bluuebunny/crossref_metadata_2025 huggingface dataset:
Flexible higher training in psychiatry
Authors: Dean Anne , Abd Samaa El , York Ann
Published: October 2008

Aims and method

This survey was commissioned and funded by the Department of Health to examine perceptions of training by flexible trainees in higher psychiatric training. A total of 214 trainees were surveyed using a postal questionnaire.

Results

One hundred and thirty-five questionnaires were returned (response rate 63%). In general, flexible trainees valued the opportunity to train part-time and perceived the quality of their training to be high. However, there were drawbacks such as: perceived lack of status, restricted training opportunities and a lack of part-time consultant posts at the end of training.

Implications

Flexible training plays a major role in maintaining doctors in the workforce. However, there is a need for part-time opportunities to extend beyond the training grades and into consultant posts.
Community treatment orders – a bridge too far?
Authors: Moncrieff Joanna , Smyth Marceleno
Published: October 2008

Compulsory treatment in the community is high on the agenda in the current review of mental health legislation and the government has already announced its intention to introduce a ‘community treatment order’ (CTO; Department of Health, 1998). Concern about the implications of community care has been gathering momentum over the last decade, spurred on by tragedies such as those involving Ben Silcock and Christopher Clunis in the early 1990s. The notion that community care has failed has taken deep root with the media and the government (Department of Health, 1998). This is despite the lack of any evidence to suggest that mental illness is less effectively treated (Johnstone et al, 1991; Anderson et al, 1993) or that violence attributable to the mentally ill is rising (Taylor & Gunn, 1999). It also indicates a tendency to ignore the fact that patients prefer to live in the community (Tyrer, 1998). Psychiatrists, who are increasingly implicated in this purported failure of care, feel besieged. In such a climate, the promise of more power is understandably attractive. However, we feel that psychiatrists should resist pressure for this sort of ‘quick fix’ and reflect upon some of the dilemmas involved.
A simple approach to the management of service risk in a local mental health service
Authors: Davies Mark
Published: October 2008

Risk, and how to manage risk, have become dominant themes of this decade. Risk is essentially any feature of an organisation which is likely to prevent that organisation from achieving its primary aims (Rosen, 1995). In general, the lower the risk in an organisation, the higher the performance of that organisation is likely to be. In turn this can lead to more efficient use of resources. In the area of mental health, the consequences of risk can be serious, this being amply demonstrated by the public inquiries into homicides by mentally disordered people. Such inquiries consistently reveal inadequacies in local services providing mental health care (Appleby, 1997). The identification and management of risk within local mental health services has therefore become a priority. Clinicians as managers have a key role in such a development, particularly with the introduction of clinical governance (Oyebode et al, 1999). This paper outlines a simple approach to risk management in a local mental health service.
Invited commentary: Anatomy of risk
Authors: Oyebode Femi
Published: October 2008

The theoretical notion of risk is sweeping all before it. Politicians, government planners, scientists and doctors, including psychiatrists, are having to confront a more formalised concept of risk. This is not to say that our awareness, as human beings, of notions of risk has hitherto been largely negligible. However, there is an evident contemporary preoccupation with risk, its assessment and management, which signals society's unwillingness to tolerate or bear anything but the most minimal possibility of adverse outcomes. There are competing definitions and concepts of risk which complicate discussions between experts and the lay public. For example, Thompson (1990) distinguishes between ‘real’ risk, ‘observed’ risk, and ‘perceived’ risk. Real risk is thought to reflect how things stand in the real world. That is, it is a term which refers to actual risk, the actual negative consequences which exist, be they random or otherwise. Whereas observed risk is our evaluation of negative consequences based upon a theoretical model of the physical world. This is further distinguished from perceived risk which is conceived of as being the estimate of real risk in the absence of a theoretical model of the world. The distinction which is being drawn is a subtle one but it is an attempt to capture the idea that our perception of risk is judgmental in nature and does not necessarily correspond with objective reality. The underlying assumption, that our subjective evaluation of risk may not coincide with the true nature of things, is one that psychiatrists are familiar with. The lay perception of the risk that psychiatric patients pose to the public is, at the least, an exaggeration of the objective facts. However, the observed risk, that is the risk calculated by experts that psychiatric patients pose to the public may not be an accurate reflection of the actual risk posed by psychiatric patients.
A course for parents of troubled adolescents: some observations
Authors: Goldberg David , Garside Eileen
Published: October 2008

Aims and method

An education-based course for parents of adolescents with mental health problems is described.

Results

The structure of the 12–week course evolved in response to parental requests. Parents were enabled to access support which they felt was inaccessible before the course.

Clinical implications

Basing an intervention for parents of distressed adolescents in an educational frame may be more acceptable currently than using a psycho-educational frame.
[no title]
Authors: Katona Cornelius
Published: October 2008

The College is aware of the Cyberanalysis clinic website and has been in contact with Dr Razzaque and his psychiatric tutor. We have agreed that the reference within the website to Dr Razzaque as being an Inceptor within the Royal College of Psychiatrists should be removed.
Josephine Lomax-Simpson
Authors: Whitely J. Stuart , Beaton Audrey
Published: October 2008

Josephine Lomax-Simpson was born on 11 March 1925 into a family with a long tradition of philanthropy. Her grandfather, as a young architect, designed model cottages for workers in Lancashire and at the turn of the century was involved with Lord Leverhulme in the creation of Port Sunlight, Merseyside. This was a similar enterprise for providing the workers in the Lever Brothers industries with decent accommodation and a quality of life.
Clinical governance in mental health services
Authors: Isherwood Jim
Published: October 2008

In this paper, I explain the strategy for achieving clinical governance within the trust's mental health directorate, and describe the role that clinicians and managers would like the chief executive to play in helping us to achieve our targets.
What psychiatrists think about Part III of the Mental Health Act 1983
Authors: Buchanan Alec , Gunn John
Published: October 2008

Aims and method

The government has proposed a ‘root and branch’ review of the Mental Health Act 1983 to be conducted by the end of 1999. The aim of the study was to establish the views of general and forensic psychiatrists as to the adequacy of present legislative provision for England and Wales. The study was carried out by postal survey.

Results

The response rates were 82%, for forensic psychiatrists and 67%, for general psychiatrists. Most respondents considered most of present provision satisfactory. Areas considered in need of amendment were: the term ‘psychopathic disorder’; the requirement for an offence punishable by imprisonment before a hospital order can be made, provision for remands to hospital and the loss of clinical independence consequent upon the making of a restriction order.

Clinical implications

Forensic psychiatrists seem more willing than general psychiatrists to see their clinical discretion limited by the courts. Most of the suggestions were for changes to individual aspects of the present legislation rather than radical reform.
Roland Littlewood: in conversation with Rosalind Ramsay
Authors: Ramsay Rosalind
Published: October 2008

Professor Roland Martin Littlewood was born in 1947. He started his training at St Bartholomew's Hospital Medical School London, where he obtained his BSc and later graduated MB, BS in 1973. Further studying at the Institute of Anthropology, University of Oxford led to a Diploma In Social Anthropology, obtained in 1979, and a DPhil in Social Anthropology, gained in 1987. He was awarded the MRCPsych In 1978. Since then his impressive career has been marked by equally impressive distinctions, such as the presidency of the Royal Anthropological Institute from 1994–1997. Having reviewed over 200 books, Professor Littlewood is himself the author of four:Pathology and Identity: The Work of Mother Earth In Trinidad(1993) won the Wellcome Medal For Anthropology as Applied to Medicine in 1993. He has also written innumerable scientific, theoretical and review papers and edited three books. Professor Littlewood has recently been elected Fellow of the Royal College of Psychiatrists.
Anaesthesia for electroconvulsive therapy
Authors: Freeman Chris
Published: October 2008

The Special Committee on Electroconvulsive Therapy (ECT) has received numerous requests for advice in the last few weeks about suitable replacement agents for methohexitone in ECT anaesthesia.
Serotonin syndrome
Authors: Mir Shameem , Taylor David
Published: October 2008

Aims and method

To define serotonin syndrome and its symptoms and to discover which drugs or drug combinations are likely to cause it. A review of literature (including case reports) relating to serotonin syndrome collated from searches of MedLine and Micromedex covering the period January 1991 to July 1998.

Results

Most of the data found were either individual case reports or reviews of case reports. Reports of serotonin syndrome seem to be growing, certainly since the introduction of selective serotonin reuptake inhibitors. Particular combinations seem most likely to induce serotonin syndrome. Awareness of this syndrome as a distinct clinical entity seems to be growing.

Clinical implications

Serotonin syndrome is more likely to occur with drug combinations, especially those involving monoamine oxidase inhibitors. It can also occur when swapping antidepressant therapy, especially If changing from a long acting antidepressant such as fluoxetine. Caution is needed when changing antidepressants and particularly when they are used in combination.
Usage of clozapine and new neuroleptics
Authors: Haw Camilla , Stubbs Jean
Published: October 2008

Sir: Bristow (Psychiatric Bulletin, August 1999, 23, 478–480) found 9.5% of psychiatrists said their trust restricted clozapine funding. By contrast, the Maudsley National Schizophrenia Fellowship (1998) survey of health authority pharmaceutical advisors reported in the Pharmaceutical Journal found clozapine funding restricted by 45% of health authorities. We have recently carried out a postal questionnaire of members of the UK Psychiatric Pharmacists Group on the use and evaluation of atypical antipsychotics. We received 82 replies giving a response rate of 45%. Eleven per cent of pharmacists reported their trust capped the number of patients prescribed clozapine. However, there was widespread use of measures by trusts to try and limit expenditure on atypicals, restricting the prescribing of atypicals to consultants only and the use of guidelines in which atypicals are not first line treatment for schizophrenia. Only 12% of trusts, our hospital among them, used no cost-containment measures.
The law and suicide
Authors: McKane Maureen
Published: October 2008

Sir: Thompson (Psychiatric Bulletin, August 1999, 23, 449–451), states ‘the Suicide Act of 1961 prohibits others from encouraging suicide’, and concludes that there may, therefore, exist ‘legal grounds' sanctioning suicide Websites. These suggested measures include possibly tracing Vulnerable individuals' who have disclosed suicidal thoughts, or who have communicated, for example, by way of the site bulletin board, that they have just acted on their suicidal ideation. Yet, it is difficult to see how there could be legal grounds propelling health care professionals (presumably), or any other individual, into such interventions. The Suicide Act 1961, prohibits the ‘aiding and abetting’ of suicide, but this is not necessarily synonymous with merely ‘encouraging’ suicide per se. Criminal liability arises in circumstances where a person takes active steps in assisting the suicide of another, such as by telling someone the amount of a drug required to secure death and leaving this within their reach. The Suicide Act 1961 does not extend to Scotland, although any individual taking similarly unambiguous steps to assist another in suicide might face ‘art and part’ liability in the aiding and abetting of a suicide, possibly resulting in a charge of culpable homicide. Neither does it apply to other countries, and it must be borne in mind that assistance in suicide is not a crime everywhere. Therefore, there can exist no competent application of the English law or governmental quantitative targets over the conduct of others in a wholly different jurisdiction.
Is the fictive personality fiction?
Authors: Eynon Terri
Published: October 2008

Sir: Chaloner (Psychiatric Bulletin, September 1999, 23, 589–66), suggests that being moved by the death of a cultural icon that you have never met, rather than by one's own suffering, may be thought of as a ‘Active personality disturbance’; a pathological process which may be a result of ‘ego impoverishment’ or a failure of development.
Royal College Golf Society
Authors: Thompson Chris
Published: October 2008

Sir: On the last evening of the Annual General Meeting in Birmingham a small group of intrepid golfers made their way beyond the M40 to the Forest of Arden Golf Course for the inaugural meeting of the Royal College Golf Society. With the addition of a very small number of interloping general practitioners we made up a multi-disciplinary band of 24 golfers all intent on a brief period of relaxation after the academic rigours of the meeting. Unfortunately we could not persuade the Continuing Professional Development office to offer us credits for sports psychology, so the altruism of all those who took part is to be applauded.
Royal College of Psychiatrists' Archives
Authors: Williams Margaret Harcourt
Published: October 2008

When Samuel Hitch and his five colleagues agreed to form the Association of Medical Officers of Asylums and Hospitals for the Insane in 1841 it probably never occurred to them that it would grow into an organisation needing its own headquarters. The first mention of a permanent headquarters is in the minutes of the 1864 annual meeting when the President, Dr Munro, suggested: “If we could get thus into bricks and mortar, and have a more solid existence than at present, that would help to establish us very much”. However, the meeting decided against this on the grounds that it would make the Association “a strictly metropolitan one”. The question was discussed at intervals until 1893 when the Association, by then called the Medico Psychological Association (MPA), began to lease space from the Medical Society of London at 11 Chandos Street.
Geoffrey Garfit Wallis
Authors: Mahapatra Sasi
Published: October 2008

Dr Wallis was born in Southsea, Hampshire and came from a Naval family. His father was a doctor in the Royal Navy and his paternal grandfather had been a Naval Paymaster Captain. His father died when he was only four years old and he grew up with his mother. Early schooling was in Hampshire and in Malta and later at Epsom College, where he was keen on rugby and cricket. He maintained his interest in these sports all his life.
Robert Hugh Cawley
Authors: Caldicott Fiona
Published: October 2008

Professor Robert (Bob) Cawley was one of the College's founding fathers who led members of the Royal College of Psychiatrists to believe that to ‘let wisdom guide’ is a most appropriate precept for our professional body.
Reflections on psychiatry in Aboriginal Australia
Authors: Laugharne Jonathan
Published: October 2008

Eighteen months ago I came to Geraldton, Western Australia from the United Kingdom to help develop a psychiatric service for Aboriginal people in the mid-west region of the state. This has been a fascinating and challenging experience both professionally and personally and I would like to outline the context of this work and to reflect on some of the issues that seem particularly relevant.
Psychopathy in Scotland
Authors: Humphreys Martin
Published: October 2008

Aims and method

The aim was to examine why the legal category of psychopathic disorder does not appear in the Mental Health (Scotland) Act 1984 and to review selected literature relating to differences between prison and special hospital populations in Scotland from those elsewhere.

Results

There is now some emerging evidence to suggest that the legislation north of the border might reflect the notion that there may be fewer people with psychopathic disorders in Scotland.

Clinical implications

With devolution and the advent of a Scottish Parliament the Mental Health (Scotland) Act 1984 is likely to be reviewed. At that time it would be inappropriate to consider including ‘psychopathic disorder’ but some alternative to the current rather narrow definition of ‘mental disorder’ may be required.
Therapeutic community provision at regional and district levels
Authors: Davies Steffan , Campling Penelope , Ryan Kerry
Published: October 2008

Aims and method

The aim of the study was to investigate changes in service utilisation following therapeutic community treatment for patients with severe personality disorder. The study examined service usage, in the form of acute psychiatric admissions, of a series of 52 admissions to a residential therapeutic community in the three years before and year after admission.

Results

There was a reduction in the mean duration of acute psychiatric admissions after treatment, this was greater for extra-contractual referral patients than local district patients.

Clinical Implications

This study replicates results from previous studies. It also suggests that more accessible local services may be able to intervene earlier in patients' psychiatric careers preventing heavy use of acute services. We argue for greater provision of therapeutic community treatment for severe personality disorder.
Trainee attitudes within the Faculty of the Psychiatry of Learning Disability
Authors: Carvill Sue , Marston Geoff , Hollins Sheila
Published: October 2008

Aims and method

Recruitment of trainees and consultants into psychiatry is a major concern. A questionnaire survey of trainees within the psychiatry of learning disability was conducted to highlight attitudes about training and career issues.

Results

Ninety per cent of trainees decided on a career in learning disability as a result of completing a junior post in this speciality. Forty-three per cent were seeking dual accreditation and nearly half of these were experiencing problems relating to this; 84% expressed fears about becoming a consultant; and 63% felt they needed more advice on how to find a consultant post.

Clinical implications

Increased exposure to learning disability at the basic training grade is required to ensure recruitment. In addition issues related to dual accreditation and anxieties about consultant posts need to be addressed.
Liaison-consultation meetings in general practice
Authors: Tipper Rebecca J. , Pullen Ian M.
Published: October 2008

Aims and method

Audio-recordings were made over a period of six months of liaison–consultation meetings between general practitioners and a community mental health team in the Scottish Borders to show general trends in length of discussion and information exchange.

Results

Meetings were predominantly supportive, with high levels of shared information, but little educational content. Some trends in discussion time are shown.

Clinical implications

Audio-recording could form the basis for reviewing the function of liaison-consultation meetings.
Bournewood: Law and capacity
Authors: Devakumar M.
Published: October 2008

The Law Lords in June 1998 overturned the judgement in the matter of L. v. Bournewood. The Law Lords, on a majority decision, were of the opinion that a compliant incapacitated patient such as L. does not need the formal powers of the Mental Health Act and admission to hospital and subsequent assessment and treatment for mental disorder can be based on the common law principles of necessity. However, this position is quite contrary to the Appeal Court judges' view, “The right of a hospital to detain a patient for treatment for mental disorder is to be found in, and only in, the 1983 Act, whose provisions apply to the exclusion of the common law principle of necessity” (L. v. Bournewood Community Mental Health Trust, 1997).
Serving the Mental Health Review Tribunal 1966–98
Authors: Woolf P. Grahame
Published: October 2008

In a lecture to the Royal College of Psychiatrists, published as an editorial in the British Journal of Psychiatry, Sir John Wood recommended a review of the structure and details of the Mental Health Review Tribunal (MHRT) system (Wood, 1995). The present article is a personal contribution to that review and describes aspects of the MHRT during 30 years of continual change.

The roles of doctors in relation to the MHRT have been reviewed in the Psychiatric Bulletin by Woolf (1991). Despite flurries of lively correspondence during 1994–95, there has been no discussion of the working conditions of medical members.
Performance in psychiatry undergraduate finals
Authors: Cullivan Rachael , Rooney Siobhan , Kelly Gabrielle , Walsh Noel
Published: October 2008

Aims and method

This study investigated the effects of gender and nationality on performance in various aspects of the undergraduate final examination in psychiatry. Results in all sections of the final examination were analysed in the case of 140 students from the same year.

Results

There were no statistically significant differences between performances by males and females, however non-nationals performed less well in all aspects of the examination.

Clinical implications

Teaching programmes need to identify which aspects of the undergraduate course cause particular difficulty for non-nationals. This information would usefully inform future developments in undergraduate teaching.
Psychiatric training of pre-registration house officers
Authors: O'Dwyer J. M.
Published: October 2008

Aims and method

The aim of the paper is to describe the pre-registration house officer training in psychiatry available in Sheffield. The report is the result of a postal questionnaire, involving all of those who undertook pre-registration house officer training in psychiatry, since the inception of this option.

Results

The results suggest that the psychiatry option as part of pre-registration house officer training was regarded as useful by almost all undertaking this training. Some of the suggestions to improve the experience are already incorporated into the current posts.

Clinical implications

The findings support the development of further posts of this type, and such developments may assist in overcoming some of the difficulties in recruitment into psychiatry as a career.
Fertile Imaginations: an inner city allotment group
Authors: Seller Joanna , Fieldhouse Jon , Phelan Michael
Published: October 2008

Engaging people with mental illness in horticultural activities is nothing new. Asylums encouraged patients to work on farms, in orchards and in kitchen gardens. This activity gradually became distilled, formalised and applied clinically as ‘moral treatment’, out of which occupational therapy evolved (Paterson, 1997). ‘Fertile Imaginations' is an attempt to offer horticultural activities to people with mental illness, within the framework of an inner city community mental health team (CMHT) and to ensure that the activities that engaged and benefited patients in the past, are not now denied.
Management training as a senior/specialist registrar
Authors: Bowden M. F.
Published: October 2008

A placement involving management training is described and discussed in relation to the current specialist training requirements. The placement was unusual in that it included some practical involvement which was extremely rewarding.
Enforcing treatment with clozapine: survey of views and practice
Authors: Pereira Stephen , Beer Dominic , Paton Carol
Published: October 2008

Aim and method

The aim of the study was to survey strategies for dealing with patients who refuse clozapine blood tests or tablets. One hundred and twenty-five psychiatric intensive care unit consultants were sent a questionnaire.

Results

Thirty-nine (31%) questionnaires were returned. Opinions and practices were diverse ranging from uncertainty around the legal right to enforce venepuncture, to the practice of slipping clozapine into a patient's drink without their knowledge.

Clinical implications

There is need for an open debate of the relevant legal and ethical issues.
GPs' views on discharge summaries
Authors: Dunn John , Burton Stephen
Published: October 2008

Aims and method

After gaining the impression that our discharge summaries were too long for local general practitioners (GPs), we proposed to produce an abbreviated summary. We sent a questionnaire to a sample of GPs asking which aspects of the current summary were helpful.

Results

Although many GPs considered the summary overly long, a majority considered all the items to be at least Very helpful’.

Clinical implications

Although previous work on discharge summaries has indicated a demand for brief, focused reports it is important to establish local GP priorities before planning changes.
Mental health services in Kumasi, Ghana
Authors: Laugharne Richard , Burns Tom
Published: October 2008

During March 1998 we had the privilege of visiting the mental health services in Kumasi, Ghana at the invitation of Dr Yaw Osei, Senior Lecturer at the Department of Behavioural Sciences, School of Medical Sciences, University of Science and Technology.
Poverty and mental health in Aboriginal Australia
Authors: Laugharne Jonathan
Published: October 2008

When the Australian Governor General, Sir William Deane, referred in a speech in 1996 to the “appalling problems relating to Aboriginal health” he was not exaggerating. The Australia Bureau of Statistics report on The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples (McLennan & Madden, 1997) outlines the following statistics. The life expectancy for Aboriginal Australians is 15 to 20 years lower than for non-Aboriginal Australians, and is lower than for most countries of the world with the exception of central Africa and India. Aboriginal babies are two to three times more likely to be of lower birth weight and two to four times more likely to die at birth than non-Aboriginal babies. Hospitalisation rates are two to three times higher for Aboriginal than non-Aboriginal Australians. Death rates from infectious diseases are 15 times higher among Aboriginal Australians than non-Aboriginal Australians. Rates for heart disease, diabetes, injury and respiratory diseases are also all higher among Aboriginals – and so the list goes on. It is fair to say that Aboriginal people have higher rates for almost every type of illness for which statistics are currently recorded.
Hypertext tools for implementing evidence-based practice in mental health
Authors: Tomlin Andre
Published: October 2008

The recent British Medical Journal series of articles entitled Getting Research into Practice included a paper which described the practice of evidence-based medicine as “a process of lifelong self-directed learning in which caring for patients creates a need for clinically important information about diagnoses, prognoses, treatment, and other healthcare issues” (Straus & Sackett, 1998). The Centre for Evidence-Based Mental Health located in Oxford, aims to promote and support the teaching and practice of evidence-based mental health (EBMH). Since April 1998 the Centre has been developing a website aimed at two broad groups of users; those who have an active role in teaching evidence-based practice in mental health, and those who wish to find high quality mental health evidence on the Internet. The site contains a wide range of tools to help professionals develop their skills in practising EBMH, as well as tools to enable groups to run training courses in evidence-based practice. In addition to this the site provides a regularly updated list of ‘quicklinks' to sources of evidence for the busy mental health care professional.
Working in partnership with probation
Authors: Cohen Andrea , Bishop Nick , Hegarty Matthew
Published: October 2008

Aims and method

To describe the characteristics of probationers assessed (n=83) and supported (n=31) by a mental health worker (MHW) attached to a probation service. A survey of cases and case descriptions.

Results

Referrals were predominantly White, unemployed males on probation orders. Most had acquisitive/property and violent convictions along with substance misuse problems and personality disorder diagnoses. The MHW supported probationers already in contact with psychiatric services and provided a safety net and sometimes sole support, to those who were not.

Clinical implications

The MHW helped to bridge the gap between criminal justice and mental health systems by facilitating contact between probationers and psychiatric services. The clinical effectiveness of the scheme should now be examined.
Early experience of the use of olanzapine across three rehabilitation services
Authors: Wolfson Paul , Paton Carol , Steadman Phillip , Needham-Bennett Humphrey , Cope Susan
Published: October 2008

Aims and method

To monitor the effect of the introduction of olanzapine under naturalistic conditions to patients with severe and enduring mental Illness in three rehabilitation services.

Results

Thirty patients were prescribed olanzapine during the first six months of its launch. Objective ratings were used. Six months later, one-third were no longer on treatment one-third were unchanged and one-third had made useful clinical gains.

Clinical implications

Patients who have suffered from neurological or prolactin-related side-effects may benefit from treatment with olanzapine. Attitudes to treatment and adherence may improve.
Effect of increased antidepressant prescribing on suicide rate in Northern Ireland
Authors: Kelly Christopher B. , Rafferty Thérèse
Published: October 2008

Aims and method

To investigate whether changes in antidepressant prescribing have been associated with alteration in suicide rate for the period 1989–1996 in Northern Ireland. Data for antidepressant prescribing were obtained from a central unit, for Northern Ireland, using the defined daily dose system for each of the above years. The number of recorded cases of suicide and undetermined death were also obtained for this period, from Northern Ireland coroners.

Results

There was no evidence of an association between suicide rate and antidepressant prescription (r2=0.019, F test=0.115, P=0.74), despite antidepressant use more than tripling over the study period.

Clinical implications

Even substantial increases in detection and treatment of depressive Illness may not impinge on suicide rate. It Is also possible that suicide rate may be a very poor marker of the benefits of antidepressant treatment.
What direction for Continuing Professional Development?
Authors: Newby David
Published: October 2008

Aims and methods

A questionnaire survey of attitudes to Continuing Professional Development (CPD) was addressed to all 58 non-training grade psychiatrists working in a large teaching community mental health trust. Ninety-three per cent provided responses. Views were sought on the value of various teaching methods, how CPD should be organised, what barriers to participation colleagues encounter and whether CPD should be made mandatory.

Results

These showed strong support for the personal study element of CPD, indicated the range of other teaching modalities used by practitioners including industry supported symposia and found a significant majority in favour of making CPD mandatory. Pressure of time was the main obstacle to participation for most.

Clinical implications

The survey provides pointers for the key Issues which are likely to affect the readiness of practitioners to participate in CPD, as well as informing decisions on the type of ongoing educational activity that psychiatrists see as relevant.
Oedipus to Jack the Ripper
Authors: Combe Gillian , Cunningham Sara , Read Anne
Published: October 2008

Since the first journal clubs were started this educational tool has been used by the medical profession with varying degrees of success (Linzer, 1987). Journal clubs allow trainees to review a piece of published research and discuss it with senior colleagues. They are frequently plagued by poor attendance and perceived as less than exciting, and at worst frankly boring. The enormous choice of journals compared with 100 years ago and the diversity of the media available mean that journal clubs should look towards developing in their format. Various methods have been tried to improve attendance, perceived relevance and enjoyment, such as evidence-based medicine reviews (Gilbody, 1996), teaching critical appraisal skills, and using structured review methods (Burstein et al, 1996). Sidorov (1995) surveyed 131 postgraduate programmes in the eastern USA and found the following features were associated with high attendance and continuous existence of journal clubs: smaller residency programmes, making attendance mandatory, providing food and promoting original research articles.
Eclipse of the sun August 1999
Authors: Gralton Ernest , Line Chris
Published: October 2008

On Wednesday 11 August 1999 there will be a total eclipse of the sun. The path of totality will start at sunrise south of Nova Scotia and pass over the Atlantic toward the UK. It will then pass through northern France, central and southern Germany, Austria, the Middle East, Pakistan and India (Bell, 1997).
Medical incapacity, legal incompetence and psychiatry
Authors: Szasz Thomas
Published: October 2008

Much of my professional career has been dedicated to showing that psychiatric coercions and excuses are incompatible with respect for individual liberty and responsibility (Szasz, 1961, 1997). Thus, I was both pleased and displeased to read the criticisms of mental health legislation by Zigmond (1998) and Szmukler & Holloway (1998). It is gratifying to see such views appear in the pages of so respected a publication as the Psychiatric Bulletin, the more so as no American psychiatric journal exhibits similar open-mindedness toward debating a subject that most psychiatrists consider taboo. At the same time, it is frustrating to see psychiatrists grappling with problems intrinsic to psychiatry's legal and social mandate, yet refusing to acknowledge the nature and implications of that mandate.
Response to Szasz
Authors: Szmukler George , Holloway Frank
Published: October 2008

Thomas Szasz is justifiably famous for his critique of psychiatry. He was instrumental in focusing an important debate on the status of ‘mental illness' and its social implications for which we are all deeply indebted. However times have moved on. Holloway and I seek to cast different “skeletons from the closet” to those of Szasz. We seek to destigmatise mental illness, so it no longer constitutes a secret source of shame or pain to a family or person. We ask that mental illness be treated neither better nor worse than physical illness. Only if a person suffers from mental incapacity, whatever the cause – brain injury, exsanguination, schizophrenia, learning disability, stroke, toxic infection – and it is in that person's ‘best interests', carefully defined, should they be treated against their will. Szasz seems oblivious that every day, many more patients with a physical illness (associated with incapacity) are treated non-consensually than those with mental illness. It is just that we don't draw attention to it, and society accepts it is right. A little bit of homework on his part would have told him that in this country, exactly opposite to his assertion, the law does justify the “medical treatment of incompetent persons, say one who has a stroke or is unconscious as a result of an accident” (if it is in the patient's ‘best interests’). Again, exactly opposite to his claims, in this country no other person can consent on behalf of an incompetent patient. We argue that all patients in this position should have similar safeguards. Mental illness does not automatically confer incapacity, nor does it raise special issues requiring specific mental health legislation. But of course Szasz does not believe mental illness exists.
The Mental Health Act 1983
Authors: Bhatti Vijay , Kenney-Herbert Jeremy , Cope Rosemarie , Humphreys Martin
Published: October 2008

Aims and method

A one-in-five random sample (n=104) of practitioners approved under Section 12(2) of the Mental Health Act 1983 in the West Midlands was selected. Opinions were sought on issues relating to current law and potential reform.

Results

Eighty-three (80%) doctors were interviewed. Over half (52%) stated that the term ‘mental illness' in the Act was unsatisfactory. Two-thirds (68%) specified the need for a review of legislation relating to treatment in the community.

Clinical implications

There was a diversity of views. This is likely to be reflected in the clinical practice of those interviewed. Many respondents believed that there was a need for reform in specific areas of the Act.
Audit of a recently introduced stimulus dosing policy in an electroconvulsive therapy clinic
Authors: Shaikh G. , Ireland R. , McBreen M. , Ramana R.
Published: October 2008

Aims and method

To audit the clinical practice of seizure threshold estimation and subsequent stimulus dose adjustment in the electroconvulsive therapy (ECT) clinic. Case notes of patients who had ECT over a six-month period were audited. Results were discussed at an audit meeting and guidelines and training modified appropriately prior to the second cycle of the audit.

Results

Initial dose titration was poor in the first period, but improved in the second. The majority of patients were insufficiently stimulated after missed seizures in both periods and stimulus doses were not being reduced following prolonged seizures.

Clinical implications

The audit identified the need for continuing supervision of trainees in addition to clear training and guidelines.
Depot antipsychotics revisited
Authors: Taylor David
Published: October 2008

Many typical antipsychotic drugs may be manufactured as alcohols, which react with carboxylic acids to form esters (organic salts). These compounds are highly oil-soluble, but are only sparingly soluble in aqueous fluids such as blood. Thus, an oily solution of an antipsychotic can be injected into a muscle, where it forms a reservoir or ‘depot’ of drug that is slowly dissolved in the surrounding blood. Once released into the blood, drug esters are rapidly hydrolysed by endogenous esterase enzymes to produce the parent antipsychotic. Stable serum concentrations of antipsychotics are usually engendered (although this is not always observed in practice (Tuninger & Levander, 1996)), and administration need only take place every few weeks or so. Adherence can be assured and relapse rates are reduced (Groves & Mandel, 1975: Davis et al, 1994).
Construction of 1D Chain from Diphosphopentamolybdate Cluster and Copper Complex: Synthesis and Characterization of {Cu(DETA)}2[{Cu(DETA)(H2O)}Mo5P2O23]·4.5H2O
Authors: Wang Jingping , Wang Jianjuan , Ma Pengtao , Niu Jingyang
Published: October 2008

A novel organic–inorganic hybrid based on diphosphopentamolybdate cluster, {Cu(DETA)}2[{Cu(DETA)(H2O)}Mo5P2O23]·4.5H2O [DETA: diethylenetriamine] (1), has been synthesized by hydrothermal method and characterized by X-ray crystallography, showing that the [Mo5P2O23]6− cluster, which supported by the {Cu(DETA)(H2O)}2+ unit, is linked through two {Cu(DETA)}2+ bridging units to construct a 1D chain-like infinitely extended structure. Each chain is further linked to two adjacent chains by hydrogen bonds to yield a 2D layer parallel to the ac plane.
Frequent mutations and amplifications of the PIK3CA gene in pituitary tumors
Authors: Lin Yong , Jiang Xiaofei , Shen Ye , Li Min , Ma Huili , Xing Mingzhao , Lu Yuan
Published: October 2008

Genetic alterations in the PIK3CA gene of the phosphoinositide 3-kinase (PI3K)/AKT pathway have been found in many human tumors, but they have not been explored in pituitary tumors. We undertook the present study to explore mutations and amplifications of the PIK3CA gene in pituitary tumors. DNA sequencing and real-time quantitative PCR were used to examine mutations and amplifications respectively, on genomic DNA samples isolated from 353 cases of pituitary tumors, and immunohistostaining was used to assess PIK3CA expression. About 8 out of 91 (9%) invasive pituitary tumors versus 0 out of 262 (0%) noninvasive tumors were found to harbor somatic mutations in exons 9 and 20 of the PIK3CA gene (P<0.001), and the mutation was associated with increased disease recurrence. Genomic PIK3CA amplifications (defined as ≥4 copies) were observed in both invasive and noninvasive tumors, with a prevalence of around 20–40% in various types of pituitary tumors. PIK3CA protein overexpression was observed in cases with high PIK3CA copy number. RAS mutations were also examined and found in 6 out of the 91 (7%) invasive tumors. PIK3CA amplifications were mutually exclusive with PIK3CA or RAS mutations (P<0.001). This study demonstrated for the first time relatively common PIK3CA mutations and amplifications as well as RAS mutations and their tendency of mutual exclusivity in pituitary tumors. The data provide strong genetic evidence supporting a role of the PI3K/AKT signaling pathway in the tumorigenesis of pituitary tumors, particularly the invasive types.
Differential regulation of human dopamine D2 and somatostatin receptor subtype expression by glucocorticoids in vitro
Authors: de Bruin C , Feelders R A , Waaijers A M , van Koetsveld P M , Sprij-Mooij D M , Lamberts S W J , Hofland L J
Published: October 2008

Dopamine agonists (DA) and somatostatin (SS) analogues have been proposed in the treatment of ACTH-producing neuro-endocrine tumours that cause Cushing's syndrome. Inversely, glucocorticoids (GCs) can differentially influence DA receptor D2 or SS receptor subtype (sst) expression in rodent models. If this also occurs in human neuro-endocrine cells, then cortisol-lowering therapy could directly affect the expression of these target receptors. In this study, we investigated the effects of the GC dexamethasone (DEX) on D2 and sst expression in three human neuro-endocrine cell lines: BON (carcinoid) and TT (medullary thyroid carcinoma) versus DMS (small cell lung cancer), which is severely GC resistant. In BON and TT, sst2 mRNA was strongly down-regulated in a dose-dependent manner (IC50 0.84 nM and 0.16 nM), whereas sst5 and especially D2 were much more resistant to DEX treatment. Sst2 down-regulation was abrogated by a GC receptor antagonist and reversible in time upon GC withdrawal. At the protein level, DEX also induced a decrease in the total number of SS (−52%) and sst2-specific (−42%) binding sites. Pretreatment with DEX abrogated calcitonin inhibition by sst2-preferring analogue octreotide in TT. In DMS, DEX did not cause significant changes in the expression of these receptor subtypes. In conclusion, we show that GCs selectively down-regulate sst2, but not D2 and only to a minor degree sst5 in human neuro-endocrine BON and TT cells. This mechanism may also be responsible for the low expression of sst2 in corticotroph adenomas and underwrite the current interest in sst5 and D2 as possible therapeutic targets for a medical treatment of Cushing's disease.
Briefing: Corporate manslaughter – radical change or false alarm?
Authors: Metherall Ann
Published: October 2008

New corporate manslaughter legislation is now in force in the UK. Ann Metherall of ICE's health and safety expert panel says it could have major consequences for civil engineering organisations and professionals.
Engineering civilisation from the shadows
Authors: Jowitt Paul
Published: October 2008

This paper discusses the key issues, opportunities and obligations facing civil engineers to engineer civilisation from the shadows cast by world poverty and global climate change. Almost all of the 1·5 billion population increase occurring by 2025 will be in urban slums in the developing world, with little in the way of civil infrastructure to protect them from disease, famine, drought and flooding. The provision of effective infrastructure, and with it the delivery of the UN millennium development goals, is vital if they are to survive. The paper is based on the author's ICE Brunel international lecture, which was presented in 16 countries during 2007.
Reconstruction of the Welsh Highland Railway, Snowdonia
Authors: Sreeves John
Published: October 2008

A largely volunteer-run project to reinstate 40 km of the Welsh Highland Railway between Caernarfon and Porthmadog in north Wales will be completed in 2009. It will link with the existing Ffestiniog railway to create a through route of nearly 62 km – the longest heritage railway reconstruction in the UK. This paper describes the historical context, planning, construction, operation and finance needed to reinstate one of the country's steepest and most scenic railway routes. A culmination of dogged persistence in the face of political indifference will result in an environmentally sustainable transport facility through the heart of Snowdonia National Park and is likely to bring significant economic regeneration to the area.
Using slag for unfired-clay masonry-bricks
Authors: Oti J. E. , Kinuthia J. M. , Bai J.
Published: October 2008

This paper reports on an investigation on the use of ground granulated blast-furnace slag (GGBS) in the development of a sustainable unfired clay binder material for stabilised masonry-brick. The compressive strength of the stabilised masonry-brick, using a semi-processed industrial kaolinite clay soil and a ‘real’ clay soil (Lower Oxford Clay) commonly used in masonry clay brick manufacture were examined. In practice between 1 and 3 wt.% lime is needed for modifying the soil properties and between 2 and 8 wt.% lime for stabilisation. Due to the high strength requirement in the building industry in comparison with stabilised highway pavement layers for example, a high maximum stabiliser dosage of 20% was used. However, only a small proportion of this high stabiliser content (20%) was lime or Portland cement. Cylindrical specimens were made at moisture contents of 25, 30, 35 and 40%, and cured for 28 days, before testing for unconfined compressive strength. Preliminary results show that the strength values for the stabilised clay systems investigated were within the strength range of 65 to 2077 kN/m2 at 28 days, with the lime–Portland cement blends tending to achieve lower strength values relative to the lime–slag blends. The results suggest that there is potential for the use of GGBS in unblended binders for the development of unfired clay masonry bricks.
Performance of a fibre-reinforced lightweight concrete panel
Authors: Arisoy B. , Wu H.-C.
Published: October 2008

This study focused on the mechanical performance of polyvinyl alcohol fibre-reinforced lightweight concrete, produced with lightweight aggregates, or airentraining agent, or a combination of both. Superior mechanical properties including low density, high flexural strength and high ductility were achieved and the potential use in wall panel production was then carefully examined.