bluuebunny/crossref_metadata_2025 huggingface dataset:
The use of Seclusion in a DHSS Youth Treatment Centre
Authors: Wilkinson Greg
Published: January 2018

Seclusion, locking up patients in isolation, has a long history in psychiatry (Hunter and MacAlpine, 1963). John Conolly (1856), for example, though an advocate of non-restraint, defended the practice: ‘That salutory exclusion of causes of excitement from an already irritated brain, has been so unjustly stigmatized as solitary imprisonment’. Even so, many of his contemporaries reviled seclusion. Indeed, experience over the years has shown that such limitations of patients' liberty need to be carried out under scrutiny, otherwise abuses may take place. Patients who give staff trouble may be secluded as a punishment or kept in seclusion for long periods without proper attention. For this reason, therefore, doctors need always to take particular care to see that this form of management is carefully regulated.
Report of the Special (Political Abuse of Psychiatry) Committee on South Africa
Authors: Timbury Gerald
Published: January 2018

Council asked the Special (Political Abuse of Psychiatry) Committee to consider allegations of the political abuse of psychiatry in South Africa. The Special Committee considered all documentation available to them and one member of the Committee was able to make a brief on-site inspection of facilities. At its meeting in January 1983, Council endorsed the following Report and it was agreed that this should be published in the Bulletin. I was also asked to send the Report to College members in South Africa, and this is being done.
The Regional Secure Units Programme: A Personal Appraisal
Authors: Snowden Peter R.
Published: January 2018

Since central government allocated capital and revenue money for the regional secure units (RSU) programme, following the 1975 Butler Report, the planning and building programme has been gathering momentum. It was felt it would be useful to review the present complicated and varied picture and to look ahead to the future. This seems a particularly apt moment to look around the regions as the climate of opinion, both within the clinical professions and in the various NHS administrative levels, is changing. Reference will mostly be made to the provisions for Mental Illness rather than for Mental Impairment and Adolescents.
The Mental Health (Amendment) Act 1982: Will it Make a Difference?
Authors: Szmukler George
Published: January 2018

An examination of the changes to be introduced by the Mental Health (Amendment) Act 1982 suggests that they might have a significant effect on the fate of many patients who are currently admitted on compulsory orders. There are potentialities for improvement, but for these to be fruitful a firm commitment will be required from the professionals involved to attend to these patients' needs. The tide generated by the new legislation is more likely, however, to carry the professionals away from these patients for the main thrust of the new Act is to make treatment more difficult.
The Psychiatric Nurses Association
Authors: Cox Denis M.
Published: January 2018

The Psychiatric Nurses Association (PNA) is a professional association, solely devoted to psychiatric and mental handicap nursing. A rapidly expanding organization, its origins are traced to the autumn of 1980. Mr Seamus Killen, RMN, SRN (Littlemore Hospital, Oxford) attempted, through the columns of the Nursing Press, to measure support for a professional organization and the concept met with tremendous interest from psychiatric nurses all over the United Kingdom.
The Future of Rehabilitation in Psychiatry
Authors: Reed John
Published: January 2018

A meeting of psychiatrists with an interest in rehabilitation was held in Oxford in April 1983 just prior to the College Quarterly meeting. The meeting was convened by Dr Brenda Morris and chaired by Professor John Wing; its purpose was to discuss the scope and future direction of rehabilitation in mental illness.
Community Care: The Sham Behind the Slogan
Authors: Major Joyce
Published: January 2018

The following letter and statement were published on 28 February 1984 and were widely circulated to influential bodies.
The Collegiate Trainees Committee
Authors: Waters Helena
Published: January 2018

Trainees in psychiatry have a unique opportunity to contribute to the policy and decision-making within the College, not only on matters relating to training but on broader issues facing psychiatry as a whole. This has been made possible by the introduction of Inceptorship (see Handbook for Inceptors and Trainees in Psychiatry) and by the more recent formation of the Collegiate Trainees Committee (CTC). The Royal College of Psychiatrists is the only college which encourages trainees to join as ‘junior members’, and gives them the opportunity to contribute actively in its working. I would like to review the progress of the CTC since its first meeting in September 1979.
Manpower 1982–1983
Authors: Robin Ashley , Caldicott Fiona
Published: January 2018

Bids for new posts for 1982–83 will be decided by Regional Authorities on the advice of Regional Manpower Committees within the next few months on the basis of guidelines formulated and issued by the DHSS. There seems little likelihood that cash limits will be significantly eased by 1982–83, and the case for psychiatry will have to be argued in face of a greater degree of consultant expansion to be allowed in the support specialties—e.g., anaesthetics, radiology, and unlimited expansion, as far as central approval is concerned, in general medicine, general surgery, and obstetrics and gynaecology. It may be expected that the non-metropolitan Regions will be better placed financially to meet consultant expansion, so that while on average two to three adult mental illness consultant posts will be permitted in each Region, Regions with resources may be encouraged to bid above this average, as preference will normally be given to Regions with the lowest ratio of establishment to population. The same principle would apply in child and adolescent psychiatry where on average one post per Region may be allowed. Only two new consultant posts in mental handicap will be created in the year in England and Wales. Applications for forensic psychiatry posts for regional secure units will be treated sympathetically, and, while there is no limit proposed for psychotherapy posts, the small number of senior registrars who will have completed training suggests that few bids are anticipated for this specialty.
A Firmer Grounding
Authors: Hill Peter , Waters Helena
Published: January 2018

The great leap forward from trainee to consultant ends with one well-grounded foot. Clinical training to current standards provides the novitiate with a firm base as far as taking clinical responsibility. Responsibilty for maintaining or developing service and the profession is another matter, and in this respect too many newly-appointed consultants find themselves with their other foot in a quagmire, at risk of being bogged down in administration. One foot that has received solid grounding is not enough to hit the ground running. Actually, the stumble goes unnoticed as often as not. Dead-end committee posts are hived off on to the new appointee and no-one remarks on his silence at table or the failure to grasp the politics of administration. Some, of course, take to the mud with squeals of glee, throwing their weight around without moving from the spot. Some colleagues get spattered. Some sink. No progress ensues. There may then evolve a distaste for administration, a spurning of bureaucracy, truancy from the Division (can there be worse?) and rotting relationships with hospital administrators. Does it matter? Surely people find out soon enough how the system works; if you can run a group you can chair a committee; individuals make better decisions than committees and nobody listens in any case.
Towards a New Mental Health Act: Sections 60 and 65 and the European Commission of Human Rights
Authors: Bluglass Robert
Published: January 2018

The Mental Health Act 1959 empowers a Crown Court (but not a Magistrates' Court) to make a Restriction Order when a Hospital Order is made and if it appears to the Court, having regard to the nature of the offence, the antecedents of the offender and the risk of his committing further offences if released, that it is necessary for the protection of the public to do so. The Judge must hear oral evidence from one of the doctors recommending the Hospital Order.
Divisional Activities
Authors: Davies C.
Published: January 2018

A few years ago this Division took a critical look at its biannual meetings, and what we saw was too often disappointing. We decided to set about improving the organization, and the social and scientific quality of the meetings.
A Very Damning Account
Authors: McGee David
Published: January 2018

A very damning account of the social work profession has been written by Brewer and Lait, a profession which the authors perceive to be a ramshackle collection of idiosyncratic practitioners who clumsily bump and grind their way through the least fortunate sections of our society, doing untold harm. It would be gratifying to dismiss what they say; but social work after just over ten years in its present form is sorely in need of critical examination. We cannot ignore our critics, and it is imperative that we should put our house in order. Should social work survive is the real question being asked here—a political statement of a quite contentious nature.
The Work of the Uffculme Clinic
Authors: Harrington John A.
Published: January 2018

The Uffculme Clinic opened 25 years ago as an early psychiatric treatment and research centre and has for the past 15 years functioned as a regional centre for psychotherapy in the West Midlands. Day and in-patients participate in a psychotherapeutic regime which includes a daily analytic psychotherapy group, relaxation therapy, projective art, psychodrama and more traditional occupational and recreational therapies. A weekly community meeting has recently been extended to give staff and patients a large group experience. Patients in intensive treatment are severely affected by neurotic or personality difficulties and are only admitted if they are incapable of functioning at work or at home.
Unemployment: A Psychiatric Problem As Well?
Authors: Fagin Leonard
Published: January 2018

The spate of suicides and riots in unemployment-stricken towns has recently brought to public attention a feature of joblessness which had not figured in the minds of those that thought that it would only have financial and probably minor social consequences. Since then, a flurry of interest has been spurred by the media; they regularly report on studies that show some association between unemployment and ill health, quite often, and not surprisingly, to make party political meal of a long-term problem that is bound to have implications for health provision in this country, at least over the next two decades. As psychiatrists we all know the central role played by regular, satisfying employment in the mental health of our patients, and I am sure many of us are affected by our total inability to secure adequate rehabilitation alternatives on which we are sure our patients' future, and that of their families, depend to a great extent. Some of us may also have been aware of the increased demand on mental health resources over the past few years and of the worrying tendency for admissions into psychiatric hospitals to be prolonged because of the time it takes for an ex-patient to re-enter the labour force.
Scottish Trainees' Day
Authors: Gallagher Jim
Published: January 2018

The first Scottish Trainees' Day was held at the Gartnavel Royal Hospital, Glasgow, on 26 June. It was organized by two Scottish representatives of the Collegiate Trainees Committee, and about 40 trainees attended and heard talks given by Professor Gerald Timbury, Dr Angus McKay, Dr John Cox, Dr S. P. Sashidharan, Dr Richard Williams and Dr Sue Philips, Secretary of the Collegiate Trainees Committee. In the afternoon the meeting broke into small groups to facilitate the expression of views over a wide range of issues. The plenary session at the end of the afternoon brought together the main themes discussed in the small groups and these are summarized below.
North-West Division, 1980–81
Authors: Cookson Ian B.
Published: January 2018

The years 1980 and 1981 have given the North-West Division a stimulating variety of influences experienced in the make-up of the Executive Committee and the interaction within the membership, Inceptors to Fellows in the ordinary meetings and two Annual General Meetings.
The Development of Broadmoor 1863–1980
Authors: Hamilton John R.
Published: January 2018

The history of Broadmoor involves the management of mentally abnormal offenders, or ‘criminal lunatics’ as they were called, over the last 180 years (Partridge 1953; Walker and McCabe 1973; Allderidge 1977). Before 1800 there were no special facilities for such patients, and they were incarcerated in local prisons where, John Howard wrote, the conditions were ‘crowded and offensive because the rooms which were designed for prisoners are occupied by the insane. Where these are not kept separate they 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’.
Teaching Counselling Skills to Undergraduates and Postgraduates
Authors: Betts T. A.
Published: January 2018

For some years my colleagues and I have been teaching counselling skills to undergraduate medical students and to postgraduate trainees in medicine, social work, nursing, clinical psychology and occupational therapy. We started teaching these skills to postgraduates (particularly family planning clinic doctors and nurses) at the request of the Family Planning Training committee of the West Midlands Regional Health Authority. At first we concentrated on teaching simple psychosexual counselling skills but latterly, as a result of consumer demand, we have extended the number of topics. We have also begun to apply the lessons we have learnt in postgraduate teaching to the teaching of medical undergraduates.
Child and Family Psychiatry: Planning for Survival
Authors: Black Michael , Harris Jean
Published: January 2018

If Child Psychiatric Services are to survive into the 1980s, we believe that practitioners will have no alternative but to make sense of the complicated administrative network on which their future depends. This is an account of one such attempt by three Child and Family Psychiatric teams working in a Health Authority Area.
A Diploma in Clinical Psychiatry
Authors: Bewley Thomas
Published: January 2018

The MRCPsych is now firmly established as the normal requirement for a career in psychiatry in this country. The need for other medical specialists to acquire psychiatric knowledge and skills raises the question of a possible demand for a second type of College examination. The Court of Electors have been considering some of the arguments for and against a College Diploma and would welcome further discussion in the College on this.
Can Planning Change the State of Research? The Experience of the Wellcome Trust
Authors: Williams Peter
Published: January 2018

For the past 24 years during which time I have been concerned with the management and financing of medical research, either at the MRC headquarters or the Wellcome Trust, I have heard it said that psychiatric research is backward and something ought to be done to improve the situation. My earliest memory of something being done was in 1959 when Professor (now Sir) Denis Hill, as a member of the Medical Research Council, wrote a report making the recommendation that the Council should set up research units, and the universities should establish more academic departments in medical schools. The reasons for these recommendations were fairly obvious. Unless established posts are available one cannot expect to recruit potential research workers to the field. The proposition accepted that even if the perfect head of department was not initially available, the next generation would have the right experience. Professor Hill's recommendations were, I think, very largely implemented. Between 1957 and 1962 the Medical Research Council set up five new units and one new research group. Only two of these units still exist but others have been established since. A number of university departments were also created.
The Inside View
Authors: Rawnsley Kenneth
Published: January 2018

I take it as axiomatic that we want more and better research in psychiatry and in the cognate disciplines, but I have the strong impression that in Great Britain, and especially among younger colleagues, the desire and the ability to contribute to the realization of this aim are tenuous. Why so? Is it the people; the training they have received; the value-systems and ideologies they take on board; the milieu in which they work, or the intrinsic nature of psychiatry which militate against fruitful developments?
The History of Mental Handicap in Bristol and Bath
Authors: Jancar J.
Published: January 2018

The cities of Bristol and Bath have played an eminent role in the history of mental handicap.

Unfortunately, documentation is rather scanty, particularly on the pre and post Reformation era but much more is known about the Holy Cross Hospital in Bath, perhaps the oldest mental handicap hospital in Great Britain. The Romans contributed to its foundations when they built Fossway Road on the outskirts of Bath which the pilgrims later used to visit Glastonbury.
A Survey of Undergraduate Teaching of Child and Adolescent Psychiatry in the United Kingdom
Authors: Cottrell David
Published: January 2018

Child and adolescent psychiatry is a relatively new sub-speciality and it is only recently that its practitioners have started to examine the problems of teaching it on the undergraduate curriculum. Questions about when it is best taught during the undergraduate years and what constitutes a core curriculum are still contentious. Indeed some psychiatrists have yet to be convinced that it should be taught at all at an undergraduate level.
Brief Report: Decline in the Use of ECT: The York Study
Authors: Bhatnagar Kumud , Kennedy Peter , Morley Stephen
Published: January 2018

A national survey in 1980 drew attention to the wide variation in frequency with which electro-convulsive treatment was being used. Yorkshire Region was at the top of the league with three times the level of the Oxford Region which had the lowest rate. Since then a good deal more research has been published on the effectiveness and limitations of ECT.1–3 Other factors which might have influenced clinicians in their prescribing of this treatment include much stricter conditions in the 1983 Mental Health Act for giving ECT compulsorily, plenty of media comment which may have reduced its acceptability, the increasing confidence of general practitioners in prescribing antidepressant drug therapies, and the greater emphasis on community care.
Patients at a Psychiatric Walk-in Clinic — Who, How, Why and When
Authors: Haw Camilla , Lanceley Colin , Vickers Steven
Published: January 2018

In recent years there has been increasing emphasis on community-based psychiatric services. If these facilities are to be comprehensive they must include ways of assessing and managing crises and avoiding unnecessary hospitalisation. One way of meeting these needs is to provide small walk-in clinics in the community. A number of clinics have been established and more are planned. Although clients may refer themselves, access is usually limited to office hours and often only to a few hours each day.
The Management of the Pregnant Drug Addict
Authors: Riley Diana
Published: January 2018

The number of drug abusers in this country has increased over the past 20 years, and the pattern of drug taking has also changed. More people now take drugs on a recreational basis, and a smaller proportion of addicts show the full-blown picture of physical and mental deterioration associated with addiction in the past. Where such deterioration is present, pregnancy rarely occurs because of suppression of menstruation and ovulation and reduction of male fertility. Perhaps because of this change, the number of pregnant drug addicts has also increased. They now create a significant problem in the obstetric departments of hospitals in major population centres where addicts tend to congregate.
Disfigurement: Perceived and Actual
Authors: Piff Christine
Published: January 2018

On 27 March 1987, the Liaison Group of the Royal College of Psychiatrists and the Society for Psychosomatic Research held a joint conference on ‘Disfigurement: Perceived and Actual’ at the Royal College of Psychiatrists. It was the first collaborative venture between the uni-disciplinary Liaison Group and the multi-disciplinary Society, but it is hoped it will be the first of a productive series. The Conference was well attended. The morning presentations were concerned mostly with dysmorphophobia, and the afternoon's with unmistakable disfigurement. The proceedings ended with a presentation, by Mrs Christine Piff, on her own experiences following surgery for facial cancer, and with her prosthesis. It is reproduced below.
AIDS and the Psychogeriatrician
Authors: Katona Cornelius L. E.
Published: January 2018

It might at first sight appear that old age psychiatrists and geriatricians are relatively well protected from having to deal with the problems of patients suffering from the Acquired Immune Deficiency Syndrome (AIDS). It is therefore perhaps surprising that the major article in the newsletter of the American Geriatric Society is devoted to AIDS and concludes that “there is no question that the AIDS epidemic is the most important world wide public health issue of this century”.
A ‘Consultation’ Workshop for Child Psychiatrists in Training
Authors: Reder Peter , Israelstam Ken
Published: January 2018

Child psychiatrists-in-training must become conversant with a range of inter-personal skills—psychotherapy, family therapy, management, consultation—in addition to their traditional expertise of assessment, differential diagnosis and psychiatric treatments in different settings. In the Riverside training scheme we have introduced a Consultation Workshop to help trainees learn this essential art, for although it is said to be practised widely it has seldom been taught systematically. This is a report from the first 18 months of the Workshop's studies.
The Local use of Section 136
Authors: Weller Malcolm P. I. , Weller Ben G. A. , Baumann Sean , Coker E.
Published: January 2018

Recent attention has been focused on divergent practices in the implementation of Section 136, problems in its practice encountered by the police, and possible means of improving the service and reducing unnecessary detention. In these studies, doubts have been raised about the justness of the section, both in principle and in practice, and about the efficiency and efficacy of its implementation. In the context of the closure of the large psychiatric institutions it seems probable that these issues will become increasingly acute. The purpose of our brief study was therefore to investigate the trends of admissions to Friern Hospital, not only of patients under Section 136, but of all patients accompanied by the police.
Teaching medical students a difficult subject – child abuse
Authors: Vizard Eileen
Published: January 2018

As a specialist in child abuse for the past five years, I have been presented with various technical difficulties in trying to convey important, but often emotive, material to medical students and, for that matter, to groups of professional colleagues from other disciplines. It is hoped that the following reflections may be useful to colleagues who teach medical students about child abuse.
Consumer survey of a mental health resource centre
Authors: Sackett Kate , Oyebode Femi
Published: January 2018

The first British day hospital was established by Bierer in 1946; by the end of the 1950s there were 45 and during the next few years the number trebled. With the trend towards community care, day hospitals and centres have continued to increase in number.
Trainees forum: “Psychiatrist, please see”
Authors: Flanigan Peter
Published: January 2018

Many junior doctors, some with only undergraduate training, will this August feel at the pointed end of psychiatry when they are asked to see an ‘overdose’. The referral letter is unlikely to be more specific concerning what service they are to render to the patient or the referring physician. In the psychiatric textbooks the tyro will find a wealth of actuarial data but little clinical advice. After four years as a junior psychiatrist I present a personal philosophy of what one is doing when one assesses the survivor of a (para) suicidal act.
An occasional series in which contributors reflect on their careers and interests in psychiatry
Authors: Freeman Thomas
Published: January 2018

I qualified in Belfast (Queen's University) in 1942. I did not have any interest in psychiatry, having the ambition to become a clinical physiologist. I had worked with Henry Barcroft, who was professor of physiology. I joined the Army and later the Airborne Forces. Fortunately, the casualties expected amongst the medical personnel of the 6th Airborne Division during the Normandy incursion did not occur, leaving myself and other medical colleagues, who had just completed our parachute training, redundant. I was posted to France and in the late summer of 1944 found myself regimental medical officer to the 1st Battalion The Herefordshire Regiment. I must confess that it never occurred to me during the winter and spring of 1944–1945 that the emotional reactions and the physical expressions of anxiety encountered, particularly amongst the young conscripts, had anything to do with the subject of psychiatry.
Phenomenology and the price of beans
Authors: Flannery Dennis
Published: January 2018

Psychiatry might be seen as a three dimensional space, with two of its dimensions caricatured in the title. Of the first, ‘phenomenology’ stands for scientific rigour, the medical view favouring diagnosis based on analytical activity, followed by construction of syndromes from individual symptoms/measures. The ‘price of beans’ stands for materials; the economics of care in the post Griffiths era, value for money, hospital closures, massive reorganisation and the negative implications for service users.
The medicine of misery: A personal account
Authors: Jones Lynne
Published: January 2018

We spent part of this morning's ward round making a priority list; which of the five patients in need of admission was most acute, which could wait. There are two elderly ladies, both living alone, both very depressed. Edith is no longer taking care of herself, picking at her skin to the point where nasty sores have formed, and pulling her eyebrows out in her distress. Jonathan should have been admitted last week, we delayed and he took an overdose of Ativan. Alan is an elderly man who gets recurrent depressions. They seem to resolve of their own accord without medication if only he can be admitted for two or three days. Eleanor is a young mother of 28 who has been depressed for three months. Now she is completely preoccupied with ideas of killing both herself and her children.
Psychiatry in Mauritius
Authors: Greedharry D. R.
Published: January 2018

Mauritius is a 720 sq mile island situated in the Indian Ocean. It has a population of about a million, made up of various racial backgrounds: Indian, African, European and Chinese. Those of Indian descent belong to the Hindu and Muslim faiths; those of African and European descent belong to the Roman Catholic faith (by and large), as do most of the people of Chinese origin. The economy rests on the export of sugar and tobacco, making the country an agricultural one. Diversification of the economy is under way.
Policy into Practice in a New Secure Unit
Authors: Faulk M.
Published: January 2018

Albert Kushlick first showed me this technique. He used it for setting up hostels for the mentally handicapped and I then used it when setting up a Medium Secure Unit. It could be applied to any Unit and I am writing it up because I found that staff members in new units had run into problems where they had not adopted this or a similar approach. The idea is to show how one can translate ‘aims' or ‘principles' into ‘brass tack’ practices by design and with consultation in a multidisciplinary setting.
Whatever Happened to the Nursing Process?
Authors: Wells Peter
Published: January 2018

The introduction of a systematic approach to their work by nursing colleagues in the last decade provoked a great deal of comment and literature some of it amusing if perhaps slightly dismissive. Not a great deal is known about how widespread is the practice, or how well it is working in places where it has been adopted. Indeed the DHSS has set up a working party within the Nurse Education Research Unit of King's College to obtain enough basic information with a view to developing a research project into the effectiveness of the nursing process.
An Introduction to Psychosynthesis
Authors: Mathers Carola B. B.
Published: January 2018

A day workshop on the subject of psychosynthesis was held in June 1985 by the Action Therapies Group. The group consists of health professionals working in psychiatry and related fields, who meet regularly to educate themselves about the ‘new’ therapies, including gestalt, transactional analysis, psychosynthesis. Teaching is carried out by group members, the emphasis being on experiential rather than theoretical learning, though time is given to theoretical issues.
Multi-district Rotational Schemes for Post-graduate Trainees in Psychiatry
Authors: Soni Som D. , Tait Alan , Pidd Sally , Goldberg David P.
Published: January 2018

The exercise of hospital accreditation by the Royal College of Psychiatrists has resulted in a significant improvement in the standards of psychiatric training in this country.1 The North West, more than any other region, adopted the policy of District General Hospital psychiatry2 in the sixties which had the effect of creating small psychiatric units, unable to muster enough resources, to provide comprehensive training programmes by themselves. These developments have highlighted the problems of organising viable rotational schemes for training in psychiatry.3,4,5
Psychotherapy Training Experience of General Psychiatrists in the North West Region
Authors: James Diane , Benjamin Sidney
Published: January 2018

Fifteen years ago the College published guidelines for the training of general psychiatrists in psychotherapy and these have now been reconsidered in the light of subsequent developments. (Bulletin, October 1986, 10, 286–289). However there is considerable doubt as to the extent to which the previous guidelines have been effective and those responsible for training schemes should consider whether they are providing or can provide the training suggested.
The First Year's Operation of a Regional Drug Problem Team
Authors: Fleming Philip M.
Published: January 2018

The recent announcement of a further £5 million which has been distributed to Regional Health Authorities makes a total of over £22 million that has been made available specifically for the development and expansion of services for drug misusers over the past three years. An important element in the development of such services has been the formation of Regional Drug Problem Teams; this seemed a useful time to review the working of one such team over the past year.
Psychiatric Referrals from the Police
Authors: Rassaby E. , Rogers A.
Published: January 2018

Section 136 of the Mental Health Act (MHA) 1983 authorises the police to take a mentally disordered person from ‘a place to which the public have access’ to a place of safety in order to be assessed by a doctor and an approved social worker. The person may be detained in the place of safety for up to 72 hours. Despite increasing controversy, the provision survived a heated parliamentary debate virtually unchanged from the 1959 Act. During the passage of the Mental Health Bill through Parliament, concern was expressed about the considerable variation in its use. Psychiatric examination of the provision has often been in comparison to compulsory admission provisions and the research populations have generally been confined to persons admitted to one hospital only. Although some researchers have recognised the variations in the way the provision operates, there has been no systematic examination of these variations. An important question is whether these variations result in differences in patient care and this question is largely unexplored. In the first part of a three part study of s136∗ the researchers set out to examine this question.
Recent developments
Authors: de Wet Vorster
Published: January 2018

Infant psychiatry research pursued over the last two years was presented at the International Conference of the Association of Child Psychology and Psychiatry and Allied Disciplines in Paris, July 1986, and the value of early intervention was underlined at the Third World Congress of Infant Psychiatry, Stockholm, August 1986.
Stepping Westward
Authors: McKeith I.
Published: January 2018

“When early summer with its bright clear days has brought the academic year to a close, emptying chalky classrooms and leaving books at rest on library shelves, then academic folk long to go on pilgrimages.”
Psychotherapy at a Time of Diminishing Resources
Authors: Macilwain I. F.
Published: January 2018

Estimating demand for psychotherapy is like trying to evaluate the size of a mountain range from the foothills—the higher one climbs, the more potential needs become apparent. The unspoken dream that at some point all these needs will be met by trained psychotherapists seems firmly destined to stay in the realms of fantasy. In reality, specialist psychotherapists will always be thin on the ground. In Surrey, where my own practice is based, I am, and am likely to remain, the only medically trained psychotherapist with four sessions allocated to a population of 200,000. The psychotherapy department at St. George's Hospital, Tooting, to which I am also attached, has a catchment which extends to the whole South-West Thames Region, encompassing places as far afield as Chichester and Haywards Heath.
Whatever Happened to Stigma?
Authors: Turner T. H.
Published: January 2018

Even before Erving Goffman's Stigma: Notes on the Management of Spoiled Identity was published in 1963, it had been a commonplace notion that there was a stigma attached to psychiatric illness. King Lear's cry ‘Let me not be mad, not mad, sweet heaven’ echoes down the ages. But in the years since Goffman's book there has been a concerted attempt by psychiatrists, by patients' groups, by the media, to ‘destigmatise’ and ‘demythologise’ psychiatry. This has taken many subtle forms, but several major themes were apparent.
Psychiatric Teaching in Malaya
Authors: Rose Nicholas
Published: January 2018

Like it or not, we all live on a planet teeming with variety. East and West for example have developed very differently, even though many of the problems faced by these divergent cultures are similar. True, Europe's colonising yoke in the past four hundred years introduced western infrastructure to many eastern countries, particularly in the fields of administration, communication, health, and education. However, traditional habits run deep, particularly in countries with large rural populations, and the apparent degree of westernisation can be deceptive.
The Problems of Tracing
Authors: O'Connor Art , Daly Joan
Published: January 2018

The importance of tracing technique and persistence was stressed by Sims. Long-term follow-up studies help to complete the clinical picture, a phrase used by Morris. They also help to clarify such issues as the effectiveness of treatment methods and changes in the socio-demographic status of patients. Unless a high percentage of the follow-up group is effectively traced, then the results of a long-term follow-up study must be suspect.
Psychoanalysis: Science or Nonscience?
Authors: Mathers Carola B. B.
Published: January 2018

The debate regarding the scientific status of psychoanalysis is considered by many psychiatrists to be a sterile one; this leads to a polarisation of views in which those in favour of psychoanalysis, feeling themselves to be losing, retreat to the position of stating that meaning is more important than scientific status, while those against argue that because psychoanalysis is unscientific it is meaningless and thus should not remain part of our psychiatric practice; the debate being reformulated as psychoanalysis: sense or nonsense? The consequence of giving up this debate is that it allows us also to give up the struggle to define science adequately to ourselves, and to question the relationship between psychiatry and science. Our understanding of science reflects directly on the quality of our research; this is particularly relevant to research in the practical application of psychoanalysis. Before we consider our understanding of science, however, we should consider our epistemological theories, or how we know things.
A Community Group in the State Hospital: A Trainee's Experience
Authors: Novosel Steven
Published: January 2018

It is often felt that group meetings with long term chronically psychotic patients have little therapeutic value and become weekly ‘complaints’ sessions. In this paper I would like to indicate that group work with such a population can be both a therapeutic and valuable training experience. I shall describe a group which I took over a six month period in one of the wards at the State Hospital, Carstairs Junction, Lanark.
Admitting Mentally Ill Mothers with their Babies into Psychiatric Hospitals
Authors: Kumar R. , Meltzer E. S. , Hepplewhite Rosalind , Stevenson A. D.
Published: January 2018

The clinical management of a mother who has a severe puerperal mental disorder is complicated by the fact that her baby is not ill and does not need to be in hospital—especially a psychiatric one. On the other hand, separating babies from their mothers can have adverse effects upon their relationship and upon the psychological development of the infant, although much depends upon the timing, nature and duration of the separation as well as on the quality and stability of the family background.
Clinical Administration
Authors: Affleck J. W.
Published: January 2018

In times of pessimism when psychiatry is described as in decline, subject to public scepticism with the psychiatrist's role threatened by social workers, psychologists and community nurses, one's immediate reaction is to adopt a historical perspective. The advances achieved during the last 50 years which I recall are so impressive that it seems reasonable to see current legal and bureaucratic problems as resembling a ditch rather than a precipice! These advances have occurred in spite of adverse administrative situations. It is important to remember that in spite of its merits the National Health Service was not conceived with Mental Health Services in mind—nor were Social Work Services.
Post-Treatment Mortality After Surgery and Stereotactic Body Radiotherapy for Early-Stage Non–Small-Cell Lung Cancer
Authors: Stokes William A. , Bronsert Michael R. , Meguid Robert A. , Blum Matthew G. , Jones Bernard L. , Koshy Matthew , Sher David J. , Louie Alexander V. , Palma David A. , Senan Suresh , Gaspar Laurie E. , Kavanagh Brian D. , Rusthoven Chad G.
Published: January 2018

Purpose

In early-stage non–small cell lung cancer (NSCLC), post-treatment mortality may influence the comparative effectiveness of surgery and stereotactic body radiotherapy (SBRT), with implications for shared decision making among high-risk surgical candidates. We analyzed early mortality after these interventions using the National Cancer Database.

Patients and Methods

We abstracted patients with cT1-T2a, N0, M0 NSCLC diagnosed between 2004 and 2013 undergoing either surgery or SBRT. Thirty-day and 90-day post-treatment mortality rates were calculated and compared using Cox regression and propensity score–matched analyses.

Results

We identified 76,623 patients who underwent surgery (78% lobectomy, 20% sublobar resection, 2% pneumonectomy) and 8,216 patients who received SBRT. In the unmatched cohort, mortality rates were moderately increased with surgery versus SBRT (30 days, 2.07% v 0.73% [absolute difference (Δ), 1.34%]; P < .001; 90 days, 3.59% v 2.93% [Δ, 0.66%]; P < .001). Among the 27,200 propensity score–matched patients, these differences increased (30 days, 2.41% v 0.79% [Δ, 1.62%]; P < .001; 90 days, 4.23% v 2.82% [Δ, 1.41%]; P < .001). Differences in mortality between surgery and SBRT increased with age, with interaction P < .001 at both 30 days and 90 days (71 to 75 years old: 30-day Δ, 1.87%; 90-day Δ, 2.02%; 76 to 80 years old: 30-day Δ, 2.80%; 90-day Δ, 2.59%; > 80 years old: 30-day Δ, 3.03%; 90-day Δ, 3.67%; all P ≤ .001). Compared with SBRT, surgical mortality rates were higher with increased extent of resection (30-day and 90-day multivariate hazard ratio for mortality: sublobar resection, 2.85 and 1.37; lobectomy, 3.65 and 1.60; pneumonectomy, 14.5 and 5.66; all P < 0.001).

Conclusion

Differences in 30- and 90-day post-treatment mortality between surgery and SBRT increased as a function of age, with the largest differences in favor of SBRT observed among patients older than 70 years. These representative mortality data may inform shared decision making among patients with early-stage NSCLC who are eligible for both interventions.
Treatment of Malignant Pleural Mesothelioma: American Society of Clinical Oncology Clinical Practice Guideline
Authors: Kindler Hedy L. , Ismaila Nofisat , Armato Samuel G. , Bueno Raphael , Hesdorffer Mary , Jahan Thierry , Jones Clyde Michael , Miettinen Markku , Pass Harvey , Rimner Andreas , Rusch Valerie , Sterman Daniel , Thomas Anish , Hassan Raffit
Published: January 2018

Purpose

To provide evidence-based recommendations to practicing physicians and others on the management of malignant pleural mesothelioma.

Methods

ASCO convened an Expert Panel of medical oncology, thoracic surgery, radiation oncology, pulmonary, pathology, imaging, and advocacy experts to conduct a literature search, which included systematic reviews, meta-analyses, randomized controlled trials, and prospective and retrospective comparative observational studies published from 1990 through 2017. Outcomes of interest included survival, disease-free or recurrence-free survival, and quality of life. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations.

Results

The literature search identified 222 relevant studies to inform the evidence base for this guideline.

Recommendations

Evidence-based recommendations were developed for diagnosis, staging, chemotherapy, surgical cytoreduction, radiation therapy, and multimodality therapy in patients with malignant pleural mesothelioma. Additional information is available at www.asco.org/thoracic-cancer-guidelines and www.asco.org/guidelineswiki .
Comparing the cost-per-QALYs gained and cost-per-DALYs averted literatures
Authors: Neumann Peter J. , Anderson Jordan E. , Panzer Ari D. , Pope Elle F. , D'Cruz Brittany N. , Kim David D. , Cohen Joshua T.
Published: January 2018

Background: We examined the similarities and differences between studies using two common metrics used in cost-effectiveness analyses (CEAs): cost per quality-adjusted life years (QALYs) gained and cost per disability-adjusted life year (DALY) averted.

Methods: We used the Tufts Medical Center CEA Registry, which contains English-language cost-per-QALY gained studies, and  Global Cost-Effectiveness Analysis (GHCEA) Registry, which contains cost-per-DALY averted studies. We examined study characteristics including intervention type, sponsor, country, and primary disease, and also analysed the number of CEAs versus disease burden estimates for major diseases and conditions across three geographic regions.

Results: We identified 6,438 cost-per-QALY and 543 cost-per-DALY studies published through 2016 and observed rapid growth in publication rates for both literatures. Cost-per-QALY studies were most likely to examine pharmaceuticals and interventions in high-income countries. Cost-per-DALY studies predominantly focused on infectious disease interventions and interventions in low and lower-middle income countries. We found discrepancies in the number of published CEAs for certain diseases and conditions in certain regions, suggesting “under-studied” areas (e.g., cardiovascular disease in Southeast Asia, East Asia, and Oceania and “overstudied” areas (e.g., HIV in Sub Saharan Africa) relative to disease burden in those regions.

Conclusions: The number of cost-per QALY and cost-per-DALY analyses has grown rapidly with applications to diverse interventions and diseases.  Discrepancies between the number of published studies and disease burden suggest funding opportunities for future cost-effectiveness research.
Motor performance in patients with knee osteoarthritis after 8-week home exercise program
Authors: Sokk Jelena , Rätsepsoo Monika , Kums Tatjana , Ereline Jaan , Haviko Tiit , Gapeyeva Helena , Pääsuke Mati
Published: January 2018

On patients with knee osteoarthritis (OA) the muscle strength, gait and  everyday activities performance capacity decreased, though patients care started many years before. Patients care includes supervised physio therapy sessions and home exercise performing. Research goal was to assess the improvement in patients with knee OA motor performance with home exercise program (HEP) 8-weeks before total knee arthroplasty (TKA). Hypothesis: 8-week HEP improve legs motor performance in patients with knee OA. Ten female patients with knee OA with the mean (±SE) age of 62.7±2.3 yrs; ten age- and gender-matched healthy controls with the mean (±SE) age of 62.6±1.1 yrs. Motor performance was assessed by isometric strength of the quadriceps femoris (QF) and hamstring (HM) muscles, gait, Five-Time-Sit-to-Stand (FTSTS) test and knee active range of motion (aROM) before and after 8-week HEP. Outcome was measured by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). After 8-week HEP, QF and HM isometric strength, knee aROM during flexion and the gait stride length for the involved leg increased (p<0.05) compared to pre-exercising level. The WOMAC score increased and FTSTS test time shortened (p<0.05) after 8-week HEP. Difference in measured parameters between the patients involved leg decreased as compared to uninvolved leg and controls. Study showed that after 8-week HEP improved involved leg thigh’s muscle strength, knee aROM, and stride length. Sit to stand test performance and patient’s self-assessed condition improved. In conclusion, HEP with at least 8 weeks should be recommended for patients with knee OA before TKA.
Benefits of Music Training in Child Development: A Systematic Review
Authors: Benítez María Angélica , Abrahan Verónika Mariana Díaz , Justel Nadia Romina
Published: January 2018

There are evidences that establish that from early childhood musical education has a positive effect on the cognitive development of the child, as well as different musical components contribute to the development of psychomotor, emotional and social skills. The musical processing is a complex issue. From a cognitive point of view production, music perception and aspects of the musical discourse, such as timbre, intensity, pace, and tonality, are processed in different parts of the brain and their structure may vary from one person to another, depending on their musical experience. Throughout this review, we will present the background related to the benefits of musical training in cognitive development of children during early childhood, emphasizing differences that involves receptive training compared to active, extending the effects to the field of music therapy and the use of techniques with therapeutic purposes.