bluuebunny/crossref_metadata_2025 huggingface dataset:
‘Elderly graduates' and a hospital closure programme
Authors: Holloway Frank , Rutherford Joan , Carson Jerome , Dunn Lynda
Published: October 2008

A sample of 49 ‘elderly graduate’ residents of a hospital designated for closure were surveyed in 1987 and followed up five years later. Twenty-two patients (45%) had died: the mortality rate was much lower than that predicted by the regional health authority and approximated to that of the general population. All but one of the survivors was living in supported accommodation at the time of follow-up. The majority were satisfied with the move and were receiving an appropriate level of care. However there was significant unmet need for structured activities and companionship. During the follow-up period the survivors had declined in functioning.
The ‘new model’ discharge summary: Is it working?
Authors: Butler Robert , Greenberg Maurice
Published: October 2008

An audit was undertaken looking at the information covered and length off discharge summaries in a psychiatric day hospital. Initially data were gathered from 90 multidisciplinary summaries over 18 months. This showed that although some key headings were being covered, 20% of summaries tailed to include a diagnosis and 63% were longer than two sides. The strategy devised to improve practice was the presentation off these findings to an audit meeting involving all staff which led to a general agreement to improve weaker areas. Over the following six months data were gathered on 26 discharge summaries. Headings were covered more frequently, 92% included a diagnosis and 88% were two sides or less in length.
Sun, sea, sand and psychiatry
Authors: Sisodia Neelam , de Sousa Corinne
Published: October 2008

Neelam Sisodia and Corinne de Sousa see a message for psychiatry in a film about Asian women
Winston Churchill Travelling Fellowship to USA to study trauma services for children
Authors: Black Dora
Published: October 2008

I have spent all my professional life as a child psychiatrist working in hospitals and clinics. For many years I have been interested in helping bereaved children and conducted research on how best to help them. As the result of my interest I found myself being asked to see increasing numbers of children who were traumatically bereaved because of one parent killing the other, an event that the children often witnessed. I needed to familiarise myself with the effects of witnessing or being caught up in severe trauma, as well as the effects of bereavement. As I saw more and more of these traumatically bereaved children, I realised that child psychiatric services were not well organised to help these children who often needed emergency help. I decided, with the backing of the Royal Free Hospital, to retire from my post as head of a busy department and set up a clinic for children who had been acutely psychologically traumatised. This work is now supported by a grant through Cruse-Bereavement Care from the Department of Health. I wanted to see how others had organised services for such children so I applied for and was granted a Winston Churchill Travelling Fellowship to study trauma services for children in the USA. I spent a month visiting San Francisco, Los Angeles, Boston, New Haven and New York in September 1993.
Defeat Depression Campaign
Authors: Jadhav Sushrut , Littlewood Roland
Published: October 2008

The vigorous public profile adopted by the College in the ‘Defeat Depression’ campaign (Psychiatric Bulletin, 1993,17, 573–574) is to be welcomed, but the proposed educational programme is premature. The MORI poll is not an adequate basis for understanding how ‘depression’ is popularly conceived nor how people respond to it. The research report (Royal College of Psychiatrists, 1992) says little about the methods used in the qualitative part of the study: whether the researchers were properly trained in ethnographic field interviewing to elicit illness categorisations, and their ability to elicit the whole complex of ideas and actions, involving nomenclature, causation, agency, recognition and recourse to treatment.
The development of a school-based psychotherapy service for adolescents
Authors: Dyer T. J. , Elliott F. M.
Published: October 2008

In this article we give an alternative view of service provision for adolescents with emotional difficulties centred around four high schools. We believe that the service we offer differs in a number of ways and has a number of benefits for clients and other pupils and staff at the schools. We present this view of our service with some information about its historical context and as a snapshot of the current state of the service in the expectation that there will be further developments.
Long-term care: reducing morbidity in residents and staff
Authors: Evans Mavis , Burgess Helen , Gore-Rees Elizabeth
Published: October 2008

Staff in nursing homes specialising in the care of the elderly mentally ill were trained to screen for psychiatric morbidity by members of the local psychogeriatric service. They were then involved in the planning and delivery of appropriate treatment, both medical and behavioural. Residents in the homes were screened again six months later and marked reduction in morbidity was found.
The crisis team as part of comprehensive local services
Authors: Beer Dominic , Cope Susan , Smith Janet , Smith Roger
Published: October 2008

An attempt to categorise the nature of the work done by an inner city crisis intervention service (CIS) which is part of a comprehensive community mental health service is described. The work of the CIS as it relates to models of crisis intervention recognised in the literature is outlined. The role of this CIS in providing additional intermittent support to individuals receiving long-term community care is commended.
Complaints against psychiatrists: a five year study
Authors: Ingram Keith , Roy Leena
Published: October 2008

Complaints made against doctors are increasingly important given the current emphasis on consumerism in the National Health Service and the publication of the report of the Wilson Committee which reviews complaints procedures. There have also been recent changes in medical indemnity and increased litigation. The origins of complaints made against psychiatrists were studied. Most complaints were made by relatives and advocates rather than the patients themselves and half were made after the patient was discharged from hospital. It was found that most complaints arose out of a breakdown of communication between psychiatrist and patient.
Employment of counsellors and mental health professionals by fundholding general practices
Authors: Mutale T. I. R.
Published: October 2008

Recent surveys have shown that general practitioners have begun to employ practice counsellors. The recent establishment of fundholding practices has made it possible for general practitioners (GPs) to be direct purchasers of health services. The number and nature of counsellors and specialist mental health professionals directly employed by fundholding practices is reported.
The coverage of psychiatry in the Irish print media
Authors: Meagher David , Newman Alison , Fee Margaret , Casey Patricia
Published: October 2008

The frequency and content of articles of psychiatric interest in the Irish print media were investigated. Issues of psychiatric interest were commonly featured. Contrary to popular opinion most articles are either supportive or neutral in tone. Where negative imagery occurred it was more frequently associated with articles in the tabloid papers. Mental health professionals, in particular psychiatrists, contributed very little towards articles of psychiatric interest (especially in the tabloid press) and need to become more actively involved in shaping the portrayal of mental illness in the print media. Their involvement is associated with a more positive portrayal of psychiatry.
Impact of a community-based ‘challenging behaviour’ service on bed occupancy
Authors: Perry David , Krishnan Vallepur H. R. , Tewari Sidhartha , Cowan Colin , Roy Ashok
Published: October 2008

People with learning disability and behavioural disturbance can be difficult to treat in the community, frequently requiring specialist in-patient assessment. The impact which a new community-based ‘challenging behaviour service’ has had on a district's in-patient bed use is described.
A perspective on suicides in the ‘90s
Authors: Meats Philip , Solomka Bohdan
Published: October 2008

We reviewed all 112 suicides and self-harm open verdicts in Central Nottinghamshire between 1987 and 1991. The rate of consultation with general practitioners of completed suicides was similar to control patients a year before death. It then increased during the succeeding months, particularly in the month before death, when 41% consulted their general practitioner. A further 12% saw another doctor in their last month. Those who did not consult were more likely to be middle-aged, male, divorced or separated, to have experienced a recent broken relationship, and to show evidence of planning the suicide. Better awareness may have detected and possibly prevented some suicides in consulters. Those who did not consult a doctor had different characteristics. Additional strategies would be needed to prevent these deaths.
Diagnostic survey in a regional psychotherapy unit
Authors: Evans Joanne , Hartman Jenny , Gladwell Stephen
Published: October 2008

Assessment of patients referred for psychotherapy has more commonly consisted of a psychodynamic assessment with less emphasis on a formal psychiatric diagnosis, whereas the reverse tends to be the case in the general psychiatric services. Within the National Health Service there are close links between the two services. A common frame of reference regarding the definition of the patient groups using the services could Improve communication, the planning and evaluation of specific treatment programmes, and outcome studies. A retrospective case-note study was carried out at a regional psychotherapy unit in order to define the population referred between 1991 and 1992 according to ICD–10 (WHO, 1992).
Treatment resistant depression: causes and consequences
Authors: Smith Andrew J.
Published: October 2008

The Joint winners of the second Merck Essay Prize for 1994 were Drs Andrew Smith and Swaran Singh. Their essays are published below. The number of entries was 15.
Out-patient care for people with learning disability and epilepsy: evaluating the audit process
Authors: Chubb Helen , Kerr Michael , Joyce Joseph
Published: October 2008

The notes of 24 individuals attending a clinic for people with learning disability and epilepsy were reviewed for all visits in the year preceding and following the Implementation of medical audit standards for out-patient review. There was no deterioration in any standard. A significant improvement was seen in recording of seizure frequency by seizure type, legibility of signatures, regular letters to general practitioners and the recording of seizure type and frequency in these. Medical audit can improve standards in epilepsy care, though its influence on outcome is not known.
Clinical pharmacists: the benefits for psychiatric trainees
Authors: Yorston Graeme , McPhail Evelyn
Published: October 2008

Psychiatric trainees' knowledge and understanding of the therapeutic principles underlying the appropriate use of psychotropic medication comes from many sources. They receive a grounding in neuropharmacology as a medical student and this is updated and expanded by attendance at a university lecture course in preparation for the MRCPsych examinations. Practical advice is handed down by supervising consultants and is augmented by reference to standard textbooks and research literature. Pharmaceutical representatives occasionally provide useful information though this may be biased, concentrating on specific drugs in isolation and without comparisons to competitors. Because of the variety and uneveness of these sources there is a risk, especially in the earlier years of training that knowledge is patchy, impractical or unsoundly based on dogmatic or out of date advice. There have been calls for training in psychopharmacology to be improved and suggestions as to how this may be achieved (Ferrier & Cooper, 1994). This paper describes the clinical pharmacy services in Fife and their value in improving the knowledge and practice of therapeutics amongst psychiatric trainees.
What is an Afro-Caribbean? Implications for psychiatric research
Authors: Hutchinson G. , McKenzie K.
Published: October 2008

The term Afro-Caribbean is used to describe black people of Caribbean origin in Britain. Migrants from the Caribbean, their children and their children's children are all covered by this term. The group as a whole is reported to have a higher incidence rate of schizophrenia than white groups, (King et al 1994), and British-born children of Caribbean parents have an even higher rate (Harrison et al, 1988). These reports have led to the hypothesis that Afro-Caribbeans may have a special vulnerability to schizophrenia. While limitations to these studies have been identified, (Wessly et al 1991) none has sought to question the use of the term Afro-Caribbean as a valid and reliable ethnic grouping. If we are to be able to produce good hypotheses for the aetiology of the reported increases in incidence, or to produce research which is useful to Black and ethnic minority groups, we need a clear understanding of the people under study.
Depot clinic: consumers' viewpoint
Authors: Singh Vinod , Hughes Geraldine , Goh S. E.
Published: October 2008

With the emphasis on ‘care in the community’ there have been moves to provide psychiatric care away from the large psychiatric hospitals, which have resulted in the development of community mental health teams and the expansion of primary care and health centres to cater for people with psychiatric needs. The opinions of patients attending a hospital-based depot neuroleptic clinic are reported. A 17-item questionnaire was designed addressing the functioning of the clinic, including aspects of the medical and nursing care offered and the overall service provided. The majority of patients were in favour of attending this facility and expressed their wish for the service to continue.
Driving and psychiatric illness
Authors: Humphreys Sharon A. , Roy Leena
Published: October 2008

A survey of psychiatrists was conducted to determine their current knowledge of the Driver and Vehicle Licensing Authority (DVLA) regulations and the advice they give to their patients regarding driving with psychiatric illness and/or medication. The results indicate that both knowledge and practices vary widely. In view of the potential risks of driving when not well or fully alert, information regarding driving should be a standard part of the advice given to all psychiatric patients.
Training experience in drug and alcohol liaison work
Authors: Williams H. , Vince J. , Salter M.
Published: October 2008

We describe our training experience as members of a drug and alcohol liaison service within a major general teaching hospital. This type of liaison work offers valuable experience in the joint management of patients with well established substance misuse problems and also provides the opportunity for early recognition and preventative interventions.
Memories of madness: the County of Lancaster Asylum, Rainhill, 1890
Authors: Barnes Richard C.
Published: October 2008

An account of the thoughts of a fictional Assistant Medical Officer (AMO) on duty at the County of Lancaster Asylum, Rainhill in 1890 is given. It is based on the contemporary case records and other literary sources and is as factually accurate as possible. However, any similarity to persons living or dead is coincidental and unintentional.
Psychiatry in Qatar
Authors: El-Islam M. Fakhr
Published: October 2008

Qatar is an Arab country occupying a peninsula in the middle of the Western coast of the Gulf separating Persia from Arabia. It is an oil-exporting country with a population of about 400000, 70% of which live in the capital, Doha. The increase in wealth with the discovery of oil made it possible for many young members of extended families to move away and led to the emergence of nuclear families. In spite of this geographical separation, most nuclear families consider themselves extensions of their original extended families and maintain ties with them for the purpose of consultation, e.g. to arrange marriages, buffer disputes or mediate to secure benefits.
Aftercare: who attends section 117 meetings?
Authors: Lethem Rosemary
Published: October 2008

The purpose of aftercare is to enable patients to return to their home or accommodation other than a hospital or nursing home, and to minimse the need for future in-patient care. Under section 117 of the Mental Health Act 1983, local health and social services authorities have a legal duty to provide aftercare for certain categories of patients when they leave hospital (Department of Health and Welsh Office, 1993).
Mental health services on Lower North Shore, Sydney
Authors: Slade Mike
Published: October 2008

This paper describes mental health services in the Lower North Shore (LNS) catchment area of Sydney, Australia, and is based on a visit made in early 1994. The local population of 170,000 is predominantly Caucasian, but there are also groups from other ethnic backgrounds. The mental health service has about 800 registered clients, with 60 new clients each month, the majority of whom have a serious mental illness. Since the service has won several awards, it may be instructive to review its structure and function.
1994 Trainees' Forum: ‘Is general psychiatry dead?’
Authors: Gaughran Fiona , Davies Steffan
Published: October 2008

The 1994 Trainees' Forum was held on the first day of the Winter Meeting of the Royal College of Psychiatrists and was well attended by psychiatrists of all grades. The speakers were Dr David Wilson, Senior Lecturer in Learning Disabilities in Nottingham, Dr Chris Freeman, Consultant Psychotherapist in Edinburgh, Professor Anthony Clare from Dublin, Vice President of the College, and Dr Dinesh Bhugra from London who is secretary of the General Psychiatry section of the College.
An examination of a staff group at a supra-regional deaf unit
Authors: Hartman D. , Kitson N.
Published: October 2008

We undertook a study on the staff group of an in-patient unit for deaf patients which is run on therapeutic community principles. The study addressed attendance patterns and attitudes of staff to the group, using a Questionnaire with open and closed Questions. About half of the staff found the group useful and attended with some regularity, while a minority expressed negative opinions and did not attend. There were conflicting views about the boundaries of the group and is purpose. The implications for setting up and running a staff group are discussed.
An ethical dilemma in child and adolescent psychiatry
Authors: Graham P. J. , Foreman D. M.
Published: October 2008

In this paper the ethical concept of competence is explored in the context of a very challenging child psychiatry case. Both mental disorder and immaturity may impair a child's competence. However, It is emphasised that competence Is not a generic quality but one that should be applied to specific decisions, even when working with children.
Job descriptions for consultant posts in psychiatry of old age
Authors: Rodger Colin R. , Wattis John P.
Published: October 2008

The Job descriptions for five consecutively advertised consultant posts in psychiatry of old age were surveyed for the content and clarity of the information provided and for the adequacy of the resources described. Only one post provided a job description which came close to meeting our audit criteria. Employers may optimise the number and quality of applicants for consultant posts in psychiatry of old age by providing Job descriptions which contain both clearly written and comprehensively detailed information.
Community care for people with learning disabilities: deficits and future plans
Authors: Bouras Nick , Holt Geraldine , Gravestock Shaun
Published: October 2008

The challenge facing services for people with learning disabilities is to create the environment in which clients have the best quality of life without preconception. The heterogenous nature of people with learning disabilities requires diversity of care provisions sensitive to their individual needs. The different demonstration and presentation of their mental health needs has influenced the development of services and different models of specialist services have emerged with local variations. There is still, however, a great deal of confusion on both ideological and service delivery level. Although services for people with learning disabilities have succeeded in resettling people in the community and supporting them in developing adaptive skills, unfortunately these successes are not matched by equally effective and efficient services to those with mental health needs.
Introducing the care programme approach to a multidisciplinary team: the impact on clinical practice
Authors: Matthews Barry
Published: October 2008

This paper describes the development of a simple computer-based care programme system. An important issue in its development was the attitude of professional staff. After one year of use staff recognised the system as a useful and practical aid in the management of their cases.
A cross-sectional evaluation of a community-orientated mental health service
Authors: Spear Jon , Cole Andrew , Scott Jan
Published: October 2008

Community mental health services have been criticised for seeing those with minor psychiatric disorders at the expense of those with severe and long-term illness. We report a cross-sectional evaluation of a UK service based entirely within the community. Most patients in contact with the service (66%) had a psychotic disorder or an affective disorder. Patients with greater impairment were likely to receive more intensive treatment. Only 20% of the community psychiatric nurse (CPN) case load focused on acute distress and neurotic disorders. Within this service careful operational planning and maintaining CPNs within the secondary care system appear to be critical factors in achieving the goal of giving priority to the severely mentally ill.
How to change prescribing of hypnotics
Authors: Harborne G. , Tudor L.
Published: October 2008

This paper charts the progress of a continuing audit cycle of prescribing of hypnotics in a psychiatric hospital. First we reviewed some possible standards from the literature, then educated the prescribing doctors, and fed back to them their own patterns of prescribing. We present the results of this exercise repeated over 18 months; these show a change and general improvement in prescribing patterns. Finally we discuss some of the motivations and possible mechanisms behind these changes, and the implications for the audit process in general.
Aftercare under the 1983 Mental Health Act
Authors: Wilkinson Ellen , Richards Hayley
Published: October 2008

The aftercare of psychiatric patients discharged from hospital is currently under debate among clinicians and in the media. Our study audited the planning of aftercare for detained patients discharged under section 117 of the 1983 Mental Health Act. Our completed audit cycle showed how discharge planning can be improved yet underlines the difficulties encountered in providing for this vulnerable patient group.
Two types of part-time registrar training in psychiatry
Authors: van den Brink Erik , Sanders Anja
Published: October 2008

Little has been published by junior trainees of their experience of part-time training. This paper discusses two different arrangements of flexible training at registrar level based on the personal experience of a married couple where both partners wished to combine psychiatric training with childcare. Job-share by working alternate periods of six months is compared with being in separate flexible training posts as super numerary registrars.
Supervision registers and the care programme approach: a practical solution
Authors: McCarthy Anthony , Roy David , Holloway Frank , Atakan Zerrin , Goss Tony
Published: October 2008

Although the principles behind the care programme approach have generally been welcomed, its implementation has at best been patchy and at worst a complete failure. The principles behind supervision registers have not been welcomed by most psychiatrists. This paper presents a practical solution to the major problems associated with the implementation of the care programme approach and supervision registers by defining pragmatic criteria for inclusion on these registers and the services which should be provided to registered patients. This solution was agreed between purchasers and providers following a series of consultative meetings and this is a process which must be recommended.
Animals, humans and Martians: the concept of persons
Authors: Oyebode Femi
Published: October 2008

This paper examines the concept of the person as distinct from the concept of the human being. It argues that the criteria which some contemporary philosophers propose for making this distinction are likely to have adverse effects for the moral status of people with learning disability and psychiatric disorders respectively.
The Mental Health Nursing Review: implications for community psychiatric nurses
Authors: Gournay Kevin
Published: October 2008

The recent review of mental health nursing recommended that nurses refocus their attention on people with serious mental illness. There are some encouraging trends in the training of nurses in problem-oriented case management. However, mental health nursing needs to face various problems. These include the need for the large-scale retraining of nurses currently working in traditional psychiatric hospitals and difficulties in the new Project 2000 programmes. In addition, there is a clear lack of leadership in the profession, largely because of the recent emphasis on management rather than clinical and academic attributes. Finally, nursing needs people who care what happens to the seriously mentally ill.
The relationship between a community psychiatric rehabilitation team and local GPs
Authors: Tough Sandra
Published: October 2008

As mental health professionals move increasingly towards providing community-based services, a good working relationship with general practitioners becomes central to patient care. This relationship depends on good liaison and communication as well as shared goals. This study examines the relationship between a community psychiatric rehabilitation team (CPRT) and GPs by means of a postal questionnaire to local principals in general practice. Although the awareness of the service was less than optimum, clear indications were made of ways of improving communication. The GPs overwhelmingly supported the priorities of the CPRT in the care of those with major mental illness.
Adolescent units–wither on the vine? A meeting with the Under-secretary for State
Authors: Wells Peter
Published: October 2008

Concern is growing over the decline of services for disturbed young people, expressed in the correspondence columns of the British Medical Journal, in professional journals (Vanstraelen & Cottrell, 1994; Saunders, 1993), and in literature from the Royal College of Psychiatrists (Pearce, 1994) among others. There has been a gradual loss of beds in adolescent psychiatric units, amounting in one survey of 60 units to nearly 20%. At least seven units have closed all their beds, and others are threatened with closure.
Why trainees fail mock MRCPsych clinical examinations
Authors: Donnelly Peter
Published: October 2008

The clinical examination is the cornerstone of the MRCPsych Parts I and II. Trainees frequently prepare for the clinical by practising in a mock examination setting. One person's experience in examining candidates in mock clinical examinations is reported and an approach to the clinical examination is described. Some of the common pitfalls are highlighted.
Conference proceedings of the Transcultural Special Interest Group
Authors: Khoosal Deenesh , Moodley Parimala
Published: October 2008

A one-day symposium was held at the Royal College of Psychiatrists on 4 October 1994 by the Transcultural Special Interest Group (TSIG) entitled The Practice of Psychiatry in a Multi-Cultural Context’. Speakers included Yvonne Christie of the Regional Race Programme for the NHS Mental Health Task Force, Drs Suman Fernando, Sashidharan, Ndegwa, Nasirullah, and Mahadeshwar.
A visit to St Petersburg: an experience of psychiatry in Russia
Authors: Collins Ian P.
Published: October 2008

‘Welcome To Reality’ announces the bright orange graffito, in English, on the perimeter wall of The City Psychiatric Hospital Number 3. A superfluous arrow points to the gate house. This is a large general psychiatric hospital of 2150 beds serving a population of 1.7 million people and also providing my first experience of Russian psychiatry. The buildings, some wooden, date from 1870 onwards and are set in a large area of mature woodland enclosed by a high wall in the northern suburbs of the city.
Ethical approaches to researching the mentally incapable patient
Authors: Hirsch Steven , Spence Sean
Published: October 2008

Patients seen in psychiatric settings may, for a variety of reasons, be incapable of informed consent. The Mental Health Act allows for their treatment, but research into their pathologies is practically impaired (while their consent is a criterion for inclusion). Is it ethically unacceptable to perform research upon these patients? If so, then the prospects for therapeutic and conceptual advance seem remote. In this paper the competing ethical claims are examined. An approach is proposed which is humane yet permissive of research in this heterogeneous group of patients.
Would you like to see a counsellor or a psychiatrist?
Authors: Strouthos Marios , Ronder Julia , Hemmings Adrian
Published: October 2008

Mental health promotion clinic funding was introduced with the new general practice 1990 contract and has been extensively used to fund counsellors and stress management clinics in primary care. This funding has been withdrawn. A postal survey was conducted on all 142 general practices in East Sussex in order to assess the impact of the introduction and withdrawal of mental health promotion clinic funding on the employment of counsellors and on stress management clinics. One hundred and forty practices participated and it was found that there was an increase from 33 to 70 counsellors employed and five to 36 stress management clinics run by January 1993. Many GPs did not know what would happen to their service and it was estimated that 44 (63%) of counsellors and 13 (36%) stress management clinics would be lost.
Showman, shaman, or charlatan … conflicting motives for the media medic?
Authors: Shooter Michael
Published: October 2008

One of the few joys of moving house, is the rediscovery of books you haven't opened for years. I was sitting among the dust-sheets rereading Francis Wyndham's anthology of criticism (Wyndham, 1991), when I came across his description of the erstwhileBlue Angelgoing through yet another reincarnation on the stage of the Queen's Theatre in 1973.
10th International Psychiatric Conference on Mental Health in Developing Countries
Authors: Bhatti M. Riaz , Chaudry M. Sharif , Hussain M. F.
Published: October 2008

In December 1994 Lahore was host to an international psychiatric conference with participants from various countries including Pakistan, UK, France, Denmark, Belgium, Germany, Kuwait, Qatar, Saudi Arabia, Belarus, USA, Canada and Australia. The main contingent of foreign delegates of about 40 consultants was from the UK.
Diploma in Psychological Medicine (DPM) at Postgraduate Medical Institute, Lahore
Authors: Haider Ijaz
Published: October 2008

There are only 130 psychiatrists in Pakistan for a population of 95 million and they are stationed at major cities where only 15% of the population of the country resides. The foreign trained psychiatrists, mostly in the UK, are attached to the departments of psychiatry of medical schools in major cities and are not willing to go to rural areas where 85% of the population lives. Thus there is an acute shortage of psychiatrists at district headquarter hospitals (DHQ) in rural areas.
Assessment of dependency level and community placement for the long-term mentally ill
Authors: Robson C. E.
Published: October 2008

The rehabilitation service for West Gloucestershire utilises a range of facilities to accommodate the long-term severely mentally ill. Group homes, supported lodgings, long-stay rehabilitation hostels and an inpatient slow stream rehabilitation ward provide increasing degrees of support according to levels of dependency. The findings of this study support the use of the Clifton Assessment Procedures for the Elderly Behaviour Rating Scale (CAPE BRS) as an aid to assessment of appropriate placement for the long-term severely mentally ill of all age groups in the community, both at the time of placement and to monitor ongoing need.
A social skills and assertiveness group for 9- to 11-year-old children: implications for training
Authors: Aldridge S. J. , Campbell H. J.
Published: October 2008

An experience by two senior registrars of a social skills group for five 9 to 11-year-old children with peer relationship difficulties at school is reported.
Stravinsky, Hogarth and Bedlam
Authors: Crichton P.
Published: October 2008

“Hogarth's Rakes's Progress paintings, which I saw in 1947 on a chance visit to the Chicago Art Institute, immediately suggested a series of operatic scenes to me.” (Stravinsky & Craft, 1960). By 1947 Stravinsky's career, which had started so brilliantly and stormily with the revolutionary Rite of Spring, was almost totally becalmed. Since emigrating from Paris to California in 1940, he had written a couple of untempestuous orchestral pieces, Circus Polka, “composed for a young elephant”, and little else. He was depressed by the lack of originality of his work and was eager to write an opera in English. When he saw the paintings of the Rake's Progress, he seized his opportunity.
Guidelines for penile plethysmography (PPG) usage
Authors: Fuller Julian
Published: October 2008

I should like to draw to the attention of psychiatric colleagues the guidelines for the use of PPG assessments. These were produced by a working group of forensic psychologists drawn from the special hospitals, NHS regional and district forensic services, the Prison Department and youth treatment centres.
Are psychiatrists sexist? a study of bias in the assessment of psychiatric emergencies
Authors: Hall Ion , Deahl Martin
Published: October 2008

In order to investigate bias in history taking among psychiatric trainees, a retrospective study of case-notes was undertaken in an emergency psychiatric clinic in a teaching district. Two hundred and twenty-seven consecutive new patient assessments were assessed for quality of alcohol, substance use and forensic histories. Trainees were more likely to take alcohol, substance use and forensic histories from men, and more likely to take substance use histories from younger patients. It is concluded that trainees make sexist and ageist assumptions when they assess patients. There is a need for the education of doctors in this area.
The impact of a hospital audit on psychiatrists' letters to general practitioners
Authors: Shah Premal J. , Pullen Ian
Published: October 2008

The quality of written communication between psychiatrists and general practitioners has become increasingly important, with the introduction of the Access to Health Records Act as well as with demands placed by the purchasers of psychiatric services. We investigated if a hospital-based audit could be used to monitor the quality of written communications with general practitioners, and if ‘closing the audit loop’ could improve the standards. We found that audit may have helped improve standards, particularly in making letters less potentially offensive and easier to read by non-psychiatrists. A method of measuring the quality of letters is described.
Evidence for the existence of a soul?
Authors: Hartman D.
Published: October 2008

D. Hartman looks at the work of the painter De Kooning, following the BBC1's Omnibus programme of 21 February 1995.
Psychotherapy – a survey of psychiatrists' attitudes, beliefs and practice
Authors: Bradbury Sue , O'Brien L S. , Göpfert Michael
Published: October 2008

A postal survey was conducted among doctors practising psychiatry in the Mersey Region to ascertain attitudes, beliefs and practice with regard to psychotherapy, achieving a response rate of over 60%. There was a surprising absence of very strong feelings for or against psychotherapy which was not seen as a powerful treatment modality. There was little knowledge of the facilities provided by the regional service, and no general support for their expansion. The role of training in psychotherapy and its significance in light of guidelines for general trainees ore discussed. A need is recognised for greater awareness and contact between psychiatrists and the psychotherapy service.
Improving methods of assessment in a community mental health team
Authors: Treloar Adrian
Published: October 2008

Changing methods of recording psychiatric histories by a community mental health team for the elderly was associated with a dramatic improvement in the quality of recording of clinical Information and of communication with general practitioners. Comparison is made with published studies of case note audit with feedback. It is suggested that restructuring the way we work may be more effective than simple review of case notes with feedback.
Psychiatry and the Net
Authors: Green Ben
Published: October 2008

The Internet opens up brand new possibilities for medicine. Nowhere before has it been possible to confer with colleagues from all over the world to swap ideas on an hour-to-hour basis on all manner of subjects.
Trends in the development of psychiatric services in India
Authors: Isaac Mohan
Published: October 2008

Over the past five decades, services for the mentally ill in India have steadily improved. From a predominantly mental hospital based service, provision has now moved to general hospitals and primary health centres. A variety of factors have contributed to changes in the quality of services. This paper briefly reviews the changes and discusses the relevance of some of them.
The Tenth Annual TAPS Conference
Authors: Freeman Hugh
Published: October 2008

From a group meeting in one room at Friern Hospital, the annual conferences of TAPS (Team for the Assessment of Psychiatric Services) have grown after ten years to overflowing a large hall, with participants from many countries. Dr Rachel Jenkins of the Department of Health, in introducing the meeting, emphasised that mental illness now had a central place in national health targets. The reduction of suicide was a special objective, particularly as it is now estimated that one in six of the severely mentally ill eventually kill themselves. She pointed out that although this conference was focused on deinstitutionalisation, there had been very little research on why such major national differences in this process had occurred.
Which patients do GPs refer to which professional
Authors: O'Neill-Byrne K. , Browning Sally M.
Published: October 2008

Referral rates to three groups of mental health professionals working In primary care were compared. All patients referred over an 18-month period at two health centres in an outer London borough were assessed by case-note review and data were collected on 181 consecutive referrals. In general, younger, more socially-stable patients were referred to the psychologist and older patients were seen by the CPN. The psychologist saw most new patients; patients previously seen by a psychiatrist were most likely to be referred again to a psychiatrist. Patients requesting referral to a mental health professional were most likely to be referred to the psychologist. Patients with a diagnosis of psychosis were seen mainly by the psychiatrist and the CPN; the psychiatrist saw most patients with a personality disorder. A high proportion of patients were seen for assessment only. In general, all interventions were brief. There was evidence of selection by GPs in the referral of patients to each mental health professional.
A local child psychiatric service as viewed by district social workers
Authors: Dover S. J.
Published: October 2008

The study examines the knowledge and views among district social workers of a local child psychiatric service and determines whether their views influence decisions to refer to the service. The results are compared with similar studies of general practitioners (GPs) and paediatricians and discussed with reference to recent national reviews of child psychiatry in the UK.
The use of the Mental Health Act in learning disabilities
Authors: Kon Yan , Bouras Nick
Published: October 2008

Psychiatrists in learning disabilities in the South-East Thames Region were asked to fill in questionnaires on the last five patients they had sectioned in an attempt to describe current practice in their usage of the Mental Health Act (1983). Clients tended to be sectioned under the category of mental impairment and were mainly young males with violent behaviour. Treatment of mental illness was less of a problem.
Treatment options for rapid-cycling bipolar affective disorder
Authors: Taylor David , Duncan Denise
Published: October 2008

Rapid cycling (RC) occurs in up to 20% of patients with bipolar affective disorder and is particularly common in women. It is generally defined as a condition where four or more episodes of (hypo-) mania or depression occur in any year. Frequently, patients with RC switch rapidly between episodes without passing through a euthymic stage. RC is notoriously difficult to treat and the refractoriness of the condition has led to a number of drugs and combinations being put forward as potential therapeutic interventions. This article reviews current treatments and suggests a treatment strategy based on available evidence of efficacy and tolerability.
The Mental Health Workshop in the Human Rights Convention
Authors: Abdul-Hamid Walid
Published: October 2008

Between the 15 and 17 of June 1995, Liberty and other organisations concerned with human rights coordinated the Human Rights Convention. This gathering examined the meaning of human rights, why they matter, and how they could be strengthened. In the full programme there was a workshop on mental health. This workshop examined how mental health legislation and practices affect the human rights of psychiatric service users.
General practitioners knowledge of and views on the care programme approach
Authors: Grace Janet , Steels Mark , Baruah Ranjit
Published: October 2008

In response to concerns raised by GPs and mental health professionals, a postal questionnaire was used to ascertain level of knowledge about and attitudes towards the care programme approach (CPA) among general practitioners in one sector of Nottingham. Less than one-third of GPs who replied had heard of the CPA. GPs did not rate the benefit of CPA reviews highly and did not feel that they would be able to spare sufficient time to attend all the reviews to which they would be invited. Other issues of practical concern such as car parking at the local teaching hospital and provision of expenses were raised. Methods of acquiring valuable information from GPs must be reconsidered.
How well do psychiatric trainees interpret electrocardiographs
Authors: Warner James P. , Gledhill Julia A. , Connell Frankie , Coghlan John G.
Published: October 2008

The consensus statement by the Royal College of Psychiatrists recommended that patients on high dose antipsychotic medication receive regular electro-cardiographic monitoring to identify prolongation of the QT interval. A survey of trainee psychiatrists in three hospitals investigated the accuracy with which trainees could identify this abnormality and found only 20% could do so.
Clinical features of alcoholic suicide attempters/ non-attempters
Authors: Agarwal Meena , Gaskell Keith
Published: October 2008

A cross-sectional study of 74 consecutive alcoholic patients admitted to a subregional alcohol treatment unit examines the socio-demographic and clinical differences between those who had/had not attempted suicide, and investigates their relationships to current suicidal ideation. The suicide attempters were significantly younger, separated and unemployed. They began regular drinking earlier, were more severely dependent and had a higher proportion of major depression, antisocial personality disorder and another drug abuse. The results suggest a high incidence of suicidal behaviour in alcoholics and high psychiatric comorbidity in alcoholics who attempt suicide.
Micro-titration of depot neuroleptic dosages
Authors: Birch J.
Published: October 2008

Depot neuroleptic treatments can be compromised by side-effects unacceptable to users or, more seriously, by tardive dyskinesia (TD). Neuroleptic dosages can be lowered to increase acceptability and decrease the Incidence of TD, but with a greater likelihood of relapse. One argument proposes that many patients changing to lower dosages break down because withdrawal from a neuroleptic is stressful in itself. Research suggests that withdrawal regimes should be radically cautious. A computer tool is offered which can aid clinicians in calculating small reductions.
A psychiatric service for the homeless mentally ill: the first two years
Authors: Merson Stephen
Published: October 2008

The characteristics of 452 patients referred over a two year period to a psychiatric service for the homeless population in inner London are described. The majority of patients were male and Caucasian, and tended to be referred through voluntary sector as opposed to statutory services. Fifty-nine per cent were sleeping rough at the time of first contact, 80% had a previous history of psychiatric treatment, but only 6% were currently in contact with psychiatric services. Serious psychiatric disorders predominated, with 52% suffering from schizophrenia or delusional disorders.
Conjoint job-share: conjugal bliss
Authors: West Andrew , Taylor Karey
Published: October 2008

By describing a conjoint job-share in a single registrar post on an acute adult psychiatric ward in Wellington, New Zealand, this paper contributes to the growing literature on the subject of part-time training. We shared, on the one hand a registrar post and, on the other hand, our domestic life and the raising of our first child. We supplement our subjective impressions with information gathered from the multidisciplinary team, using a short
Smoke, don't smoke – two steps forward one step back
Authors: Dunn John , Laranjeira Ronaldo R.
Published: October 2008

The mayor of Sao Paulo, Paulo Maluf, has a bullish approach to arguing and is not renowned for his subtlety. Despite this he has been a key campaigner and instigator of various public health policies that form part of an international “healthy city” initiative. The most successful of these has been the introduction of a law making the use of car seat belts compulsory, which has led to a massive reduction in the number of fatal road traffic accidents. An attempt to prohibit cigarette smoking in restaurants has been less successful owing to a number of legal challenges that have left the legislation in a consitutional and legal limbo – but the fight goes on.
Tardive dyskinesia: screening and risk disclosure
Authors: Chaplin Robert , Potter Mark
Published: October 2008

A questionnaire was sent to a random sample of 339 psychiatrists on the Royal College mailing list, enquiring about their practice of screening and risk disclosure in patients at risk of tardive dyskinesia. The response rate was 70%. There was wide variation in the rate of informing patients of the risk. Over half of the respondents felt that knowledge about tardive dyskinesia would reduce compliance, a view which predicted a low rate of informing patients. There was support for the issuing of clinical practice guidelines by the College. Psychiatrists need further education about tardive dyskinesia.