bluuebunny/crossref_metadata_2025 huggingface dataset:
Some aphorisms of psychiatric rehabilitation
Authors: Bennett Douglas
Published: October 2008

During my years in rehabilitation and community psychiatry I have picked up a number of aphorisms which I believe enshrine some of the lasting truths in this field. I have always liked Albert Kushlik's remarks about doctors as the “hit and run” staff in terms of the duration of their contact with patients. But over the years other aphorisms have been brought to my attention by colleagues or students, although I can claim to have coined a couple myself.
Ten years of academic psychiatry at Keele
Authors: Boardman Jed , Hodes Tamar
Published: October 2008

Academic psychiatry at Keele University reached its 10th birthday in 1996. In 1986 John Cox was appointed to the foundation Chair of Psychiatry in what was then the Department of Postgraduate Medicine (Cox, 1990; Barrett, 1991). The School of Postgraduate Medicine was established in 1989 and along with it a formal Department of Psychiatry. There is no undergraduate medical school at Keele and the School of Postgraduate Medicine, with 14 full Professorships, is now the largest in the United Kingdom, outside of London. The Department of Psychiatry has expanded in size since 1989 and has one Professor of Psychiatry, four Senior Lecturers and two Lecturers. With its busy MRCPsych teaching programme, a Diploma and MSc in General Psychiatry and research activity it has made a significant contribution to the raising of the standards of North Staffordshire psychiatry. From its small beginnings it has now attained a national and international profile.
Confessions of a beer drinking man
Authors: Webb Tim
Published: October 2008

The West Suffolk Strategy to Combat Alcohol Misuse and the first edition of the Good Beer Guide to Belgium and Holland hit the streets on the same day. More importantly the press releases hit the newsdesks of the regional media by the same post. Fortunately, alcohol is entertainment and alcoholism is public affairs so none of the news editors twigged that the two publications had the same author.
Forensic psychiatry in Israel
Authors: Gordon H. , Zabow A. , Carpel L. , Silfen P.
Published: October 2008

In May 1995 a Conference on Forensic Psychiatry was held near Tel Aviv, to which psychiatrists and other health professionals specialising in forensic psychiatry from Britain and Israel and Palestinians from the West Bank were invited. Participants at the Conference took part in discussions on forensic psychiatry and visited a maximum security prison with a hospital wing at Ramleh and an Arab psychiatric hospital in Bethlehem on the West Bank. On the days between Conference events, the British group visited Jerusalem and the Dead Sea and became aware of the almost unique interflux between Muslim, Christian and Jewish religion and culture which underlies the historical evolution of this area of the world. The modern social and political landscape is of course characterised by a violent confrontation between Arabs and Jews yet permeated now by a growing realisation of the need for peace and reconciliation, even if this has its ambivalent aspects at times. In this context the participation of Jewish and Arab health professionals together is a sign that ultimately medical and health care has its universal qualities which can bridge over or supersede the differences between nations that are so endemic to history.
APP Spring Conference 1995
Authors: Garner Jane , Evans Sandra
Published: October 2008

This Conference, organised by the Association for Psychoanalytic Psychotherapy in the NHS, brought to the St Charles Day Hospital psychoanalysts and workers from different disciplines within NHS old age psychiatry services. Over 70 delegates attended, bringing varying experience of dynamic work.
Managing the high risk psychiatrist
Authors: Fisher Nigel
Published: October 2008

Psychiatrists, politicians and the public continue to be concerned about the care of mentally ill people who are potentially dangerous or vulnerable. In this context the College convened a conference on ‘Managing the high risk patient’1, which addressed issues of risk assessment, resources and legislation. The issues debated were of relevance beyond ‘high risk’ patients and underscored the difficulties the College and the Department of Health face in trying to achieve a satisfactory level of psychiatric service and practice across the country.
Who's in the lions' den?
Authors: Wolff Geoffrey , Pathare Soumitra , Craig Tom , Left Julian
Published: October 2008

Most long-stay patients discharged from psychiatric hospitals under community care policy are being accommodated in suburban communities. The communities' attitudes have a major bearing on the success of this policy. A census of perceptions of psychiatric services was conducted in two areas prior to the opening of long-stay supported houses for the mentally ill. Many respondents (37%) had a negative perception of psychiatric treatment in hospital. Most (82%) had heard of community care policy but few (29%) knew about the imminent opening of supported houses for the long-term mentally HI in their own street. Most respondents (66%) were against the closure of psychiatric hospitals and many saw It as a cost cutting exorcise. The majority agreed with the idea of long-stay patients being discharged into smaller units in the community although a substantial minority (20%) thought it would have a bad effect on the local community. An overwhelming majority of respondents (91%) thought it was important for local residents to be given information about new mental health facilities in their neighbourhood. Respondents were worried that patients would not get adequate support and that they might be dangerous. If community care policy is to succeed, attention needs to be paid to the community's opinions and desire for information about local services.
Neuroleptic drug use in psychiatric intensive therapy units: problems with complying with the consensus statement
Authors: Hillam Jonathan , Evans Chris
Published: October 2008

The pharmacological management of acute behavioural disturbance in psychosis is not straightforward. The real, or perceived, dose:effect relationship of the various neuroleptics in common use has an important influence on prescribing patterns leading, in certain situations, to very high doses of neuroleptic medication being prescribed. Data from a study of the use of neuroleptic medication in two psychiatric intensive therapy units illustrate the potential extent of the problem. Over half of the cases were not amenable to accurate dosage monitoring due to the use of depot neuroleptics, Clopixol Acuphase or polypharmacy. The majority received doses exceeding the limit suggested by the British National Formulary. Efforts to standardise the use of such drugs would help to optimise the clinical management of this challenging group of patients.
Needs of carers of people with long-term mental illness in Mid Glamorgan
Authors: Cohen David , Thomas Lisa
Published: October 2008

In recent years, the care of people with long-term and persistent mental illness has been shifting from institutional to community care with a consequent increase in the use of informal carers. Given that both professionals and carers are human resources contributing to the health and well-being of patients, it is surprising that so little research on the needs of carers or means to improve their effectiveness has been undertaken.
General practitioners' views of a psychogeriatric service
Authors: Ashaye Olakunle , Dhadphale Manu , Okore Anthony
Published: October 2008

The views of referring general practitioners (GPs) on a psychogeriatric service were obtained through a questionnaire. Most GPs were satisfied with the service. A number of GPs wanted faster responses to referrals, telephone discussions after initial psychogeriatric assessments and more communication with consultants. In response to these findings, secretarial staff was increased and telephone discussions with referring GPs are to follow initial assessments of all urgent and emergency referrals.
Rapid tranquillisation: a questionnaire survey of practice
Authors: Simpson Deborah , Anderson Ian
Published: October 2008

A postal survey of the drug treatment of behavioural emergencies by senior registrars and consultants in psychiatry revealed that 90% would initially use a non-depot antipsychotic (including 24% who would combine it with a benzodiazepine if the situation warranted), and 10% the short-acting depot, zuclopenthixol acetate, with another antipsychotic or a benzodiazepine, or both. The choice was made from a restricted range of drugs, with haloperidol being the most popular antipsychotic and diazepam the most popular benzodiazepine. Half of respondents did not considerBritish National Formularymaximum dose recommendations to be useful for rapid tranquillisation and many would exceed them. A substantial minority did not consider that adequate resuscitation was available at their unit and deficiencies were revealed in the training of junior doctors and in the audit of rapid tranquillisation. Very few psychiatrists reported that their units had written guidelines.
Psychotherapy patients: are they “the worried well”?
Authors: Amies Peter
Published: October 2008

Patients waiting for psychotherapy show high levels of morbidity and distress from psychiatric symptoms and a high frequency of personality disorder diagnoses. They constitute a group at risk of completed suicide. Local NHS provision is less than half the minimum amount of treatment needed.
Treatment of psychosis in Parkinson's disease
Authors: Duncan Denise , Taylor David
Published: October 2008

Psychosis is often associated with Parkinson's disease. The cause of the psychosis cannot usually be confirmed but it may be due to disease progression or, more commonly, to the drugs used in the management of Parkinson's disease.
Recruitment into psychiatry
Authors: Storer David
Published: October 2008

The major problem of manpower planning in psychiatry has until fairly recently been one of securing enough posts in the training grades to place doctors wishing to train in psychiatry and to ensure an adequate supply of applicants for consultant posts. Numerous consultant vacancies and a ‘bottleneck’ between registrar and senior registrar grades was the frustrating combination largely consequent upon the failure of some regional health authorities to fund the posts which Joint Planning Advisory Committee (JPAC) had approved.
Mental health care and the big IT
Authors: Glover Gyles R.
Published: October 2008

When I was at school the big IT everyone talked about, some explored avidly and others shunned nervously was sex. In psychiatry today, as in so many other fields IT is information technology. This article is a polemic. I believe IT (the new sort) is indispensable for modern mental health care. In the British National Health Service we have a window of opportunity to get IT right and if clinicians fail to act decisively and quickly, there isa risk that the chance will be lost.
Supervision registers and medium secure units
Authors: Isherwood Jim
Published: October 2008

The introduction of supervision registers for mentally ill people according to the NHS Executive Guidelines in February 1994 aroused debate among psychiatrists. This paper highlights many of the issues and describes the development of the supervision register at one medium secure unit.
Prevalence of confirmed child abuse and the use of resources in child psychiatric out-patients
Authors: Wright Barry , West David , Worrall Anne , Tagg Gillian
Published: October 2008

This paper explores the extent of known child sexual and physical abuse in child psychiatric out-patient services in Leeds. We surveyed a one-month period, looking at all out-patient contacts, and found that at least 17.9% of patients had been physically or sexually abused and these patients took up 25.8% of out-patient time. When the 70 abused children were compared to a group matched for age group, clinical team and diagnosis It was found that they were more likely to be followed-up for longer and they received more therapeutic time over a given period than non-abused children. The implications for resources are discussed.
A short course in planning, development and evaluation of community mental health services
Authors: Powell Robin , Strathdee Geraldine , Thornicroft Graham
Published: October 2008

In response to the expressed needs of trainees for training in the planning development, and evaluation of mental health services, a short course was designed and is described here. The course was run several times and proved flexible enough to be presented to either multidisciplinary, inter-agency audiences or to a solely medical audience.
Belize: a new psychiatric service revisited
Authors: Walsh C. , Ward L. , O'Neill-Byrne J. , O'Neill-Byrne K. , Herzberg J. L.
Published: October 2008

In 1990 a UK psychiatrist and community psychiatric nurse (CPN) went to Belize, in Central America, to set up a comprehensive mental health service, based on community clinics staffed by psychiatric nurse practitioners. This work was completed by 1992. In 1994 two medical students visited Belize for eight weeks to review the new mental health service.
Establishing a sex offender treatment programme within a prison
Authors: Jones C.
Published: October 2008

In 1991 the Prison Service began to develop a programme of treatment for sex offenders in custody. HMP Risley was the first establishment to successfully establish and run the ‘Core Treatment Programme’. This paper examines some of the issues involved in setting up such a programme, which was designed to be implemented by relatively inexperienced staff.
You pays your money and you takes your choice
Authors: Davey Robert , Littlewood Stephen
Published: October 2008

Health services are now commissioned at a local rather than a regional level. It is essential for local consultants to have an input to the planning and commissioning process. For the child and adolescent psychiatrist this task is complicated by an absence of nationally agreed guidelines on the level of resourcing required for a district child and adolescent mental health service. This paper describes an approach to advising purchasers which offers them a choice of service models that differ in their levels of resourcing. Each of the service models is described briefly. The advantages and flexibility of this approach are discussed.
School pressures and child mental health in Afro-Asian countries
Authors: Bartlet L. B.
Published: October 2008

Educational pressure on children is worldwide. In the United Kingdom this is seen in the growth of structured classes and courses for two- to four-year-olds such as ‘Making French Fun’ and ‘Musical Appreciation for Under Fours' (Matthews, 1995). Such programmes are of particular interest to aspiring middle-class parents but other groups also have high educational expectations. Some parents with a West Indian background, believing the British educational system to be superior to that in their country of origin, look for high attainments which often results in their children showing psychosomatic symptoms. In developing countries the signs of educational pressure are especially evident.
Electrocardiograms, high-dose antipsychotic treatment and College guidelines
Authors: Krasucki Christopher , McFarlane Fran
Published: October 2008

A cross-sectional survey of all in-patients at a psychiatric hospital was performed to see to what extent College guidelines on neuroleptic prescribing were being adhered to. Thirteen (7.3%) patients were found to be on high doses and one (0.6%) on megadoses. Only 23% in the high-dose group had had an ECG at all, and Just 7.7% had had one in the previous three months. The single patient on megadose treatment had had an ECG but not In the previous three months. Prescribing habits that could potentially have led to 21.9% of patients receiving high doses and 9.0% megadoses were identified, and reasons for the low rate of ECGs discussed.
Blood tests for patients prescribed psychotropics: what, when and why?
Authors: Paton Carol , Beer Dominic
Published: October 2008

Although baseline blood tests are routinely checked on hospital admission when patients may be medication-free, it is frequently forgotten that psychotropic drugs can cause a wide range of abnormalities in such tests, some common and some very rare. These abnormalities, and the monitoring requirements associated with them are summarised in Table 1.
Which dose of haloperidol?
Authors: Hilton Trudi , Taylor David , Abel Kathryn
Published: October 2008

Although haloperidol (HAL) has been available as an antipsychotic for over 30 years, controversy still surrounds the appropriate dose in the treatment of psychosis and in particular, schizophrenia. In practice, high dose HAL (greater than 20 mg/day) continues to be prescribed, despite good reason for not doing so: the incidence of extrapyramidal side-effects (EPSE) is known to be dose-related; and compliance with treatment may be adversely affected by side-effects, especially akathisia and Parkinsonism.
Methods of deliberate self-harm in Pakistan
Authors: Khan Murad Moosa , Reza Hashim
Published: October 2008

Reports of deliberate self-harm (DSH) are rare from Pakistan where psychotropic drugs can be obtained ‘over the counter’. A retrospective analysis of 302 index cases presenting to a university hospital in Karachi showed self-poisoning with benzodiazepines as the most common method, followed by organophosphate insecticides. Salicylates and non-opiate analgesics were significantly absent from our series. Implications of these findings are discussed.
Skills training for senior registrars
Authors: Haddad Peter , Creed Francis
Published: October 2008

Newly appointed consultants in general adult and old age psychiatry were asked to rate how well their senior registrar (SR) training had prepared them for their first year's work as consultants. Training in 39 specific skills was assessed, 14 were rated poorly. In general terms SR training appeared satisfactory in four areas (clinical skills, teaching, research, working with groups) but deficient in three areas (general management, personal management, information technology). SR study days, courses, consultant supervision and ‘hands-on’ experience are all potential ways of improving training in these areas. Audit is necessary to ensure such changes are effective.
How to establish case registers: I. Suicide
Authors: Evans J. , Johnson C. , Stanton R. , Morgan H. G.
Published: October 2008

The importance of establishing case registers for suicide is discussed along with their potential uses. Suicide data can be derived from the coroner, the District Health Authority or the Office of Population Censuses and Surveys (OPCS). The relative merits of these different data sources are discussed and local methods described. Some data derived from the suicide register are shown.
How to establish case registers: II. Non-fatal deliberate self-harm
Authors: Evans J. , Johnson C. , Stanton R. , Morgan H. G.
Published: October 2008

The importance of establishing registers for non-fatal deliberate self-harm is discussed along with their potential uses. Deliberate self-harm (DSH) data for a single hospital can be derived from the Accident and Emergency (A&E) casualty cards, A&E on-line registers, mental health assessments or general hospital in-patient data. The relative merits of these different data sources are discussed and local methods described. Some data derived from the DSH register are shown.
Influences on psychotropic drug prescription in a psychiatric service
Authors: Babor E. , Ballinger B. R. , Fenton G. W.
Published: October 2008

Prescriptions for psychotropic drugs for in-patients in the Dundee Psychiatric Service were studied for three five-month periods in 1991, 1992 and 1993 using computer data and drug sheets. Information about Journal advertising and advice to doctors was obtained for the same period. A possible effect of Journal advertising was detected in the first year but there was no further Increase in the second year in the total of prescriptions. Information is presented of a similar survey in 1975 and 1976. A high proportion of prescriptions was for formulary drugs and doctors rated the British National Formulary as the strongest influence on their prescribing.
Psychiatrists' knowledge of drug induced psychosis
Authors: Brabbins Clare , Poole Rob
Published: October 2008

‘Drug induced psychosis' is a commonly used clinical label but lacks a universally accepted definition. Psychiatrists' understanding of the term was examined using a specifically designed questionnaire. Knowledge about the effects of drugs of abuse and their relationship with psychosis was also examined. A substantial proportion of clinicians did not have a logical and coherent scheme for understanding ‘drug-induced psychosis' and there was no consensus as to which reactions to drug taking should be included within the rubric. Diagnostic errors have potentially serious consequences, so lack of knowledge in this area needs attention and a proposed classification is given.
Failure to produce improvement in ECT documentation
Authors: Childs Peter , Edwards J. Guy
Published: October 2008

A previous survey carried out in our unit revealed deficiencies in electroconvulsive therapy (ECT) documentation. With the aim of correcting these deficiencies, the standard procedure for completing the audit cycle was followed and the survey was repeated. The results question the assumption that simply completing the audit cycle ‘automatically’ leads to an improvement in practice. Possible reasons why Improvement did not come about in this study are discussed.
Collecting suicide statistics for the severely mentally ill
Authors: Abed Riadh T.
Published: October 2008

Since the Health of the Nation government document (Department of Health, 1992) set the target for the reduction of suicide in the severely mentally ill by 33% by the year 2000 it has become necessary to collect the suicide data for this population of patients at district and national level. There are a range of problems concerning the definition and identification of patients with severe mental illness as well as problems concerning the compilation of suicide data for this population at district level.
Liaison psychiatry in detection and management of mental illness
Authors: Semple Margaret , Brown David , Irvine Elizabeth
Published: October 2008

Of 299 referrals to the Dundee general psychiatry liaison service over a six month period, deliberate self-harm (DSH) was the reason in 83%. An overdose was used in 94%, and alcohol misuse occurred in 56% of DSH episodes. Fifty-two per cent of referrals were followed up by the general psychiatry service; 31% of these were admitted directly to a psychiatric ward, 10% on a compulsory basis. At follow-up, 23% remained in contact with the Dundee psychiatric service. Twenty-three per cent of all patients referred to the Area Alcohol Service (AAS) were in contact with it six months later. Clearly, liaison psychiatry has a role in detection and management of significant mental disorder.
Psychiatric clinics in residential homes for the elderly
Authors: Jackson Graham A. , Lyons Donald
Published: October 2008

We have evaluated the effects of providing a ‘roving’ psychiatric clinic to local authority residential homes for the elderly. The clinic was well received by the staff in the homes, reduced the need for urgent domiciliary consultations and hospital admission and appeared to be highly cost-effective.
Comparison of psychogeriatric domiciliary visit service between urban and suburban sectors
Authors: Jha Arun K. , Lawrence Robert
Published: October 2008

This study presents a comparison between the domiciliary consultation services in urban and suburban sectors of the Croydon Health District. Urban general practitioners requested less domiciliary visits (DV) and tended to be less satisfied with this service than their suburban counterparts. Sociodemographic factors such as population density and multi-ethnicity in the urban sector may be responsible for a smaller referral rate and the degree of satisfaction with the psychogeriatric DV service in Croydon.
Out in the cold: a guide to survival in community surveys
Authors: Wolff Geoffrey , Pathare Soumitra
Published: October 2008

Literature giving a ‘behind-the-scenes' view of community-based research is, at best, sparse. Most authors present only the finished product leaving others with the task of forever re-inventing the wheel. This paper provides a light-hearted account of the bittersweet experience of conducting a survey of community attitudes to mental illness. The survey was part of a controlled trial of an educational campaign for neighbours of residential facilities for mentally ill people. It involved Interviewing members of the local community in their own homes. The paper highlights common pitfalls and gives practical advice for the novice researcher.
The role of the speech and language therapist in psychiatry
Authors: Muir N. J.
Published: October 2008

Speech and language therapy is a small profession. It only reached its golden jubilee year in 1995 and misleadingly, remains for many highly associated with the elocution training in which the profession had its genesis. In the last few years the greatest developments have been in the area of cognitive neuropsychological and functional (pragmatic) models for the assessment and management of language and communication. It is the premise of this article that speech and language therapists are likely to prove flexible and valuable members of the multidisciplinary team, with the ability to contribute a further dimension to care planning – that of specific clinical input to the wide range of language, speech and communication impairments associated with the major mental illnesses (Gravell & France, 1991).
Rationality without reason and the aetiology of mental illness
Authors: Baldwin Chris
Published: October 2008

For over three centuries we, in Western societies, have lived in an Age of Reason. The accepted wisdom is that decision-making must be a purely rational process devoid of emotion and underpinned by objective knowledge. This article draws attention to the invasion of human affairs by an ideology which makes deliberate use of one kind of rationality to the exclusion of all others. Changes in work and its organisation have been particularly driven byeconomicrationality which allows no thought for the effects on individuals. The clinical evidence centres around four specific cases which are presented against a background of the business practices current in the control of work. It is argued that these have a deleterious effect on mental health, especially for those psychologically disposed to respond faithfully to management calls for greater teamwork and commitment.
Smoking in chronic psychiatric illness: is it worth it?
Authors: McDonald C. , Sheppard N.
Published: October 2008

The prevalence of smoking is higher among chronic psychiatric patients than the general population, in spite of their lower income. The purpose of this study was to calculate the percentage of income these patients spend on smoking and to discuss the relationship between smoking and chronic psychiatric disorders, in particular schizophrenia. Ninety-six smokers were included in the study. The mean percentage expenditure on smoking was 294% of income. We discuss why chronic psychiatric patients smoke so much, why they should not, and what factors may encourage them to quit.
The need for dynamic psychotherapy
Authors: Whyte Chris
Published: October 2008

A survey of consultant psychiatrists identified the core characteristics of patients who require referral for specialist dynamic psychotherapy. Those are patients with neuroses, personality disorders and affective disorders who have longstanding and complex emotional and interpersonal problems which stem from their early life experiences. They need a level of expertise and an intensity and/or length of treatment which cannot safely and reliably be provided by either general psychiatric services or primary care. The survey suggests that 0.1% of the population/year would benefit from referral for specialist dynamic psychotherapy.
The care programme approach
Authors: Jamieson J. S.
Published: October 2008

The CPA encourages good psychiatric practice in the continuing care in the community of people who suffer with serious mental illness. The tiered CPA has recently been proposed with a view to channel resources towards those patients who are most in need. This study assesses whether the CPA is used appropriately and effectively among patients discharged in an inner city sector where there is a high level of serious mental illness. The results suggest that it is feasible provided there is an adequately developed community mental health team.
In-patient group psychotherapy: a survey of staff and patients
Authors: Clunie Fiona S.
Published: October 2008

An in-patient psychotherapy group was started in an acute female psychiatric ward. Staff and patients were asked to fill in a questionnaire about the group. The response rate was 65% from patients and 58% from staff. The commonest diagnosis was depression. Most patients who attended the group found it helpful. They most frequently valued not feeling alone and being able to talk to others. Staff confidence was low and staff resistance could have contributed to the group being discontinued.
Intensive home nursing
Authors: Williams D. D. R. , Ellis Mary M. , Hardwick Fawzea
Published: October 2008

This paper describes the establishment of a team of four nurses to provide a service in old age psychiatry along the lines of “Hospital At Home”. Its aim was to treat and nurse patients at home who otherwise would have to be admitted to hospital. An integral part of this initiative is the use of a problem orientated approach with integrated records. The work of the team over six years is reviewed and how it has evolved to provide a rapid response to difficult and fraught situations.
Essential information for filling consultant posts
Authors: Mactier Fiona , Khoosal Deenesh
Published: October 2008

There appear to be more posts being advertised for consultants in psychiatry than available suitably qualified applicants. The process of advertising, contacting interested candidates and compiling an information pack is reviewed in an attempt to formulate an ‘ideal approach’.
1996 Trainees' Forum
Authors: Cornwall Peter
Published: October 2008

“Men at some time are masters of their fates: The fault, dear Brutus, is not in our stars, But in ourselves, that we are underlings” (Julius Caesar. Act I, Scene 2).
Training in prison psychiatry
Authors: Dorkins Eluned
Published: October 2008

Training in psychiatric work in prisons may not always receive adequate attention, as highlighted in the Reed Report (Department of Health and Home Office, 1992). As a first step in addressing this, a one-day induction procedure has been added to the Induction Programme for the Forensic Senior Registrars at the Regional Secure Unit (RSU) in Bristol. The contents of the programme were determined by discussion among prison medical staff, the Training Department and Forensic Senior Registrars, and are outlined in the following timetable:
Analysis of psychotropic drug advertising
Authors: Quinn John , Nangle Marie , Casey Patricia R.
Published: October 2008

The use of metaphors as the main marketing strategy in psychotropic drug advertising in journals and the quality of information provided in these advertisements has been criticised. We investigated marketing strategies and information provision in advertisements appearing in three different psychiatric journals. The majority of advertisements in two of the journals used metaphors as their main marketing strategy. The level of prescribing information varied between journals. Our findings suggest that improvements are needed in psychotropic drug advertising in journals.
Meeting the psychiatric needs of children in foster care
Authors: Phillips Jeannette
Published: October 2008

This study sought social workers' views on the mental health needs of a sample of foster children. Out of the sample 80% of the children were considered to require treatment from a child mental health professional but only 27% had received any input. The reasons given for not referring for treatment were placement instability, inadequate child mental health resources and insufficient local authority funding. The provision of consultation services to allocated social workers and the availability of child mental health professionals at local authority reviews should be considered.
Holding powers in A&E departments
Authors: Nicholls K. R.
Published: October 2008

The Mental Health Act as an instrument of statute law is unable to address practicalities of caring for mentally disturbed persons who are awaiting formal detention. The common law relevant to this area is ill-defined and depends on interpretation of precedent. The resulting confusion and consequent problems will become more apparent with the advancement of community care, and is a matter which warrants urgent review.
Communication between GPs and psychiatrists: the long and short of it
Authors: Blakey Andrew , Morgan Jessica , Anderson Ian
Published: October 2008

Good communication between general practitioners (GPs) and psychiatrists is important. An audit of new patient referral letters from GPs and the first assessment letter in reply from psychiatrists found that GP letters were short (mean 106 words) with limited information which increased with letter length. Psychiatrist's letters were longer (mean 849 words), of a high quality but with a negative relationship between length and information score. Use of the ‘preferred’ format derived from previous research was associated with shorter letters of higher quality. Communication between GPs and psychiatrists might be improved if GPs wrote more and psychiatrists wrote less.
Urgent psychiatric assessment in an inner-city A&E department
Authors: Crawford Michael J. , Kohen Dora
Published: October 2008

Data on day time referrals to a liaison psychiatry team from an inner London accident and emergency department (A&E) were analysed over a two-year period. Despite the availability of local community-based alternatives for urgent assessment almost 5000 patients were seen. A quarter were self-referrals and two-thirds had had no previous contact with psychiatric services. The most common reason for referral was aggressive or disruptive behaviour. Characteristics of patients in this inner-city population suggest a continuing need for a high quality liaison service to the A&E department.
Non-consultant psychiatrists' knowledge of emergency detention procedures in Scotland
Authors: Humphreys Martin S.
Published: October 2008

There is growing concern with psychiatrists' knowledge of mental health law, in particular with the introduction of new legislation and more complex statutory arrangements for after care. Despite this, little systematic research has been undertaken in the UK. This study was designed to determine the knowledge of a sample of doctors in psychiatry in Scotland, of part of the Mental Health (Scotland) Act 1984 which provides for urgent involuntary admission to hospital. A one in three sample of all non-consultant grade psychiatrists throughout Scotland was interviewed on the aspects of the Act considered essential to lawful detention. Knowledge of even this restricted part of the Act was poor regardless of experience. Evidence emerged which suggested that at times civil liberties might be compromised or the right to treatment denied. The findings clearly point to the need for increased emphasis on training in mental health law.
Time to amend Section 135
Authors: Cutajar Peter , Hampson Michele
Published: October 2008

Section 135 of the Mental Health Act (1983) allows a Justice of the Peace, on information provided on oath by an approved social worker, to issue a warrant allowing any constable named in the warrant to enter, if need be by force, any premises in which there is reasonable cause to suspect that a person believed to be suffering from a mental disorder:

(a)

has been, or is being, ill-treated, neglected or kept otherwise than under proper control: or

(b)

being unable to care for himself, is living alone in any such place, and, if thought fit, to remove him to a place of safety.
Choice of neuroleptics in epilepsy
Authors: McConnell Harry , Duncan Denise , Taylor David
Published: October 2008

The decision to use a neuroleptic in people with epilepsy (PWE) depends on the nature of the psychosis being treated. In some cases a neuroleptic is not required and an adjustment of the antiepileptic drug therapy may be all that is necessary. Antiepileptic drug therapy itself can cause psychosis and this, as well as other aetiologies, should be considered. The choice of neuroleptic in PWE depends on: the nature of the patient's psychosis, including the temporal relationship with seizures and/or any relationship to antiepileptic drug therapy; the epileptogenicity of the neuroleptic; antiepileptic drugs; the efficacy of the neuroleptic; and individual tolerability of side-effects.
Rebuilding psychiatry in Uganda
Authors: Boardman Jed , Ovuga Emilio
Published: October 2008

Psychiatry in Uganda has a fine pedigree. Academic psychiatry was established in the late 1960s when the Makerere University Department of Psychiatry was founded. Academic medicine and psychiatry suffered during the Amin regime but, like the country as a whole, these have begun to rebuild themselves over the past 10 years. Problems still remain including poor facilities, lack of resources, and a need to revise the Mental Treatment Act and standards of treatment. The high prevalence of AIDS and post-traumatic stress disorder place added burdens on Ugandan psychiatry.
Nurses' help in psychiatric out-patient clinics
Authors: Meats Philip , Ashton Terry
Published: October 2008

Increasing referrals to psychiatric clinics, combined with restricted medical manpower, require innovative ways of meeting the demands. We appointed a nurse to help in an out-patient clinic. The nurse recorded new patients' case histories and presented them to the consultant, who could then see the patients in less time. In the first 15 months the clinic saw 260 new patients, compared with 190 in the previous period. The median waiting time for appointments came down from 32.5 to 22.5 days (P=0.018). Patients reported a high level of satisfaction with seeing a nurse and a doctor.
Evaluating and improving the quality of risperidone prescribing
Authors: Taylor David , Holmes Robert , Hilton Trudi , Paton Carol
Published: October 2008

Clinical studies suggest that risperidone is an effective antipsychotic with a low incidence of extrapyramidal adverse effects. In a prescription survey of several trusts, we found that risperidone was widely prescribed at high doses alongside typical neuroleptics and anticholinergic drugs. We also demonstrated that prescribing in a single trust can be improved by simple interventions. Risperidone should be prescribed as the sole antipsychotic at doses below 8 mg/day to realise fully its clinical advantages. Few prescriptions met this standard.
Health economics in mental health. 1: Principles
Authors: Craig Neil , Stark Cameron
Published: October 2008

This is the first of two papers which summarise key concepts in health economics and explains the differences in the various types of economic evaluation published in the economics literature. Examples from the economic analysis of mental health care are used to illustrate the key points. This paper explains the concepts of scarcity, rationing, opportunity cost and efficiency from a health economics perspective, and presents an ethical argument for the use of health economics in making decisions on resource use in mental health care.
Characteristics of patients admitted to in-patient psychiatric care following parasuicide
Authors: Shajahan Polash , Logan Katharine , Masterton George
Published: October 2008

Parasuicide referrals and subsequent transfers to psychiatric in-patient care were recorded for January to April, 1972 to 1996. Information regarding the psychiatric outcome of transfers for the years 1985, 1990 and 1994 was obtained by case note review. Parasuicide referrals show a decline from 1972 to 1990 but they have more than doubled since then. Referrals transferred to in-patient psychiatric care fell from 10.7 to 2.8% during 1985 to 1994. Fewer patients with acute stress reaction, adjustment disorder, personality disorder and substance misuse are being transferred. Transfers of patients with ‘severe mental illness' have remained constant.
ECT in Scotland
Authors: Robertson Carol , Freeman Chris P. L. , Fergusson Grace
Published: October 2008

Previous audit of electroconvulsive therapy (ECT) standards has identified deficiencies in service provision. Little national information was available on ECT services in Scotland. Survey questionnaires were sent to all consultants in charge of ECT clinics in Scotland. There was a 100% response rate. The service provision varied across Scotland, and in some cases fell below Royal College of Psychiatrists' recommendations. There now exists a base of information on services available and an ongoing national audit system should be considered. Several recommendations have been made for the future of ECT services in Scotland and these have been distributed to consultants in charge of clinics.
Assessing risk of violent behaviour
Authors: Lodge George J.
Published: October 2008

All British mental health professionals will be aware of several highly publicised deaths at the hands of mentally ill people and will have seen the conclusions of inquiries and government reactions. To reduce the risk of future tragedies effective methods of risk assessment and prediction are needed.
Psychotherapy and trainees
Authors: Byrne Peter , Meagher David
Published: October 2008

The value and efficacy of psychotherapy is currently being debated both within (Gabbard et al, 1997) and outside the profession. One commentator has spoken of psychotherapy's populist synonym ‘counselling’, as the ‘valium of this era”, where counselling “does not cause the same clouding of consciousness as drugs, but its side-effects are twice as bad” (Dalrymple, 1996).
Conflicts of a 90-year-old transsexual
Authors: Ong Yong-Lock , Davies Pam
Published: October 2008

Within the ageing population there exists a small number of elderly transsexuals. There is a growing impression that they are beginning to require the services of old age psychiatry. Most services are ill equipped to deal with this group and require specialist support. This case history illustrates this need and describes the social dilemmas involved.
Psychiatry and the death penalty
Authors: Ferris Rob
Published: October 2008

Ninety-five countries throughout the world retain the death penalty. All make provision for excluding the ‘insane’ from liability to capital punishment (Hood, 1990). Psychiatrists and other mental health professionals are therefore involved in the process leading up to capital sentencing and execution in many of these countries. Such involvement may take many forms though, with the notable exception of the USA, very little is known of its nature or extent in practice. Whatever form psychiatric involvement takes, and however much it may be shaped in different places by social, economic and cultural variables, as well as the configuration of particular criminal justice systems, certain fundamental ethical questions arise which do not admit of simple answers. It might be argued that these ethical dilemmas no longer have relevance to European countries because they have all effectively abolished capital punishment. However, others may claim that the death penalty, as the most spectacular example of the extra clinical harm to which a psychiatrist's dealings with patients may contribute, ought to be of central concern when practitioners come to consider the uncertain balance between their duty to an individual patient and society at large.
Greek mythology and medical and psychiatric terminology
Authors: Athanasiadis Loukas
Published: October 2008

A great number of terms in modern psychiatry, medicine and related disciplines originate from the Greek, including pathology, schizophrenia, ophthalmology, gynaecology, anatomy, pharmacology, biology, hepatology, homeopathy, allopathy and many others. There are also many terms that originate from figures from ancient Greek mythology (or the Greek words related to those figures) and I think that it might be interesting to take a look at some of them.
The Mental Health Review Tribunal and the restricted patient
Authors: Prins Herschel
Published: October 2008

Some recent criticisms of Mental Health Review Tribunal practices are reviewed against the background of concerns about public protection.
The Criminal Procedure (Scotland) Act 1995: new legislation for mentally disordered offenders
Authors: Chiswick Derek
Published: October 2008

The Criminal Procedure (Scotland) Act 1995 came into force on 1 April 1996. It contains major new provisions in respect of defendants found insane, together with changes concerning other mentally disordered offenders.
Birmingham community mental health team for the homeless
Authors: Commander Martin , Odell Sue , Sashidharan Sashi
Published: October 2008

Mental health services have been criticised for failing to respond to the needs of the rising number of homeless mentally ill. We report on the first year of referrals to a community mental health team established to meet the needs of the severely mentally ill homeless in Birmingham. Most users had a psychotic disorder and a lengthy history of unstable housing, and experienced a range of other disadvantages. Although the team is successfully reaching its priority group, examination of other characteristics of users has highlighted a number of issues which should inform the future planning and development of the service.
Consultants' views of Leave of Absence and Community Care Orders in Scotland
Authors: Atkinson Jacqueline M. , Gilmour W. Harper , Dyer James A. T. , Hutcheson Fiona , Patterson Lesley
Published: October 2008

Following consultation in 1994, changes were proposed to mental health legislation. In Scotland these included the limitation of Leave of Absence (LOA) to 12 months and the introduction of Community Care Orders (CCOs). All consultants in general psychiatry in Scotland were surveyed regarding their views on LOA and CCOs. The results of our survey showed that the majority of consultants use LOA and extended LOA, giving lack of insight and threat of stopping medication as the main reasons. Consultants reject both CCOs and the limitations on LOA. Those who have been consultants for more than 16 years are significantly more likely to agree with restriction of LOA than others.
‘No sex please, we're British’
Authors: Singh Swaran P. , Beck Andrew J.
Published: October 2008

The case notes of 100 consecutive admissions to a general adult psychiatry service revealed that no sexual history was recorded in 73 cases. Only one patient had a detailed sexual history taken. In 22 cases the sex history was limited to a single mention of ‘reduced libido’ and in another four cases a brief explanation was done. Sexual side-effects of medication were not explored in any case. Sex history was more likely to be recorded when the doctor and patient were of the same sex; in cases with a history of sexual abuse or relationship problems; and where psychopathology had a sexual content.