bluuebunny/crossref_metadata_2025 huggingface dataset:
Developing a community orientated mental health service
Authors: Scott Jan , Normanton Mel , McKenna Julie
Published: May 2008

This paper describes the development of a community orientated mental health service including the introduction of a community-based admission unit. The catchment area is a compact conurbation with a population of 56,000 in a deprived part of North Tyneside. Most people come from social classes IV and V and less than 1 % are from ethnic minorities. The male unemployment rate varies from 16–24% and the area is ranked 58th (out of 192) on the Jarman deprivation indices. The primary health care services suffer from many of the problems of inner-city general practices, with the Family Practitioners Committee being the highest prescriber in the country.
Behavioural and cognitive psychotherapy experience and supervision: a possible model of delivery
Authors: Drummond Lynne M.
Published: May 2008

In 1987 and 1989 surveys of junior doctors' experience of behavioural and cognitive psychotherapy in the South West Thames Region were published (Drummond & Bhat, 1987; Drummond & Bhat, 1989). These surveys demonstrated that a marked increase in the numbers of trainees gaining cognitive and behavioural experience was shown following monthly visits by the peripatetic Senior Lecturer in Behavioural Psychotherapy. The number of trainees gaining experience of treating at least one case under supervision increased from 17% to42% over this period. However, this still fell short of the College recommendations that every trainee should receive this experience and treat at least two cases under supervision.
Natalie Cobbing Travel Fellowship
Authors: Bambrick M.
Published: May 2008

In 1987–88 I undertook a research project, to look at parental views on sterilisation for their mentally handicapped offspring. This project was prompted by the then recent decision of the High Court in the UK, which authorised the sterilisation of a 17-year-old girl with mental handicap, and created much controversy and debate at the time. Very little was known about the views of parents as a group in the UK on this issue, and hence the decision of our Department of Mental Handicap in Nottingham to explore this area (Bambrick & Roberts, in press).
False teeth and Alzheimer's disease
Authors: Burns Alistair , Howard Robert , Förstl Hans , Levy Raymond
Published: May 2008

Alzheimer's disease (AD) is the commonest form of dementia and affects about 6% of people over the age of 65. The aetiology is unknown and putative causes range from environmental toxins (Martyn et al, 1989) to chromosome abnormalities (St George Hyslop et al, 1987). Despite the extensive resources being channelled into AD research, it is surprising that no study has yet discussed the role of false teeth.
Changes in referral rates following community psychiatric nurse attachment to a primary care team
Authors: Wells Andrew D. , Eagles John M. , Hunter David , Fowlie Douglas G.
Published: May 2008

Over the past three decades there has been a shift in emphasis from hospital based to community care of psychiatric patients. Central to this change has been the development of the community psychiatric nursing services and an increase in its numbers. Until recently community psychiatric nurses (CPNs) were almost entirely hospital based, working as members of a multidisciplinary team and providing follow-up for psychiatric patients.
The present and future of higher training
Authors: Abou-Saleh M. T. , Goepfert M.
Published: May 2008

As part of an ongoing educational audit of the process, content, and outcome of higher training in the Mersey Region, the Senior Registrar Tutor (MA-S) and the Psychotherapy Speciality Tutor (MG) organised a whole-day workshop for the senior registrars, involving them in internal audit as well as providing an experience of strategic thinking on the impact of NHS changes on higher training. We modified a package used in industry for strategic planning called the Quick Environmental Scanning Technique (QUEST) (Nanus, 1984). The QUEST process involves two whole-day meetings usually separated by a month which we condensed and adapted to one day, alternating large group discussion with small group work.
Interactive television in psychiatry
Authors: McLaren P. M. , Watson J. P. , Summerfield A. B. , Lipsedge M.
Published: May 2008

Population movements away from large cities and congestion in urban areas create problems for the delivery of psychiatric care which are compounded by the move towards greater care in the community. These developing service patterns require adequate methods of communication between service components. There is a proliferation of new technology offering opportunities for improved national and international communication in psychiatry as in other branches of medicine. It will be important to decide which technological innovations will improve the efficiency of service delivery rather than end up as expensive ‘gadgets’, or solutions looking for problems to solve. In this paper the use of interactive television in psychiatry is reviewed and the implications for the evaluation of new communications technology are discussed.
The use of Guardianship Orders
Authors: Benbow S. M. , Germany E.
Published: May 2008

Guardianship Orders (GOs) are being applied more often in care of people suffering from mental illness (Hughes, 1991) and the elderly may have problems particularly suited to their use. Since many individual psychiatrists have little experience of GOs, we decided to examine our use of them. One of us had been involved in six orders over seven years working as a full-time consultant in the psychiatry of old age.
The College Research Unit and its clinical audit programme
Authors: Lelliott Paul
Published: May 2008

The College Research Unit was established initially with donations from College members. After a year of pilot work and fund-raising a programme of work began in October 1990 supported by a three-year grant from the Department of Health. The main theme of the programme is clinical audit. This report outlines the nature and role of audit in psychiatry, describes the structure of the Unit, and presents a brief summary of the Unit's work.
The training of psychiatrists for the developing world
Authors: Mbwambo Jessie , Appleby Louis , Gater Richard
Published: May 2008

How relevant is the training which postgraduate psychiatrists from the developing world receive in the West? Are the investigations, treatment, and clinical practices taught in the UK transferable across widely disparate cultures? Should trainees be taught basic psychiatry or only sub-specialities? Should they come at all?
Pseudo-science?
Authors: Marjot D. H.
Published: May 2008

Our countrymen, including ourselves, share numerous prejudices.

We are sexist, racist, ageist, chauvinist (an un reasonable patriotism), and classisi (by birth, wealth or education). We also share that fear, dislike and rejection of the mentally disordered, which I would like to call the prejudice of ‘psychiatrism’. Not only those who suffer are stigmatised – but so are their carers.
Kaohsiung (Taiwan)
Authors: Chong Mian-Yoon , Soong Wei-Tsuen
Published: May 2008

In his memorial speech given on the 30th anniversary of the Chinese Society of Psychiatry in Taiwan, the founder of the Society, Professor T. Lin, spoke on the evolution of psychiatry in Taiwan. He stressed that the “building up of psychiatry from almost nothing against all odds” just after World War II in an area where “the general attitude of the medical profession as well as the lay public to psychiatry was characterised by indifference and contempt arising from their ignorance and also prejudice against mental illness” (Lin, 1961) is like Robinson Crusoe surviving on his desert island. Today, the Society with its 518 members has had considerable success in the development of psychiatry in Taiwan.
Guidelines for out-patient electroconvulsive therapy
Authors: Laidlaw Jim
Published: May 2008

Psychiatry is much more community based than ten years ago. Despite this there is little specific research published on out-patient electroconvulsive therapy (ECT) and there is a lack of well-defined guidelines for its administration.
The doctor–patient relationship and psychiatric out-patients
Authors: Timimi Sami B.
Published: May 2008

A trainee in psychiatry soon realises that one of the great differences between working in psychiatry and in other specialities is the presence of different working models, each with its own boundaries, which are often kept quite separate in clinical practice (see, for example, Straus et al, 1964). This naturally presents the newcomer with many dilemmas. In this paper I want to explore my own experiences in using psychodynamic approaches within the setting of a routine (medical model) psychiatric out-patient clinic.
An introductory course
Authors: Williamson D. J.
Published: May 2008

Computers themselves do very little other than make a rather soothing whirring noise and blink expectantly at you. It is the application software that you do work with, not the computer itself. Before we look at some of the common software applications, a brief word about files.
South West Region senior registrar jamborees
Authors: Vassilas Christopher , Metcalfe Michael
Published: May 2008

Trainees are often called upon to organise educational events. We hope that our experience will be helpful and that some of the lessons we have learnt will be of use to others.
Resources available to develop mental health services
Authors: Mahoney John
Published: May 2008

The Audit Commission has drawn attention to local champions of change in mental health services. Good Practices in Mental Health (GPMH) (1985) has highlighted a district which has overcome some of the myths about the impossibility of transforming the service, and recently the Institute of Health Services Management (IHSM) Working Group (1991) has entered the debate with “good psychiatric services can be developed in areas where managers are determined to introduce improved services”. The Audit Commission singled out Torbay Health Authority, GPMH highlighted Exeter Health Authority, and the IHSM Working Group have listed 12 exemplary health authorities (including Torbay and Exeter) where good local services have been developed.
Working group on mental health information systems
Authors: McClelland Roy
Published: May 2008

The importance of information systems for clinical management, audit and resource management has been widely recognised by both the professions and management alike. While major advances in information technology have taken place in the acute hospital sector, a relative void exists within community services. Nevertheless over the last few years a number of developments have taken place which hold considerable promise for the information needs of community mental health services. In response to this void the Research Committee of the College has established a Working Group whose remit is to advise the College, and through it the Department, on the information needs of psychiatrists and the requirements of information systems that should support those needs.
Specialist Section for the Psychiatry of Old Age: Residential Conference Review
Authors: Goddard Cait , Rands Gianetta
Published: May 2008

The third annual residential conference of the Section was held in Jersey from 5 to 7 March 1992. One hundred and twenty delegates gathered to hear from a range of practitioners. Trainees had a high profile – the policy of increasing to a third the proportion of higher trainees intending to be old age psychiatrists is beginning to bear fruit. A whole morning session was devoted to higher training issues ranging from the historical view of the relationship between old age psychiatry (OAP) and geriatrics, to a review of a successful higher training scheme, to innovative hopes for the future in the shape of Individual Performance Review (IPR) and an audit of audit. The senior registrar group's nationwide survey of current higher training experiences was presented.
1992 Trainees' Forum: Psychiatry in the Europe of the 1990s
Authors: van Beinum Michael , Castle David
Published: May 2008

On 21 January 1992 the annual Trainees' Forum, organised by the Collegiate Trainees' Committee, was held in London as part of the Winter Quarterly Meeting of the Royal College of Psychiatrists. The theme was European integration and the implications for training in psychiatry. Three speakers presented different aspects of this topic: Dr Fiona Caldicott, Dean of the Royal College of Psychiatrists, spoke on the role of the College in Europe; Dr Sharon Binyon, of the BMA Permanent Working Group of European Junior Doctors, spoke on medical manpower issues; and Dr Jim van Os, from the Institute of Psychiatry, looked at recent research illustrating differences in the understanding and treatment of psychiatric illnesses between France and the UK.
Behavioural-cognitive psychotherapy training for psychiatrists
Authors: Stern Richard
Published: May 2008

“The therapist can cite Bertrand Russell's observation that the degree of certainty with which one holds a belief is inversely related to the truth of that belief. Fanatics are true believers, scientists are sceptics”. (Beck et al, 1979)

I propose to describe the evolution of behavioural treatments, and the more recent leap forward made by cognitive therapy. Exciting new treatments are now available that did not exist when I was a trainee. The accepted term for these treatments is “behavioural-cognitive psychotherapy’ (BCPT). They are behavioural in the sense that emphasis is on observable behaviour, e.g. avoidance of supermarkets in agoraphobia. They are cognitive because many approaches involve working with patients' thoughts, e.g. the negative thinking of depressed patients. The treatment is psychotherapy as it is therapy that works at the mind level, rather than at say the synaptic level as pharmacotherapy does. BCPT combines well with pharmacotherapy, and other therapeutic methods such as social therapy, and so is suitable for a multidisciplinary approach to a psychiatric problem, as well as offering specific techniques for identified disorders.
Untreated schizophrenia in hostels for the homeless: a cause for concern?
Authors: Marshall M. , Sharpe M.
Published: May 2008

We report two cases from a study of Oxford hostels for the homeless of patients who were suffering from schizophrenia and are not receiving medication. After compulsory admission to hospital and treatment both showed a dramatic improvement in behaviour which was confirmed by a standardised rating scale. We discuss how hostels for the homeless have become both asylums and traps for those who suffer from schizophrenia and conclude that doctors should not under-estimate the potential benefit of anti-psychotic drug therapy even in homeless people with chronic psychosis.
A survey of voting in elderly psychiatric and medical in-patients
Authors: Stanners Andrew , Kite Suzanne , Hargreaves David , Burn Wendy
Published: May 2008

The UK has recently held a general election in which the future of the National Health Service has been a major issue. The elderly constitute a growing proportion of the electorate and are frequent users of the Health Service, yet some may have been unable to vote because they are in-patients. Elderly in-patients can vote by post or proxy or by being taken to their polling station by relatives or party representatives, but for many these arrangements may be inadequate.
Research activity among trainees on Merseyside
Authors: Stanway T. L.
Published: May 2008

An active interest in research aids understanding of research methods helps in the reading of scientific papers, and is rapidly becoming a prerequisite for career progression in psychiatry.
Exporting psychiatric skills
Authors: Nadarajah J.
Published: May 2008

In early 1992, I spent five weeks at the Costina Hospital in Romania – an exchange visit organised by the West Midlands Regional Health Authority at the request of a charity known as Faure Alderson Romanian Appeal, based in London. The team who set off with me in a lorry, minibus and a Land Rover, included a residential social worker, a medical student who helped me with the assessment of patients and four other volunteers from the charity to help in an orphanage. The journey across Europe was confronted with difficulties at Romanian customs but we eventually managed to meet the Director of the Hospital we were visiting, after a week on the road.
Psychiatric emergencies in people with a mental handicap
Authors: Kohen Dora
Published: May 2008

With the implementation of community care and resettlement programmes, the extent, frequency and the management of emergencies in the mentally handicapped population have attracted a good deal of attention. Among the issues of importance are crisis in the community and unnecessary and repeated hospital admission; inappropriate emergency referrals leading to abuse of services; the need for emergency services and the importance of short term admission facilities (Nolan et al, 1992). While the number of psychiatric emergencies in people with mental handicap is not large, the trend towards living in the community has brought the need to monitor such referrals.
A protocol to augment ECT seizure duration
Authors: Gee Douglas , White Anthony
Published: May 2008

The presence of a generalised seizure is necessary, although not sufficient, for effective ECT. Awareness of this has led to a widespread practice of documenting not only the occurrence but also the duration of seizures; a minimum duration of 25 seconds has been suggested (Royal College of Psychiatrists, 1989). Yet even the most recent surveys of practice have shown that on most occasions when a seizure is brief or absent the treating doctor does nothing about it (Scott et al, 1989; Pippard, 1992).
Whose body is it anyway: paternalism and Section 57 of the Mental Health Act 1983
Authors: Oyebode Femi
Published: May 2008

Section 57 of the Mental Health Act 1983 relates to certain forms of medical treatments for mental disorder which require both consent and a second opinion. It applies to any surgical operation for destroying brain tissue or for destroying the functioning of brain tissue; it also applies to the surgical implantation of hormones for the suppression of male sexual drive. These treatments cannot be given unless the patient has consented and three independent people, including a medical practitioner, certify that the patient is capable of understanding the nature of the treatment proposed, has consented to it, and the appointed registered medical practitioner has certified that the treatment is appropriate. This paper examines whether Section 57 is indeed justifiable and whether the current procedure needs amendment.
Prevention in psychiatry
Authors: Paykel E. S.
Published: May 2008

This report reviews the current status of prevention in psychiatry. A more detailed discussion of specific topics, derived from working papers prepared for the Committee, will in addition be published as an edited book by Gaskell Press.
London capitation weighting: social deprivation, homelessness and mental health
Authors: Turner Stuart , Haskins Carolyn
Published: May 2008

Inner London, together with many other inner city areas, faces a crisis of funding in health services. Budgets are now allocated to commissioning authorities primarily on the basis of the sizes of resident populations. Although it is recognised that different communities have different needs and that some adjustment to this simple approach (capitation weighting) is required, there is no clarity about the best mechanism to achieve a fair resolution (Stern, 1992). Those inner city areas with high levels of social deprivation, high indices of health service need and especially those with high numbers of homeless people require additional resources to provide acceptable levels of overall care. Failure to take adequate account of these pressures may result in further gradual reductions in funding and consequently in service provision.
Who's sleeping in my bed?
Authors: Weller Malcolm P. I. , Sammut Robert G. , Santos Maria J. H. , Horton John
Published: May 2008

The number of psychiatric beds in Friern Hospital in North London was steadily reduced in line with plans to close the hospital in 1993. Meanwhile some discharged patients deteriorate, most of whom have schizophrenia, with significant and multiple disabilities of a chronic nature and are service dependent as described in the recent report of the Royal College of Psychiatrists (1993). Return to their accommodation may be prejudiced by their relapse and the attendant disturbed behaviour. The poor employment prospects too are unhelpful in rehabilitation, particularly since we are running down and closing probably one of the best industrial rehabilitation facilities in the world. The combined effects generate great pressures on the remaining beds and there are increasing numbers in prison.
Measuring patient satisfaction in children
Authors: Walters Elizabeth
Published: May 2008

The report of the Standing Medical Advisory Committee to the Department of Health, The Quality of Medical Care (1990), states that outcome is the most relevant indicator of quality of medical care. In addition to providing information about the appropriateness of treatments, there are important ethical and resource implications if activities are found to be unjustified. However, measuring outcome is difficult if there is no quantifiable change in symptoms or function following treatment. In child psychiatry this is a relatively common dilemma and outcome studies, while agreed to be essential, are frequently abandoned at an early stage or fail to get off the ground because of the complexity of the problems they generate. In a review of the ways in which child mental health services attempt to measure outcome (Pound & Cottrell, 1989) the authors acknowledge these difficulties and conclude that a start should be made by “Asking the customer's opinion” about the treatment they have received. In other words, “Are they satisfied?”.
Part-time higher training in child and adolescent psychiatry
Authors: Talbot Ruth
Published: May 2008

The rise in the proportion of female medical graduates has led to an examination of the alternatives to full-time continuous postgraduate training. Part-time training has become more common, particularly in psychiatry and non-acute specialties. The means of establishing this type of training have been described in detail (Royal College of Psychiatrists, 1987) and the training requirements are discussed in the JCHPT Handbook. However, when part-time training is written about it is presented as a daunting process, fraught with concerns about a less than optimum training and practical difficulties. The survey by Ann Gath (1988) of supernumerary senior registrars in child and adolescent psychiatry detailed problems such as prejudice, a sense of exploitation, and lack of support and advice. These issues are clearly of great importance to those considering this option but there is also a more positive and optimistic view of part-time training which seems of particular relevance to child psychiatry. At the time of writing I am nearing the end of my higher training on the PM 79(3) scheme and am in a position to describe some of these more positive aspects.
The Association of Teachers of Sexuality within Medical Education: an inaugural meeting
Authors: Webster L.
Published: May 2008

The inaugural meeting of the Association of Teachers of Sexuality within Medical Education was held in London on 2 July 1993. The list of participants reflected the fact that teaching about sexuality does not fit neatly into any subject area, and although some departments of psychiatry see this as their responsibility, others seem happy to leave it to colleagues in reproductive medicine. So as well as psychiatrists and psychologists, we included gynaecologists, specialists in family planning and general practitioners with psychosexual training. We represented a wide geographical area with participants attending from as far apart as Aberdeen and Southampton. What we had in common was some responsibility for teaching about human sexuality, and a belief in the importance of this topic in medical education.
Why we should be worried about community care: a personal view of the Eighth Annual TAPS Conference
Authors: Crichton Paul
Published: May 2008

In 1985, nearly two years after the announcement of the intended closure of Claybury and Friern Hospitals, the Team for the Assessment Psychiatric Services (TAPS) was set up to evaluate this policy. TAPS has now grown to a staff of six full-time researchers (three psychologists, a psychiatrist, a sociologist and a health economist) and is funded mainly by the North East Thames Regional Health Authority, but also by the Department of Health. This was the eighth annual conference, and the first since the closure of Friern Hospital in March 1993.
Development and audit of Charles Street Parent and Baby Day Unit, Stoke-on-Trent
Authors: Cox John L. , Gerrard Janice , Cookson David , Jones J. Mary
Published: May 2008

Although several studies have found the frequency of postnatal depression to range from 9 to 13%, optimal services for the recognition and management of this disorder are not fully established. There is a lacuna in the provision and costing of comprehensive services for women with postnatal mental illness, although it is recommended that each large district requires a consultant led team (three to five sessions per week) and a district or supra-district mother and baby unit (Oates 1988; Royal College of Psychiatrists 1992).
‘The development of alcohol strategies in England and Wales’: a review
Authors: Godfrey Christine
Published: May 2008

The misuse of alcohol causes a range of health, legal, social and employment problems for the individual and the rest of society. Many agencies are involved in dealing with the consequences of alcohol misuse and providing services to those with problems. Sources of funds to finance interventions for drinkers whether from health authorities, social services, probation or other sources are very limited. Without some coordination there will be a tendency for each funder to shift responsibility and costs. These difficulties have been recognised and in 1989 a government health circular was issued emphasising the need for the development of local multi-agency alcohol misuse prevention strategies. Implementing policies such as community care andHealth of the Nationalso require multi-agency co-operation if they are to fulfil their aims. The survey of the development of local alcohol strategies reported in this paper (Wallaceet al, 1993) is therefore of great interest.
The psychiatric secretary: a key player in the ‘new’ health service
Authors: Foster Sally A. , Davison Philip S.
Published: May 2008

Over recent years the National Health Service has undergone many changes, one of the most important being the development of purchaser/provider roles. From April 1993 district health authorities (DHAs) and general practitioner fund holders (GPFHs) have been able to choose from which provider to purchase their adult psychiatric out-patient services. While discussions on how to attract and keep the contracts from DHAs and GPFHs have been underway at a managerial and consultant level, we believe that the potential role of a key player for hospitals, the psychiatric medical secretary, has been overlooked. This paper examines the secretarial role in the context of the ‘new’ health service.
Emergency work at an Inner London psychiatric hospital: a study of assessments made over six months
Authors: McPhillips M. A. , Spence S. A.
Published: May 2008

Following the introduction of a 24 hour Emergency Clinic at the Maudsley Hospital in 1952, psychiatric hospitals across the UK have come to offer a similar but often smaller service.
Teamwork and satisfaction: the team member's view of multidisciplinary teams
Authors: Klemperer Frances , Herzberg J. L.
Published: May 2008

The responsibility for patient treatment is shifting from physician to non-physician professionals throughout medicine. Multidisciplinary teams are replacing hierarchical structures in which the consultant is dominant, particularly in disciplines which care for patients suffering from multiple or chronic disabilities.
Continuity of care in serious mental illness
Authors: Abbati Joy , Oles Greg
Published: May 2008

It has been claimed (Abbati et al, 1987) that patients benefit from continuity of professional involvement sustained over a long period. Schizophrenia sufferers in particular find it harder than non-sufferers to articulate their difficulties and concerns, and may adjust poorly to change, only building up trust in professionals over an extended period. In their turn, professionals need time to get to know such individuals and to recognise ‘early signs’ (Birchwood et al, 1989) of possible relapse. Management of potential decompensation involves a knowledge of how the individual has responded to changes in medication in the past and what psychosocial factors may be relevant. Working with such patients refines the clinician's skills in interacting with them, obtaining their compliance with a particular regime, and pre-empting potential problems. Without this background of knowledge and experience, the management of sufferers may be crude with adverse results for the patient.
Evaluation of a psychiatric training scheme
Authors: Khan Abid , Oyebode Femi
Published: May 2008

Rotational training schemes are now well established as appropriate means of organising psychiatric training in the UK. There are already a number of good descriptions of how schemes are organised and managed (Soni et al, 1987; Davies, 1990) and one report of the experiences of trainees in a particular scheme (Fahy & Beats, 1990).
Mildly mentally handicapped offenders: an alternative to custody
Authors: Johnson Christine , Smith Jeanette , Stainer Geoff , Donovan Martin
Published: May 2008

Concern is increasingly being expressed about the lack of provision for mentally disordered offenders, who by default end up within the penal system. Gunn et al (1991) in a study of sentenced prisoners identified a significant number who were mentally disordered to be in need of psychiatric treatment. Among these, 0.4% were considered to be mentally handicapped. Recent reports have emphasised the importance of diverting these individuals from the criminal justice system (Woolf & Tumin, 1991; Home Office, 1990; British Medical Association, 1990). However, the majority of such offenders do not fulfil the criteria for admission to hospital under the Mental Health Act 1983. Most are not overtly mentally ill and do not require treatment in conditions of medium security such as exist in regional secure units. However, it is not clear what provision there should be for such individuals. Smith (1988) described an open forensic unit for mildly mentally handicapped offenders (the Leander Unit). She concluded that there was a need for a specialised service to cater for these patients, who were neither appropriately nor adequately provided for by the general psychiatric services, the mentally handicapped services, regional secure units or special hospitals. Unfortunately, in practice there are very few facilities for this group of patients.
The Vron – a short-stay rehabilitation hostel
Authors: Robson C. E.
Published: May 2008

The development of hospital hostels was advocated by the DHSS in 1975. These combined the clinical expertise and back-up of hospital resources with a domestic environment. The suggested level of provision was eight to ten places per 200,000 population in areas of average need and ten to 12 places in high need areas.
Junior psychiatrists and the “new deal”
Authors: Smith Simon , England Simone , Doshi Monica , Weaver Mark
Published: May 2008

The “new deal” for junior doctors is set to ensure reduction of hours worked to a maximum of 72 per week by the end of 1996. To facilitate this reduction, juniors with a higher workload are being asked to consider alternative working patterns to the traditional “on-call” total system, and either work full shift systems (e.g. as in casualty departments) or a partial shift system that falls between these two extremes.
Social services response to psychiatric emergencies
Authors: Huxley Peter , Kerfoot Michael
Published: May 2008

This paper reports the results of a nationwide survey of social services responses to psychiatric emergencies. The survey is a companion to that by Johnson & Thornicroft (1991) (J&T) who reviewed the emergency service options available in psychiatry, including the emergency clinic, general hospital services, the emergency ward, acute day hospital and crisis intervention and residential services, as well as considering the role of sectorised services, and community mental health centres (CMHCs). For the purposes of our respective surveys of health and social services in England and Wales, we have defined a psychiatric emergency as “occurring when someone (patient, friend, relative or professional) requests urgent intervention on behalf of someone in the community who is suffering from a mental disorder”.
The last dance
Authors: Reeves R. W. K.
Published: May 2008

In December we held the last dance. Shortly after 1 a.m. the ghosts of long dead patients would have heard the strains of Auld Lang Syne drifting down the hospital corridors. Perhaps they should have joined us.
Presidential Keynote
Authors: Sims Andrew
Published: May 2008

Three years is a long time in the life of a President, rather longer than the gestation of an elephant, and about the time that my vines took to start bearing fruit! As I write this in February we are in the middle of the rugby season; Union in the four nations served by the College, and League, also here in Yorkshire. I see the role of the President rather like a good fly-half – a strategic and accurate pass will enable somebody else to score; when in trouble, kick for touch and gain as much territory as possible: A fly-half rarely scores tries himself! The College and its Officers try to improve the ground for the practice of psychiatry, but it is Members and Fellows locally who can capitalise on this and improve the quality of care for their patients.
Scottish rehabilitation services: eight year follow-up
Authors: McCreadie Robin G. , Williamson Douglas J. , Robertson Lesley J.
Published: May 2008

A survey of Scottish psychiatric rehabilitation and support services, carried out in 1983 (McCreadie et al, 1985), found that although there were wide between-hospital differences, the National Health Service in Scotland was making considerable efforts to provide services for the long-term mentally ill. However, services provided by local authorities were seriously deficient.
Assisted suicide or culpable suicide: is there a difference?
Authors: Maharajh Hari D.
Published: May 2008

In 1991, Derek Humphry published Final Exit – The Practicalities of Self-Deliverance and Assisted Suicide for the Dying. The book was written for mature adults who were suffering from terminal illnesses and required guidance in committing suicide, but it has encouraged suggestive and susceptible people to attempt suicide (Lavin et al, 1992). There appears to be a thin line between assisted suicide and culpable suicide. ‘Culpable suicide’ is used here to describe contributory negligence attributed to persons who unknowingly assist another person's suicide.
Journal clubs
Authors: Rowlands Paul , Geddes John
Published: May 2008

We were interested to read J. J. Hutchinson and A. Puranik (1992) on journal clubs at St Edward's Hospital, and would like to share our experience of running journal clubs in Sheffield. As stated, the College does not provide guidelines on the format of journal clubs, but they do provide a suggested reading list. While this contains interesting and relevant papers, it does not provide a good basis for a journal club programme.
Developing case management for the long-term mentally ill
Authors: Ford Richard , Beadsmoore Alan , Norton Paul , Cooke Anna , Repper Julie
Published: May 2008

Mental health policies and the focus of psychiatric services have shifted over the last three decades from hospital to community care. Greater care in the community and reduced psychiatric bed numbers have contributed to the discharge or non-admission of many patients with severe and persistent disorders who formerly would have been cared for in hospital. Increasing numbers of the chronically ill in the community will necessitate the development of systems to provide continuous and integrated services for such people.
Management supervision for senior registrars: an example from child psychiatry
Authors: Reder Peter
Published: May 2008

Many trainees contemplating becoming a consultant admit that their greatest concern is how they will find their way through the NHS bureaucracy and politics and relate to managers and colleagues who them selves are embroiled in these webs. We have therefore made management a high profile component of senior registrars' training during their 16-months placement in the Centre. As well as attending formal courses run by the King's Fund or the Region, trainees are exposed to diverse management issues and we ensure that the weekly hour of consultant supervision includes discussion of managerial and clinical matters.
Who should act as the second medical recommendation for Sections 2 and 3 of the Mental Health Act?
Authors: Ung E. K.
Published: May 2008

Since 1959, the responsibility to detain a patient in hospital compulsorily has been given to doctors, social workers and hospital managers. The 1983 Mental Health Act stipulates that medical recommendations are made by two medical practitioners (one an “approved” doctor) for compulsory admission for assessment (Section 2) and compulsory admission for treatment (Section 3). When this was debated in Parliament, the importance of the independence of the two doctors making medical recommendations was stressed. This was to avoid collusion, influence or interference with clinical judgement (Bluglass, 1983).
Pound foolish: a review
Authors: Cottrell David
Published: May 2008

Earlier this year a senior Department of Health official asked me if I had seen an article in the Health Services Journal about child psychiatry (Light & Bailey, 1993). Shortly afterwards a consultant colleague asked me about the same article, having been told about it by her manager, and one of my own managers mentioned it to me and asked for my thoughts. Now the Psychiatric Bulletin wants 500 words on this same article. If nothing else, Professor Light and Dr Bailey have stimulated debate.
A training experience in the voluntary housing sector
Authors: Phelan Michael , Lloyd Keith
Published: May 2008

It is 25 years since the Royal Commission on Medical Education recommended that “every psychiatrist should be familiar with the conduct of community psychiatry”. This is now more important than ever. As the National Health Service and Community Care Act (1990) comes into force and community care initiatives are developed throughout the country, psychiatrists are at risk of being left behind. To be effective players in these developments, psychiatrists need to be armed with a thorough knowledge and understanding of the workings of community care. Training future consultants in all aspects of community care must be a continual priority.
GP use of psychotherapy services
Authors: Morton Mary J. , Staines Jill
Published: May 2008

In a rapidly changing NHS, there is a great awareness of the need to consult with general practitioners about their expectations of a service. A number of studies have looked at GPs' perceptions of psychological and psychiatric services (e.g. Eastman & McPherson, 1982; Whitfield & Winter, 1980) but to date little is known about how GPs view psychotherapy services. About 40% of the referrals to the Leicestershire psychotherapy department come directly from GPs and the present study aimed to ascertain local GPs' perceptions of the service. This was timely for the purpose of planning local development but clearly has important implications for psychotherapy services in general.
A guide for the trainee
Authors: Allen Danny
Published: May 2008

Audit is certainly the topic of the moment. It is much talked about and a lot of money is being made available for it, yet it seems that there are few real guidelines about how to do it. Many junior doctors who would like to do audit may be put off by the computers and other paraphernalia which are deemed necessary for this purpose. While technology can help, it is by no means necessary and some of the best audit follows the same principles as research: keep it simple.
The quality of computerised tomography use in two psychogeriatric services
Authors: Spear Jon
Published: May 2008

The aim of medical audit is to improve the quality of medical care (Department of Health, 1989). There was concern that patients referred to a psychogeriatric service (Service X) did not have adequate access to computerised tomography. The nearest computerised tomography scanner was located in a neighbouring district and direct referrals were not accepted. Computerised tomography scans could be obtained indirectly by referral to neurosurgeons. Because of these difficulties “potentially treatable structural lesions” (such as cerebral tumours and subdural haematomas) may have been missed. We decided to compare the use of computerised tomography scans with a nearby service (Service Y) which had a computerised tomography scanner on site. Service X had a catchment population of 33,000 aged over 65 and Service Y a catchment population of 23,420 aged over 65.
Literature search from home
Authors: Elameer M. S.
Published: May 2008

British Medical Association members are now able to use a new service to doctors which, until recently, has been largely exlusive to libraries in big hospitals and other institutions. At the time of writing, the BMA Library Dial-Up Medline Project has just completed its pilot stage and is due to be launched formally at the beginning of June. Trials started in November 1992 and the system is now up and running.
W. H. Sheldon
Authors: Walker Richard N.
Published: May 2008

Dr William H. Sheldon, Director of the Biological Humanics Center in Cambridge, Massachusetts, died there on 16 September 1977. Sheldon is the man who invented somatotyping—a classification of variations in human body structure, to which he related variations in temperament, in physical and mental illness, and in patterns of growth and ageing.
An Honorary Fellow Extraordinary
Authors: Cobbing Natalie
Published: May 2008

Dr Alexander Walk, at that time President-Elect, Librarian, Co-Editor, Secretary of the Parliamentary Committee and our representative on the General Nursing Council, was the first Officer I spoke to when I joined the staff of the RMPA in January 1960. It was typical that he should telephone to welcome the newcomer, and, as I have learned over the years, also typical that he should then have been serving the Association in so many and varied ways, and that he should now still be engaged in the service of the College. To this service he has given his skill, wisdom, generosity and wit for half a century, and last month he and the College celebrated the Jubilee of his first official appointment—as Assistant Editor of the Journal of Mental Science—in May 1928—a record never equalled by any other member.
Professional Self-Help in Alcoholism
Authors: Lloyd Gareth
Published: May 2008

The North West Doctors and Dentists Group is part of the wider British Doctors Group. In Britain Doctors' groups began when the London Group was formed in 1973. Since then new groups have been established in Birmingham, Bristol, Durham, Glasgow, Manchester, Northampton, Petersfield and Portadown.
The Foundations of Psychiatric Nurse Training
Authors: Parry-Jones William
Published: May 2008

The gradual transition from unqualified attendant to the trained psychiatric nurse of the present day was described in detail by Walk. A key turning point in this story occurred at the Quarterly Meeting of the Medico-Psychological Association in Edinburgh on 16 November 1883, when Dr A. Campbell Clark, Medical Superintendent of the Glasgow District Asylum, read a paper entitled ‘The special training of asylum attendants'. This paper was published in the Journal of Mental Science in January 1884. Whilst attention had been given by many other asylum doctors to the training of attendants, Clark's experience of organizing attendant training courses and his firm recommendations opened the way to practical steps which set training on a new footing. Clark acknowledged the work of Dr T. S. Clouston, Physician Superintendent of the Royal Edinburgh Asylum, who read a paper to the annual meeting of the Association in 1876 entitled ‘On the question of getting, training, and retaining the services of good asylum attendants'. This paper aroused a good deal of interest amongst members of the Association, and a small committee was formed to report ‘on the advisability of the formation of an association or registry of attendants in connection with this Association and the best manner of carrying it into effect’. However, there is no record of any report by this committee.
The Responsibilities of Consultants in Psychiatry within the National Health Service
Authors: Rawnsley K.
Published: May 2008

This document, originally published in the Bulletin, September 1977, is now reprinted on the instructions of Council. The reasons for this decision are incorporated in the fourth section of the paper by me, ‘The Future of the Consultant in Psychiatry’, which appears in this issue.
How Has Clinical Psychiatry Changed? A Historical Perspective
Authors: Burns Alistair
Published: May 2008

During some recent research for a project in the history of psychiatry, I had the opportunity of studying the first hundred years' Annual Reports of Glasgow's Gartnavel Royal Mental Hospital dating from 1814. I was struck at how applicable some of the comments were in modern psychiatry and was interested in some of the phraseology used and ideas expressed. Some were quaint, some entertaining and surprisingly few abstruse.
Negative Regulation of Parathyroid Hormone (PTH)-Activated Phospholipase C by PTH/PTH-Related Peptide Receptor Phosphorylation and Protein Kinase A
Authors: Tawfeek Hesham A. W. , Abou-Samra Abdul B.
Published: May 2008

PTH binding to the PTH/PTHrP receptor activates adenylate cyclase/protein kinase A (PKA) and phospholipase C (PLC) pathways and increases receptor phosphorylation. The mechanisms regulating PTH activation of PLC signaling are poorly understood. In the current study, we explored the role of PTH/PTHrP receptor phosphorylation and PKA in PTH activation of PLC. When treated with PTH, LLCPK-1 cells stably expressing a green fluorescent protein (GFP)-tagged wild-type (WT) PTH/PTHrP receptor show a small dose-dependent increase in PLC signaling as measured by inositol trisphosphate accumulation assay. In contrast, PTH treatment of LLCPK-1 cells stably expressing a GFP-tagged receptor mutated in its carboxyl-terminal tail so that it cannot be phosphorylated (PD-GFP) results in significantly higher PLC activation (P < 0.001). The effects of PTH on PLC activation are dose dependent and reach maximum at the 100 nm PTH dose. When WT receptor-expressing cells are pretreated with H89, a specific inhibitor of PKA, PTH activation of PLC signaling is enhanced in a dose-dependent manner. H89 pretreatment in PD-GFP cells causes a further increase in PLC activation in response to PTH treatment. Interestingly, PTH and forskolin (adenylate cyclase/PKA pathway activator) treatment causes an increase in PLCβ3 phosphorylation at the Ser1105 inhibitory site and that increase is blocked by the PKA inhibitor, H89. Expression of a mutant PLCβ3 in which Ser1105 was mutated to alanine (PLCβ3-SA), in WT or PD cells increases PTH stimulation of inositol 1,4,5-trisphosphate formation. Altogether, these data suggest that PTH signaling to PLC is negatively regulated by PTH/PTHrP receptor phosphorylation and PKA. Furthermore, phosphorylation at Ser1105 is demonstrated as a regulatory mechanism of PLCβ3 by PKA.