bluuebunny/crossref_metadata_2025 huggingface dataset:
Cognitive–behavioural therapy for body dysmorphic disorder
Authors: Veale David
Published: August 2002

The DSM–IV classification of body dysmorphic disorder (BDD) refers to an individual's preoccupation with an ‘imagined’ defect in his or her appearance or markedly excessive concern with a slight physical anomaly (American Psychiatric Association, 1994). An Italian psychiatrist, Morselli, first used the term ‘dysmorphophobia’ in 1886, although it is now falling into disuse, probably because ICD–10 (World Health Organization, 1992) has discarded it, subsuming the condition under hypochondriacal disorder.
Management of first-episode psychosis
Authors: Spencer Elizabeth , Birchwood Max , McGovern Dermot
Published: August 2002

Over recent years early intervention in psychosis has fired the imagination of clinicians and researchers, following the publication of several studies linking a long duration of psychosis prior to receiving treatment with a poor treatment outcome: a relationship that has been cogently argued to be independent of illness factors (e.g. Scully et al, 1997). Most influential was Wyatt's (1991) review of 22 studies, in which relatively similar groups of patients suffering from schizophrenia were, or were not, given antipsychotic medication early in the course of their illness. This pointed towards an improved long-term course in schizophrenia with early treatment.
Proposed treatment for adolescent psychosis. 2: Bipolar illness
Authors: Clark Andrew
Published: August 2002

Bipolar illnesses are typically considered as disorders primarily occurring in adult life, but a substantial number have their onset during the teenage years. Any acute illness in the teenage years affects social, emotional and educational development disproportionately, as it may prevent the normal transitions and learning experiences inherent in adolescence. Additionally, there is some evidence for a lack of early recognition or for misdiagnosis in early-onset cases of psychiatric disorders in general and the psychotic disorders in particular, with consequent increased suffering and impairment of functioning. Finally, bipolar affective disorders rarely present with one single episode followed by full and permanent recovery, but are usually illnesses characterised by a relapsing and remitting course through adult life. Prompt and effective recognition and treatment may therefore not merely reduce immediate impact but may also set up patterns of understanding and treatment compliance with longer-term implications. In this paper, I consider the particular features of bipolar affective disorder in adolescence and to describe a practical framework for its management. In view of the relative lack of age-specific research findings, particularly in respect of treatment effectiveness, I draw heavily upon clinical practice and extrapolation from studies carried out among adult sufferers.
Competence and consent to treatment in children and adolescents
Authors: Shaw Mike
Published: August 2002

English law on young people's consent to treatment and competence is complex and can even appear contradictory. For example, competent minors can consent, but their refusal can be overruled by the consent of a person with parental authority or by the court. This paper is an attempt to make sense of the topic for clinicians. It includes a discussion of the law and the small body of relevant research evidence. There are clinical case examples, checklists and guidelines for good practice. However, it is not a substitute for legal advice, which should be sought wherever doubt remains.
Needs of women patients with mental illness
Authors: Ramsay Rosalind , Welch Sarah , Youard Elizabeth
Published: August 2002

Women patients suffer from a range of mental disorders similar to those that men may experience. However, there are some striking differences in the prevalence of specific disorders, and in their presentation and management. Some mental illnesses only occur in women. It seems that women patients may have a different experience of treatment, a consequence of differences in their needs and also of the way that health professionals perceive those needs. These differences are embedded in the wider cultural milieu in which we live. There are particular issues for women patients in relation to, for example, childhood sexual abuse, rape and domestic violence. At present, tools to measure needs of individual patients are generally not gender specific.
Do men need special services?
Authors: Kennedy Harry
Published: August 2002

The targeting of services to groups with special needs is today commonplace in enlightened public health policies. To list men among the ‘minorities’ in need of such special help might have the semblance of satire. This air of levity is not really reduced by listing male's shorter life expectancy, higher infant mortality and higher rates of natural and unnatural deaths in all age groups (Drever & Bunting, 1997; Kelly & Bunting, 1998).
Post-traumatic stress disorder in people with learning disability
Authors: McCarthy Jane
Published: August 2002

It is well recognised that traumatic events can cause psychological disorders in those who experience them. The most common disorders suffered are depression and substance misuse; others include acute stress reactions, anxiety states and personality changes. One disorder following trauma that has received considerable attention over the past 20 years is post-traumatic stress disorder (PTSD). PTSD occurs in 20–30% of people exposed to traumatic events and the prevalence in the general population is 1% (Helzeret al, 1987), with life-time prevalence of 9.2%.
Guidelines for choice of selective serotonin reuptake inhibitor in depressive illness
Authors: Anderson Ian M. , Edwards J. Guy
Published: August 2002

The selective serotonin reuptake inhibitors (SSRIs) are the most extensively studied of the newer antidepressants and are increasingly being used as first-line treatment for depression (Anderson et al, 2000). In this article we concentrate on issues that need to be taken into account when selecting one of the five SSRIs marketed in the UK (citalopram, fluoxetine, fluvoxamine, paroxetine and sertraline) for individual patients. We have concentrated on treatment of depression and have not reviewed their use in anxiety disorders because comparative data are lacking.
Electromagnetic stimulation in psychiatry
Authors: Ebmeier Klaus P. , Lappin Julia M.
Published: August 2002

One hundred years ago, D'Arsonval and Beer first described the effects of magnetic fields on human brain function. Placing one's head into a powerful magnet produced phosphenes, vertigo or even syncopes (George & Belmaker, 2000). However, only since 1985 has the technology of fast discharging capacitors developed sufficiently to generate reproducible effects across the intact skull, with peak magnetic field strengths of about 1–2 tesla (Barker et al, 1985). The headline-grabbing news has been about therapeutic applications of transcranial magnetic stimulation (TMS), but in the meantime a revolution in functional brain research has taken place, based on the manipulation of brain activity by focused magnetic fields. TMS applied in this way is, in a manner of speaking, brain imaging in the reverse. While common modes of functional brain imaging, such as positron emission tomography (PET) and functional magnetic resonance imaging (fMRI), demonstrate associations between brain metabolic activity and ‘brain tasks', the causal interpretation of such associations can be difficult. Is the frontal lobe activation observed during a memory task, for example, necessary for performing the task, or does it correspond to monitoring activity that runs parallel to task performance proper? If, on the other hand, focal brain activation during TMS results in a muscle twitch, there is no doubt that stimulation of at least some of the neurons within the magnetic field is sufficient cause for the observed movement. Functional neuroimaging is now often combined with TMS, carried out in the same session in order to exploit the complementary strengths of the methods. Although direct stimulation of association (as opposed to motor or sensory) cortex does not usually result in an observable response, TMS applied in repetitive trains can produce reversible ‘lesions'. By interfering with tasks that are dependent on the functioning of the stimulated neurons, it can thus contribute to the localisation of brain function.
Substance misuse and violence: the scope and limitations of forensic psychiatry's role
Authors: Snowden Peter
Published: August 2002

For the past 25 years, forensic psychiatry has been concerned with violent offenders with psychosis and/or personality disorder. If dual diagnosis or comorbidity meant anything to a forensic psychiatrist, it would be the ‘typical’ forensic case – an individual with schizophrenia and a premorbid dissocial personality who had been arrested for a violent crime. In this article I use comorbidity to describe the co-occurrence of two or more conditions (here a psychiatric disorder and health problems arising from substance misuse) rather than dual diagnosis. In fact, many violent offenders have multiple diagnoses. Williams & Cohen (2000) argue that dual diagnosis suggests a closer relationship, perhaps including cause and effect, and is a subset of comorbidity.
Diversion from custody
Authors: Birmingham Luke
Published: August 2002

Diversion from custody is a policy supporting the removal of people with mental disorders from the criminal justice system to hospital or a suitable community placement where they can receive treatment. There are three principal reasons why such a policy is necessary. First, when those with mental disorders fall through the net of psychiatric services they tend to gravitate towards the criminal justice system; second, the standard of health care provided in prison is, generally speaking, poor; and third, because prison health care centres are not recognised as hospitals for the purposes of the Mental Health Act (MHA) 1983, treatment for mental disorder cannot be given against a prisoner's will unless this can be justified under common law.
Training implications of community-oriented psychiatry
Authors: Linsley K. , Slinn R. , Nathan R. , Guest L. , Griffiths H.
Published: August 2002

Over the past 20–30 years psychiatry has gradually moved from predominantly hospital-based care to care in the community. Community psychiatry embraces a variety of definitions: it may describe the practice setting, the population served or the philosophy of illness and treatment (Johnston et al, 1995). In discussing the training implications of this shift towards community models of psychiatric care, we will not consider a separate discipline of ‘adult community psychiatry’. We believe that nearly all psychiatric specialities now involve substantial elements of work outside the hospital, and we therefore contend that the new skills, knowledge and attitudes required to meet the challenge of providing both hospital- and community-based care are pertinent to all trainees. Furthermore, the development of these are essential if the consultant of the future is to provide the safe, effective and sustainable service to those with complex mental health needs detailed in the recent National Service Framework (NSF) for Mental Health (Department of Health, 1999). We will also not attempt specifically to assess the merits of the move to community psychiatry, which may be subject to a separate debate.
Migration and mental illness
Authors: Bhugra Dinesh , Jones Peter
Published: August 2002

Human beings have moved from place to place since time immemorial. The reasons for and the duration of these migrations put extraordinary stress on individuals and their families. Such stress may not be related to an increase in mental illness for all conditions or to the same extent across all migrant groups. In this paper, we provide an overview of some observations in the field of migration and mental health, hypothesise why some individuals and groups are more vulnerable to psychiatric conditions, and consider the impact of migration experiences on provision of services and care.
Cognitive–behavioural therapies for children and adolescents
Authors: Bailey Veira
Published: August 2002

The merging of behaviour and cognitive therapy into cognitive–behavioural therapy (CBT) occurred in the 1980s in both Europe and North America, particularly on the basis of the successful treatment of panic disorder by Clark (1986) in the UK and Barlow (1988) in the USA. The behavioural emphasis on empiricism with good-quality research design was combined with the cognitive focus on content and meaning.
Use of written cognitive–behavioural therapy self-help materials to treat depression
Authors: Williams Chris
Published: August 2002

Both primary and secondary care practitioners often wish to offer their patients access to effective psychosocial interventions, yet the lengthy waiting-lists for specialised psychological or psychotherapeutic services create frustration among both referrers and their patients. There is therefore a need for new ways of accessing such treatments that can be delivered in most psychiatric team settings. For this to be realistic, such delivery must be possible within the time available to most practitioners (10–20 minutes for many consultant psychiatrists). One approach is to offer structured self-help materials.
Cognitive–analytic therapy
Authors: Denman Chess
Published: August 2002

Cognitive–analytic therapy (CAT) is a brief focal therapy informed by cognitive therapy, psychodynamic psychotherapy and certain developments in cognitive psychology. It was developed by Anthony Ryle specifically in response to the needs of the National Health Service (NHS) for treatment approaches of short duration. However, it has advanced far beyond its initial aims and is now a well-developed self-contained methodology backed by a fully structured theory of mental functioning and therapeutic change.
Brain injury in children and adolescents
Authors: Middleton Judith A.
Published: August 2002

Acquired brain damage in children is not uncommon, head injuries being the most frequent cause. Brain injury may also occur during the very vulnerable periods of rapid growth of the foetal brain from prenatal trauma/strokes, during a difficult birth, or postnatally from strokes, infections (e.g. meningitis and encephalitis), metabolic disturbances (e.g. phenylketonuria), treatment (e.g. central nervous system (CNS) surgery or radiotherapy for leukaemia) or toxins (e.g. alcohol and valproate). This paper concentrates on the assessment of and interventions following acquired brain injury sustained after the first 2 years of life, that is, after a period of relatively normal development when there has been an expectation that a child will follow the usual trajectory in development and learning throughout childhood and adolescence. Acquired brain injury in younger children tends to have global and profound effects, for instance, from CNS radiation (Said et al, 1989) or head injury (Levin et al, 1995). Injury in older children may result in more specific or focal problems depending on the mechanism of injury.
Somatising in children and adolescents. 1. Clinical presentations and aetiological factors
Authors: Eminson D. Mary
Published: August 2002

Somatising disorders, characterised by complaints of unexplained physical symptoms, are common presentations in children and adolescents, both in primary and secondary care settings. They have significant impact on the children themselves and on health care resources: as in adults, there is a wide range of severity and resulting handicaps.
Antidepressant drugs in the treatment of anxiety disorders
Authors: Scott Allan , Davidson Alan , Palmer Karen
Published: August 2002

In March 1997 APT published two reviews of the use of benzodiazepines, buspirone, beta-blocking drugs and antidepressants in the treatment of anxiety disorders (Cowen, 1997; Tyrer, 1997). These were followed by a paper on the practical pharmacotherapy of anxiety (Nutt & Bell, 1997). The present review was originally prompted for several reasons. A number of large-scale investigations of the use of antidepressants in anxiety disorders have been completed since those papers were published. Indeed, several antidepressant drugs have since been licensed to treat anxiety disorders, and more applications are being considered. El-Khayat & Baldwin (1998) found that the prescription of antipsychotic drugs for anxiety disorders was widespread, but concluded there was no methodologically sound evidence to support their prescription. They suggested that this use of antipsychotic drugs reflected the fears of practitioners about the risks associated with benzodiazepines. There is no reason why the prescription of antidepressant drugs should arouse such fears, and it seemed timely to produce an up-to-date review of their efficacy in the treatment of anxiety disorders. This view was reinforced while this manuscript was in preparation, when the Committee on Safety of Medicines issued a statement in December 2000 that restricted the indications for the prescription of thioridazine because of concerns about rare but serious cardiotoxicity; thioridazine was no longer to be indicated for the treatment of anxiety or psychomotor agitation.
African–Caribbeans and schizophrenia: contributing factors
Authors: Bhugra Dinesh , Bhui Kamaldeep
Published: August 2002

The epidemiology and management of schizophrenia have been well studied over the past few decades. In the UK, key findings that have emerged time and again are the excess prevalence and incidence rates of schizophrenia among people of African–Caribbean origin. The reasons for this excess and the implications of this finding are many. The findings may reflect a true excess or a methodological artefact related to errors in the estimation of numerator and denominator data. The findings have been increasingly accepted as better designed studies have emerged, but these still do not fully address concerns about the nature of schizophrenia in other cultural groups and in societies in which industrialisation and economic productivity of the individual are not considered to be as crucial for an individual's sense of belonging in a community.
Decision-making capacity in adults: its assessment in clinical practice
Authors: Bellhouse John , Holland Anthony , Clare Isobel , Gunn Michael
Published: August 2002

In English Law, an adult has the right to make decisions affecting his or her own life, whether the reasons for that choice are rational, irrational, unknown or even non-existent. This right remains even if the outcome of the decision might be detrimental to the individual (Re T (Adult: Refusal of Treatment), 1992) or to a viable foetus (Re S (Adult: Refusal of Medical Treatment), 1992). However, such a right to self-determination is meaningful only if the individual is appropriately informed, has the ability (capacity) to make the decision and is free to decide without coercion (Grisso, 1986).
Do women need special secure services?
Authors: Bartlett Annie , Hassell Yonette
Published: August 2002

Clinicians working with women patients in secure units will already know that they are the centre of a debate not of their own making, which is about the appropriate specification of services for women patients with security needs. This paper attempts to outline the relevant issues and proposed solutions.
Diagnosis and differential diagnosis of Asperger syndrome
Authors: Fitzgerald Michael , Corvin Aiden
Published: August 2002

Asperger syndrome is an uncommon condition, but probably more common than classic autism (the only published population study estimated prevalence at 36 per 10 000 children for Asperger syndrome and 5 per 10 000 for autism (Ehlers & Gillberg, 1993)). Misdiagnosis or delayed diagnosis of this disorder is a serious problem, and the average age at diagnosis is several years later than for autism (Gillberg, 1989). Obviously, this can be traumatic for individuals and families; furthermore, the most effective intervention programmes begin early, and establishing management strategies at an early age can minimise later behavioural problems (Howlin, 1998).
The dilemmas posed by new and fashionable treatments
Authors: Healy David
Published: August 2002

A new drug is introduced to the market. It has been approved (after stringent scrutiny) by regulators, who require ever more convincing evidence for safety and efficacy. Aside from the increased costs of the new treatment compared with the old, what could the problems be?
Psychiatric services for women
Authors: Kohen Dora
Published: August 2002

The need for specific psychiatric services for women has been debated by many practitioners involved in care delivery and management of women with differing degrees of mental health problems.
The management of stalkers
Authors: Mullen Paul E. , Pathé Michele , Purcell Rosemary
Published: August 2002

Stalking (Box 1) has only recently been distinguished from a wide range of other socially inappropriate, intrusive and potentially distressing activities. It is now a specific form of criminal offending and has established itself as a recognised social problem (Meloy, 1998; Mullenet al, 2000). Stalking may well reflect, as Emersonet al(1998) argue, “intricate social processes”, but if the psychopathology of the stalker is a necessary, even if far from sufficient, cause then treating that psychopathology may end the stalking (Mullen & Pathé, 2001).
Racism, racial life events and mental ill health
Authors: Bhugra Dinesh , Ayonrinde Oyedeji
Published: August 2002

The association of life events with the onset of various psychiatric disorders is well-known. The body of evidence has highlighted the impact of negative or positive life events on the genesis of common mental disorders, especially depression. These findings have been replicated across different cultures, although the impact of different life events varies between cultures. In addition, the roles of chronic difficulties (defined in Life events and psychiatric disorders, below) and resulting ongoing chronic stress have been shown to contribute to vulnerability to certain mental illnesses. However, data on the impact of life events, especially those perceived as racial, on members of minority ethnic groups are rather sparse. The questions that need to be addressed concern the perception of life events as racial, the role of pervasive and perceived institutional and individual racism, and chronic difficulties.
Qualitative methods in psychiatric research
Authors: Brown Christine , Lloyd Keith
Published: August 2002

“Evidence-based medicine builds upon, rather than disparages or neglects, the evidence gained from good clinical skills and sound clinical experience.” (Sackett, 1995: p. 840)
Treating depression complicated by substance misuse
Authors: McIntosh Claire , Ritson Bruce
Published: August 2002

Dependence on alcohol or other drugs is a depressing experience. The way of life of the individual who is dependent on alcohol is replete with incidents that are demoralising, waking daily with a hangover or with tremor and retching, coupled with amnesia for events of the night before, a sense of inability to face the day ahead and awareness of recriminations at work and at home. Little wonder that depressed mood is common in such circumstances. Similarly, the drug addict, when life is dominated by the daily problem of obtaining supplies of a substance that brings transient relief or pleasure but also experiences of an impoverished existence and low mood. Add to this the fact that the biological action of many commonly misused substances can induce depression then it is hardly surprising that depression is common in this population. There are also a smaller number who use alcohol or illicit drugs to cope with primary depression. Teasing out the interplay of affect and substance misuse is a challenge for the general psychiatrist and the addiction specialist.
Therapeutic communities
Authors: Campling Penelope
Published: August 2002

The term ‘therapeutic community’ is usually used in the UK to describe small cohesive communities where patients (often referred to as residents) have a significant involvement in decision-making and the practicalities of running the unit. Based on ideas of collective responsibility, citizenship and empowerment, therapeutic communities are deliberately structured in a way that encourages personal responsibility and avoids unhelpful dependency on professionals. Patients are seen as bringing strengths and creative energy into the therapeutic setting, and the peer group is seen as all-important in establishing a strong therapeutic alliance. The flattened hierarchy and delegated decision-making are sometimes misunderstood as anarchy by outsiders. However, staff in modern therapeutic communities are deeply aware of the need for strong leadership and their responsibility to provide a safe ‘frame’ for therapeutic work (Association of Therapeutic Communities, 1999).
Very brief dynamic psychotherapy
Authors: Aveline Mark
Published: August 2002

The practice of brief psychotherapy is a distillate of the active ingredients in longer-term work but with the addition of two special elements: limited time and therapist activity in formulating a focus and focusing on it. Typically, patient and therapist work together over 10 to 25 sessions in weekly meetings. In very brief dynamic psychotherapy (VBDT), the time frame is shrunk to fewer than 10 sessions, sometimes just a single session; the constraint means that there is less room for corrective manoeuvre in order to achieve the therapeutic task of maximum benefit and minimum harm in the time available. To do this well requires knowledge, skill and sensitivity. In this paper, special attention is paid to a ‘three-plusone’ intervention (brief intervention and followup (BRF)) that has been tested in a randomised controlled trial (RCT).
Decision-making competence in adults: a philosopher's viewpoint
Authors: Dickenson Donna
Published: August 2002

What does it mean to respect autonomy and encourage meaningful consent to treatment in the case of patients who have dementia or are otherwise incompetent? This question has been thrown into sharp relief by the Law Lords' decision inR.v Bournewood Community and Mental Health NHS Trust, ex parte L(1998). The effect of the Law Lords' ruling in the Bournewood judgment is to reinforce problematic and serious anomalies in the way we view patients whose competence is in doubt because of their mental disorder. Others, such as relatives and informal carers, are frequently allowed to decide on behalf of adults whose competence is doubtful in a way that English law generally abhors, even for totally incompetent patients in a persistent vegetative state. This raises profound questions about autonomy. And incompetent adults' consent to treatment is not required to be of the same quality as it is for the rest of us: mere absence of resistance will do. This paper will explore the philosophical, jurisprudential and legal implications of this difference. Throughout I will be more concerned with the ramifications of a finding of incapacity than with how such a finding is made (for the latter, see such classic texts as Applebaum & Roth (1982), Grisso & Applebaum (1998) and Bellhouseet al(2001)).
Somatising in children and adolescents. 2. Management and outcomes
Authors: Eminson D. Mary
Published: August 2002

In this paper I outline the assessment, engagement and management of children and adolescents with somatising conditions. The major diagnostic groups, in rough order of prevalence, are adjustment, dissociative (transient and chronic), somatoform and factitious disorders and chronic fatigue. See Eminson (2001) for more detailed descriptions and subtypes.
Management of victims of stalking
Authors: Pathé Michele , Mullen Paul E. , Purcell Rosemary
Published: August 2002

Victims of stalking are a diverse group, but most individuals who are subjected to the persistent pursuit of a stalker, regardless of age, gender or socioeconomic background, experience fear. Some suffer profound distress and lifestyle disruptions, and many experience a decline in their psychological and physical well-being. Stalking is not uncommon in today's society and there is evidence to suggest its incidence is increasing (Budd & Mattinson, 2000). It is therefore anticipated that the victims of these behaviours will be presenting to law enforcement and health professionals in ever-expanding numbers. The efficacy of the interventions they receive will determine whether they can reclaim their lives and premorbid functioning or whether, through ignorance, they are condemned to continuing torment and chronic disability, to the detriment of society as a whole.
Murmurs of discontent: treatment and treatability of personality disorder
Authors: Adshead Gwen
Published: August 2002

“They murmured, as they took their fees ‘There is no cure for this disease’.”

Hilaire Belloc

Treatability is a confused and confusing concept in psychiatry. In its legal sense, it is a measure that limits the involuntary admission of patients with some particular types of mental disorder. The legal term itself has generated considerable discussion and dissent (e.g. Mawson, 1983; Grounds, 1987), and the Government's White Paper on reforming mental health legislation in England and Wales proposes to abolish it (Department of Health, 2000).
Problem-solving treatment in general psychiatric practice
Authors: Mynors-Wallis Laurence
Published: August 2002

The role of the general adult psychiatrist has changed significantly over the past decade. There is a focus (almost exclusively in some cases) on the management of patients with severe mental illness. Within the multi-disciplinary team, the key role of the psychiatrist is often perceived as the management of medication, making decisions about clinical risk and acting as gatekeeper to often restricted in-patient beds. Psychological and social interventions are commonly seen as the remit of other members of the team. Although psychiatric training should equip psychiatrists to have at least a reasonable understanding and practical knowledge of psychological treatments, many consultants in their day-to-day practice do not have sufficient time to utilise such treatments. These factors brought together result in a situation where the practice of many general adult psychiatrists is almost exclusively the treatment of patients with severe illness and within the treatment of such patients, psychiatric practice is much more about medication and risk management than the personal implementation of psychological interventions.
Psychiatry in the renal unit
Authors: Phipps Andrew , Turkington Douglas
Published: August 2002

Consultation–liaison psychiatry in renal medicine provides a unique experience for the psychiatrist. There is the opportunity to work with a specialist multi-disciplinary team managing patients with chronic and complex physical problems in in-patient and out-patient settings. We aim to consider the common psychiatric problems experienced by renal patients and the particular problems that face the renal team and the liaising psychiatrist in relation to assessment and treatment.
Delirium: the role of psychiatry
Authors: Meagher David
Published: August 2002

Acute mental disturbance associated with physical illness is well described in early medical literature, but it was not until 1 AD that Celsus coined the term ‘delirium’ (Lindesay, 1999). Although delirium has many synonyms that are applied in particular clinical settings (Box 1), all acute disturbances of global cognitive functioning are now recognised as ‘delirium’, a consensus supported by both ICD–10 (World Health Organization, 1992) and DSM–IV (American Psychiatric Association, 1994) classification systems. Delirium is a complex neuropsychiatric syndrome that typically involves a plethora of cognitive and non-cognitive symptoms, resulting in a broad differential diagnosis dominated by mental disorders. Psychiatrists' skills in assessing cognitive function and psychopathology, coupled with their knowledge of psychotropic agents, make them well suited to improving detection, coordinating management and facilitating research into this understudied disorder.
Administering medicines to patients with dementia and other organic cognitive syndromes
Authors: Treloar Adrian , Beck Sarah , Paton Carol
Published: August 2002

At present, the elderly constitute 18% of our population but receive 45% of prescribed drugs (Royal College of Physicians, 1997). Many patients (78%) receive medication via a repeat prescription system and for approximately a quarter of prescriptions written for this age group, patients have not seen their doctor for over a year. A substantial proportion of the elderly live not in their own homes but in residential or nursing homes, and a small number live hospital. Prescribing and administering medicines poses different problems in each of these settings.
Part-time training and working for male and female psychiatrists
Authors: Cremona Anne , Etchegoyen Alicia
Published: August 2002

Part-time training and working have become popular acceptable options for both male and female psychiatrists, regardless of age. There are a number of reasons for this, the most common being family commitments such as those to children or elderly relatives, but also including personal ill health, wanting to reduce stress and prevent burn-out, wanting to pursue different priorities, portfolioworking or simply trying to achieve a better quality of life. The importance of providing flexible working patterns has been emphasised by the Department of Health (1998) in Working Together – Securing a Quality Workforce for the NHS.
The role of psychodynamic psychotherapy in a modern general psychiatry service
Authors: Hook John
Published: August 2002

The relationship between psychiatrists and psychotherapists is a complicated one. It has become no easier as mental health services have come under increasing strain over recent years, with pervasive bureaucratisation and the introduction of market forces. I aim in this article to elucidate the roles that a psychodynamic psychotherapy service can play as an integral part of a general psychiatric service in addition to its specialist treatment functions. I also explore some of the reasons why psychotherapy and general psychiatric services are still not fully integrated, thus failing to provide the most effective range of treatments and enhance the effectiveness of mental health staff in all settings in the delivery of those treatments.
Premenstrual syndrome: an update on definitions, diagnosis and management
Authors: Connolly Moira
Published: August 2002

Most articles on the management of the premenstrual syndrome (PMS) begin by noting that the term “premenstrual tension” was first coined by R. T. Frank in 1931 and “pre-menstrual syndrome” by Greene & Dalton in 1953. However, in 1847, Dr Ernst F. von Feuchtersleben wrote:

“The menses in sensitive women is almost always attended by mental uneasiness, irritability and sadness.” (quoted by Rubinow & Schmidt, 1995)
Principles of managing patients with personality disorder
Authors: Davison Sophie E.
Published: August 2002

The management of individuals with personality disorder is one of the most challenging and sometimes controversial areas of psychiatry. This paper describes the principles involved in identifying the clinical problems and formulating a management plan for patients with personality disorder in everyday clinical practice. It demonstrates that the principles of assessing and managing personality disorders and the clinical skills required are no different from those of treating any other chronic mental disorder.
Dialectical behaviour therapy for borderline personality disorder
Authors: Palmer Robert L.
Published: August 2002

The concept of borderline personality disorder (BPD) seems to include, almost by definition, the idea that people described by the term are difficult to help. The broad picture portrayed by the diagnostic criteria (Box 1) is likely to be familiar to most clinicians and to cause the hearts of many to sink. A core issue for those with BPD is difficulty of relationship, and this will inevitably – even especially – include clinical and therapeutic relationship. It is all too common for distress to be met with much therapeutic effort but for little to change. Indeed, there is often a nagging sense that attempts at treatment may be making matters worse. The care of people with BPD presents an important challenge to mental health services. At the individual level, the patient continues to be at risk and to suffer and the clinician feels frustrated. At the service level, substantial resources may be expended to little apparent benefit.
Psychosocial costs of war in Rwanda
Authors: Palmer Ian
Published: August 2002

The extraordinary events of 1994 in Rwanda touched the world, and the extent and brutality of the atrocities committed scarred it (Anderson, 1998). There are no simple explanations or solutions for such human tragedy. Societies are shattered by war, and societal interventions are required to heal the physical and psychological wounds. The final outcome of such interventions is, however, difficult to predict. Psychiatric involvement in Rwanda's suffering has been small and examination of the literature reveals a paucity of data. Most of the data that are available are qualitative, as that is the only way of understanding what happened. Everyone involved in Rwanda in 1994 was changed by their experiences. Rwanda was a catastrophe.
Mental illness in Black and Asian ethnic minorities: pathways to care and outcomes
Authors: Bhui Kamaldeep , Bhugra Dinesh
Published: August 2002

A substantial body of research indicates that, for people from Black and Asian ethnic minorities, access to, utilisation of and treatments prescribed by mental health services differ from those for White people (Lloyd & Moodley, 1992; for a review see Bhui, 1997). Pathways to mental health care are important, and the widely varying pathways taken in various societies may reflect many factors: the attractiveness and cultural appropriateness of services; attitudes towards services; previous experiences; and culturally defined lay referral systems (Goldberg, 1999). Contact with mental health care services may be imposed on the individual, but people who choose to engage with services usually do so only if they think that their changed state of functioning is health-related and potentially remediable through these services. In such cases, they will contact whoever they perceive to be the most appropriate carer, and these carers are often not part of a national health care network.
Role of dynamic group therapy in psychiatry
Authors: Montgomery Charles
Published: August 2002

Group psychotherapy is one of the most widely practised treatment methods in psychiatry, with an extensive literature, but it has long been regarded as the poor relation to individual therapy. Nineteenth-century ideas about the primacy of the individual, taken up by psychoanalysis, continue to dominate Western culture. Mrs Thatcher's famous remark “I don't believe in society. There is no such thing, only individual people, and there are families” (Women's Own, 31 October 1987) typifies the extreme view in which the self and the individual's needs are paramount and are set above those of the group. Foulkes in the 1950s had put forward the opposite position, arguing that there is no such thing as an individual that exists apart from and outside the social (Foulkes, 1948; Foulkes & Anthony, 1957).
Nicotine addiction and smoking cessation treatments
Authors: Luty Jason
Published: August 2002

It is estimated that 29% of adults in the UK smoke (Office for National Statistics, 2000). Each year smoking kills 120 000 people (13 deaths per hour), making it the single most common preventable cause of death in Britain (Callum, 1998). Around half of all smokers will die prematurely because of their addiction (Petoet al, 1994). Their overall life expectancy is, on average, 8 years less than for non-smokers (Callum, 1998). Smoking also costs the National Health Service (NHS) £1500 million, with around 1000 admissions every day for smoking-related illnesses (Parrottet al, 1998). (However, the UK treasury earns £8 billion in tax on tobacco sold in the UK alone, in addition to the enormous revenue from overseas markets.)
Use of atypical antipsychotic drugs in old age psychiatry
Authors: Bouman Walter Pierre , Pinner Gill
Published: August 2002

Antipsychotic drugs are among the most widely prescribed psychotropic medications for elderly people, particularly for the 5–8% of patients who are in institutions. The antipsychotics are indicated for treating psychotic disorders, including schizophrenia, delusional disorder, psychotic symptoms in mood disorders and for a number of organic psychoses.
Home assessments in old age psychiatry
Authors: Richardson Barbora , Orrell Martin
Published: August 2002

“For people to be successfully supported at home, a comprehensive assessment is an essential first step.” (Audit Commission, 2000: p. 43.)

Home visits by old age psychiatrists remain popular with elderly patients, their carers and general practitioners (GPs). Home assessments by various disciplines working with older people have been endorsed as a sign of good practice by the Audit Commission (2000) in their recent national report on mental health services for older people:

“Assessment at home is often better as people are most likely to behave and communicate in their normal way in familiar surroundings. Staff can also build a more accurate picture of people's needs and learn the views of their carers. Professionals can observe whether there is adequate food in the house, whether people can make themselves a hot drink, and whether there are any likely risks from poor hygiene or fire hazards.” (Audit Commission, 2000: p. 43.)
Management of sexually abused children with learning disabilities
Authors: Allington-Smith Pru , Ball Richard , Haytor Ruth
Published: August 2002

Children who have a learning disability are at increased risk of sexual and physical abuse and neglect. They and their families are more likely to be socially isolated and to suffer material and emotional poverty. The range of emotional reactions in carers can vary at different times from extreme overprotection, through relative equanimity, to sometimes outright hatred and rejection of the child. Society largely reflects this, only rarely viewing the individual with learning disability in a positive way, choosing often to pity, patronise, ignore, ridicule or openly despise. These attitudes are internalised by children with the disability, who invariably suffer from low self-esteem. All of these factors combine to facilitate abuse.
Clinicians' guide to reading psychiatric literature: therapeutic trials and systematic reviews
Authors: Warner James
Published: August 2002

Getting to grips with critical appraisal is not easy. To some extent, it is a metaphorical bandwagon, overloaded with dogma, misinformation and mathematics. Its introduction into the MRCPsych curriculum (Royal College of Psychiatrists, 2001) has left many trainers trying to catch up with their trainees' skills. This paper attempts to demystify some of the concepts, provide a balanced overview of the advantages and drawbacks of critical appraisal, and discuss ways of developing skills in critical appraisal.
Treating anxiety complicated by substance misuse
Authors: Lingford-Hughes Anne , Potokar John , Nutt David
Published: August 2002

The relationship between anxiety disorders and substance misuse is intimate. Here we concentrate on alcohol, although for completeness we also briefly mention other substances taken for anxiety relief or that cause anxiety.
Delivering psychiatric care to prisoners: problems and solutions
Authors: Reed John
Published: August 2002

‘In some few jails are confined idiots and lunatics, –many of the bridewells are crowded and offensive, because the rooms which were designed for prisoners are occupied by lunatics. The insane, when they are not kept separate, disturb and terrify other prisoners. No care is taken of them, although it is probable that by medicines, and proper regimen, some of them might be restored to their senses, and usefulness in life’ (Howard, 1784: pp. 10–11).
Psychodynamic work and older adults
Authors: Garner Jane
Published: August 2002

Man can change and go on changing as long as he lives (Horney, 1942)
Comprehensive health care services for people with learning disabilities
Authors: Lindsey Mary Patricia
Published: August 2002

Comprehensive health care services respond effectively to the needs of their patients not just in terms of treatment of health problems but also by addressing overall well-being by understanding, informing, involving, counselling and respecting the individual. By contrast, the history of health care for people with learning disabilities has been characterised by a lack of communication and poor understanding of their ordinary and special needs. There have been many barriers to access to health services that most members of the population take for granted. In addition, people with learning disabilities have many special health care needs that also have to be addressed. Therefore, person-centred services must be aware of the wide range of needs to which they must be able to respond while treating each person as an individual (see Box 1).
Solution-focused brief therapy
Authors: Iveson Chris
Published: August 2002

Solution-focused brief therapy is an approach to psychotherapy based on solution-building rather than problem-solving. It explores current resources and future hopes rather than present problems and past causes and typically involves only three to five sessions. It has great value as a preliminary and often sufficient intervention and can be used safely as an adjunct to other treatments. Developed at the Brief Family Therapy Center, Milwaukee (de Shazer et al, 1986), it originated in an interest in the inconsistencies to be found in problem behaviour. From this came the central notion of ‘exceptions’: however serious, fixed or chronic the problem there are always exceptions and these exceptions contain the seeds of the client's own solution. The founders of the Milwaukee team, de Shazer (1988, 1994) and Berg (Berg, 1991; Berg & Miller, 1992), were also interested in determining the goals of therapy so that they and their clients would know when it was time to end! They found that the clearer a client was about his or her goals the more likely it was that they were achieved. Finding ways to elicit and describe future goals has since become a pillar of solution-focused brief therapy.
The female psychiatrist: professional, personal and social issues
Authors: Kohen Dora , Arnold Elaine
Published: August 2002

In recent decades the professional life of the psychiatrist has become increasingly difficult. Several reports have highlighted the problems, which lead to disenchantment, low morale, sick leave, anxiety, depression and even early retirement (Ramirez et al, 1996; Kendell & Pearce, 1997; Pattani et al, 2001). Changes in the National Health Service (NHS), the difficulties in daily practices, the climate of litigation and the culture of blame have all contributed to an atmosphere where lack of empathy and appreciation has become the norm.
Use of cholinesterase inhibitors in dementia
Authors: Holden Mark , Kelly Cornelius
Published: August 2002

Alzheimer's disease is the most common cause of dementia in older people, with about half a million people affected in the UK. Its effects are devastating and far-reaching for sufferers, their carers and society in general – the Audit Commission estimated the annual cost of dementia care for 1998–1999 at £6.1 billion (Audit Commission, 2000). There is no cure and it is terminal within 3 to 7 years of diagnosis. Given an estimated doubling of dementia cases over the next 50 years (Melzer et al, 1997), the burden of care is set to increase substantially.