which they work. A questionnaire was developed to elicit views of mental health care workers on this issue. Overwhelming agreement was found among a wide variety of staff groups on the need for provision of treatment options outside the local service. Considerable thought and planning are needed in the development of formal operational policies to ensure such a service is provided by all hospitals/Trusts.
Observations from community care for serious mental illness during a controlled study
Authors: Connolly Joseph , Marks Isaac , Lawrence Robin , McNamee Gary , Muijen Matt
Published: October 2008

A controlled study of community care in serious mental illness (SMI) was carried out. Patients with SMI were randomised to have hospital care or be looked after by a community psychiatric care team in a Daily Living Programme (DIP). The day-to-day work of a clinical team with the difficulties encountered in delivering community psychiatric care in an inner city is described. There were seven deaths from self-harm during the 45-month study. One DIP patient committed homicide. An ordeal by media following this and the suicides are described. Lessons learnt include the need for the community care team to be responsible for discharge from any in-patient phases and for attention to team morale, especially during adversity, and to time spent working under pressure.
Lady Cockburn and children
Authors: Kapp Elinor
Published: October 2008

Why do children always know when we want them to behave beautifully and do the opposite? No doubt Lady Cockburn thought it a delightful idea to pose as Cornelia with her children in the classical style so fashionable in 1773. Sir Joshua Reynolds has caught a moment of formal harmony just before it dissolves into all too human chaos. Who can doubt that at any second George, the imp on the right of the picture, will tighten that chubby clasp into a strangle-hold and pull down the temptingly loose coils of mother's hair? James, the child on the left, will not be slow to join in and baby William will howl as he is trampled on by his lively brothers. One small boy on his own is (sometimes) manageable; three together in any century spell trouble for grown-ups! Their mother already has a faintly strained look behind her lofty pose. She is distancing herself from the situation by fixing her eyes on the middle distance in a way well known to those who have discovered from experience that pleas, bribes, prayers and even threats cannot prevail against the exuberant life in a group of children. Will she eventually give way with good humour and indulge in a romp, or will it be smacks and tears all round and nursemaids summoned to remove the guilty parties, roaring, back to the nursery? She looks quite young in spite of the stuffy pose so who knows which way it will go. We tend to assume that youngsters in the old days were always brought up with harsh discipline. Of course life was hard and brutal for everyone and child abuse common, but many parents have also loved, petted and delighted in their children throughout the ages. The stem puritanical manuals that grate on us so much – “You must break a child's will by the age of five”, “Spare the rod and spoil the child”, “Rule by fear” – were written by disapproving experts to counteract what were seen as lax tendencies to over-fondness and spoiling of children.
Clinical practice guidelines: the priorities
Authors: Palmer Claire
Published: October 2008

The Clinical Practice Guidelines (CPG) Steering Group commissioned a survey to find out which areas of clinical practice the mental health community view as priority for the development of clinical practice guidelines (CPGs). Fifty per cent of all professionals and service users surveyed considered the assessment of risk and management of deliberate self-harm and dangerousness' a priority area for guideline development. These findings provided the basis for a successful bid to the Department of Health for the development of The Royal College of Psychiatrists' first CPG.
The psychiatric consultation reconsidered
Authors: Hartman David , Rozewicz Leon
Published: October 2008

We have subjected the current structure of the psychiatric consultation to critical examination, and We propose that the concepts of ‘history’, ‘mental state’ and formulation’ should be abandoned. In their place we propose the more carefully defined concepts of ‘narrative’, ‘interaction’, ‘examination’ and ‘inferences'. The clinician should make a dear distinction between information that is reported, observed or inferred, as these sources of knowledge are qualitatively different, and subject to psychodynamic, systemic and cultural influences. We propose that this approach would facilitate a clearer and more comprehensive understanding of the patient, and lead to a more creative therapeutic relationship.
Evaluation of a community based service for urgent psychiatric assessment
Authors: Crawford M. J. , Kohen D. , Dalton J.
Published: October 2008

The Urgent Assessment Service (UAS) was set up to provide community based urgent psychiatric assessment to a range of referrers. The work of the service was assessed over a six month period. Results show that it was popular with a broad range of medical and non-medical professionals. Patients generally presented with depression or psychotic illnesses and those referred from non-medical sources were more likely to be suffering from schizophrenia and assessed as being at least as unwell as those referred by GPs and hospital based doctors. Rates or referral to hospital services were low with the vast majority of patients being referred back to their general practitioner after initial assessment and treatment.
Chlormethiazole or chlordiazepoxide in alcohol detoxification
Authors: Duncan Denise , Taylor David
Published: October 2008

The alcohol withdrawal syndrome is characterised by symptoms such as anxiety, insomnia, anorexia, nausea, tremor, sweating and disturbances in coordination. These symptoms tend to occur within 6 to 12 hours of alcohol-dependent patients stopping or reducing their alcohol intake. Less frequently, convulsions, hallucinosis and delirium tremens can occur. Delirium tremens (disturbed orientation, visual and auditory hallucinations, paranoid ideation and tremulousness) is the most serious complication of alcohol withdrawal and occurs in up to 5% of patients withdrawing from alcohol. If it is severe or poorly treated, death can occur. In the UK some clinicians use chlormethiazole while others favour chlordiazepoxide. This article will examine and compare the use of these two drugs.
Psychotherapy training and experience of successful candidates in the MRCPsych examinations
Authors: Hwang Kim S. , Drummond Lynne M.
Published: October 2008

We conducted a survey of the psychotherapy training of a national sample of successful MRCPsych candidates to discover the extent of their psychotherapy training and their opinion about its adequacy. Ninety doctors answered the survey. Overall 71% of trainees had clinical experience in behavioural–cognitive psychotherapy and 78% in psychodynamic psychotherapy with fewer gaining experience in group and family psychotherapies. The majority of trainees were dissatisfied with the extent of their behavioural-cognitive psychotherapy training (82%) and psychodynamic training (50%). Trainees felt that their psychotherapy training was an important component of their psychiatric training.
“The Sorcerer and the Apprentice”
Authors: Arnott Stephen , Dorkins Eluned , Aylard Paul
Published: October 2008

Clinical supervision of counselling and psychotherapeutic work performed in a district general adult psychiatric service is examined. Most staff received regular supervision, usually having more than one source of supervision. Paired peer supervision, within a discipline, was the commonest structure. Supervision was mainly focused in two areas, on interventions made by the therapist, and examining the therapeutic relationship. Most staff had confidence in their supervision, but those who had not discussed a supervision contract were significantly less likely to be satisfied with their supervision.
Drug misuse among medical students
Authors: Mesquita Ana Maria C. , Dunn John
Published: October 2008

Most doctors are probably uncomfortably aware of the old joke that an alcoholic is someone who drinks more than his doctor. But how would one define a drug addict? Because of the taboo and illegal nature of drug misuse, if a similar doctor-based definition were coined, even in jest, it would cause a degree of consternation and indignation among the profession. However, the evidence that doctors abuse certain substances, in particular opiates and tranquillisers (Hughes et al, 1992), more commonly than the general population is well established.
Feigned psychosis revisited –a 20 year follow up of 10 patients
Authors: Humphreys Martin , Ogilvie Alan
Published: October 2008

Feigned psychosis, although rare, presents considerable diagnostic problems in clinical psychiatric practice. Long-term follow up data are lacking. A retrospective case note study was undertaken of 10 patients described in a previous paper, published in 1970, on the simulation of psychosis. The computerised diagnostic instrument OPCRIT was applied to both index episode and lifetime occurrence of symptoms. All 10 patients were found to have had a major psychotic illness based on lifetime symptoms at 20 year follow-up by DSM–III–R criteria. Eight had met such criteria at the time of the initial episode. Diagnosis in patients thought to be feigning psychotic symptoms changes over time and major mental illness is likely to emerge which may be schizophrenic or affective. The term feigned psychosis should be abandoned and more attention given to why symptoms are accepted as genuine in some cases but not others.
Evidence-based medicine
Authors: Gilbody Simon
Published: October 2008

Evidence-based medicine is an approach to clinical training and practice that is increasing in popularity. When introduced into the journal club format, it provides an opportunity to integrate real clinical problems with critical evaluation of the psychiatric research literature. The principles of evidence-based medicine and the practicalities of its introduction into the Journal club format are described.
High-dose antipsychotic medication
Authors: Cornwall Peter L. , Hassanyeh Fuad , Horn Caprice
Published: October 2008

We audited the use of high-dose antipsychotic drugs in patients admitted to a special (intensive) care unit over two periods. Five out of 57 patients in the first sample and three out of 62 in the second were treated with a single antipsychotic drug above the British National Formulary maximum dose. The proportion of patients treated with antipsychotic drugs such that the total dose in chlorpromazine equivalents was greater than 1000 mg, fed. The audit showed improvements in clinical practice, particularly with respect to the onset of, indication for and outcome of high-dose treatment and in monitoring the patients' physical status.
Letter from Euroland: caring for the temporary migrant
Authors: Klemperer Frances
Published: October 2008

The International movement of traders, political envoys and soldiers is not new. But the late 20th century has seen an unprecedented growth in the activities of at least the first two groups. Increase in international mobility has been accompanied by growing interest in the psychological problems faced by these temporary migrants. It has prompted the development of specialised services for preparing expatriates before departure, and supporting them during their sojourn. Brussels is an example of an International centre with a huge expatriate population, and a demand for a dedicated telephone crisis service. This is the oldest, and one of the largest, services of this kind in Europe.
Recruiting patients for drug trials: a difficult task
Authors: Skerritt U. , Pitt B. , Armstrong S. , O'Brien A.
Published: October 2008

In successfully recruiting patients for drug trials in dementia the Therapeutic Research Unit for the Elderly (TRUE) had referrals from various sources. The local Memory Clinic (MC) provided 38 patients for screening of which 31 (81%) were recruited, 75% of the overall number recruited. This number was small (n=41) despite various efforts and does not reflect the time invested and amount of contact work with GPs, out-patient departments and other psychiatric services.

The memory clinic provides a source of recruitment of patients for drug trials as well as services for those who do not qualify for such trials. But recruiting without the aid of a memory clinic is difficult and time-consuming and new approaches must be found.
Predicting attendance at child and adolescent clinics
Authors: Potter Rob , Dorwish Ahmed
Published: October 2008

Non-attendance rates are high in child psychiatry clinics. This potential waste of resources is coming under increasing scrutiny within the NHS. This study shows that therapists themselves are good at predicting who will attend and who will not. The family's previous attendance rate is the most reliable predictor. Why then is not more use made of this information when organising clinics? Ways are suggested how attendance rates might be improved.
The Manchester advanced course in liaison psychiatry
Authors: Puffett Alison , Williams Bill
Published: October 2008

Liaison psychiatry is a relatively new and expanding speciality in the UK. A survey conducted in 1990 revealed widespread inadequacies in the training opportunities and resources in consultation liaison services (Mayou et al, 1990). In spite of a growing recognition of the need for more consultants with designated responsibility for general hospital patients, there is currently no formal training programme and many psychiatric schemes fail to provide satisfactory supervision and training opportunities in liaison psychiatry (House & Creed, 1993). The Manchester University liaison psychiatry course was developed in 1993 and is currently the only advanced liaison training course in the UK. Lasting five days, it provides an opportunity for senior psychiatric trainees to improve their specialist knowledge and to develop clinical, research and management skills in liaison psychiatry. The course does not give a comprehensive review of all aspects of liaison psychiatry but aims to generate ideas and discussion through skills based seminars, case discussion and workshop exercises.
Training and employment in Canada
Authors: Kisely Steve , Jones Judy
Published: October 2008

Previous articles have dealt with aspects of training in Canada (Green, 1985), and in particular arrangements that exist for UK trainees to undertake a year's experience in Nova Scotia (Munro et al 1987). In addition, there have been accounts of trainees' experiences in particular settings (Ferguson, 1989; Gojo, 1992). Procedures required to enter Canada to practise psychiatry are complex and involve general and specialist medical registration (licensure to practise and certification as a specialist), remuneration and immigration procedures. This article is an introductory guide and highlights recent changes in registration and postgraduate training.
Assessing detainees' ‘fitness to be interviewed’
Authors: Protheroe David , Roney Gerard
Published: October 2008

The police are increasingly requesting assesments of detainees' fitness to be interviewed. Senior registrars in psychiatry are often asked to perform this task. Gudjonsson has derived a set of guidelines from a Judge's ruling following a recent court case. Our survey identifies that the current practice of a group of senior registrars in psychiatry falls short of these guidelines. Reasons for this and implications for training are discussed.