bluuebunny/crossref_metadata_2025 huggingface dataset:
Conspiracy of silence? Telling patients with schizophrenia their diagnosis
Authors: Clafferty Robert A. , McCabe Elaine , Brown Keith W.
Published: September 2002

Aims and Method

We undertook a postal questionnaire survey of all consultant psychiatrists working in Scotland to examine whether psychiatrists themselves may contribute to the misunderstandings surrounding schizophrenia by avoiding discussion of the diagnosis with their patients.

Results

Two-hundred and forty-six (76%) responded. Ninety-five per cent thought the consultant psychiatrist was the most appropriate person to tell a patient their diagnosis of schizophrenia, although only 59% reported doing so in the first established episode of schizophrenia, rising to 89% for recurrent schizophrenia. Fifteen per cent would not use the term ‘schizophrenia’ and a variety of confusing terminology was reported. Over 95% reported telling patients they had mood disorders or anxiety, under 50% that they had dementia or personality disorders.

Clinical Implication

Greater openness by psychiatrists about the diagnosis of schizophrenia may be an essential first step in reducing stigma.
On being in a young offender institution: what boys on remand told a child psychiatrist
Authors: Dimond C. , Misch P. , Goldberg D.
Published: September 2002

Aim and Method

To describe the reported experiences of 15- and 16-year-old boys on remand in a young offender institution (YOI) as told to a child psychiatrist. Nineteen remanded adolescents were interviewed using the Kiddie-Schedule for Affective Disorders and Schizophrenia as part of a study. During the warm-up conversation prior to this semi-structured interview, the boys were given the opportunity to talk about their experiences of being in a YOI.

Results

The boys described experiences of institutionalisation, including the deprivation of incarceration and the intimidation of a ‘macho-culture’, which on occasions verged on the abusive. Their responses are described.

Clinical Implications

An emotionally deprived prison environment that lacks appropriate care for children is likely to contribute to the very high levels of mental disorder known to exist in this population. A major reform of conditions for young prisoners has commenced since this study was conducted. The prison service and society as a whole must, however, ensure that the planned improved living conditions for children in prison are reached. Child psychiatry has a very important contribution to make by providing mental health care within prison institutions in order to engage young prisoners with mental health problems and their families.
Postal survey of psychiatrists' knowledge and attitudes towards driving and mental illness
Authors: Wise M. E. Jan , Watson James P.
Published: September 2002

Aims and Method

We assessed psychiatrists' knowledge and attitudes towards the Driver and Vehicle Licensing Agency (DVLA) regulations concerning mental illness. A postal survey of all consultant and trainee psychiatrists (228) on the South Thames (East) regional psychiatry rotation was carried out.

Results

For category 1 (private car and motorcycles) licenses, 40.0% of psychiatrists could correctly advise patients with a bipolar affective disorder; this figure was 0% for schizophreniform disorders. For category 2 (heavy goods vehicles) licenses the corresponding figures were 13.2% and 11.8%, respectively.

For alcohol misuse, alcohol dependency and alcohol related disorders, the scores were 26.0%, 29.1% and 19.7%.

Clinical Implications

Psychiatrists fail to know or apply existing DVLA regulations, for a number of reasons. Failure to inform patients of the restrictions and to record this may result in medico-legal liability for practitioners.
Service innovations: multi-agency standardised assessment schedule as a model of shared-care in managing drug misuse
Authors: Ogundipe Laofe Oladele , Bloor Roger
Published: September 2002

Managing drug misuse is a challenge to health care workers because of the social, psychological and physical factors that contribute to drug use. Multi-disciplinary working beyond routine discharge and referral letter has been recommended but no single model of shared-care will be appropriate for all situations. We developed an innovative approach to collaborative working between agencies, which led to early access to treatment of people who misuse drugs and their greater satisfaction with the care provided. This seamless approach to sharing assessment data is reported in this article. It offers a model of ‘shared-care’, which improves services for people who misuse drugs, within current resource levels.
A national survey of old age psychiatry services in Wales
Authors: Napier Alison
Published: September 2002

Aims and Method

A postal questionnaire was circulated to all consultants in old age psychiatry in Wales, examining provision of services with reference to the indicative service levels defined by the Royal College of Psychiatrists and Royal College of Physicians.

Results

The response rate was 100%. Levels of staffing and resources overall fell well below recommendations and varied widely between services. The average population over 65 served by a whole time consultant was 22 995; more than twice that recommended. No association was found between morale or how well population needs were perceived as being met, and the size of the population served.

Clinical Implications

Considerable investment in staff and other resources is needed for the recommendations made by the royal Colleges concerning service levels and, by implication, service quality to be met.
What about the workforce?
Authors: Appleby Louis
Published: September 2002

How many consultants do we need nationally to deliver mental health care? It is a simple question, but it has no simple answer – except that we need substantially more than we have at the moment.
Old age psychiatry services: long-stay care facilities in Australia and the UK
Authors: Snowdon John , Arie Tom
Published: September 2002

We are old age psychiatrists; T.A. based in Britain, J.S. in Australia. A return visit by T.A. to Australia allowed us to focus attention on differences between the two countries in their provision of long-term care for old people with mental disabilities. What works well? What constrains development?
Who wants to be a general psychiatrist?
Authors: Colgan Stephen M.
Published: September 2002

When I was appointed to my consultant post nearly 10 years ago I was one of several able candidates. This was the culmination of many years' hard work and I was proud to be working at an inner-city teaching hospital, one where I had trained as a medical student. This was probably the last time that my department was fully staffed, with each year since bringing more challenges. In recent years only one of the specialist registrars I have trained has continued with general psychiatry, with the attractions of old age, liaison and forensic psychiatry seemingly unassailable. My confidence finally reached rock bottom when a senior house officer announced that she no longer wished to continue in psychiatry because the role models we (consultants) set were unattractive. Apparently the image we project is of long hours, unlimited demands, endless risks and little time to practise the art of psychiatry. With the anniversary of my appointment approaching now it seems appropriate to consider why my hard fought for job has all the attractions of the plague.
The Exeter half-day release psychotherapy training scheme – a model for others?
Authors: Wildgoose J. , McCrindle D. , Tillett R.
Published: September 2002

Training in psychotherapy is a mandatory part of general professional training in psychiatry. The College produced guidelines in 1993 outlining the breadth and depth of training required (Royal College of Psychiatrists, 1993).
Joint trainers and trainees forum – a collaborative approach to higher specialist training
Authors: Hewson Lesley , Wright Barry
Published: September 2002

The Royal College of Psychiatrists' Higher Specialist Training Handbook (1998) emphasises the need for training schemes to be well organised in order to provide an environment in which training needs can be met. Training programme directors are tasked to provide “regular meetings with the trainees as a group to discuss the scheme and its placements” as well as “occasional meetings with trainers to discuss the scheme and its further development”.
Acute general psychiatry: too hot in the kitchen?
Authors: Tyrer Peter
Published: September 2002

One of the best-known aphorisms of Harry Truman, US president at the time the atom bomb was dropped on Hiroshima, was “if you can't stand the heat, stay out of the kitchen”. This has a nice euphonious ring to it, but at first sight it seems an odd metaphor to describe an important truth. The problem with Truman's kitchen is that it pre-supposed the wish to be in it. The average man in the US at the time of Harry's utterance, and probably in the UK too, had no particular wish to be in the kitchen. This was the place for women, and indeed, in Lancashire where I was brought up, men were often banned entirely from this part of the house, most particularly when it was on heat. But, nevertheless, Truman had it right by pointing to the kitchen as an important central place in the household.
The MacLean Committee: Scotland's answer to the ‘dangerous people with severe personality disorder’ proposals?
Authors: Darjee Rajan , Crichton John H. M.
Published: September 2002

The MacLean Committee was established in 1999 by the Scottish Office to review and make recommendations concerning the sentencing of serious violent and sexual offenders, including those with personality disorder. It provides an alternative perspective on the problem of offenders with personality disorder to that of the Home Office and Department of Health (1999) for England and Wales.
NHS Direct – a telephone helpline for England and Wales
Authors: Boardman Jed , Steele Carolyn
Published: September 2002

NHS Direct is a nurse-led telephone helpline covering England and Wales. The intention to develop this helpline was announced in December 1997 in a White Paper, The New NHS, Modern and Dependable (Department of Health, 1997), following recommendations in the Chief Medical Officers' report, Developing Emergency Services in the Community (Caiman, 1997). Three initial pilot sites were set up in Lancashire, Milton Keynes and Northumbria and began taking calls in March 1998. The project was extended in April 1999 to cover 40% of the population of England and by November 2000 was available throughout the whole of England and Wales. NHS Direct provides 24-hour advice and information via 22 call centres and is the largest telephone health care service in the world. A similar system is planned in Scotland, NHS 24.
The role of the doctor when a patient commits suicide
Authors: Campbell Colin , Fahy Tom
Published: September 2002

The literature concerning psychiatrists' responses to patient suicide is sparse (Brown, 1987; Chemtob et al, 1988; Alexander et al, 2000) but even less attention has been given to the psychiatrist's role in the aftermath of such an event. Psychiatrists infrequently discuss their own experience of patient suicide with their colleagues, either at an individual level (Kaye & Soreff, 1991) or in group settings such as team meetings (Ruben, 1990). This is all the more remarkable when one acknowledges that the suicide of a patient is arguably the event that causes most concern for clinicians, irrespective of their experience or seniority (Kaye & Soreff, 1991).
The impact of suicide on community mental health teams: findings and recommendations
Authors: Linke Stuart , Wojciak Jenny , Day Samantha
Published: September 2002

Aims and Method

The study investigated the personal impact of patient suicides on the members of community mental health teams and the sources of support utilised for coping with adverse effects.

Results

Forty-four questionnaires were returned. Eighty-six per cent of staff reported having had at least one patient suicide, with an average of 4.2 suicides. The majority of staff reported that patient suicides had significant adverse effects on their personal and professional lives. Some of the effects were long-lasting (greater than 1 month). Staff found that peer support, reviews, dedicated staff meetings and support from senior colleagues were of most value.

Clinical Implications

Staff require skilled and dedicated support following a patient suicide in order to minimise its detrimental effects on personal, professional and team functioning.
Impact of patient suicide on psychiatric trainees
Authors: Yousaf Farida , Hawthorne Malcolm , Sedgwick Philip
Published: September 2002

Aims and Method

A survey of 89 psychiatric trainees in a regional rotational training scheme was carried out to investigate the impact immediately after a patient's suicide and at the time of the study. Main outcome measures used were the Impact of Events Scale and a rating scale of the impact on personal and professional life.

Results

Twenty-three trainees out of 53 who returned questionnaires reported at least one suicide. Initial reactions included shock, self-blame, guilt, grief and fear of negligence. Impact on personal and professional life was moderately severe. Over half of the trainees were ‘clinically stressed’ in the immediate aftermath, with no statistically significant reduction overtime.

Clinical Implications

The impact of a patient suicide can be profound. It can be experienced as a stressful event but can also lead to positive changes in clinical practice. Greater availability of training and support as well as further research in this area are recommended.
Gatekeeping access to community mental health teams
Authors: McEvoy P. , Colgan S. , Richards D.
Published: September 2002

Aims and Method

A retrospective survey to explore how consultant psychiatrists, senior house officers and community psychiatric nurses prioritised referrals to four sectorised community mental health teams.

Results

Referral outcomes appeared to be comparable for patients with psychoses, sub-threshold mental health problems and personality disorders. However, differences in the outcomes were apparent for patients with a primary diagnosis of drug/alcohol misuse, as well as for patients with affective disorders and neuroses.

Clinical Implications

It may be necessary to establish clearer, consistent boundaries in order to consolidate services for patients with severe mental health problems.
A survey of amphetamine prescribing by drug services in the East and West Midlands
Authors: Moselhy H. F. , Georgiou G. , Kahn A. , Day E.
Published: September 2002

Aims and Method

This study aimed to assess the current level of amphetamine prescribing for adults in drug services in the West and East Midlands. A questionnaire was developed to investigate prescribing habits and attitudes, and was addressed to the senior member of staff in each drug service within the West and East Midlands area.

Results

A total of 41 services were identified, and 29 questionnaires were returned (a 71% response rate). Of the services that replied, 20 (69%) prescribed amphetamines, with 132 (12%) patients identified as amphetamine misusers currently receiving a prescription. However, 26 (90%) services felt that substitute prescribing did have a role in a comprehensive service for this group.

Clinical Implications

Although amphetamine prescribing has been shown to reduce both criminal and injecting behaviour, only two-thirds of the local services prescribe such drugs, with a small percentage of amphetamine users receiving a prescription. There is a need for a national consensus about substitute prescribing of amphetamines and increased flexibility within drug services when managing the problem.
Psychiatric training in India
Authors: Das Mrigendra , Gupta Nitin , Dutta Kavita
Published: September 2002

With the population of India recently increasing to over 1 billion, the need for personnel to cater to the health services is ever increasing. This article will touch upon various aspects of psychiatric training in India and briefly cover some aspects of psychiatric practice and services in the country.
How does Australia train its psychiatrists?
Authors: Stratford Joe
Published: September 2002

Currently there are about 2000 practising consultant psychiatrists in Australia, 80% of whom are in private practice. In terms of training there are close to 700 trainees (registrars) with approximately 100 qualifying each year (Henderson, 2000). Training takes place all over the country but, as with many other aspects of Australian life, is largely confined to a small number of larger cities dotted around the coast of the mainland.
Mentoring for newly appointed consultant psychiatrists
Authors: Roberts G. , Moore B. , Coles C.
Published: September 2002

The south-west Mentoring Scheme has developed in the context of a general and increasing concern for the health and morale of senior doctors (British Medical Association (BMA), 2000). Their problems are now well described (Allen, 1999; Ghodseet al, 2000), but there is little evidence of effective intervention. The aspirations of the National Service Framework and the NHS Plan will come to nothing if there are not sufficient trained and experienced staff to implement them, and senior staff are increasingly looking forward to early retirement rather than the continued satisfactions of working within the NHS. Recruitment and retention of consultant psychiatrists is the most problematic of all medical specialities, with 14% of posts empty or occupied by locums (Sainsbury Centre for Mental Health, 2000). There is a clear need to find ways of preventing work-related ill health, stress and burn-out among practitioners (Roberts, 1997; Department of Health, 1999: p 115), and to sustain their creative and productive engagement in health care. A demotivated profession cannot be expected to deliver an effective service (McBride & Metcalf, 1995; Appletonet al, 1998) and policy is not a substitute for personnel.
An audit of risk assessment in an emergency setting
Authors: Stone James , Szmukler George
Published: September 2002

Aims and Method

Patient records from the emergency clinic at the Maudsley Hospital were analysed from July 1999 to assess the standard of risk assessment for self-harm and for harm to others routinely recorded by junior doctors. The recorded risk factors for the consultation and the evidence that risk had been considered were noted. An intervention that comprised two seminars and two written reminders about the importance of risk assessment was made and the analysis of records in the emergency clinic repeated for July 2000.

Results

Risk factors were recorded more frequently for harm to self than for harm to others. There was little recorded evidence that consideration had been given to the overall risk of harm to self, and there was no evidence of this for harm to others. Recording of risk did not change significantly between 1999 and 2000.

Clinical Implications

Assessment for risk of harm to others is not a part of the emergency consultation that is emphasised by the majority of junior psychiatrists. Changing practice will require a shift in the way that risk to others is presented in psychiatric teaching.
A survey of academic provision for old age psychiatry in the UK and Ireland
Authors: Lindesay J. , Katona C. , Prettyman R. , Warner J.
Published: September 2002

Aims and Method

This paper reports the findings of a 1999 survey of academic old age psychiatry staffing and teaching in UK and Irish medical schools.

Results

Just over half had staff established at the level of senior lecturer or above. These schools devoted more time to undergraduate teaching, covered more topics and used a wider range of teaching methods.

Clinical Implications

There is a need for further academic development in old age psychiatry to drive the development of the speciality, and to ensure that all medical undergraduates receive an adequate training in this subject area.
Evaluating the quality of educational materials about schizophrenia
Authors: Currie C. , Di Mambro P. , Joice A. , Mcglip R. , O'Neill M. , Ralston G. E. , Davidson R. , Scott J.
Published: September 2002

Aims and Method

To identify and evaluate the reliability and quality of educational materials provided to individuals with schizophrenia and their carers. Materials used by mental health professionals working in community and in-patient settings were collated. Two independent raters used the ‘Discern’ questionnaire to assess the publications.

Results

Fifteen documents were identified, but only 11 were suitable for evaluation. Interrater reliability of ratings using the Discern tool was highly significant. No educational package scored maximum marks, but four scored in the good quality range. About a fifth of the materials in widespread use were assessed as of poor quality.

Clinical Implications

The use of a rating instrument to assess the quality of educational publications appears to be a reliable and acceptable way to identify the strengths and weaknesses of widely available materials. Staff can use these data to assess the quality of their preferred materials against other publications and make an informed selection.
Service innovations: a neuropsychiatry outreach clinic
Authors: Leonard F. , Majid S. , Sivakumar K. , Toone B.
Published: September 2002

Aims and Method

We describe the neuropsychiatry outreach clinic in west Kent and review referrals to the clinic over a 4-year period. By comparing the referral pattern of west Kent with adjacent health authorities we show how an outreach clinic can influence the number of neuropsychiatric referrals.

Results

Referrals from west Kent increased from 87 in the 4-year period prior to the outreach clinic to 255 in the 4-year period that the clinic has been in existence. Forty-nine of these patients were first assessed in the outreach clinic. The number of referrals from east Surrey and east Sussex remained low in the same period.

Clinical Implications

An outreach clinic provides access to specialist expertise and increases local awareness of specialist services. Similar outreach clinics in other areas may enhance the clinical care of patients who are currently not being referred to neuropsychiatry.
The interface between general and prison psychiatry – the consultant's perception
Authors: Smith Sara , Baxter Vincent , Humphreys Martin
Published: September 2002

AIMS AND METHOD

A postal questionnaire was sent to 100 Section 12 (2) approved consultant psychiatrists in the West Midlands to ascertain their perceptions of the role of general psychiatric services in the care of imprisoned patients with mental disorder previously cared for by generic services.

RESULTS

Of 59 respondents 90% believed they could contribute to the care of imprisoned patients with mental disorders. Ten per cent would delegate total responsibility to specialist forensic services. Lack of awareness of imprisonment of patients was a common problem.

CLINICAL IMPLICATIONS

Insufficient liaison between prison and general psychiatric services may impede the provision of psychiatric care in prison and prevent discharge planning in line with the Care Programme Approach and current Government guidelines.
Mental health presentations to an inner-city accident and emergency department
Authors: Cassar S. , Hodgkiss A. , Ramirez A. , Williams D.
Published: September 2002

AIMS AND METHOD

To study the presentation, assessment and management of all patients attending St Thomas' accident and emergency (A&E) department with overt mental health problems. The method included a pragmatic definition of ‘overt mental health problems' and a range of strategies to maximise case ascertainment.

RESULTS

The department saw 565 presentations in a 3-month period. Patients were predominantly young, male, single, unemployed, housed outside the area served by the local primary care group and presented outside normal working hours.

CLINICAL IMPLICATIONS

This study confirms that A&E departments may be the most frequently used setting for urgent mental health assessments in central London. The patients attending differ from those using community mental health teams. It is argued that mental health liaison services based in inner-city A&E departments should be developed.
Are poetry and psychotherapy too ‘wet’ for serious psychiatrists?
Authors: Holmes Jeremy
Published: September 2002

Not long ago I met for the first time a psychiatrist colleague whose articles I had enjoyed reading. I introduced myself, saying how impressed I was by his account of introducing cognitive–behavioural approaches in a tough inner-city general psychiatry setting. He responded graciously, saying ‘Oh, but you're the psychotherapist fellow who writes those nice articles about poetry in the Bulletin’ (Holmes, 1996). Feeling slightly put down by this male banter, implying that there was something vaguely ‘wet’ and irrelevant about both poetry and psychotherapy, and keen as always to establish psychotherapy as a vigorous equal player with social and psychical treatment approaches, I was reminded of how easy it is to see psychotherapy as a frivolous luxury when compared with the rock face of general adult psychiatry – and how to view it as ‘poetic’ might merely reinforce that view. But poetry can be extremely tough – Kipling, Graves and Hughes would be obvious 20th century examples – as can psychotherapy, which often outmatches other psychiatric disciplines in the rigour of its research methods (Roth & Fonagy, 1996) and strictness of its boundaries.
Problem of drawing from psychiatry for a fiction writer
Authors: McGrath Patrick
Published: September 2002

Transcript of a talk given at the Annual Meeting of the Royal College of Psychiatrists, 10 July 2001

My topic is the problem of drawing from psychiatry for a fiction writer. This is a subject on which I am eminently well-qualified to speak. I have written five novels and a short-story collection, all of which have dealt with minds in disorder. Two of my novels – one called Spider, the other Asylum – have been focused centrally on psychiatry and psychiatric illness, so it is about the writing of these two novels that I want to talk today.
Service innovations: attention-deficit hyperactivity disorder – development of a multi-professional integrated care pathway
Authors: Burgess Isabel C.
Published: September 2002

AIMS AND METHOD

There is a need for multi-disciplinary input into the diagnosis and management of attention-deficit hyperactivity disorder (ADHD). We describe the development of a multi-professional integrated care pathway incorporating education, community paediatrics, child and adolescent mental health services and general practice.

RESULTS

Using parent-held documentation this pathway forms the bass of a community-based ADHD clinic.

CLINICAL IMPLICATIONS

A training programme for schools and health professionals raises awareness of the features of ADHD and covers appropriate management within schools.
Psychiatry training in Europe: a brief history of the European Federation of Psychiatric Trainees
Authors: Day Ed , Grimmer Claudia , Lloyd Adrian
Published: September 2002

At a time of increasing European harmonisation this paper gives a brief history of the main European organisation for trainees in psychiatry (the European Federation of Psychiatric Trainees) and details the proceedings of the most recent European Forum held in Berlin.
An ethical perspective on institutional abuse of older adults
Authors: Garner Jane , Evans Sandra
Published: September 2002

Old age psychiatrists and their teams have a particular responsibility in the identification and prevention of elder abuse and in carefully examining the factors that foster ‘the corruption of care (Wardhaugh & Wilding, 1993).
Practical and legal aspects of withholding patient's mail
Authors: Birmingham Luke , Humphreys Martin S.
Published: September 2002

There are a number of different clinical circumstances in which the issue of incoming and outgoing mail to or from a patient in a psychiatric hospital, whether detained or not, may present particular difficulties. Under current mental health legislation there is provision for post to be stopped or inspected on clinical and legal grounds (Jones, 1999), but these are fairly limited and concern only outgoing mail in specific circumstances, other than for patients detained in special hospitals (Mental Health Act (MHA) 1983). The issue of patients' mail may lead to problems in day-to-day practice where patients' desire to send or receive correspondence is linked to their abnormal mental state, is a direct result of symptoms of their illness or when it might constitute a potential or actual criminal offence. This paper reviews the relevant part of the MHA 1983 and describes three case vignettes that illustrate some of the difficulties and potential solutions to problems associated with patients' correspondence.
Socio-economic deprivation and psychiatric referral and admission rates – an ecological study in one London borough
Authors: Soomro G. Mustafa , Burns Tom , Majeed Azeem
Published: September 2002

AIMS AND METHOD

We retrospectively investigated the association between the Jarman and Townsend indices of deprivation and referral rates to community mental health teams (CMHTs) and in-patient admissions rates, including the contribution of general practice factors to these rates. The samples consisted of all community/out-patient referrals and admissions to four CMHTs over 1 year.

RESULTS

Low positive correlation was found between community/out-patient referral rates for all diagnoses and psychosis with the Jarman index, and between both the indices and admission rates for all diagnoses and non-psychosis. Referrals from general practitioners (GPs) varied nearly 40-fold and were not related to either indices, fundholding status or having practice manager or practice nurse.

CLINICAL IMPLICATIONS

Overall, the Jarman index appears to be a more useful index for planning psychiatric service provision. However, because of the small correlation with referral and admission rates, deprivation indices in themselves would be of limited value, as there may be other relevant factors that require investigating. GP characteristics investigated did not predict referral rates.
Significance of the chaplain within the mental health care team
Authors: Rattray Lorna H.
Published: September 2002

In psychiatric care, where patients experience a wide range of difficulties – emotional, physical, mental, social and spiritual – care must be given to the patient as a whole person. This article is about the significance of the presence of the chaplain within the mental health care team as it seeks to offer this holistic care.
An experience of New Zealand psychiatry
Authors: Bale Rod
Published: September 2002

New Zealand, an outstandingly beautiful country, offers an opportunity for the psychiatrist from the UK to work in an alternative environment. There is currently a shortage of trained psychiatrists to fill the available posts. The experience of a locum consultant post in adult mental health in the Nelson Marlborough Mental Health Service at the top of the South Island, at the beginning of the new millennium, forms the basis of observations made in this article, the purpose of which is to describe points of interest in the similarities and differences in psychiatric practice between the UK and New Zealand.
Service innovation: the first year of a brief psychiatric screening clinic in primary care
Authors: Hamilton Ross , Gordon Peter , Naji Simon
Published: September 2002

AIMS AND METHOD

To introduce a monthly screening clinic for new patients referred to the community mental health team with less severe mental health problems.

RESULTS

Sixty patients were selected for screening in the first year. Their non-attendance rate of 48% was more than double the rate for all new patients. We did not diagnose severe mental illness in any patients on first assessment or during the 6 months of follow-up.

CLINICAL IMPLICATIONS

Patients referred from general practice with minor psychiatric morbidity may have particularly high rates of non-attendance. The brief screening clinic model offered us considerable savings in consulting time. The outcome for our service is shorter waiting times for patients with more severe mental health problems.
European Union of Medical Specialists – activities of the Section and Board of Psychiatry
Authors: Saliba Joseph , Katona Cornelius
Published: September 2002

The European Union of Medical Specialists (UEMS) was set up on 20 July 1958, 16 months after the Treaty of Rome was signed. In 1962, the UEMS Section of Psychiatry was established. It was, however, relatively inactive until it was revitalised following a meeting of the European Societies in 1990 called by the Royal College of Psychiatrists and chaired by Dr (now Dame) Fiona Caldicott. The UEMS Board of Psychiatry was established in 1992 as a working group of the Section with a particular focus on training matters. The Section is currently chaired by Dr Anne Lindhardt (Denmark) and the Board is chaired by Professor Manuel Gomez-Beneyto (Spain). Both Section and Board meet twice a year.
Military psychiatry: a unique national resource
Authors: Greenberg N. , Temple M. , Neal L. , Palmer I.
Published: September 2002

The aim of the defence medical services (DMS) is to maintain the health of those individuals who volunteer for service in HM Armed Forces, in order that they may efficiently discharge their duties.
Training late – from branch to mainline at 40
Authors: Leaman Christine , Lyle Sarah
Published: September 2002

In 1996, after working in career-grade posts in psychiatry for over 5 years, the authors began training at Senior House Officer (SHO) level with the intent to sit the MRCPsych and enter higher specialist training. We feel that our experiences of coming late to training may be of interest to other doctors, and in particular we describe our experiences of the transition from non-training to training grades. Currently, career-grade doctors who toil on the unglamorous branchlines of psychiatry face difficulties in transferring to the mainlines because relevant experience gained in these grades is not recognised for MRCPsych. This may act as a deterrent to doctors who might, otherwise, train successfully to consultant level. We propose the use of career portfolios to facilitate movement between training and non-training grades.
Least restrictive alternative – advance statements and the new mental health legislation
Authors: Atkinson J. M. , Garner H. C.
Published: September 2002

Proposals for new mental health legislation make the case for using the ‘least restrictive alternative’ (Scottish Executive, 2001) and the ‘least restrictive environment’ (Department of Health & Home Office, 2000) as guiding principles in deciding the management and treatment of the patient. This appears to be the case made for introducing compulsory treatment in the community. The patient living in the community, while maintained on medication, rather than the hospital would appear to be defined as on the ‘least restrictive alternative’. This, however, takes only a limited approach to what is ‘restrictive’, which should be interpreted more widely, including the patient's view as well as that of clinicians and policy makers. Thus, a patient may see it as less restrictive during an acute phase to be in hospital and not on medication, than in the community but on medication. It is likely, given our knowledge of patients' attitudes to medication (Eastwood & Pugh, 1997), that many patients will prefer to be on oral medication rather than depot, which they see as less restrictive.
Underdetection of comorbid drug use at acute psychiatric admission
Authors: Ley A. , Jeffery D. , Ruiz J. , McLaren S. , Gillespie C.
Published: September 2002

Aims and Method

The ability of routine clinical practice to detect drug use at acute psychiatric admission was assessed by comparing the results of urinalysis with information on drug use extracted from patient records (n=112).

Results

Urinalysis detected drug use in 23% of the sample. Cannabis was the drug most frequently found. Of the cases of drug use positively identified by urinalysis, 54% were not identified in the notes. Some information on drug use proximal to admission was found in 40% of patient records. Patients asked about proximal drug use were younger than those not asked.

Clinical Implications

All patients should be asked about drug use.
MIDAS: a new service for the mentally ill with comorbid drug and alcohol misuse
Authors: Bayney R. , St John-Smith P. , Conhye A.
Published: September 2002

Aims and Method

To describe the work and patient characteristics of one of the first combined mental illness and drug and alcohol services (MIDAS) in the UK. We examined MIDAS as an assertive community service, for individuals receiving long-term community care. We selected the case files of the first 80 patients accepted over a 10-month period and examined variables including demographic details, diagnosis, associated substance use and length of engagement with the service.

Results

Our findings show that there was no relationship between responders to the service and basic demographic data. Patients with bipolar affective disorder and personality disorders were more likely to use the service than patients with unipolar disorder or schizophrenia. Despite the use of an assertive service, there was difficulty engaging patients with schizophrenia and comorbid drug use. These same patients also had a high level of criminal convictions as well as a trend towards using alcohol and cannabis as their main substances of misuse. At 18 months 38% of patients had failed to remain engaged with the service.

Clinical Implications

This specialist type of service may be more useful than other services in engaging patients with comorbidity. Systematic research is required in the UK to explore the effectiveness of this type of new service. More innovative resources need to be identified to specifically deal with patients with severe mental illness and comorbid substance use.
The clinical management of a patient with depressive disorder: a case vignette study to examine general practitioners' views
Authors: Marriott Sarah , Wright Christine , Lelliott Paul
Published: September 2002

Aims and Method

The study aimed to examine general practitioner (GP) views about the appropriate management of a patient with a depressive disorder. A questionnaire based around a patient case history was sent to 188 GPs from 11 primary care groups nationally.

Results

The response rate was 62%. At first presentation, a third of GPs offered ‘watchful waiting’ and a third prescribed medication. If the patient's condition deteriorated, nearly all GPs initiated therapeutic doses of antidepressant medication immediately. If the patient failed to respond, 60% of GPs commenced second-line antidepressant treatment. Following recovery, a quarter of GPs would continue antidepressant treatment for 4 months or more.

Clinical Implications

GPs' interventions in the management of depression concur with expert national guidelines. There is scope for strengthening the effectiveness of pharmacological intervention in the later stages of treatment.
The relationship between medical school of training, age, gender and success in the MRCPsych examinations
Authors: Tyrer S. P. , Leung W.-C. , Smalls J. , Katona C.
Published: September 2002

Aims and Method

Factors leading to success in the MRCPsych Part I and Part II examinations, including age, gender and original medical school of training, were examined in the 1999 MRCPsych examination entrants to determine how far they are associated with the results. The ethnic breakdown of examiners of the MRCPsych examinations was also determined and compared with the origin of all consultant psychiatrists.

Results

Younger age at taking the examination and training at a British or Irish medical school were found to be highly significant predictors of success in the MRCPsych examinations. When allowance was made for confounding variables, the gender of candidates did not contribute to success. There was no difference in ethnic background of examiners compared with consultant psychiatrists overall.

Clinical Implications

Factors affecting trainees wishing to undertake a psychiatric career need to be more closely examined. To ensure fairness and transparency in future examinations the ethnicity of candidates taking the examination needs to be addressed.
Service innovations: the eCPA
Authors: Howells Roger , Thompsell Amanda
Published: September 2002

This paper describes the implementation, merits and future potential of the eCPA – a computer-based Care Programme Approach (CPA) system for care planning. The system is designed to improve the quality of information in CPA care plans and, for the first time, to enable the rapid and standardised adoption of evidence-based good practice by all community mental health team (CMHT) staff.
Service innovations: development of a psychoeducational programme for patients with personality disorder
Authors: D'Silva Karen , Duggan Conor
Published: September 2002

Aims and Method

This study describes a survey of in-patients with personality disorder admitted to a specialist personality disorder unit, in terms of their knowledge and understanding of their diagnosis, and the subsequent development of a psychoeducational programme.

Results

Overall, patients had a poor knowledge and understanding of their diagnosis. Most had not had their diagnosis explained to them, and if they had, they had not retained the information. Consequently a structured psychoeducational programme was developed, incorporating diagnostic information obtained at the pre-admission assessment.

Clinical Implications

Diagnostic information for those with personality disorder, even when it is available, is not transmitted to patients. Imparting this information through a psychoeducational programme is one way in which the therapeutic relationship between patient and clinician can be strengthened.
Research in psychiatric higher specialist training: a survey of specialist registrars
Authors: Allsopp L. , Allen R. , Fowler L. , Hall C. , Woodbury-Smith M. R.
Published: September 2002

Aims and Method

Specialist registrars (SpRs) in psychiatry spend only 3 years in this grade, with 1 day a week allocated to research. In view of this sizeable proportion of time designated for research, we undertook a postal survey of the experiences of and attitudes towards research of SpRs in developmental psychiatry.

Results

A high proportion of respondents were involved in research at the time of the study, although half described difficulty starting and a third described difficulty taking the day. The majority of respondents believed research to be important and about three-quarters found it enjoyable.

Clinical Implications

While research remains a mandatory part of training it is important that trainers ensure that research time is protected.
The ‘suicide’ bomber: is it a psychiatric phenomenon?
Authors: Gordon Harvey
Published: September 2002

Although there is an association between suicide and suicidal behaviour and homicide and violence to others (van Praag, 2000), few, if any, major texts on suicide comment on the phenomenon of the ‘suicide’ bomber. However, the events in the USA of what Americans have now come to call ‘9/11’, have left an enduring traumatic memory throughout the world. On the morning of 11 September 2001 four aeroplanes were hijacked and transformed from a means of mass transportation to a means of terror and destruction, killing a total of 233 passengers, 33 crew members and some 3000 people on the ground in the USA (Alexander & Swetnam, 2001). It is not clear whether all of the hijackers knew that they were on a ‘suicide’ mission because in only six cases were ‘suicide’ notes found (Jenkins, 2001). Indeed, the term ‘suicide bombers' may be misleading because the main objective seems to have been not suicide but mass homicide, albeit carried out by means of self-destruction designed to inflict lethal harm on others. Those who planned and perpetrated the acts of 11 September 2001 would not conceptualise the acts as suicide but instead would perceive them as martyrdom, rationally underpinned by a legitimate struggle in a conflict of national and religious dimensions (Juergensmeyer, 2001).
Prescribing patterns for psychotic and behavioural symptoms in dementia: a national survey
Authors: Scott K. , Lawrence R. M. , Duggal A. , Darwin C. , Brooks E. , Christodoulou G.
Published: September 2002

Aims and Method

To compare current prescribing practice for psychotic and behavioural symptoms in dementia with the available research. An anonymous questionnaire was sent to all members of the Faculty of Old Age Psychiatry, enquiring about preferred drug treatments.

Results

Classical antipsychotics were chosen by 50% for psychotic symptoms over atypical antipsychotics (43%) and were preferred for aggression (48%) and sexual disinhibition (55%). Antidepressants were favoured in treating anxiety (41%) and lability (45%).

Clinical Implications

Alternatives to classical antipsychotics, especially for behavioural symptoms, have yet to be researched satisfactorily. In view of the continued widespread use of classical antipsychotics and recent concerns about their safety, we call for this to be addressed.
Naturalistic study of the antipsychotic medication review service at the Maudsley Hospital
Authors: Stone James , Ohlsen Ruth , Taylor David , Pilowsky Lyn
Published: September 2002

Aims and Method

To evaluate the effectiveness of the antipsychotic medication review service (AMRS) at the Maudsley Hospital. Patient notes were analysed from the AMRS and estimates of Global Assessment Scale (GAS) scores were made from entries in the notes. Data on hospital admissions before and during attendance at the AMRS were obtained from the trust-wide computerised patient administration system.

Results

A statistically significant improvement in GAS scores was seen for patients who stayed in contact with the AMRS. Patients who did not respond to the first atypical drug often made a good response to an alternative atypical antipsychotic. Patients attending the AMRS had fewer hospital admissions than they did before attendance, although this was not statistically significant.

Clinical Implications

Although more expensive on a dose-by-dose rate, atypical antipsychotics may be cost effective by improving compliance and reducing the number of relapses and hospital admissions. Specialised services with frequent patient contact can be effective in preventing relapse and improving global function.
Psychiatry of learning disability – a future with mental health?
Authors: Alexander R. , Regan A. , Gangadharan S. , Bhaumik S.
Published: September 2002

Aims and Method

A postal survey was sent to all consultants in the psychiatry of learning disability from four English regions. Their views on job satisfaction, their core roles and the management re-structuring of services were elicited.

Results

The proportion agreeing or strongly agreeing with each management option was 79% for integrated mental health–learning disability trusts, 61% for specialist learning disability trusts, 47% for care trusts, 10% for primary care trusts and 5% for social services. Only 34% felt consulted or able to influence the process of change and only 33% were satisfied with the current management changes within their trust but 67% were satisfied overall with their jobs.

Clinical Implications

Management from integrated mental health–learning disability trusts is the most preferred option for psychiatrists in learning disability. A large number of consultants, though otherwise satisfied with their jobs, feel excluded or unable to influence the current changes in management structures. A model of integrated service provision in line with the government's learning disability strategy is presented.