bluuebunny/crossref_metadata_2025 huggingface dataset:
The use of clozapine plasma levels in optimising therapy
Authors: Taylor David , Duncan Denise
Published: October 2008

Clozapine is well known to be an effective treatment for neuroleptic-resistant schizophrenia. However, its use is complicated by a variable and delayed response and by a range of troublesome adverse effects. Current practice is usually to increase the dose initially to around 450 mg/day and then by small increments to a maximum of 900 mg/day according to response and tolerability. While this method is often successful, it has been suggested that a better way of optimising the dose of clozapine might be to monitor plasma concentrations of the drug.
Experiment in postgraduate psychiatric education: students teaching students
Authors: Edwards J. Guy
Published: October 2008

Psychiatric trainees in the Wessex Region gave their own lectures on an MRCPsych course and received feedback on their performance from their peers. The form and content of the lectures were given high ratings and the presentations were considered at least as good as those given by more experienced lecturers. The experiment can serve as a model to supplement existing courses for trainees and as a ‘do-it-yourself form of education for areas and countries that have inadequate access to centres for postgraduate education.
J. T. Arlidge (1822–1899): a disillusioned alienist?
Authors: Myers Edward
Published: October 2008

John Thomas Arlidge was a prominent alienist in the mid 19th century. After thirteen years involvement with asylum psychiatry in London he changed direction to become a physician in North Staffordshire, achieving fame as an expert in occupational disorders. This paper describes his contributions to the psychiatric literature and suggests that disaffection with the way psychiatry was progressing may have led to his change of career.
The stresses of peacekeeping: Rwanda 1994
Authors: Palmer Ian
Published: October 2008

In August 1994 the British Army mounted its first ever Humanitarian Aid effort. I was the psychiatrist to this endeavour and this is a brief account of the stresses on those intimately involved with the medical aspects of ‘Operation Gabriel’.
Mental health, by Jane Austen
Authors: Hendriks Jean Harris
Published: October 2008

In the year of the College's 150th anniversary, the President invited essays with the title The Therapeutic Effects on Psychiatric Patients of a Pleasant and Congenial Environment’. Writers were asked to consider “current literature”.
Psychiatry at Glastonbury Festival
Authors: Knight Anna , Hughes Michael
Published: October 2008

Having viewed the Glastonbury Festival for many years as local residents, it seemed time for us to venture inside and see how 100,000 people can converge onto a dairy farm in rural Somerset for three days of music and assorted entertainments. We were interested in reactions to such intensely communal living and also the organisational aspects of psychiatric services in this extreme version of community care.
Resource consumption in psychiatric intensive care: The cost of aggression
Authors: Hyde Clive E. , Harrower-Wilson Colina
Published: October 2008

The coils of operating a psychiatric intensive care unit (PICU) were recorded for a six-month period. There were 110 admissions and 99 discharges. Mean length of stay was 12.3 days. Total costs were £346,516 over the study period, £283.56 per patient-day. Fixed costs comprised 93% of the total, inducing nursing staff ($169,447), overheads ($77,017), medical staff ($48,819), hotel costs (£24,160) and miscellaneous (£1,750). Variable costs included special nursing, (£19,405), treatment of major self-harm (£3,024), drugs (£1,707) and staff time to manage aggressive incidents (£1,188). Reduction of the incidence of aggression could result in valuable cost savings.
Neuropsychiatry: A different approach or a different clientele?
Authors: Scheepers Bruce D. M. , Bird Jonathan M. , Rogers Daniel G.
Published: October 2008

Results of a retrospective survey of the reasons for referral and admission to a specialist neuropsychiatric hospital are presented in an effort to address the uncertainties which exist regarding the nature of the conditions treated by this subspecialty. The results indicate that a wide range of both neurological and psychiatric conditions are treated, but the paper suggests that boundaries between these two specialities are largely conceptual and that the differentiating principle in the practice of neuropsychiatry is mainly philosophical.
The administration of general professional training schemes in psychiatry: A three year review
Authors: Herzberg J. L. , Watson J. P.
Published: October 2008

We have previously reported on the formation of a large regional registrar scheme covering 11 health districts in the South Thames region (Herzberg & Watson, 1991) and highlighted educational principles which we considered important for registrar training. The purpose of the present paper is to review those principles in the light of experience to date in running senior house officer (SHO) and registrar training schemes.
A psychiatric emergency walk-in clinic: a dangerous substitute for primary care?
Authors: Whittaker Jane F. , Appleby Louis
Published: October 2008

Data were collected on a six month sample of patients attending a psychiatric emergency walk-in clinic (n=378), based on the clinical impressions of the interviewing doctor. This information was then compared with a hypothetical model emergency service on the following five items: nature of patient problem, severity of problem, diagnosis, referring agent and current contact with psychiatric services. The severity of the perceived threat to the interviewer was recorded. Only 4.7% of referrals conformed to the hypothetical model on all five criteria. The majority of patients referred themselves, and the problems of self-referrals were significantly less severe than those of general practitioner referrals; 17.2% of consultations were perceived by the interviewing doctor as presenting a moderate or severe threat to his or her safety. The findings suggest that such an emergency facility operates as a form of primary care and is therefore inappropriately used. The level of perceived threat to interviewing doctors is unacceptably high.
Can staff predict day hospital responders?
Authors: Shergill Sukhwinder S. , Butler Robert , Greenberg Maurice
Published: October 2008

To maximise the effectiveness of psychiatric day hospitals it is important to establish which patients benefit most. We tested the hypothesis that day hospital therapists can predict responders. The consultant, key-workers, junior psychiatrist and secretary predicted outcome for 26 patients. These were measured blind using the Brief Psychiatric Rating Scale (BPRS), Global Assessment Scale (GAS), Becks Depression Inventory (BDI) and the Social Functioning Questionnaire (SFQ). There was poor correlation generally between staff predictions and patient progress as measured by the standardised instruments. The only significant correlation was the consultant's prediction with the BPRS. We suggest this is consistent with the consultant's experience and training in phenomenology. We conclude that consultants should be fully involved in day hospital assessments.
Hospital to hostel: what benefit?
Authors: McConnell Pamela
Published: October 2008

Resettlement of 15 long-stay psychiatric in-patients from a hospital rehabilitation unit to a new hostel was assessed by measuring symptoms, social behaviour and client satisfaction beforehand, then six and 12 weeks afterwards. Three residents experienced relapses with varying degrees of recovery. Overall, symptoms and social behaviour improved significantly. Change in satisfaction with the services offered proved difficult to measure accurately. A well resourced resettlement project can enhance long-stay patients' well-being.
Are psychiatry attachments in developing countries for the British trainee useful?
Authors: McCutcheon Ruth
Published: October 2008

Experience of psychiatry in a developing country is not generally regarded as pertinent to the training of the British psychiatrist. In this article I draw on my own experience of a psychiatric attachment in India to argue that such experience can be useful and relevant for British psychiatry trainees, and that it should be encouraged.
Sexual harassment of staff by patients in mental health units
Authors: Tomé de la Granja Maria B.
Published: October 2008

The Health and Safety Executive (1992) defines violence against staff as “any incident in which an employee is threatened or assaulted by a member of the public in circumstances arising out of the course of his or her employment”. Verbal abuse and threats are, as the Health and Safety Executive notes, the most common types of incidents, and staff have the common-law right to be protected from such incidents in the course of their work. While the literature on physical violence against mental health professionals is quite large and expanding (see, for example, Health and Safety Commission, 1987; Shepherd, 1994; Wykes, 1994), comparatively little emphasis has been placed on verbal assaults, although these may be extremely distressing.
The Mental Health Act Commission: medical members
Authors: Malcolm M. T.
Published: October 2008

The paper by Curran & Bingley (Psychiatric Bulletin, 1994, 18, 328–332) is most clear and helpful. While much is written in our Bulletin about the operation of the Act, little is written about the Commission itself. The Commission visits most of us far more frequently than does the College and makes much wider and more critical comments on our services. The account given, quite properly, gives little discussion to the role of the medical member. Many psychiatrists are or have been members of the Commission – currently 16 out of a total membership of 90. One year after completing a four year stint some very personal and subjective views may be of interest to colleagues about to be proposed, or propositioned, for membership of the Commission.
British continuing medical education: a framework for the future
Authors: Tait David
Published: October 2008

This is the kind of conference at which the Royal Society of Medicine excels – an international array of speakers, firm chairmanship, time and space to meet other delegates, abstracts published with the programme and a Consensus Overview published within a fortnight (by Professor Hugh Freeman as rapporteur).
A model for an integrated psychotherapy service
Authors: Holmes Jeremy , Mitchison Sally
Published: October 2008

A model psychotherapy service is proposed, integrated in the double sense of combining different psychotherapeutic modalities in a single psychological treatment service, and forging close links with general psychiatry. The four limbs of the service extend into supporting counsellors in general practice, providing psychotherapeutic input into the treatment of the severely mentally ill, managing patients with personality disorders, and supplying psychotherapeutic aspects of a liaison service. The advantages of this model in the current managerial climate are discussed.
A depression screening day for the elderly in a general practice setting
Authors: Forbes Walter , Tracy Diana E. , Hamilton Ross J. , Eagles John M.
Published: October 2008

Unrecognised and untreated depression is common, particularly in the elderly. This paper describes an attempt to offer screening for depression to 4,500 people over the age of 60. Only two people attended and both were depressed. This may have related to the arrangements for screening, to the symptoms of depression, to inadequate publicity or to characteristics of the elderly population. Others contemplating screening for depression in elderly populations are advised to adopt a different methodology.
Change in neuroleptic prescribing practice
Authors: Warner James P. , Slade Richard , Barnes Thomas R. E.
Published: October 2008

Concerns about the use of high doses of neuroleptic medication prompted an audit of prescriptions of these drugs in a large psychiatric hospital. Following an initial audit in 1991 of 196 patients, a follow-up of 192 patients was undertaken in 1993. A significant reduction in levels of neuroleptic medication was found, although doses still tended to remain high.
The efficacy of training in dynamic psychotherapy
Authors: Morton Mary , Bailey James
Published: October 2008

The efficacy of training in dynamic psychotherapy was assessed by sending a questionnaire to all visiting therapists (trainees) in the Leicester Psychotherapy Department. Questions were directed towards the effect of training on trainees' work in non-psychotherapy settings. Trainees noted improvements in communication skills, assessment/referral skills, anxiety and boundary management and overall management of the therapeutic relationship. Improvement was also noted in job satisfaction and motivation at work. These improvements were more prominent in trainees who had had more than two years' training.
The Mental Health Task Force Support Group
Authors: Wattis John , Thompson Chris
Published: October 2008

The Mental Health Task Force was set up by the Secretary of State for Health under the leadership of David King to assist in the process of the closure of the large mental hospitals and to ensure adequate provision was made to replace their services. Its strategic objectives, to be accomplished by the end of 1994, were to map the replacement of the remaining large institutions by good quality services, ensuring that this happened effectively; to identify what makes a service good and find ways of ensuring that services possessed these qualities; and to develop a vision of the shape of the mental health market in years to come. To assist in this a wide support group of about 20 people was set up. This included representatives of the Department of Health, Research and Development in Psychiatry, carer organisations, users, social services, general practice, nursing and the Royal College of Psychiatrists. The authors represented the College.
Mental health care in Spain
Authors: Torres-González Francisco
Published: October 2008

Spain is a member state of the European Union, covering over 500,000 km2 and with a population of more than 40 million. However, taking into account only the gross national product, there is no doubt that Spain still belongs to the southern countries.
Monitoring inner London mental illness services
Authors:   MILMIS Project Group, Audini Bernard , Crowe Michael , Feldman Joan , Higgitt Anna , Kent Andrew , Lelliott Paul , McKee Heather , Moorey Stirling , Palazidou Eleni , Pilling Steven , Roy David , Schapira Robert , Seth Ram , Weller Malcolm
Published: October 2008

Our objective was to establish a mechanism for monitoring indicators of the state of health of inner London's mental illness services. Data were collected for a census week around 15 June 1994. Local data collection was coordinated by consultant pyschiatrists working in inner London services. Twelve services participated with a combined catchment population of 2.6 m. They included ten London services which were among the 17 most socially deprived areas of England. Main indicators were admission bed occupancy levels (including an estimate of the total requirement), proportion of patients detained under the Mental Health Act, number of assaults committed by inpatients, number of emergency assessments and CPN caseloads. The mean true bed occupancy (which reflects the number of patients who were receiving, or required, in-patient care on census day) was 130%. To meet all need for acute psychiatric care, including for patients who should have been admitted and those discharged prematurely because beds were full, a further 426 beds would have been required. Fifty per cent of patients were legally detained. Physical assaults were virtually a daily occurrence on the admission units. Average community pyschiatric nurse caseloads were 37, suggesting that the majority were not working intensively with limited caseloads of patients with severe mental illness. These indicators, although imperfect, will allow for some measurement of the impact of local and central initiatives on the poor state of London's mental illness services.
Responsibility and accountability in community mental health teams
Authors: Onyett Steve
Published: October 2008

Community mental health teams are handicapped by long-standing ambiguities about responsibility and accountability. Professional responsibilities need to be separated from practitioner's responsibilities as employees, and clear lines of accountability established accordingly. This requires stronger delegated operational management responsibility at team level. Greater attention should be paid to defining shared, core responsibilities among team practitioners employed by health and social services. These are here defined as ‘care coordinating’ responsibilities and provide a means of reconciling the care programme approach and care management into coherent practice.
Services for adults with learning disabilities and mental health needs
Authors: Gravestock Shaun , Bouras Nick
Published: October 2008

A postal questionnaire assessing key professionals' and managers' views about local services achieved an overall 72% response rate. The results demonstrated concerns about the range, quantity and quality of mental health and social care provision for adults with learning disabilities and mental health needs in all 15 districts. Only eight (14%) respondents provided specific local service utilisation data, and confusions about care co-ordination responsibilities were evident. Improving future service provision should involve utilising needs assessments and quality assurance data to better inform multi-agency commissioning and purchasing strategies.
Improving out-patient attendance using postal appointment reminders
Authors: Rusius C. W.
Published: October 2008

Previous studies have demonstrated high rates of non-attendance among new referrals to psychiatric out-patient clinics. Consistent factors which distinguish non-attenders have not been shown. Forgetting an appointment contributes towards non-attendance and offers potential for its reduction. The effect of sending patients an appointment reminder three working days prior to the appointment date was examined. The rate of attendance of those sent a reminder improved significantly.
Recent changes in mental health legislation and government policy in psychiatric care in Australia
Authors: Boerma Bernard , Hayes Robert , Moen Alissa , Williams Anthony T.
Published: October 2008

There have been a number of recent changes in mental health care legislation in Australia some of which mirror the changes that have occurred in the UK. These are reviewed within the context of the differing health care system in Australia and with particular reference to the State of New South Wales.
Elizabeth I of England
Authors: Kapp Elinor
Published: October 2008

This is the first in a short series of articles on portraits of children from the point of view of a child psychiatrist.
Catchment areas: A model for the future or a relic of the past?
Authors: Kellett John M.
Published: October 2008

The shift of power from specialist services to the primary care teams has forced the former to examine the value of their hallowed traditions. In psychiatry, and geriatric medicine, the catchment area is a favoured restrictive practice, enabling demand to be regulated to suit the resources of each team. It is time to decide whether this is a practice to be defended and retained or whether, like many other restrictive practices, it is harmful to the consumer.
Improvements in practice from assessing standards of recording psychiatric case-notes
Authors: O'Hare Tom
Published: October 2008

The case-notes of all patients in a district general adult psychiatric unit were assessed for standards of recording selected key items. The results were presented at a departmental audit meeting, and the assessment repeated after four months. Initial audit revealed poor standards of notekeeping in certain areas. On repeat assessment, standards of documentation had improved for all the key items assessed, and reached statistical significance for physical examination. This audit was quick, easy and cheap, revealed unexpectedly poor standards of notekeeping, and evidently produced a measurable and significant improvement in practice.
Clinical Practice Guidelines: who needs them?
Authors: Marriott Sarah
Published: October 2008

Clinical Practice Guidelines (CPGs) are systematically developed statements to assist practitioner and patient in clinical decisions about appropriate health care for specific clinical circumstances. The Royal College of Psychiatrists CPG Programme aims to develop clinical guidelines which are scientifically valid and acceptable to those affected by them. At the same time, CPGs must be responsive to advances in knowledge, and versatile enough for the demands of routine practice. Their development involves a number of stages and a variety of methods, built into a cycle of evaluation and review. The Programme has established priorities for clinical topics for CPG development through consultation with the mental health community. Well-developed CPGs would benefit clinicians, patients and purchasers of care. It Is now important to appraise their ability to change clinical practice, the associated direct and indirect costs, and their value as a medical technology. The clinical professions are in the strongest position to co-ordinate their development, and guide their evaluation.
Fund-holders and child mental health services
Authors: Mutale T. I. R.
Published: October 2008

Three hundred randomly selected fund-holding general practitioners were sent a questionnaire that asked them to indicate their priorities for child mental hearth services. They were also asked to rate their local child mental health services; 210 (70%) returned completed questionnaires. Items accorded the highest priority by the largest number of GPs included written communication, short waiting time following referral, sensitivity to patient's cultural background, child sexual abuse services, and mental handicap services. Child psychiatrists were seen as the most essential members of multidisciplinary teams, and family therapy was the most popular choice of treatment. Financial considerations did not appear to dictate GPs' choices. About half of respondents rated their local services as barely satisfactory, unsatisfactory or extremely unsatisfactory.
Psychiatry on Tobago in 1989
Authors: Cembrowicz Stefan
Published: October 2008

An unstructured observation concerning low rates of observed psychological disturbance was explored by estimating rates of suicide, and psychotropic drug use. Recorded suicide, overdose, and ‘minor’ tranquilliser and antidepressant use were strikingly low on Tobago, when compared with the United Kingdom. Tobagonians were unlikely to medicalise distress by presenting with overt psychological symptoms. Most local doctors felt that patients preferred spiritual support, e.g. from charismatic religious groups and traditional healers (some using obeah). A rich network of social and recreational groups may also give important support, as may ‘liming’ (a local conversational pastime). Tabanka (a local culture specific syndrome) may also be a non-medical outlet.
If Freud had not been a doctor …
Authors: Hughes Patricia
Published: October 2008

If psychoanalytic psychotherapy is to be part of the undergraduate medical curriculum, it must be well taught, and demonstrably relevant to the training of doctors. Psychotherapy teachers have a responsibility to devise a syllabus which is clear and relevant and to provide teaching which stimulates and engages the students so that they learn by thinking and understanding. An outline of a syllabus for medical students is included and one seminar as an illustration of interactive learning is described.
Psychiatric outreach clinics held in a general practice setting and community mental health centre
Authors: Hindler Charles
Published: October 2008

Over nine months, 57 consecutive newly referred and previous out-patient attenders to two community psychiatric out-patient clinics located in a deprived inner city area of London were interviewed to elicit demographic information, psychiatric details and obtain their views about their preferred location for the out-patient clinic. The majority (94%) preferred a community out-patient setting to a hospital out-patient clinic, with 76% preferring a community out-patient setting to a home assessment. The overall attendance rate was 89%. A 10% higher rate of attendance was found at the community mental health centre compared with the general practice and 15% higher rate for new referrals. Patients preferred to attend a psychiatric out-patient clinic based in the community. This suggests that introducing community-based psychiatric clinics would make a substantial improvement on the current high rates of non-attendance at hospital psychiatric out-patient clinics.
Deliberate self-harm: service development in Kettering
Authors: Gordon Catherine , Blewett Andrew
Published: October 2008

Services for deliberate self-harm patients in the general hospital are unsatisfactory in many respects. A survey of activity and quality in a district general hospital confirmed recent trends observed elsewhere and highlights areas in which service provision can be improved.

High rates of deliberate self-harm (DSH) are a public health problem. A study in Oxford showed rising rates among young women during the late 1980s, and a threefold increase in the proportion due to paracetamol poisoning between 1976 and 1990 (Hawton & Fagg, 1992). A multicentre European study found a trend of increasing peak age, a declining female to male ratio, and unexplained differences between regions (Platt, 1992). In the year following DSH, 9% repeat (Hawton & Fagg, 1992); and suicide rates reach 1.1 to 1.3% of patients in the three years following an episode of DSH (Owens et al. 1991).
Failed discharges from the psychogeriatric ward
Authors: Too Judy , Gardner Justin , Savla Navin
Published: October 2008

‘Failed discharge’ was used as a measure of service efficacy on a psychogeriatric unit. Thirty-eight failed discharges from hospital were compared with 38 controls. Failed discharge was associated with a diagnosis of depression and a greater number of previous admissions. Possible underlying causes are discussed.

In the current NHS climate, it is increasingly important to measure the outcome of medical care. In psychiatry, the most appropriate methodology is not clear-cut (Garden & Oyebode, 1989). Tailed discharge’, or readmission to hospital within a short period of discharge, has been advocated as a possible outcome measure (Jones, 1991). This point prevalence study, of patients under 65 years, yielded a ‘failed discharge’ rate of 27%. Recurrence of original symptoms, poor treatment compliance and failure of follow-up arrangements emerged as important factors.
Improving electroconvulsive therapy practice through audit
Authors: Robertson C. , Wheeldon T. , Eagles J. M. , Reid I. C.
Published: October 2008

Recent studies have highlighted deficiencies in ECT service delivery. This audit was set up to monitor and improve the ECT administered in a large psychiatric service. In the first phase of the audit Information was collected regarding stimulus adjustment in response to brief seizures. This highlighted inconsistencies In clinical practice and an education programme was instigated to correct these deficiencies and to bring practice into line with the Royal College of Psychiatrists guidelines. A repeat audit was performed and a marked improvement in the quality of stimulus adjustment was shown.
The impact of training on the views and knowledge of prospective Cruse counsellors
Authors: Alexander David A. , Poidevin David Le , Lobban Mairead , Muir Mary
Published: October 2008

Few would challenge the view that the contribution made by Cruse to the welfare of the bereaved is a very important one. Much effort is put into the training of Cruse counsellors but little is known about the impact of this training. An assessment of 30 prospective counsellors by means of questionnaires and ‘clinical’ vignettes to assess their knowledge of and attitudes to various matters pertaining to grief and bereavement is reported. While the results are encouraging In many respects, they also highlight areas of ignorance and bias which seem resistant to the influence of training.
Natural Born Killers
Authors: McLoughlin Declan
Published: October 2008

If one is to believe the histrionic and sensationalist media coverage that preceded the release of Oliver Stone's satirical film Natural Born Killers, and which ironically paralleled events in the film, a busy time may be expected for our colleagues working in forensic psychiatry. It would not be surprising if viewing of the film was to be adduced by a desperate defence lawyer as an incitement to commit acts of violence. Hopefully, no such argument would be deemed admissible as the film's formal qualities deliberately militate against audience identification with on-screen characters and incidents.
A summer fellowship with Albert Ellis
Authors: Mander Anthony J.
Published: October 2008

Albert Ellis formulated what is now known as rational emotive behaviour therapy (REBT) in 1955. The Institute for Rational Emotive Therapy (IRET), a not-for-profit organisation chartered by the Regents of the University of the State of New York, opened in its current mid-town Manhattan site in 1965.
A strange deceit
Authors: Stafford-Clark David
Published: October 2008

“In cottage gardens sweet flowers drink Last dregs of colour from the fading light. Their scent floats on the dusk, to link With the now distant thunder of the engines In a strange deceit; As if the world went well …”
Haematological monitoring for clozapine: do patients know why?
Authors: Paton Carol , Wolfson Paul
Published: October 2008

Clozapine is effective in treatment resistant schizophrenia, but unfortunately is associated with a 3% incidence of neutropenia. Regular haematological monitoring is mandatory for all patients. We asked forty patients who had been taking clozapine for more than six months why they thought they had to have regular blood tests. Almost half did not know and only a small proportion were subject to a Mental Health Act (MHA) second opinion for consent to treatment. Initial explanations of the potentially serious side effects of clozapine may not be understood or retained. Ongoing education of patients is essential. The wider use of MHA second opinion doctors should also be considered.
Plasma levels of tricyclics and related antidepressants: are they necessary or useful?
Authors: Taylor David , Duncan Denise
Published: October 2008

Opinions on the value of measuring tricyclic plasma levels vary substantially. In the United States, plasma levels of several tricyclics are frequently used to ‘optimise’ therapy. In the UK, plasma level monitoring is less often undertaken and measured levels are more usually used simply to assure compliance rather than as a guide to dose adjustment.
Which antidepressants are safe to use in breast-feeding mothers?
Authors: Duncan Denise , Taylor David
Published: October 2008

As postpartum depression can occur in up to 10% of mothers, antidepressants will often be required in mothers who are breast-feeding. The judicious use of antidepressants is important since all psychotropic drugs cross into the breast milk. Drug excretion into breast milk occurs primarily by passive diffusion. Small, highly lipid soluble, unionised drugs diffuse more rapidly than other drugs. It must be remembered, however, that for those drugs with a high volume of distribution, such as the highly lipid soluble drugs, most of the drug is outside the plasma compartment, leaving only a small proportion free to transport from plasma to milk. Also, most lipophilic drugs are concentrated in hind milk which is richer in fat than fore milk. All of the antidepressants are highly lipid soluble with large volumes of distribution.
Use of fluoxetine in patients with diabetes mellitus
Authors: Salmon Gill
Published: October 2008

Although pharmaceutical companies report side effects that may occur with use of their medications, little data on specific groups of patients that may be at risk of particular side effects is available (Katz et al, 1991). Patients with diabetes mellitus form an important group for psychiatrists since the occurrence of depression is relatively common with this group and guidance on its treatment is lacking.
Masters courses in psychiatry
Authors: Shoebridge Philip J. , McCartney Mark
Published: October 2008

The variations in structure and content between Masters degree courses offered to psychiatry trainees around the country are documented. Most courses are integrated to some degree with statutory Membership teaching. The extent to which courses differ is likely to surprise readers. The implications for the junior trainee as well as for consultant or senior registrar appointment committees is discussed. Universities act autonomously, hence a Masters degree awarded by one may bear no relation to that awarded by another.
Training in genetics for child and adolescent psychiatrists within a senior registrar training scheme
Authors: Wood A. J.
Published: October 2008

The benefits of experience in paediatric genetics to child psychiatrists are discussed. Pursuing a special interest within a child psychiatry rotational training scheme is an important way of widening experience in light of the proposed reforms to training for hospital doctors.
Learning from the patient
Authors: Klemperer Frances , Browning Sally
Published: October 2008

One of the most enduring images of the BBC2 Horizon States of Mind: ‘Hearing Voices' was of an exercise used by Ron Coleman from the Hearing Voices Network. Dividing his audience of mental health professionals into groups of three, he asked two to hold an ordinary conversation while the third whispered comments, repeated sentences or gave orders to one of those trying to talk.
Should the on-call psychiatrist be residential?
Authors: Lawrie Andrew , Serfaty Marc , Smith Chris
Published: October 2008

The need for psychiatrists to be residential when on call is questionable, To determine whether becoming non-residential resulted in duty doctors being unable to provide the same quality of care in dealing with psychiatric or medical emergencies, a prospective study was carried out logging calls received by the duty doctor before and after transition from a residential to a non-residential on-call system. Outcome showed that requiring doctors to be resident did not seem Justified.
An essay on the use of new antipsychotics
Authors: Kerwin Robert W.
Published: October 2008

In a textbook of psychopharmacology published as recently as 1990, Hollister and Csernansky wrote about antipsychotics “It is most discouraging that more effective pharmacotherapy has not been developed. Present drugs have many deficiences: they are not curative; their ameliorative effects are often limited, many patients remain totally unresponsive; they are unpleasant to take so that many patients are less than fully compliant; they produce major side effects such as tardive dyskinesia whose full implications are still uncertain”.
Training on dispersed sites
Authors: Davies Steffan , Cox John
Published: October 2008

The closure of large mental hospitals, the move of services into the community and the formation of multi-district rotations have led to a dispersal of trainees onto many sites. This paper seeks to raise awareness of the problems faced by trainees working and training on disposed sites and suggests some solutions. It is the product of discussions within the Collegiate Trainees Committee, the Education Committee and the Psychiatric Tutors Sub-committee.
Psychiatry in Sudan: a personal experience
Authors: Hughes Peter
Published: October 2008

I would like to describe my brief impressions of psychiatry in Khartoum, Sudan and raise some ethical issues that arose for me there.
The impact of the Defeat Depression campaign
Authors: Orrell Martin , Collins Elizabeth , Baldwin Bob , Katona Cornelius
Published: October 2008

A postal questionnaire survey of nearly a thousand doctors investigated their awareness of the Defeat Depression campaign. Nearly all the consultant psychiatrists had heard of the campaign compared to less than half of the geriatricians and the general practitioners (GPs). Just over half of the psychiatry trainees had heard of the campaign. GPs who had not heard of the campaign were also less likely to continue antidepressant treatment beyond three months after recovery, less familiar with the psychological therapies, and less confident about treating depression in the elderly. The campaign may benefit from an increased emphasis on doctors other than psychiatrists.
Six years' experience of sharing the care of Edinburgh's drug users
Authors: Greenwood Judy
Published: October 2008

Six yean ago, Edinburgh's community drug problem service established a model of shared care between drug specialists and general practitioners who were encouraged to prescribe oral methadone and other drug substitutes in an attempt to reduce drug injecting and the spread of HIV in a city with a high seroprevalence rate. Of Edinburgh's GPs, 70% now prescribe for around 1200 drug users who have altered their pattern of drug taking, with a marked shift away from injecting drug use, and towards oral pharmaceutical drugs. HIV rates among new referrals to the service have fallen from 21% to 8%.
Reflections on part-time training in psychiatry
Authors: Reichenberg Fran
Published: October 2008

We have seen many interesting accounts of people's training experiences on the part-time scheme published in this journal, and one or two interesting articles looking at broader related issues, for example looking at attitudes and awareness of part-time training among colleagues and the impact of these factors on recruitment to part-time training.
A case report of hypo-parathyroidism with psychiatric complications
Authors: Palia S. S. , Dawkins J. , Webb D.
Published: October 2008

Hyper and hypo-parathyroidism both lead to psychiatric disorder. In the former the hypercal-caemia is responsible for an acute or chronic organic reaction, depending on the speed with which the calcium has risen. The hypocalcaemia of the latter is more likely to present as tetany, and enters into the differential diagnosis of hysterical over-breathing (Hill et al, 1987). Hypo-parathyroidism most commonly follows inadvertent parathyroidectomy during thyroiddectomy when an abrupt fall in serum calcium can precipitate psychiatric disturbance. The mental state is closely related to the serum calcium level. If this is borderline there may only be symptoms such as anxiety, depression and tension, but with lower levels acute confusion may result. More chronic symptoms occur in long standing hypo-parathyroidism, such as poor concentration, emotional lability and impaired intelligence (Kendall & Zealley, 1983).
Images of madness in the films of Walt Disney
Authors: Beveridge Allan
Published: October 2008

It has been demonstrated that images of madness in the media powerfully influence the general public and serve to perpetuate popular stereotypes of mental illness (Philo et al, 1993). While the cinema's treatment of psychiatric issues has received critical attention (Gabard & Gabard, 1987), there is one area of film-making that has, so far, been neglected: the work of Walt Disney. Perhaps, because it has been primarily regarded as entertainment for children, Disney's work has not been subjected to serious examination. This neglect, however, is surprising in view of the current debate about the influence of the media on children. When one also considers that Disney films are now available on video and are being seen by millions, it seems worthwhile to look at the images of madness they present.
Mental incapacity: implications of the Law Commission Report
Authors: Benbow Susan M. , Jones Rob
Published: October 2008

The Law Commission report on Mental Incapacity was published in 1995 and examines how decisions can be made on behalf of those who are unable to make decisions for themselves. It has far reaching implications for psychiatrists and recommends the introduction of new legislation. Research with those unable to consent, advance treatment directives, decisions about medical treatment and public law protection of vulnerable Incapable people are areas covered in the document. Although there are some concerns for psychiatrists, many of the proposals can be welcomed.
The consequences of maternal overdoses on children
Authors: Lax-Pericall M. T. , Cox A.
Published: October 2008

The children of women who take overdoses may suffer due to the same factors that predispose to the overdose, to witnessing the event and the immediate and long-term consequences of it. We examined what arrangements had been made for the children of 21 women admitted to hospital after an overdose, and enquired into the explanation that the mother planned to give the children. Children of mothers with psychiatric disorder were more likely to have witnessed the overdose. Mothers preferred that the children did not know about the overdose. The importance of this for the psychological development of the children is discussed.
The use of Mental Health Review Tribunals
Authors: Shah Miranda , Oyebode Femi
Published: October 2008

Three hundred and fifty-six patients admitted under sections of the Mental Health Act (1983) were studied. One hundred and twenty-six (35%) patients appealed against their detentions and 52 of these appeals were heard. Only 18 patients were discharged from their detentions by the Tribunal in the study period. Younger patients were more likely to appeal and no patient whose first language was not English appealed in the study period. The tribunals appear to be a fair system once the opportunity to appeal is taken up.
Nurses' and doctors' expectations towards neuroleptic response in dementia
Authors: Thacker Simon
Published: October 2008

A survey of a group of doctors and nurses specialising in the care of the elderly demonstrated a wide range of opinions on the usefulness of major tranquillisers for controlling behavioural disturbance in dementia. However, there was ‘broad agreement’ among medical and nursing respondents that these drugs were unlikely to be helpful in controlling non-violent resistiveness and sexual inappropriateness. The nurses indicated less ‘forth’ in neuroleptic therapy than their medical counterparts. The importance of auditing the use of major tranquillisers in dementia is emphasised.
The organiser and the MRCPsych Exam: the College's instruction versus Murphy's law
Authors: Abdul-Hamid Walid , Cooney Colm , Stein George
Published: October 2008

Murphy's law states that if something can go wrong it will go wrong. Our recent experience in organising the MRCPsych exam at two centres confirms the general validity of this aphorism. We wish to share our experiences with other senior registrars who may find themselves in a similar predicament.
External placements: a potentially valuable addition to higher training in old age psychiatry
Authors: Bentham Peter , Patel Abdul
Published: October 2008

This article briefly describes the experience of two final year senior registrars visiting services in other regions. The potential training benefits of such external placements for higher trainees are outlined and practical suggestions are made on how to make them more widely available.
Nursing in a multi-ethnic NHS -Leeds, 31 January 1996
Authors: Moodley Parimala , Khoosal Deenesh
Published: October 2008

“You try to be kind, but you know you feel it when a patient despises you because of your colour. They give you a cold look and you cannot reach them”.
Use of mental health legislation in a regional adolescent unit
Authors: Nicholls Judith E. , Fernandez Carol A. , Clark Andrew F.
Published: October 2008

The use of mental health legislation in a Regional Adolescent Unit over a 10 year period was reviewed. There was a trend of increasing use over time. This was thought to reflect changes in attitude and professional practice subsequent to the introduction of the Children Act 1989. Conversion rates of Section 5(2) were high and practitioners with appropriate training were involved in the majority of sections, indicating good practice.
Involving lay participants in mental health clinical audit
Authors: Summers J. A. , Kehoe R. F.
Published: October 2008

Lay involvement in clinical audit has been advocated but rarely reported. Since early 1994 in the mental health unit at Airedale, Yorkshire, lay representatives have participated in all stages of clinical audit, Including selection of topics and methods, data collection and standard setting. After 8 months of lay involvement, all respondents to a brief questionnaire saw lay involvement as important, although none identified specific benefits that had already occurred. The paper outlines themes in respondents' perceptions of the benefits and problems of lay involvement and in their suggestions for minimising difficulties.
Can poetry help us become better psychiatrists?
Authors: Holmes Jeremy
Published: October 2008

Learning medicine and psychiatry is a moral as well as an intellectual challenge. Successful training in psychiatry can lead to significant personality maturation. Using poetic examples, the paper explores aspects of emotional development relevant to the traditional values of dynamic psychiatry. Such values are contrasted with those of the prevailing bureaucracy.
A survey of general hospital in-patients detained under Section 5(2) of the 1983 Mental Health Act
Authors: Buller Christopher , Storer David , Bennett Rachel
Published: October 2008

Detention of general hospital in-patients under Section 5(2) is a rare occurrence. This study of the use of Section 5(2) in general hospitals uncovered a frequent neglect in following the guidelines of The Mental Health Act and The Code of Practice. Surprisingly the conversion rate of Section 5(2) to Section 2 or 3 was similar to that seen in a number of other studies conducted in the quite different setting of large psychiatric hospitals. A number of patient characteristics were identified that appeared to influence whether 5(2)s were converted to an admission Section. Each general hospital needs to develop guidelines to be followed when staff feel that a patient should be detained under Section 5(2) – an example of such a policy is included.
Psychiatric training in Spain: is there a need for change?
Authors: Cervilla Jorge
Published: October 2008

Over the last 20 years the Spanish system for postgraduate education has been channelled, for all specialities including psychiatry, through the MIR Exam (Medico Interno Residente). This is an exam that all Licenciates in medicine and surgery (the Spanish equivalent for the British MBBS degree) can take after finishing their medical school training.
The American Psychiatric Association Annual Meeting 1996 – New York
Authors: Brandon Sydney
Published: October 2008

The APA is concerned about its declining membership. Only 16 700 psychiatrists were able to attend this year's meeting in New York and many of them came mainly to consult the job bureau in search of employment. For the first time unemployment is a real issue for psychiatrists as health care providers restrict services and seek alternative and cheaper patterns of care. Most health care organisations have lists of approved psychiatrists and anyone not on that list is not able to claim reimbursement for their services. Exclusion may be because of unreported and unchallenged complaints about care or conduct or a penchant for expensive drugs or high risk therapies. In this context a high risk therapy is one which exposes the insurers to a high risk of litigation, such as ‘recovered memory therapy’. The buzz in the corridors, which used to be of art collections, the new home by the lake or the costs of putting the kids through college, is now of managed care. These dread words reduce the most ebullient colleagues to anger or tears. Some time ago I reported in amazement the discussions at an earlier meeting on alien abduction, ritual abuse, multiple personality disorder (110 different individuals in one body was then the record) and the false memory syndrome.