bluuebunny/crossref_metadata_2025 huggingface dataset:
Introducing a nurse-led deliberate self-harm assessment service
Authors: Griffin Gill , Bisson Jonathan I.
Published: September 2002

Aims and Method

This study considered patients admitted to hospital following deliberate self-poisoning. The characteristics of the patients and the outcomes of assessments by trainee psychiatrists and a mental health nurse were compared.

Results

There were no significant differences in the outcome of 68 assessments performed by a trainee psychiatrist and 77 by a mental health nurse. The nurse assessment service was well-received by the poisons unit, a medical ward specialising in overdose treatment, and trainee psychiatrists.

Clinical Implications

Psychosocial assessments following self-poisoning can be provided by appropriately trained and supervised mental health nurses. The introduction of a nurse-led service should enhance relationships with the local poisons unit and reduce the workload of junior doctors without compromising their training needs.
Audit of an electroconvulsive therapy clinic's missed-fit rate
Authors: Davies Richard Huw , Wilson Rowan
Published: September 2002

Aims and Method

To audit the missed-fit rate of a consultant-led electroconvulsive therapy (ECT) clinic adhering to a stimulus dosing policy. After an initial first audit a standard for the missed-fit rate was set at ≤ 5%. A second and third audit examined whether the standard was met and then maintained over time.

Results

The audit standard of maintaining a missed-fit rate ≤;5% was achieved in the second audit and maintained in the third audit. The missed-fit rate dropped from 5% in the first audit, to 2% in the second audit and to 1.8% in the third audit.

Clinical Implications

A missed-fit rate of ≤ 5% was achieved and maintained over a 6-year period with rigorous adherence to a stimulus dosing policy in a consultant-led ECT clinic. This compares favourably with missed-fit rates of 25% found in national audits of ECT. A missed-fit rate of ≤ 5% might provide one possible standard for the efficiency of ECT clinics nationally.
How much risk training takes place in mental health services?
Authors: Davies Sue , Amos Tim , Appleby Louis
Published: September 2002

Aims and Method

The main aim of the study was to establish the proportion of hospital trusts in England and Wales in which training in the assessment of suicide risk and risk of harm to others is available to mental health professionals. A questionnaire was sent to clinical directors covering training on these subjects and in mental health legislation, details of training and the existence of risk-related policies.

Results

Seventy-six per cent of trusts said they provided training in suicide risk assessment for junior psychiatrists; for hospital and community nurses, the figure was just over 50%. Between 50% and 60% of trusts said they provided training in the assessment of risk of harm to others. Provision of training in mental health legislation was said to occur in most trusts. In some key areas of risk management, hospital policies were uncommon.

Clinical Implications

Despite the current importance of risk assessment in mental health services, many hospital trusts do not provide their staff with relevant training.
Psychiatrists' views of in-patient child and adolescent mental health services: a survey of members of the child and adolescent faculty of the College
Authors: Worrall Adrian , O'Herlihy Anne
Published: September 2002

Aims and Method

To obtain a prioritised list of psychiatrists' concerns relating to in-patient child and adolescent mental health services. Four-hundred and fifty-four members of the child and adolescent faculty of the Royal College of Psychiatrists were asked to list their main concerns.

Results

Two-hundred and seventy-four members responded. The most reported themes included lack of emergency beds; lack of services for severe or high-risk cases; lack of beds in general; poor liaison with patients' local services; lack of specialist services; and poor geographic distribution of services.

Clinical Implications

The range of themes identified from this survey have served to focus the National In-patient Child and Adolescent Psychiatry Study (NICAPS) and several design changes have been made to NICAPS as a result.
Community psychiatry in developing countries – a misnomer?
Authors: Farooq Saeed , Minhas Fareed A.
Published: September 2002

There has been a rush towards community psychiatry in the developed world in the past few decades (Tyrer, 1998a). In developing countries the concept has been equally popular and various programmes have been described (Burns, 1998; Goldberg, 1992; Issac, 1996). The term ‘community psychiatry’ originates from a peculiar historical background, is based on certain principles and is shaped by the existing pattern of mental health services in many Western countries. Although the term is vague, its application is especially problematic in developing countries. In this article an attempt will be made to highlight the origins of the term community psychiatry and its application in developing countries.
Workshops at annual general meetings
Authors: Fagin Leonard
Published: September 2002

Workshops at the College's Edinburgh Annual General Meeting (AGM) in July proved to be very popular, attested by the fact that nearly 1000 delegates attended 27 of them, which were distributed over the 5 days of the conference. The College has only recently introduced this format into their AGMs, although faculties and sections have long been including them into their residential meetings, again with positive feedback from those attending. As a result, the Edinburgh Organising Committee asked me to take on the job of Workshop Director for the conference, for which I had no real track record, although I had been previously involved in organising conferences and workshops for the Rehabilitation and Social Sections.
Clozapine-induced nocturnal enuresis: diagnostic and treatment issues
Authors: Kho King Han , Nielsen Olaf
Published: September 2002

Aims and Method

To report the management of three cases of clozapine-induced enuresis, by description of these cases and literature review.

Results

Heavy sedation, generalised epilepsy and diabetes mellitus induced by clozapine are some of the mechanisms that underlie the emergence of this side-effect.

Clinical Implications

These cases illustrate several different pathophysiological mechanisms necessitating further diagnostic investigations before adequate treatment can be started. Clozapine-induced enuresis is probably under-reported owing to the embarrassing nature of this side-effect.
Developing a child and adolescent mental health service for children with learning disabilities
Authors: Green Kath , Williams Chris , Wright Barry , Partridge Ian
Published: September 2002

Aims and Method

We discuss the development of a service for children with learning disabilities within a child and adolescent mental health team using the Health Advisory Service Together We Stand tier system. The paper also includes an audit of the service 8 months after it was started.

Results

We present a model of service that has proved successful to date. We give details from the audit of the service, its aims, funding, referral numbers, sources, types and criteria.

Clinical Implications

The audit suggests that the aims of the service are being achieved but given the fact that the numbers of new referrals significantly outweigh the discharge rate, it is concluded that a greater emphasis is placed on liaison, consultation and joint working with other agencies.
First-line atypical antipsychotics for schizophrenia are appropriate – with psychosocial interventions
Authors: Mortimer A. M.
Published: September 2002

Conventional antipsychotics, historically the mainstay of schizophrenia treatment, were ineffective in many patients, at least 30% fitting treatment-resistance criteria (Kane & Lieberman, 1987). All had the same mechanism of action: none was any more effective in the individual than any other. Therapeutic nihilism accepted poorly controlled positive symptoms and disabling negative symptoms: nearly all patients suffered side-effects (Barnes & Edwards, 1993), particularly extrapyramidal side-effects (EPS) and hyperprolactinaemia. Conventional antipsychotics raise prolactin to a range associated with sexual dysfunction or even macroprolactinoma: effects in men include erectile dysfunction and hypospermatogenesis; in women, galactorrhoea, oligo- or amenorrhoea, hirsutism and increased risk of osteoporosis. In both men and women there is loss of libido, and a link between hyperprolactinaemia and weight gain.
Evidence biased psychiatry?
Authors: Healy David
Published: September 2002

For a variety of reasons evidence-based medicine is currently in vogue. The evidence most commonly appealed to comes from randomised controlled trials (RCTs), even though the creator of the RCT, Austin Bradford Hill, argued in the 1960s that while it was good to see some swing toward using RCTs, if we ever ended up thinking that RCTs were the only method to evaluate a treatment the pendulum would not only have swung too far, it would have come off its hook (Hill, 1966).
“Nobody ever expects the Spanish Inquisition” (Python, 1991)
Authors: Adams C. , Gilbody S.
Published: September 2002

Guidelines are systematically developed statements designed to help practitioners and patients make decisions about appropriate health care for specific circumstances (Jackson & Feder, 1998). ‘Help’ is an important word. Guidelines/guides, in most instances, may suggest a road to take in order to travel from A to B, and make explicit why those suggestions have been made. Provision of this information respects the traveller's ability to assimilate the information, and make decisions on applicability. The traveller is then not constrained by information but helped by it. At the end of the day, for clear reasons, a different road may be chosen.
Characteristics and outcomes of patients admitted to a psychiatric intensive care unit in a medium secure unit
Authors: Dolan Mairead , Lawson Alan
Published: September 2002

Aims and Method

There have been no reports on psychiatric intensive care units (PICUs) in medium secure psychiatric facilities. Using case files, we retrospectively examined the characteristics and outcomes of 73 patients who were admitted to a PICU in a medium secure unit between 1 July 1994 and 30 April 1998.

Results

The PICU population was predominantly male, suffering from illness and detained under Part III of the Mental Health Act, 1983. Although the mean length of stay was 75 days, the majority were ultimately transferred to less intensive nursing environments and only nine required transfer to maximum security. In 10% of cases PICU admission was owing to lack of appropriate facilities elsewhere.

Clinical Implications

Although the PICU was intended as a crisis facility for the management of challenging behaviours, its function was affected by the lack of clear admission and discharge criteria and appropriate facilities for patients with diverse mental, physical and security needs.
A survey of forensic psychiatry teaching in UK medical schools
Authors: Reiss David , Chamberlain Sherelle
Published: September 2002

Aims and Method

To survey forensic psychiatry teaching in UK medical schools. A questionnaire was sent to all 24 deans.

Results

Twenty-one schools responded, 15 (71%) provided forensic psychiatry teaching. Thirteen organised one or more lectures and 13 organised visits to forensic psychiatric settings, predominantly high security hospitals, but these were usually only available to a proportion of the students in each year. Clinical placements, seminars or workshops and tutorials or supervisions were each arranged in about half of the schools. Only four schools offered special study modules (SSMs).

Clinical Implications

Forensic psychiatry teaching would benefit from further development, with additional use being made of medium secure hospital units and prisons for the purposes of clinical placements and visits. More SSMs should be organised.
A survey of psychiatrists' views of the use of the Children Act and the Mental Health Act in children and adolescents with mental health problems
Authors: Mears Alex , Worrall Adrian
Published: September 2002

Aims and Method

To identify psychiatrists' concerns relating to the use of legislation in children and young people with mental health problems. Four hundred and eighty members of the child and adolescent faculty of the Royal College of Psychiatrists were asked to list their main concerns.

Results

Two hundred and fifty-eight members responded. The four most reported themes were: choosing between the Mental Health Act and the Children Act; general issues around consent to treatment; issues with social services departments; and the stigma associated with using the Mental Health Act.

Clinical Implications

The range of themes identified from this survey have served to focus the evaluation of the use of the Children Act and the Mental Health Act in Children and Adolescents in Psychiatric Settings (CAMHA-CAPS), and informed the design of subsequent data collection tools. The project report has now been submitted to the Department of Health for consideration.
Learning styles of psychiatrists and other specialists
Authors: Airey Nicholas , Marriott James , Rodd June
Published: September 2002

Aims and Method

To describe how the Learning Styles Inventory was used to assess the preferred learning styles of a group of senior and specialist registrars from different specialities attending a management course.

Results

Of the 272 doctors studied, the learning styles of psychiatrists (n=42) emerged as significantly different to the group as a whole, favouring reflective observation and concrete experience rather than active experimentation or abstract conceptualisation.

Clinical Implications

Knowledge of learning styles can help improve interactions with other specialities that adopt different learning strategies, and assist with the individual psychiatrist's lifelong learning. To engage the interest of medical students, psychiatrists may need to consider different teaching approaches in line with the prevalent learning style.
Origins of a Section: liaison psychiatry in the College
Authors: Lloyd Geoffrey G.
Published: September 2002

Why has liaison psychiatry been slow to develop in the UK? The asylum mentality and the current flight into the community have focused psychiatric resources on chronic psychotic illnesses, neglecting the psychological problems of general hospital patients. Nevertheless, there is abundant evidence that medical and surgical patients have a high prevalence of psychiatric disorder that can be effectively treated with psychological or pharmacological methods.
Towards successful implementation of continuing professional development – a survey of psychiatrists' attitudes
Authors: Davies Mark , Ford Mike
Published: September 2002

Aims and Method

This survey aims to aid implementation of continuing professional development (CPD) by determining the acceptability of current proposals and predict problem areas. All non-training grade psychiatrists working in the area of a single deanery were asked about their attitude to CPD and, in particular, focusing on the peer group method.

Results

Of the 115 respondents, 98% said they agreed with some form of CPD. Just under half of respondents thought peer groups were appropriate for CPD planning, with four being the most popular size, and 3 months the preferred frequency of meeting. Problems identified with the peer group structure included individual, speciality-based and organisation-related issues. Regarding sharing of CPD information, 40% of respondents thought the College should receive updates of individual progress, while the medical director was cited in over half. Finally, loss of educational supervisor status was felt to be the most appropriate penalty for failure to adhere to the CPD process.

Clinical Implications

These results indicate that although there is general agreement to some form of CPD, peer groups are not universally accepted as the best design.
The changing climate for women patients in medium secure psychiatric units
Authors: Hassell Yonette , Bartlett Annie
Published: September 2002

Aims and Method

We conducted a telephone survey of medium secure units in England and Wales to determine the distribution of women patients.

Results

The survey identified 1836 medium secure beds, housing 342 women patients. Women in the NHS were housed primarily in mixed-gender units (170 women, 94%). Most NHS beds in single-gender units were for men (56 beds), whereas most private sector beds in single-gender units were for women (79 beds).

Clinical Implications

Increased awareness of the often inappropriateness of services for women in mixed-gender units has led to units deciding not to admit women patients and, inadvertently, more single-gender beds for men in NHS units than for women. The NHS units have to rely on private sector units to provide beds in single-gender units for women, perhaps at the expense of effective continuity of care.
The use of ginkgo biloba in the treatment of dementia
Authors: Maidment Ian
Published: September 2002

Aims and Method

To assess and update the available data on use of ginkgo to treat dementia. A Medline search as conducted for the period January 1985 to October 2000. The search included other aspects of the usage of ginkgo, such as side-effects, mechanism of action and drug interactions.

Results

Most of the trials using ginkgo were to treat cerebral insufficiency. Only five trials could be identified that used ginkgo to treat dementia. There are no trials comparing ginkgo to cholinesterase inhibitors such as donepezil.

Clinical Implications

Ginkgo is generally well-tolerated and appears to ease the symptoms of dementia. Although it has been suggested that the effect is comparable to donepezil, confirmation from controlled studies is required.
Anticonvulsant monitoring in psychiatric practice
Authors: Nelson Debbie , Gray Douglas
Published: September 2002

Aims and Method

A Medline literature search revealed a large number of articles on anticonvulsant monitoring. More relevant articles were selected with the aim of summarising current best practice in this area.

Results

Most articles were written to address monitoring in epilepsy and not psychiatric illness. Serum ranges should only be regarded as guidelines. Some patients may show toxic signs at therapeutic serum levels while others may show tolerance and require higher levels.

Clinical Implications

Appropriate monitoring of serum levels improves efficacy and enhances safety. Clinician ignorance may lead to inappropriate or inaccurate sampling with resultant adverse consequences for the patient.
Teaching psychiatric trainees ‘compliance therapy’
Authors: Surguladze S. , Timms P. , David A. S.
Published: September 2002

Aims and Method

Training workshops were organised to teach junior psychiatrists ‘compliance therapy’. A questionnaire was administered to 19 trainees before and after participation in the workshop. Data from 54 non-participating psychiatrists from the same NHS trust were also obtained for comparison.

Results

Those receiving training were similar to the comparison group except for having less confidence in dealing with non-compliant patients. After training, participants showed a broader awareness of the potential causes and costs of non-compliance and an increased confidence empathising with patients. Beliefs concerning management did not change significantly.

Clinical Implications

A brief training programme is capable of changing trainee psychiatrists' attitudes towards patient non-compliance in the desired direction.
Access to a child mental health service
Authors: Lamb Graeme , Anfield Anita , Sheeran Anne
Published: September 2002

Aims and Method

This was a retrospective case note analysis of all referrals to an inner-London child and family consultation service aiming to examine any changes in patterns of referral and attendance of Bangladeshi and indigenous families over the previous 10-year period.

Results

Bangladeshi referrals increased over the period but remained under-represented compared to indigenous families. They were less likely to attend an initial appointment, but once engaged with the service dropout rates were unaffected by ethnicity.

Clinical Implications

Improved communication between the department, families and referrers may help to increase understanding of the function of the department and lead to more equitable uptake of services in the future.
The Collegiate Trainees' Committee
Authors: Day Ed , Bolton Jim
Published: September 2002

The Collegiate Trainees' Committee (CTC) has been in existence for over 20 years and continues to represent the opinions of trainees in psychiatry within their College and beyond. This article briefly summarises the historical development and current role of the CTC, and outlines the activities of the committee throughout the past year.
Interpersonal psychotherapy – a trainee's ABC?
Authors: Morris Jane
Published: September 2002

A recent article in the Bulletin (Rees, 2000) suggests that cognitive–analytic therapy (CAT) “may emerge as the preferred form of psychotherapy within the NHS”. I would question Rees' claim that CAT “uses an understandable language and straightforward techniques”. For many patients – and therapists – it is too ridden with jargon and complex diagrams. Moreover, as he admits, “formal CAT training is long [2 years for basic qualification] … this is impractical for most psychiatrists”. In addition, “research has yet to provide a robust evidence base for its effectiveness”. CAT in expert hands is an attractive and powerful model, but does not suit the needs of junior psychiatrists striving to rapidly acquire and integrate broad effective psychotherapeutic techniques. I suggest that another of the ‘newer’ therapies, interpersonal theray (IPT), would fit the bill better.
Psychiatry and the Palestinian population
Authors: Murad Ibrahim , Gordon Harvey
Published: September 2002

Palestinian sources estimated the population in 1992 on the West Bank as approaching 1.5 million, and that of Gaza as just under 800 000 (Abdeen & Abu-Libdeh, 1993), with an increase of about 45% anticipated over the next decade (Planning and Research Centre, 1994). Significant numbers of Palestinians also live in surrounding Arab countries, especially Jordan, where they may even be in a majority (Stendel, 1996). About 1 million Israeli Arabs also live within the borders of Israel. The majority of Palestinians are Muslim, but about 6% are Christian (Bin-Talal, 1995).
Two weeks in the life of a community mental health team: a survey of case-mix and clinical activity in the north-west of Sheffield
Authors: Hunter Michael D. , Jadresic Danitza , Blaine Anne , Clancy Louise , Leyshon Noelle , McDonald Eileen , Sanderson Ian , Whiffin Moira , Spearing Graham
Published: September 2002

Aims and Method

The aim of the study was to determine whether diagnostic case-mix influenced the distribution of clinical activity within the community mental health team (CMHT). Information concerning every patient involved with the CMHT and every episode of clinical activity was collected over a 2-week period.

Results

Data were obtained concerning 417 patients and 1744 corresponding episodes of clinical activity. Diagnostic case-mix significantly differed between the professions. The duration of episodes of clinical activity varied significantly according to the type of patients involved and whether or not direct face to face contact occurred.

Clinical Implications

Diagnostic case-mix, in addition to absolute numbers, should be considered when estimating the actual work generated by the different professions' case-loads. Patients with psychosis may place an increased time burden upon CMHT members.
Survey of the use of abreaction by consultant psychiatrists
Authors: Wilson Simon
Published: September 2002

Aims and Method

To find out current practice in the use of abreaction by consultant psychiatrists a survey was conducted, by postal questionnaire, of all consultant psychiatrists working with adult patients in the Yorkshire area.

Results

Out of 170 consultants, 133 (78%) returned the questionnaire; 64 consultants (48%) had used abreaction at some point in their career and 20 (15%) had done so in the past 5 years. The median number of times abreaction had been used in the previous 5 years was two and only seven consultants (5%) had supervised a trainee in using abreaction.

Clinical Implications

Abreaction is used rarely and only by a minority of consultants. Few consultants have supervised trainees in the use of abreaction. Future psychiatrists are unlikely to be skilled in the use of abreaction and its use will decline.
Building a culturally capable workforce – an educational approach to delivering equitable mental health services
Authors: Moodley Parimala
Published: September 2002

A working group was brought together in a 2-day workshop by the Sub-Dean to take forward training in transcultural psychiatry. The group comprised senior members of the College; psychiatrists with particular expertise in transcultural issues and/or education; and included trainers from undergraduate to continuing professional development (CPD) level.
Therapeutic community research: past, present and future
Authors: Haigh Rex
Published: September 2002

This paper gives an outline of four research areas examining therapeutic community practice: an international systematic review, health economics cost-offset work, a cross-institutional multi-level modelling outcome study and a proposed action research project to deliver continuous quality improvement in all British therapeutic communities. Results of the first two have been published and are summarised here; the third is under way and the fourth is seeking funding.
Grand rounds: catatonia
Authors: Carey S. J. , Hall D. J. , Jones G. A.
Published: September 2002

Classical cases of catatonia in schizophrenia have become much less frequent with the introduction of neuroleptic drugs (Blumer, 1997), and psychiatrists practising in Western countries may well have seen few cases. Neuroleptic malignant syndrome (NMS), however, continues to occur in between 0.02% and 0.4% of patients and may occasionally prove fatal (Addonizio et al, 1986). We report a case with features of both these conditions.
Time to abandon the subjective–objective divide?
Authors: Beveridge Allan
Published: September 2002

“We don't see things as they are, we see things as we are” (Anaïs Nin, 1969)

In the mental state examination, a standard method of describing the clinical encounter is to contrast the patient's supposedly ‘subjective’ account with the doctor's ‘objective’ description. In this model, the doctor is granted a privileged position: the clinician's perspective is taken to be superior to that of the patient. The doctor's objective approach is considered neutral, scientific and representing the truth of the matter. In contrast, the patient's subjective report is regarded as unreliable, distorted and potentially false. The lowly status of the subjective perspective is further emphasised by the frequent use of the accompanying prefix, merely.
Competency and use of the Mental Health Act – a matrix to aid decision-making
Authors: Tan Jacinta , Elphick Martin
Published: September 2002

Aims and Method

Competence in patients with mental illness is an issue of growing importance. We present a matrix that provides a new tool to separate the elements involved.

Results

This matrix is compatible with, and makes explicit, the Richardson Committee's suggestions concerning the incorporation of a test of capacity in Mental Health Act assessments.

Clinical Implications

We suggest that use of this matrix may offer practical help to clinicians in arriving at a clear understanding of each clinical situation and guide good practice in the use of the Mental Health Act, particularly in problematic cases.
Should there be a Faculty of Learning Disability Psychiatry?
Authors: Carpenter P. K.
Published: September 2002

Does the completion of the closure of the old ‘mental deficiency’ hospitals in Great Britain mean that the relevance of learning disability as a major sub-speciality of psychiatry has been lost? In the past 10 or 20 years many non-psychiatrists, including service users, have blamed learning disability specialist psychiatrists for these hospitals and for many of the adverse social effects of being labelled as having a learning difficulty. With the new White Paper, Valuing People (Department of Health, 2001), is the role of the Faculty changing?
The Scottish scene
Authors: Loudon John , Coia Denise
Published: September 2002

Health service provision now lies almost completely within the powers of the Scottish Parliament and accounts for 40% of the Executive's budget. There is a Minister and a Deputy Minister for Health. There are six key groups – the Scottish people, the Scottish Parliament, the Scottish Executive, the health service, the local authorities and the press, all with high expectations that things should get better.
A follow-up study of the use of a patient-held record in mental health
Authors: Stafford A. , Laugharne R. , Gannon K.
Published: September 2002

Aims and Method

Patient-held records have been introduced in mental health over the past 2 decades. This follow-up study aimed to evaluate one pilot project 5 years after the records were introduced. All patients initially interviewed 4 years previously were approached and asked about their use and opinion of the record.

Results

Of the 19 people interviewed, 12 were still using the record and had a positive opinion of its usefulness. Of all community mental health team contacts, 72% were recorded in the patient-held notes.

Clinical Implications

Patient-held records are sustainable in a naturalistic clinical setting over the period of 5 years.
Covert medication – ever ethically justifiable?
Authors: Welsh Susan , Deahl Martin
Published: September 2002

‘The practice of psychiatry is more vulnerable to criticism than any other area of medicine’ (Mason & McCall Smith, 1999). The interventionist philosophy of psychiatry and the legacy of the psychiatric practices of the past century have left an imprint on society's mind of coercive treatments against a background of unscientific evidence of benefit. Other medical specialities conversely are forgiven their history of barbarism (has anyone been to a medical museum lately?) on the grounds that they were using the only tools available to them at the time. Public attitudes, including stigma and suspicion, make it more difficult for us to claim a similar defence, and modern day psychiatrists appear to bear the indelible scars of our predecessors' actions.
A community survey establishing the prevalence rate of autistic disorder in adults with learning disability
Authors: Morgan C. N. , Roy M. , Nasr A. , Chance P. , Hand M. , Mlele T. , Roy A.
Published: September 2002

AIMS AND METHOD

Most studies into autistic disorder have concentrated on children. This study aims to establish a prevalence rate of autistic disorders in an adult population with learning disabilities. Adults accessing learning disability services were diagnosed as having an autistic disorder by a two-stage process. The first stage was screening using the Pervasive Developmental Disorder – Mental Retardation Scale and then those identified by screening were diagnosed clinically.

RESULTS

An overall population rate of 7.7/10 000 for autistic disorder was obtained, which is a prevalence rate of 30% in those with learning disability. The prevalence rate was higher in intensive service settings.

CLINICAL IMPLICATIONS

Specific funding and interventions need to be targeted for the treatment of autistic disorders.
Psychiatric training revisited – better, worse or the same?
Authors: Herzberg Joe , Paice Elisabeth
Published: September 2002

AIMS AND METHOD

To evaluate psychiatric training in one deanery following a programme of site visits, interviews with trainers and trainees, reports, and recommendations. To assess the findings in the context of NHS training requirements. Information was collected by semi-structured interviews and questionnaire surveys.

RESULTS

Forty-three sites were visited, training is generally of a high standard and most trainees are satisfied with their posts. There are significant problems in delivering sufficient community experience to general practice trainees and deficits in availability of multi-professional training programmes.

CLINICAL IMPLICATIONS

College tutors should work to ensure that trainees have access to shared learning occasions with non-medical health professionals to meet the NHS training agenda.
When language weakens
Authors: Hart David
Published: September 2002

To work in a mental health system you need to be a kind of translator. Our rich English language moves at a lot of different speeds, works through different moods and modes, at different levels of sound, boldly some of it, hesitantly some of it, and so on, for different purposes. Medical talk is impenetrable to most other people, senior administrative people speak whatever is the current jargon, there's everyday language modified for the variety of situations and all these means will be adapted according to who is speaking to whom. It is routine to move between them and, as it were, to translate.
Forensic psychiatry in Israel
Authors: Barak Peretz , Gordon Harvey
Published: September 2002

Israel is a nation of ancient and contemporary interest. Its population is made up of approximately 5 million Jews, 1 million Arabs and a few other small minorities. As in the Arab world more generally, most Arabs in Israel are Muslim, with a small percentage being Christian (Bin-Talal, 1995). More than 2 million Arabs also live on the West Bank and in Gaza (Abdeen & Abu-Libdeh, 1993), currently under partial autonomous Palestinian rule and the foci for ongoing negotiation of a potential Palestinian State. Close links have historically existed between Arabs and Jews in the Middle East, notwithstanding current military and political conflict (Goitein, 1989). The city of Jerusalem is held in reverence by all three of the monotheistic religions.
Almost an electronic patient record and almost free
Authors: Searle G. , Rynkowski T. , Sephton A. , Pickford D. , O'Neill G.
Published: September 2002

AIMS & METHOD

This paper describes a project to make all the patient letters held on secretaries' computers available 24-hours a day to improve patient care and risk management. Following a system audit a solution using existing resources was constructed.

RESULTS

The implementation of a uniform coherent patient letter naming and filing convention (the CLinically Useful Enquiry System) allowing rapid access to letters to support effective care without massive cost or disruption.

CLINICAL IMPLICATIONS

This process can be quickly, simply and cheaply replicated in any organisation with a network supporting e-mail and has the additional benefit of making transition to a future paperless system fast and economical.
Co-prescribing of atypical and typical antipsychotics – prescribing sequence and documented outcome
Authors: Taylor D. , Mir S. , Mace S. , Whiskey E.
Published: September 2002

AIMS AND METHOD

To evaluate patterns of antipsychotic co-prescription and to establish documented outcome, we reviewed 1441 in-patient and community prescriptions written in a large mental health trust. For patients co-prescribed regular atypical and typical antipsychotics for longer than 6 weeks, medication histories were taken and case notes examined to determine sequence of prescribing, documented outcome and reasons for co-prescription.

RESULTS

Fifty-three patients had been co-prescribed aytpical and typical antipsychotics for more than 6 weeks. In 62% of cases the atypical drug had been prescribed first and a typical drug added later. The most frequently documented reason for co-prescription was that symptoms persisted when prescribed a single antipsychotic. Clinical outcome was documented for 64% of patients: 45% of the total number treated showed some improvement, with seven of 53 patients noted to have shown improvements in psychotic symptoms.

CLINICAL IMPLICATIONS

Co-prescription of aytpical and typical antipsychotics often occurs as a consequence of poor outcome with single drug treatment. In this study there was minimal evidence to suggest that co-prescription improved outcome to an important extent. There remains little support for co-prescription of antipsychotics but considerable evidence to suggest that such practice worsens adverse effect burden. Co-prescription of atypical and typical antipsychotics should be avoided in all but very exceptional circumstances.
Use of atypical antipsychotics by consultant psychiatrists working in forensic settings
Authors: Paton Carol , Garcia Jose A. , Brooke Deborah
Published: September 2002

AIMS AND METHOD

Atypical antipsychotics have less neurological side-effects than the older drugs but are only available as oral preparations. This may limit their use in forensic patients. We sent a postal questionnaire to all consultant psychiatrists working in forensic settings in the UK to determine their views.

RESULTS

The response rate was 60%. Respondents tended to overestimate the benefits and underestimate the side-effects of the atypical antipsychotics. The majority often prescribed atypical antipsychotics and depots together. Psychoeducation and serum level monitoring were used to optimise/monitor compliance by 50%.

CLINICAL IMPLICATIONS

Using atypical antipsychotics as monotherapy is problematic in forensic settings. The extent of polypharmacy means that patients may experience the side-effects of both typical and atypical antipsychotics. More could be done to facilitate and monitor compliance.
The stigmatisation of psychiatric illness: the attitudes of medical students and doctors in a London teaching hospital
Authors: Mukherjee Raja , Fialho Antonio , Wijetunge Aruna , Checinski Ken , Surgenor Tammy
Published: September 2002

AIMS AND METHOD

To study the attitudes and opinions of doctors and medical students with regard to psychiatric illness a questionnaire was sent to all medical students (832) and all doctors of all grades (441) at a London teaching hospital.

RESULTS

A total of 520 questionnaires were returned. More than 50% felt that people with schizophrenia and drug and alcohol addiction were dangerous and unpredictable. It was felt by the majority that people were not to blame for their conditions and there were low negative responses towards lack of treatability for a majority of conditions.

CLINICAL IMPLICATIONS

There were more optimistic views with regard to treatment than the general population. There appeared to be a lessening in stigma as experience increased. This would suggest that early improved education and exposure in the future may lead to a greater decline in stigmatised attitudes.
Police case disposal: an introduction for psychiatrists
Authors: Bayney Richard , Ikkos George
Published: September 2002

Establishment of boundaries, limit setting and safety of patients and staff are important aspects of mental health care delivery, but some psychiatric patients appear unwilling to cooperate when faced with appropriate limits. They may become involved in violence, criminal damage or public order offences. Rates of assault by in-patients against staff are increasing (Schneiden, 1993). In NHS hospitals this has been found to range from 0.15 incidents per patient per year in rural settings to 0.60 incidents per patient per year in urban hospital settings (Drinkwater & Gudjonsson, 1989). A high rate has been confirmed recently among psychiatrists (Davies, 2001).
Not just salsa and cigars: mental health care in Cuba
Authors: Collinson S. R. , Turner T. H.
Published: September 2002

Given the marginal nature of psychiatry in terms of Western health priorities, it is always worth reviewing how countries with clearly different political systems treat their mentally ill. The 40-year economic embargo imposed by the USA on Cuba, the effects of which have been compounded by the hardships suffered during the ‘Special Period’ from 1989 onwards when the collapse of the Soviet Union left the island's economy in ruins (Pilling, 2001), is one of the most stringent of its kind. It prohibits the sale of food, and sharply restricts the sale of medicines and medical equipment, which, given the USA's pre-eminence in the pharmaceutical industry, effectively bars Cuba from purchasing nearly half of the new world class drugs on the market (Rojas Ochoa, 1997). Between 1989 and 1993, Cuba's gross domestic product fell by 35% and exports declined by 75% (Pan American Health Organisation, 1999). This has reduced the availability of resources and has adversely affected some health determinants and certain aspects of the population's health status. Despite this, however, Cuba has developed a system prioritised to primary and preventive care, with an infant mortality rate half that of the city of Washington, DC (World Health Organization & Pan American Health Organization, 1997; Casas et al, 2001). Furthermore, biotechnology and family medicine are being developed by Cuba as a human resource for other developing countries. Cuban medical schools also train physicians specifically for many developing countries around the world (Waitzkin et al, 1997).
Fear of flying, reviewed: An example of evidence-based old age psychiatry
Authors: Rands Gianetta
Published: September 2002

‘Doctor, would it be alright to take mum to Cyprus for a family wedding?’ In a cosmopolitan city such as London hardly a month goes by without hearing a similar sort of query. If ‘mum’ has dementia I tend to advise the family against flying. This advice is based on anecdotal observations from past clinical practice. I have witnessed a number of patients experience significant deterioration in cognition following flying. While disorientation in unfamiliar environments may explain some of the difficulties in travelling for a person with dementia, as illustrated by John Bayley in Iris (1998), this may not be the only explanation. On this occasion, I decided to use evidence-based practice to review the situation.
Promoting psychiatry in the medical school: the case of Uganda
Authors: Ovuga E. B. L. , Buga J. , Oboke H. , Boardman J.
Published: September 2002

Uganda has a rich history of medical education (Odonga, 1989) that was severely harmed by the rise of Idi Amin and the years of internal strife. It is only over recent years that the country has begun to rebuild itself (Boardman & Ovuga, 1997).
What does ‘responsible medical officer’ mean in a modern mental health service?
Authors: Kennedy Peter , Griffiths Hugh
Published: September 2002

Dean (2001) found conflicting views among consultant psychiatrists about ‘what is actually meant by having responsible medical officer (RMO) status'. Many clearly feel that they are responsible for virtually all patients referred to secondary care: Tyrer et al (2001) found in a large audit many consultants with big personal case-loads of 200–300 patients. They concluded that the statutory duties of a RMO needed to be revised to avoid consultants merely becoming bureaucratic administrators of their case-load’.
Commentary: audit of case-load and case mix of higher specialist trainees in child and adolescent psychiatry
Authors: Cottrell David
Published: September 2002

The Child and Adolescent Psychiatry Specialist Advisory Sub-Committee (CAPSAC) of the Royal College of Psychiatrists has produced a detailed set of advisory papers covering all aspects of training in child and adolescent psychiatry, the existence of which makes the audit of training a more straightforward task than in the past (Royal College of Psychiatrists Higher Specialist Training Committee, 1999). The paper by Sharp and Morris (see pp. 212–215, this issue) is part of a continuing tradition of audit and evaluation of higher training in child and adolescent psychiatry (Garralda et al, 1983; Bools & Cottrell, 1990; Smart & Cottrell, 2000). In the past, supervision (or lack of it) has been a preoccupation (see Kingsbury & Allsopp, 1994). However, the most recent national survey of higher trainees in child and adolescent psychiatry suggests that the number of trainees receiving inadequate supervision is continuing to fall (Smart & Cottrell, 2000). Sharp and Morris focus instead on case-load and case mix and are to be commended for persevering over three annual cycles with an audit that clearly demonstrates changes being made in the light of data collected, followed by re-audit and re-evaluation – audit projects rarely ‘close the loop’ so clearly.
What services are available for the treatment of transsexuals in Great Britain?
Authors: Murjan S. , Shepherd M. , Ferguson B. G.
Published: September 2002

AIMS AND METHOD

We conducted a questionnaire survey of all 120 health authorities and boards responsible for the commissioning of services for the assessment and treatment of transsexual people in England, Scotland and Wales, in order to identify the nature of the input offered and assess conformity to current international standards of care.

RESULTS

Eighty-two per cent of the commissioning authorities responded and confirmed that most health authorities/boards provide a full service for the treatment of transsexuals, although this would be delivered at a local level in only 20% of cases. However, 11 commissioning authorities gave confused and inaccurate responses and three other health authorities appear to hold views on the commissioning of these specialist services that are not in keeping with the current legal situation and a recent High Court ruling, which establishes the right of transsexual people to NHS assessment and treatment.

CLINICAL IMPLICATIONS

There are discrepancies in prioritisation and provision of clinical services for this group that are not standard across Great Britain.
Audit of case-load and case mix of higher specialist trainees in child and adolescent psychiatry
Authors: Sharp Nicola , Morris Tim
Published: September 2002

AIMS AND METHOD

The aim of the audit was to ensure that the case-load and case mix for trainees in child and adolescent psychiatry met Child and Adolescent Psychiatry Specialist Advisory Committee guidelines and that trainees were seeing cases with an appropriate mix of age, gender and diagnoses. Data on case-load and case mix were analysed annually and problem areas were identified and reviewed when the audit cycle was repeated. The audit cycle has been repeated three times.

RESULTS

Specific findings from the audit included: female trainees were seeing a high percentage of girls; male trainees were seeing a high percentage of boys; some trainees were seeing a high proportion of cases of deliberate self-harm; and there was a recent increase in the number of cases of attention-deficit hyperactivity disorder. The first two issues were rectified as a result of the audit process; the last is being monitored.

CLINICAL IMPLICATIONS

Training needs should come before service needs. Auditing trainees' case-loads and case mixes helped best to utilise the time available for clinical work during training.
Improving the quality of medical reports to mental health review tribunals
Authors: Egleston Paul , Hunter Michael D.
Published: September 2002

AIMS AND METHOD

We aimed to determine, using clinical audit, the effect of implementing national guidelines on the quality of responsible medical officers' (RMOs’) reports to the mental health review tribunal (MHRT). We blindly assessed the quality of 50 consecutive reports concerning patients detained under Sections 3 and 37. Twenty-five reports were written before guidelines were circulated; a further 25 were written following the distribution of guidelines and a checklist with every request for a report.

RESULTS

The quality of reports, as measured by our checklist, significantly improved following the circulation of guidelines.

CLINICAL IMPLICATIONS

Increasing the awareness of guidelines by widespread circulation and the audit process is an effective way of improving the quality of RMOs' reports to the MHRT.