bluuebunny/crossref_metadata_2025 huggingface dataset:
Psychiatry and religion: A general psychiatrist's perspective
Authors: Cox John L.
Published: October 2008

This paper contributes to a debate about the nature of religious belief and its relevance for the practice of psychiatry. The need for dialogue is recognised not only because of multi-faith UK society but also because mental health services are now more tailored to the expectation of patients. To understand the possible relevance of spiritual and existential dimensions to mental illness, even in a secular society, has become more necessary. Training, service delivery and research issues are briefly addressed.
Epilepsy in the mentally handicapped: A hospital survey
Authors: Amaladoss A.S.P. , Arumainayagam M.
Published: October 2008

A survey of the medical management of 75 mentally handicapped in-patients with epilepsy was carried out between June and December 1991. The study focused on the number and type of anti-epileptic drugs used, the frequency of monitoring of serum anti-epileptic drug levels and the nature and frequency of other blood tests carried out. Quality standards were then agreed and the survey repeated a year later. The results show that the agreed standards were generally achieved, although a large number of patients continued to receive more than one type of anti-epileptic drug.
The films of Wim Wenders
Authors: Spence Sean A.
Published: October 2008

For the devotee of Wim Wenders, the German film director, London was the place to be this summemr. The National Film Theatre showed all his films, his latest (‘Far Away, So Close’) opened, and the full five hour cut of Until the End of the World’, was shown in July.
‘Health of the Nation’: measuring mental health outcomes
Authors: Wing John , Curtis Roy , Beevor Anne
Published: October 2008

Two years ago, the government set out a strategy for improving health in ways that can be measured. Health of the Nation set down specific targets, including those for reductions in death rates from heart disease, cancer and accidents. For mental health, targets are more difficult to specify. The goal the government set is “to improve significantly the health and social functioning of mentally ill people”.
Consent to medical treatment and people with learning disability
Authors: Curran Jenny , Hollins Sheila
Published: October 2008

For those people who have the cognitive and social impairments described as a learning disability, personal choice is more often than not a limited experience, (Mencap, 1989). Simple choices may be usurped by the preferences of carers, and more serious decisions may be correctly or incorrectly deemed beyond their capacity. We will address two questions which repeatedly face clinicians working with adults with learning disabilities. First, how do we ascertain a person's level of competence to give consent in relation to medical treatment? Second, in the case where a person with learning disability is considered unable to give informed consent to treatment, how do we proceed to make a decision regarding treatment?
Proposed new legislation for the care of mentally ill people in the community
Authors: Hampson S. , Davison P.
Published: October 2008

The Department of Health has published proposals for new legislation, which it hopes will provide a legal basis for effective community care of mentally ill people. Consultant psychiatrists and approved social workers were surveyed to determine attitudes towards the proposals. Despite the impression that new powers are provided, respondents saw little in the way of new powers, and could not see how the proposals would improve community care. Not all of the proposals were fully understood, and wider consultation with those who would be using any new legislation is recommended.
Attitudes towards mental illness and the elderly
Authors: Cohen Robert , Kennard David , Pitt Brice
Published: October 2008

Views of the elderly were obtained from a cross-section of the public using 12 semi-structured interviews in the form of stratified group discussions. As a group, the elderly were generally thought of in negative terms. Furthermore, they were held partly responsible (or their perceived status, in particular by falling to keep physically active and to avoid mental deterioration and depression which were not considered conditions requiring treatment. In contrast, Alzheimer's disease was recognised as a disease, and sympathy was expressed for patient and carer. It was expected that responsibility for caring for the elderly mentally ill should pass to the State once the burden on carers became intolerable.
Issues in clinical practice in a South Asian Muslim community
Authors: Sheikh A. Jawad , Farooq Saeed
Published: October 2008

The bulk of transcultural research has concentrated on particular themes, which include parasuicides among British Asian women, schizophrenia among Afro-Carribeans, and clinical presentation of somatisation in different races (Littlewood & Lipsedge, 1989). The focus has largely been on clinical patterns of illness and the social determinant of distress as experienced by ethnic minorities in the community remains largely neglected. An attempt has been made, after two years experience of working in a Birmingham city catchment area with an Asian Muslim community, to highlight day to day cultural issues which directly or indirectly contribute to psychiatric morbidity.
A treatment service for adolescent sex offenders
Authors: Will David
Published: October 2008

A case-note survey was carried out on the first 50 referrals to a treatment service for adolescent sex offenders. The average rate of referral was 10.5 per year and all referrals were male. of those who attended, 66% showed evidence of psychiatric morbidity, while only a minority had a past history of child sexual abuse. The majority had offended against victims known to them. Treatment was labour-intensive with a mean of 19 sessions being provided per patient. of those taken on for treatment, 2.6% re-offended, while of those not offered treatment, 25% did so.
Eating disorder referrals to a district adult psychiatric service
Authors: Bray J.C. , Simon A. , Dawson S. , Palmer R.L.
Published: October 2008

This paper documents the rate of referral to an eating disorders service for adults which predominantly serves a large defined catchment area. It also defines the proportion of all new patients which presented with such disorders. People with eating disorders amounted to about one in ten of young women and one in 30 of all patients presenting to psychiatric services for the first time.
Broken Glass
Authors: Kemp Roisin
Published: October 2008

Is it possible for a Jewish woman in 1938 New York to develop hysterical paralysis of her legs in response to events in Nazi Germany? And how much are her symptoms a reaction to longstanding difficulties in her marriage to a man who is impotent, autocratic, subject to sporadic violent rages, and uncomfortable with his Jewish identity? Is it appropriate for an honest play which explores issues of prejudice, oppression, tryanny, and genocide to be simultaneously humorous and entertaining? What if at the end one feels almost as moved by the miserable (and dead) husband as the heroine, who finds the power to walk again only when her husband expires? These are the difficult questions posed by Arthur Miller in Broken Glass, his latest play recently in repertory at London's National Theatre. The weighty themes are leavened by the hallmark wry humour, sparkling dialogue and deft characterisation.
Psychiatry past and present in the Russian territory of Primor'e
Authors: Alekseyev S.A.
Published: October 2008

Primor'e is a former Soviet colonial area in the Far East. It is now part of free Russia's national parkland, rich in flora and fauna. In the present chaotic period of transition to a market economy, business leaders from Japan, China and Korea have rushed in to develop its potential.
Who works with adult victims of childhood sexual abuse?
Authors: Macpherson Rob , Babiker Isam
Published: October 2008

A survey of mental health professionals in a Bristol NHS trust found that most had experience of therapeutic work with sexually abused patients and over half were currently engaged in such work. Supervision was variable and often considered inadequate. Few responders routinely enquired about historical abuse in the course of psychiatric assessment. The findings indicate a need for agreed strategy involving training, supervision and inter-agency co-operation to deal with this increasingly common problem.
An introduction to computer diagnosis in psychiatry
Authors: Morgan Janice , Sireling Lester
Published: October 2008

The concept of computer diagnosis in medicine is not new. As early as 1971, a computer program was demonstrated to be more accurate than a senior clinician at diagnosing acute abdominal pain before surgery. In psychiatry, however, the problems surrounding diagnosis and classification are more complex than in other branches of medicine, depending as they do on the clinical interview and some agreed classificatory system in the absence of external validating criteria. Reliability has been improved by the application of standardised interview techniques and by the use of operationalised diagnostic criteria but such tools are lengthy and their use requires specialist training. Consequently they tend to be reserved for research purposes rather than routine clinical use. The potential contribution of computer technology to the vexed question of psychiatric diagnosis is here evaluated.
Care programme approach: the experience in Bath
Authors: Broughton Maria , Divall Paul
Published: October 2008

The care programme approach was developed to ensure that patients in the community receive the health and social care they need. It pre-empted the philosophy and practice of care management and can form the core. There are several strengths to this approach in that it permits a response to individual needs that may change over a period of time, and co-ordinates the contribution of all care agencies to make effective use of the available resources.
NHS trusts
Authors: Weich Scott
Published: October 2008

The present paper reviews the restructuring of the NHS that has taken place since 1991, with particular reference to the introduction of self-governing NHS trusts. Established to strengthen the financial management of NHS assets and to contain costs, NHS trusts represent a political solution to the problem of health service funding. Despite the speed of the reforms, there is no evidence yet of any improvement in the cost-effectiveness of resource deployment, and it is too soon to say what effect trusts will have on mental health services. Concern remains that the present reforms will ultimately lead to fragmentation of the NHS.
Psychological aspects of disorders of the eye
Authors: Brook Alexis , Fenton Peter
Published: October 2008

This paper gives an overview of the first year of a project in which a psychoanalytic psychotherapist worked with the staff of the ophthalmic department of a general hospital to study some psychological aspects of disorders of the eye. The purpose was to see whether semi-structured interviews based on psychoanalytic insights could increase our understanding of the disorder and, if so, how this understanding might be used to help the patient.
Choice of antidepressants by psychiatrists working with old people
Authors: Wattis John , Bentham Peter , Bestley John
Published: October 2008

In 1992, 46 consultants in old age psychiatry were asked to list their five most frequently used antidepressants, with reasons for their choices, and to comment on an information set for evaluating an antidepressant for use in older people. Lofepramine tied with dothiepin as the most popular antidepressant. The relatively new selective serotonin reuptake inhibitors (SSRis) were also widely used. Cardiovascular safety, lack of anticholinergic side effects and safety in overdose were important factors in choice. Some antidepressants were preferred for particular symptoms or circumstances. A modified information set for evaluating an antidepressant for use in older people is presented.
The role of the psychiatrist in learning disability
Authors: Bernard Sarah H. , Bates Rosalind E.
Published: October 2008

This study assessed, by postal questionnaire, how the role of the psychiatrist in learning disability is perceived by general practitioners. One hundred and forty-six GPs were questioned on various aspects of assessment and management that the psychiatrist in learning disability might be involved with; 43.5% of questionnaires were returned. The results indicated that confusion continues. The psychiatrist was perceived as having a global role in the care of this group of patients with lack of knowledge of community teams for learning disability being evident. Further education at a primary care level is indicated.
Detoxification in a community-based alcohol recovery unit and psychiatric department of a general hospital
Authors: Mortimer Ruth , Edwards J. Guy
Published: October 2008

The experience of detoxification and satisfaction of patients with their treatment in a community-based alcohol recovery unit established by a voluntary organisation and in a psychiatric unit in a general hospital were assessed with the help of a structured questionnaire. Patients admitted to the two units were satisfactorily matched on most, although not all, variables. The types of withdrawal symptoms and lengths of stay were similar. No patient was transferred to hospital from the community facility. Patient satisfaction was greater in the detoxification unit where the cost of treatment was about a third of that in the psychiatric unit.
Community care plans and the Mental Illness Specific Grant
Authors: Doodson Jeff , Davies Sara
Published: October 2008

Mental Illness Specific Grant was made available to local authorities for the care of people with severe mental illness, as part of care in the community. Although only a small sum of money it has had the effect of giving the newly created community care planning system a boost start. It has enabled professionals from all agencies to see tangible benefits from collaborative working. MISG is time limited but has already shown that health and social services can work together to make a reality of community care.
Fund-holding general practices and old age psychiatry
Authors: Fear Christopher F. , Cattell Howard R.
Published: October 2008

In a retrospective study, referrals to a community old age psychiatry service were obtained for local practices a year before and a year subsequent to the introduction of prospective general practitioner (GP) fund-holding. Although overall patterns of referral were the same, there was a significant reduction in domiciliary consultations requested by fund-holding GPs which was not balanced by a rise in other referrals. The findings suggest a shortfall in the number of referrals to old age psychiatry services in the light of GP fund-holding, prompting speculation as to the fate of those who would otherwise have been referred.
‘A ward in a street’
Authors: Kaye N. , Khoosal D.I.
Published: October 2008

Attempts to deliver quality service outside the traditional mental hospital to those with chronic mental illness have resulted in several new models of care. We describe one such model of alternative care and asylum. Considerable improvements in quality of life, quality of care and clinical state occurred.
The use of electroencephalography in an in-patient mental handicap population
Authors: Puri B.K. , Tamrazian S. , Duffield G. , Singh I.
Published: October 2008

The use of electroencephalography over a three year period in a large mental handicap hospital was studied. There were no significant differences in its use according to sex or intelligence. The majority of requests were made following seizures and in the investigation of behavioural abnormality. In over a quarter of cases the EEG requests appeared to be inappropriate. It is suggested that a more cost-effective use would result if EEGs were requested only in those cases in which the result will lead to a change in the management of the patient.
General practice training for psychiatrists
Authors: Burns Tom , Silver Trevor , Freeling Paul , Crisp Arthur
Published: October 2008

Eighteen psychiatric trainees from St George's Hospital were placed in three local general practices for periods of six months each. The aim was to broaden their postgraduate education by an experience of primary care and to test the feasibility of such a scheme. Their assessments of the placement were canvassed by postal questionnaire. All considered the experiment a success but there were a number of problems. Resistance among the trainees was much greater than expected. Some of the relationships in practice posed problems for them and the ongoing demands of their psychiatric training exceeded the practices' expectations. Supervision by the GP trainers was rated very highly and old knowledge returned rapidly.
Working with the media
Authors: Casey Patricia
Published: October 2008

Professor Patricia Casey of University College, Dublin explains why it is worth risking the microphones and phone-ins
The dilemma of the forensic psychiatrist
Authors: Adshead Gwen , Smith Jeanette
Published: October 2008

Forensic psychiatrists have particular ethical duties in relation to the protection of the public, which few other doctors have. Part of the fulfillment of that duty is the assessment of risk, upon which many ethical decisions rest. But comprehensive risk assessment may require information which is not available, leaving the forensic psychiatrist in a dilemma between her duty to the patient and to the public. This case history is based on a real case.
Grief counselling for bereaved families with children
Authors: Ubeysekara A.
Published: October 2008

The effects of losing a loved one through death on the physical and mental health of both adults and children are well documented in the literature. Children are likely to be referred to mental health professionals for various behaviour and emotional problems which may have a causative link with a bereavement within the family. In this paper I discuss the need for preventive work and, propose a role for child psychiatric services in preventive work for bereaved families with surviving children and adolescents. A ten-point plan is suggested as a guideline.
What do we think about our training?
Authors: Castle David , Reeve Anne , Ivinson Louise , Hampson Simon
Published: October 2008

A working party of the Collegiate Trainees' Committee of the Royal College of Psychiatrists sent a questionnaire to all trainees taking Part II of the MRCPsych examination in October 1992, asking about their satisfaction with various aspects of their training. Almost 70% rated their training as ‘good’ or ‘excellent’, but specific areas showed wide variation. Cognitive/behavioural psychotherapy, family therapy, research, the management of dangerous patients and the use of ECT were all highlighted as areas in need of Improvement. The working party make recommendations in the light of these findings.
Four years experience of a monthly training committee
Authors: King Keren , Kerr E. Angela
Published: October 2008

The remit of our monthly training committee is to facilitate and audit postgraduate training. A clear remit, attention to the organisation and composition of the committee and clear links with other committees have helped us in our aims. Input to the committee from consultants, management and trainees are all essential to the maintenance of high training standards, particularly in a period of rapid change in the health service. The achievements and future plans of the committee are discussed.
Ethics and resource allocation: can health care outcomes be QALYfied?
Authors: Oyebode Femi
Published: October 2008

This paper discusses the theoretical foundation of QALY and examines the assumptions which underlie these theories. It argues that there are methodological flaws in the construction of QALY and that there are inherent risks in its possible application to psychiatry. It also draws attention to fundamental ethical problems with the concept of QALY as a tool for valuing the quality of life or well-being of persons.
The pattern of delays in Mental Health Review Tribunals
Authors: Blumenthal Stephen , Wessely Simon
Published: October 2008

Mental Health Review Tribunals (MHRTs) are intended to protect the liberty of the detained patient. In practice, however, they have been said to fall short of providing this safeguard. This is frequently for administrative reasons. We report a systematic examination of the pattern of delays in holding MHRTs. Our main finding is that delay cannot be attributed to a single factor but rather reflects the inherent complexity of some cases.
Senior registrar training in home treatment
Authors: Smyth Marcellino , Bracken Pat
Published: October 2008

We offer an account of training experience within an inner city service dedicated to home treatment as an alternative to hospital admission for acute psychiatric illness. The Ladywood service in Birmingham is described and the challenges and opportunities for trainees outlined. A dominantly institutional based training seemed to us deficient, after this exposure. We regarded home treatment very positively and felt that it enriched our professional development in both clinical and conceptual terms.
A writer's madness exposed
Authors: Kemp Roisin
Published: October 2008

Roisin Kemp explores the fact and fiction behind Guy de Maupassant's Le Moria
Trainees' Charter
Authors: Cox John , Davies Steffan
Published: October 2008

The College since its inception has striven to ensure the highest standards of psychiatric training and education. We are aware, however, that these training recommendations are not as widely known as we would like. The objective of the Collegiate Trainees' Committee Trainees' Charter is to disseminate as widely as possible a brief document on training that draws together strands from other documents including the Statement on Approval of Training Schemes for General Professional Training for the MRCPsych. This Charter has the fun support of the Court of Electors. The intention is to raise awareness about training problems and encourage trainees to be more proactive in ensuring that their training needs are met. Only by providing the best possible level of postgraduate training can we ensure the standard of patient service we would wish and the public increasingly expect.
Local authority planning for the mentally disordered offender
Authors: Elverstone J. , Cameron Angus , Taylor Pamela J.
Published: October 2008

As part of a project designed to assess the impact of the NHS and Community Care Act 1990 upon the care of patients discharged from special hospitals, an attempt was made to obtain local authority community care plans. The difficulties encountered during this exercise and the level of planning obtained for the mentally disordered offender as identified in those plans, may be a cause for concern to all those working in this field.
Antidepressant prescribing among referrals to a community mental health unit in New Zealand
Authors: Thomson Robert J.
Published: October 2008

This study involved a case-note review of referrals to community psychiatric services in a university town in New Zealand. About one third of all 163 patients referred were taking antidepressants for depression; of these one third were taking therapeutic doses, with the remainder taking inadequate doses. This tends to confirm the findings of other studies that have identified problems relating to GP prescribing of antidepressants.
Acquired cognitive impairment in the presenium
Authors: Baldwin R.C.
Published: October 2008

In a catchment area survey, 43 patients with cognitive impairment acquired in the presenium associated with behavioural or social dysfunction, or both, were identified. Twelve of 18 carers were also interviewed. The patients were mainly in their 50s, had a high prevalence of behavioural as opposed to cognitive disorder, were frequently taking psychotropic drugs and had disorders which were largely progressive. Those living at home were as disabled as those living in residential settings. Carers were stressed but uncomplaining. The findings suggest that psychiatrists, perhaps especially old age psychiatrists, have an important role in developing services for this neglected group of people.
An ethical dilemma in psychotherapy
Authors: Holmes Jeremy , Adshead Gwen , Smith Jeanette
Published: October 2008

This paper examines the ethical principles of justice and autonomy in psychotherapy. A case history is presented which illustrates how ethical dilemmas concerning the type of psychotherapy to be offered are powerfully influenced by often unconscious counter-transference feelings in the resource allocators. The question of how autonomous a psychotherapy patient can be, when unconscious motivations could be affecting rational choice, is also explored and possible answers provided.
A trainee's view of basic issues in audit
Authors: Cook Alastair , Langa Arturo
Published: October 2008

The evaluation of medical practice dates back many centuries. However, the concept of systematic medical audit is relatively modern. It is recognised that audit of every area of health services (including that of trainee's work and training) has been taking place. This article briefly discusses some of the basic issues in audit, which include the principles, levels and types of audit, from a trainee's point of view.
Hospital v. community paediatric experience for trainees in child psychiatry
Authors: Duke Sandra
Published: October 2008

The benefits of paediatric experience towards training in child psychiatry are discussed, with emphasis on the differences between hospital and community posts. Proposed reforms to training for hospital doctors are discussed with respect to specialised training in child psychiatry. It is concluded that future training regulations should allow trainee child psychiatrists to benefit from training in hospital and/or community paediatrics.
Street children and volatile substance misuse
Authors: Dunn John
Published: October 2008

Living in London one gets used to seeing teenagers living rough on the streets, sleeping in shop doorways, and begging for money. Similarly in São Paulo and other large cities in Brazil homeless and destitute children are a common sight, but there are several striking differences. First, in Brazil there are many more of them, they are noticeably younger and they are often seen doing some form of job or ‘bicos' to earn money, such as cleaning shoes or car windows, ‘guarding’ cars, and selling small items, e.g. sweets, fruits and flowers. Another important difference is the danger to which these children are exposed. There have been frequent reports, some of which have reached the international media, of street children being massacred by vigilantes (some of whom have links with the police).
A view from the road: experiences in four continents
Authors: Patel Vikram
Published: October 2008

Since graduating from medical school eight years ago, I have had the chance of experiencing clinical psychiatry in four countries on four continents; Bombay and Goa, India, my home, where I trained in medicine and began my psychiatric training; Oxford and London, United Kingdom, where I acquired a taste for academic psychiatry and completed my clinical training; Sydney, Australia, where I worked in a liaison unit in a large general hospital and a community mental health centre; and now, Harare, Zimbabwe, where I am conducting a two year study on traditional concepts of mental illness and the role of traditional healers and other care providers in primary mental health care.
‘Sorry, no beds’: a problem for acute psychiatric admissions
Authors: Hollander D. , Slater M.S.
Published: October 2008

Perceived difficulty in obtaining hospital admission for acute psychiatric patients was investigated in one health region using a self-reporting method. Over 17 months both inner city and rural districts reported a total of 327 episodes of difficulty in finding a bed. One hundred and six (32%) of reported cases could not be admitted, the remainder being admitted to a ‘leave’ bed, a bed booked for another patient, or elsewhere, solutions likely to compromise care. Attempts to locate a vacant bed required numerous telephone calls and led to considerable delays. Thirty-nine (12%) of the patients were described as particularly ill, but five of them absconded during the prolonged search for a bed, and a further 17 had to remain in the community, pending a vacant bed, including two aggressive and eight suicidal patients. Considerable under-reporting was confirmed. Possible consequences of the situation are discussed.
The mental health market
Authors: Ward Paul
Published: October 2008

When introduced into the NHS in 1991, the internal market world off purchasers and providers was greeted with considerable cynicism by many working in the mental health field. Three years on, this cynicism has to a large extent been supplemented by either support or hostility about the changes dependent upon individual experiences. However a more detached analysis suggests a more balanced picture of the impact off the internal market beginning to emerge.
Ethical dilemmas in old age psychiatry
Authors: Oppenheimer Catherine , Adshead Gwen , Smith Jeanette
Published: October 2008

Patients and their relatives sometimes make what to others appear to be unfortunate decisions. In this paper the ethical dilemmas raised by such decisions in the context of old age psychiatry are examined. The case also raises questions about financial responsibility for the care of the elderly and suggests that the health needs of patients can no longer be separated from their financial interests.
Activity in a district psychotherapy service
Authors: Tillett Richard
Published: October 2008

The Royal College of Psychiatrists (1991) has recommended that all local mental health services should include specialist psychotherapy departments. At present these are uncommon outside major teaching centres, although a considerable amount of simple psychotherapy is provided on an ad hoc basis by mental health professionals of various disciplines. This paper describes the structure, functioning and costs of a specialist department in a non-teaching district in the south west of England.
Back to the asylum
Authors: Allen Danny
Published: October 2008

As hospitals close and relocate, our patients are increasingly being moved between different sites and out into the community. A move back to a large institution, however, is rare. This article describes the move of an in-patient facility located in a general hospital to an old psychiatric hospital with which, historically, it did not have very strong links.
Carnival and condoms
Authors: Dunn John
Published: October 2008

Compare the following: “AIDS, Why We Won't Be Silenced.” (Sunday Times, December 1993) and “… sex is an extremely important activity for a person's physical and mental health … wear a condom.” (Folha de São Paulo, February 1994). The first is the now notorious banner headline from the Sunday Times’ self-righteous campaign to “search for the truth” by casting doubt over the causal role of HIV in AIDS. The second is an encouraging and straightforward message from an editorial in an equally prestigious and widely read Brazilian newspaper in the run up to Carnival.
Europe and psychiatric ethics
Authors: van Os Jim , Neeleman Jan
Published: October 2008

European Integration confronts both Individual psychiatrists and psychiatric service planners with ethical dilemmas that should best be dealt with proactively by medical and psychiatric organisations. Selected examples are presented of ethical Issues arising out of differences In psychiatric practice across Europe. Some of the ethical implications may seem relatively minor, but still require a major adjustment effort on the part of psychiatrists who are exposed to transcultural practice In the European Union. Other examples have been selected, not because they are common, but because of their massive ethical ramifications.
What influences general practitioners' use of child psychiatry services?
Authors: Thompson Anne , Place Maurice
Published: October 2008

There are good reasons for Improving liaison between child psychiatrists and general practitioners. This study examined whether characteristics of the GP, patient or service influenced the referral of patients from primary care to the local child psychiatry service. Data collected by semi-structured interview from two samples of general practitioners who had either referred frequently or not at all over a two year period failed to show many of the associations found in other studies. Referral behaviour appears to be a complex phenomenon which may be influenced by increasing personal contact between professionals.
A pharmacy-controlled lithium clinic
Authors: Courtney Mary E. , Acomb Janine A. , Lovatt Veronica
Published: October 2008

A pharmacy-run lithium clinic was set up In a district general hospital in order to save medical staff time, utilise pharmacist skills and provide an efficient lithium monitoring service. After one year the clinic was evaluated in terms of the control of serum lithium levels, the acceptability of the arrangements to the patients and the patients' knowledge of and attitude towards lithium therapy. We suggest this model of a lithium clinic could be usefully adopted In other psychiatric departments.
Staffing a district psychotherapy service: further developments
Authors: Whyte C. R.
Published: October 2008

The adult psychotherapist model of staffing is considerably strengthened by a clinical directorate management structure with a specific local pay scale for psychotherapists. When such arrangements exist they are usually welcomed by clinicians and managers. One reason for this is that they make it possible to ensure that services maintain good clinical standards while meeting the managerial objectives of the unit or trust. Underlying the success of these arrangements is the fact that by promoting separation and individuation they give services a firm identity. This is good for the service itself and also for the unit or trust as a whole, because separation and individuation are the basis of co-operation and integration.
Reducing the risk of violence to junior psychiatrists
Authors: Lillywhite Alan , Morgan Neil , Walter Elizabeth
Published: October 2008

As mental health care services move increasingly into the community with staff working in more isolated settings, violence against staff is becoming an increasing health and safety issue. Education and training of staff to cope with potentially violent situations is a priority, equally important is the design and physical layout of the room in which potentially violent patients are seen. This audit looked at the safety features present in consulting rooms used daily, for interviewing patients, by mental health professionals. The study identified rooms which were judged unsuitable for interviewing potentially aggressive patients in, and as a result, several recommendations for safety improvements to these rooms were made.
Discrepancies and inaccuracies in statistics for detained patients
Authors: Nemitz Teresa , Bean Philip
Published: October 2008

While conducting a study on the nature and extent of compulsory admissions to mental hospitals within the four London regional health authorities, discrepancies and inaccuracies were revealed in many of those mental hospital in-patient statistics. The nature and extent of some of these are examined. It is suggested that the value of such statistics for government planning must be questioned as is their value for research. It is recommended that a centralised system of collecting and collating such data be introduced as a matter of priority and that such a system be operated by the Mental Health Act Commission.
The experience of patient suicide among Irish psychiatrists
Authors: Cryan Elizabeth M. J. , Kelly Paul , McCaffrey Brian
Published: October 2008

One hundred and nine consultant psychiatrists completed an anonymous questionnaire on the suicide of patients In their care. A patient suicide was reported by 82%, of whom 47% had experienced their first patient suicide within five years of entering psychiatric practice. A formal review of the suicide had occurred in 24% of cases. The study examines the perceived effects of their first patient suicide on the professional practice of the respondents, and measures the personal stress related to it, using the Impact of Event Scale. We discuss the implications of this common experience for psychiatric training programmes.
The emergency treatment of overdose: a problem of consent to treatment
Authors: Hardie Tim , Bhui Kamaldeep , Brown Phillip
Published: October 2008

We surveyed 119 psychiatrists to see how they would act with a patient who has taken a potentially lethal overdose, has no mental illness, and is refusing treatment. There was substantial disagreement. There may be a risk of action under civil law whether the psychiatrist decides to treat the patient without his or her consent or not. The Law Commission are examining whether mental disorder, as defined in the Mental Health Act 1983, should be used as a test of Incapacity to give consent to medical treatment. Such legislation would help doctors but may encourage a wide interpretation of the definition of mental disorder.
The extent and effects of violence among psychiatric in-patients
Authors: Thomas C. , Bartlett A. , Mezey G. C.
Published: October 2008

Actual and perceived safety of male and female in-patients in an inner-city psychiatric hospital were examined. Using semi-structured interviews, 59 inpatients were asked to report on their direct experiences of physical or sexually threatening behaviour towards them during their admission. Of the sample, 75% reported unwanted physical or sexual experiences: female patients were significantly more likely than males to report sexual harassment. Most incidents were not reported to staff and both staff and patients appeared to perceive the ward environment as safe despite fairly high levels of verbal and physical aggression. This study has implications for the way that ‘violent incidents' in psychiatric hospitals are defined and recorded and raises questions about the provision of women-only space in hospitals.
Management of violence among psychiatric in-patients
Authors: Agarwal Meena , Roberts Mark
Published: October 2008

In a retrospective study at a medium secure unit, the incident reports where a degree of restraint was used in dealing with in-patient aggression were examined for management strategies used and their relationship to various factors. There was a decrease in the use of seclusion over the period of study, seclusion being more likely to be used when agression was aimed at staff and property, following staff-patient interaction (demands) and younger age of perpetrators.
What do day hospital attenders really want?
Authors: Riordan Denise , Appleby Louis
Published: October 2008

The views of psychiatric day hospital patients on the helpfulness of components of their treatment programme were surveyed. Ratings given to social activities were significantly higher than those given to therapeutic activities. Patients rated having a bus pass and access to hairdressing services as the most helpful parts of day hospital attendance while community meetings and ward round attendance were regarded as the least helpful. Ratings were, however, generally favourable. No significant effect of patient age, gender, or duration of attendance was found. Possible explanations for these preferences are discussed. Patient preferences such as these are likely to influence purchasers of care, and thus the use of resources by providers.
Thirty years of in-patient consultation-liaison psychiatry at Guy's
Authors: Lucas Ben , Doyle Harry
Published: October 2008

In order to inform planning decisions, we aim to show how an in-patient consultation-liaison service has changed in 30 years. A year's referral of 175 inpatients was compared with surveys carried out in the same hospital 20 and 30 years previously. Neurosciences continue to refer the greatest percentage of its patients while general medicine produces the greatest demands on the service. There has been a large increase in substance misuse referrals, although other diagnostic groups have similar referral rates. Liaison service planners should be aware of the unmet demand for psychiatric services of the general hospital in-patient population.
Attitudes to and awareness of flexible training in psychiatry in Birmingham
Authors: Hofberg Kristina , Sargeant Rhona
Published: October 2008

Part-time training has been available for over 25 years. However, women remain under represented in the higher grades. Following the report of the Joint Working Party on Flexible Training, April 1993, we aimed to investigate awareness and attitudes towards flexible training in Birmingham among psychiatric trainees and their consultants. The results suggest that while most had heard of flexible training, many had little knowledge of the recent registrar flexible training scheme locally. A substantial minority of doctors agreed with pejorative statements about part-time training and more of these were Juniors. Senior psychiatrists did not perceive part-time training adversely and many would consider part-time work in the future.
“John Barleycorn.” Jack London's ‘Alcoholic Memoirs’
Authors: Stanley W. J.
Published: October 2008

Jack London's autobiographical account of his long struggle with alcoholism was first published in 1913, three years before he committed suicide by taking an overdose of drugs; he was 40 years of age.
Who am I? Self or self-less?
Authors: Culliford Larry
Published: October 2008

As human beings we are each invited to fulfill expectations. We are asked to prove ourselves, to achieve, and we are encouraged in strong allegiances to family, community and culture. We identify with and take pleasure in, or alternatively dissociate ourselves from and dislike, certain people, places, possessions, and later theories, philosophies, even what we call ‘facts'. Thus we form strong (but in the final analysis relinquishable) attachments and aversions.
An encounter with Albania's best known drug addict
Authors: Fleming Philip M.
Published: October 2008

Albania borders the Adriatic Sea and lies between the former Yugoslavia to the north and Greece to the south. Seventy per cent of the land mass is mountainous, the coastal strip containing most of the country's agricultural land and having the densest population. The total population of the country is 3.4 million while the capital Tirana has a population of 250000. Until very recently Albania was rarely visited by people from the West. It had become increasingly isolated under the Stalinist dictatorship of Enver Hoxha and the paranoid attitude towards foreigners that existed in the 1970s and 1980s is well illustrated by the concrete pill boxes that were built to repel invaders. More than 600 000 of these were built and they can be seen today scarring the attractive countryside of hills and fields around Tirana. With the collapse of communism in Eastern Europe, Albania followed the same path and went through a period of disorganisation in 1991 before electing its first democratic government in 1992. As with other former communist countries private enterprise began to develop, land was sold back to the peasants, and private cars began to appear in the streets. In 1992 there were no private cars in the country; in 1995 there were 35 000 in Tirana alone.
Psychiatric ethics and research
Authors: Bartlett Annie
Published: October 2008

Formal teaching in ethics is neglected in psychiatric training. This paper takes a practical approach in outlining ethical issues relevant to different stages of a research project. It is suggested that whatever the scale of the research, it is important to examine the ethical issues which surround the development of a project, as well as those which are integral to the protocol.
The retainer scheme and psychiatry in primary care
Authors: Morris Jane
Published: October 2008

Publications in the Psychiatric Bulletin have highlighted trainees' interest in part-time training and described different kinds of part-time training, but the feasibility of working as little as four hours a week has not been addressed. I have made unusual use of a Retainer Scheme for Doctors with Domestic Commitments to support part-time psychiatry in a general practice setting. This has proved a useful short-term option for bridging a career gap.
Letter from Moscow
Authors: Brown A S.
Published: October 2008

The political and economic changes in Russia in the last five years have been enormous, however, Russian psychiatry remains isolated from the mainstream. This isolation started in the aftermath of allegations in the seventies about the misuse of psychiatry, and has been exacerbated by recent economic uncertainty. I was therefore interested to receive an invitation to stay with a Russian psychiatrist for a week in September 1994, to investigate the possibilities of research collaboration between the Institute of Clinical Psychiatry in Moscow and the Department of Psychiatry in Southampton.
The use of guardianship in mental handicap services
Authors: Whitworth Helen , Singhal Shashi
Published: October 2008

There has been little published on the use of Guardianship Orders in mental handicap (the term ‘mental handicap’ is used rather than ‘people with learning disability’ to avoid ambiguity). Its use in the mental handicap services in four health districts in the Mersey region was surveyed. The study was retrospective, covering a five year period ending August 1994. Guardianship was used on ten occasions. Health professionals have been divided over the interpretation of the definition of “mental impairment” in the Mental Health Act (MHA) 1983. They have tended to exclude many mentally handicapped adults who do not, in their opinion, exhibit “abnormally aggressive or seriously irresponsible conduct”. It is clearly shown by our study that some health professionals are willing to classify self-neglect and vulnerability as “seriously irresponsible conduct”, thererefore allowing wider usage of the order.
A study of facial dysmorphophobia
Authors: Thomas Christopher S.
Published: October 2008

The psychopathology of 20 subjects who presented to psychiatrists with facial dysmorphophobia was examined. Seven had body dysmorphic disorder and 13 had dysmorphophobic symptoms secondary to an underlying psychiatric disorder (usually depression). The body dysmorphic group had a younger age of onset and overvalued ideas about their appearance. In both groups there was a high proportion of associated personality disorder, usually of the anxious (avoidant) type.
A survey of the prescribing of selective serotonin reuptake inhibitors by psychiatrists
Authors: Lawton John , Naik Prakash
Published: October 2008

Questionnaires were sent to 92 doctors asking them about aspects of their antidepressant prescribing; 72 returned them. Sixty had prescribed selective serotonin reuptake inhibitors (SSRIs) in the previous year. The ratio of SSRIs to all antidepressants prescribed in the previous year exceeded 40% in only eight doctors. Inability to tolerate and failure to respond to established antidepressants were the most common indications for prescribing SSRIs. Side effects and cost were the most common reasons deterring doctors from prescribing SSRIs. SSRIs being new products and doubts regarding their efficacy were factors that were significantly more likely to deter ‘doctors of other grades' than consultants from prescribing them. Fluoxetine and paroxetine were the most frequently prescribed SSRIs.
Implementation of the care programme approach in the community
Authors: Gilleard Chris
Published: October 2008

The comprehensive implementation of the care programme approach is described within a large Mental Health Unit serving two London boroughs. Methods used to introduce an incremental improvement in the care programme approach (CPA) practice and documentation are outlined together with an account of the development of a set of quality standards and a CPA annual audit system.