bluuebunny/crossref_metadata_2025 huggingface dataset:
The Home Office Mental Health Unit
Authors: Potts J. M.
Published: October 2008

On 1 April the mental health section of the Home Office's C3 Division was renamed “Mental Health Unit”, as part of a wider initiative to streamline the Department and give more meaningful titles to the various different areas of work. The responsibilities of our Unit remain the same, however. First, we deal with the cases of restricted patients under mental health legislation. As well as advising Ministers or taking decisions on their behalf about leave, transfers and discharge, the Unit also authorises the transfer of mentally disordered prisoners to hospital. This prison transfer work is focused in a separate section of the Unit which is able to provide a very rapid response to urgent requests for transfer warrants. The number of transfers has gone up from 337 in 1990 to over 700 in each of the last three years.
Cows, pigs and dirty hands – the story of cysticercosis
Authors: Dunn John
Published: October 2008

The story of ‘mad-cow’ disease has been closely followed by the media in Brazil with a nagging concern that it could happen here. Beef is big business in Brazil, there are 169 million head of cattle, a high beef consumption (35 kg per person per year) and a thriving export trade; indeed Brazil is one of the main providers of corned beef to the UK. If BSE were to be found in Brazilian cattle it would be a massive problem. However, before the investigative journalists had a chance to dirty their boots on the nearest cattle ranch, a respected authority was quoted as saying that there had been no reported cases of BSE in Brazil and since cattle were not fed protein that came from other animals, the risk of it developing was extremely low.
Ethical issues in dementia
Authors: Burns Alistair , Harris John
Published: October 2008

Public debate on dementia has intensified recently with scientific advances being scrutinised in the media, the genetics of Alzheimer's disease regularly portrayed as inextricably linked with the personal agony of whether to have ‘the test’ (which exists only for a small number of people) and the announcement by ex US President Ronald Reagan that he suffers from the disease. Several different areas provoke interest and speculation and this brief article attempts to highlight some, based on a recent meeting on the subject.
Waiting for rehab?
Authors: Davies Steffan , Payne Simon , Jenkins Jane
Published: October 2008

It is a common belief among staff in Nottingham's acute psychiatric services that the Rehabilitation and Community Care Services (RCCS) are slow to respond to referrals leading to blocking of acute beds. In response to this the authors examined ‘bedblocking’ while RCCS responded to referrals of acute in-patients and long stays of existing RCCS patients admitted to acute wards during exacerbations of their illness.
Making community based comprehensive mental health services work
Authors: White Karen , Ness Maresa , Craig Tom , McNamee Gary
Published: October 2008

There hat boon until recently a dearth of descriptions of locally targeted community mental health services. Such a service, developed by changing a traditional psychiatric service in an inner setting, is described. The service addresses the needs of those with predominantly severe/enduring mental health problems, by increasingly using research based treatments in an ordinary district setting.
The needs for care assessment – a longitudinal approach
Authors: O'Leary Denis , Webb Marcus
Published: October 2008

This report describes the use of the needs for care assessment (NFCA) in measuring symptom and social function in patients with long-term mental Illness. The schedule recommends specific care interventions and these were implemented where appropriate. The problem status of the patients was reassessed using the needs for care schedule after the interventions had been offered and tried. The recommended care items were within the compass of our rehabilitation service, were rarely refused by the patients and there was an improvement in symptom and social function. These findings provide some validation for the concept of unmet need.
Mental health needs for children of parents seeking help for substance abuse
Authors: Thompson Anne E. , Blennerhassett Richard
Published: October 2008

A survey of 101 new attenders at a regional drug and alcohol service found that 46 adults had a total of 88 children at home. Twenty-three children were considered by their carers to show signs of emotional or behavioural disturbance. Difficulties had only been discussed with professionals in a minority of cases. Help for troubled children from primary care services was preferred to secondary services. Closer liaison between child psychiatry and primary health care workers should be considered.
The supervision register: one year on
Authors: Vaughan Phillip J.
Published: October 2008

A postal survey was conducted within four regional Health Authorities to ascertain how widely the supervision register had been applied in its first year of operation in adult mental health. A 72% response rate was achieved. The results showed that the register has been absorbed organisationally but is less accepted professionally. One hundred and nineteen of the 367 consultants in the sample (32%) had no entries on the register at 31st March 1995. The provision of training on its use had a significant effect on compliance, although London-based services had marginally less registrations per consultant than their colleagues elsewhere. Very few outside agencies had required access to the register.
The information superhighway and psychiatry
Authors: Littlejohns Carl , Briscoe Martin
Published: October 2008

The Internet, a military creation, is a collection of services shaped by its users, and offers the rapid transfer of vast quantities of information. Already there is concern that Developing World countries may be left behind by this revolution in information availability. Psychiatrists need to be aware of the type of facility the information in the superhighway provides, so that the useful aspects can be refined and directed. The type of facilities in use now by psychiatrists around the world is briefly described.
Training in the Mental Health Act: see one, do one, teach one?
Authors: Harrison Judy
Published: October 2008

In contrast to other professional groups, psychiatrists currently receive little formal training in the use of the Mental Health Act (MHA). This article describes a locally organised training day for senior registrars and reports on their previous experiences and future training needs in the use of the MHA.
Minimum and medium security
Authors: James A. J. B. , Smith J. , Hoogkamer R. , Laing J. , Donovan W. M.
Published: October 2008

This paper examines the use of Section 17 trial leave from local psychiatric units to regional secure units in order to facilitate the return of patients to local services when higher security is no longer necessary. The current national shortage of medium secure beds is exacerbated by such patients when general psychiatric services are unwilling to have them back. Experience from the regional secure units in the old South Western Region has shown beneficial effects of the use of Section 17 trial leave in this way.
Psychiatric clinics in probation offices in South Wales
Authors: Huckle Phil , Travier Tara , Scarf Sylvia
Published: October 2008

A descriptive study of a psychiatric probation clinic based in South Wales is presented. Over a three year period, 100 probation clients were assessed by forensic psychiatrists at the request of the Probation Services in South Wales. The majority of these clients were mentally disordered, with common diagnoses being personality disorder (35%), substance misuse (11%), schizophrenia (10%) and post-traumatic stress disorder (9%). The non-attendance rates for these clients was 0% for the first and 13.3% for subsequent appointments. Psychiatric probation clinics seem to be analogous to general psychiatric clinics based in Primary Care.
Criteria for long-stay care
Authors: Jolley David , Jolley Susan , Benbow Susan
Published: October 2008

Most old age psychiatrists see long-stay care in good quality community hospitals as an essential component of a comprehensive service for older people suffering from mental illnesses (Jolley & Arie, 1992). Yet in recent years some Health Authorities have sought to reduce or close their long-stay beds and this has caused a great deal of controversy (Alzheimer's Disease Society, 1993; Benbow et al, 1994).
Group therapy for adults with a learning disability: use of active techniques
Authors: Salmon Gill , Abell Shirley
Published: October 2008

We describe our experience of running a group using active therapy techniques for adults with a teaming disability, and briefly explore cognitive developmental theory in an attempt to understand some of our observations.
Psychiatry: a core curriculum for undergraduate medical students
Authors: Nasser Mervat
Published: October 2008

There is a growing pressure on universities to review their curriculum for undergraduate medical students in the light of the new General Medical Council (GMC) Education Committee recommendations (1993). One major recommendation was for universities to develop a ‘core curriculum’ for every medical discipline. In psychiatry, the curriculum for undergraduate medical students has always varied between universities. We propose a broad design of a core curriculum that consists of eight modules covering what is considered vital to the subject and relevant to the student's future medical practice. The curriculum is designed to be taught in pre-clinical as well as clinical years in an attempt to achieve full integration and aspires to succeed in eliminating this traditional divide.
Adolescent offenders referred to a forensic psychiatric service
Authors: Huckle Phil , Williams Tegwyn
Published: October 2008

This paper describes the results of a survey of adolescent offenders referred to a tertiary National Health Service forensic psychiatric service based in South Wales over a three year period. Seventy-seven adolescents aged between 13 to 18 years were seen (5.1% of all referrals to the Service during this time). The majority of the adolescents had committed major offences including serious sexual crime, wounding and murder. A high rate of mental disorder was observed in this survey as well as high levels of substance misuse. Eighteen per cent were admitted to a hospital for further assessment and treatment.
In-patient characteristics in a regional secure unit
Authors: McKenna J.
Published: October 2008

A survey of 100 completed Regional Secure Unit (RSU) in-patient episodes shows that most patients are young, male, short-stay and suffering from chronic psychotic disorders. Substance abuse is prevalent, and many currently face serious charges. A significant minority of patients had previously been admitted to the Unit, especially those admitted directly from the community. Nearly half of all discharges were directly into community placements, and nearly as many remained under the care of the forensic service. Despite the sampling frame, it is clear that a few ‘long-stay’ patients contribute disproportionately to overall bed occupancy, so that beds for acute admissions may be blocked. Further, ‘parallel care’ is operating to a significant degree in this service, with the inevitable accumulation of patients who will continue to require future in-patient care. These two factors in particular suggest that the ability of the RSU to fulfil its basic functions may become increasingly compromised, particularly with respect to emergency requirements for medium secure beds at the district level.
Consumer satisfaction of patients attending psychiatry of learning disabilities clinics
Authors: Bretherton Karen , Gravestock Shaun
Published: October 2008

A consumer satisfaction survey of patients with learning disabilities and mental health needs attending outpatient psychiatry clinics was performed using a questionnaire administered by their carer. Sixty completed questionnaires were returned and the results were analysed to determine whether demographic or service variables were correlated with the degree of satisfaction. Younger patients living independently or with their family and those who were not prescribed psychotropic medication were more satisfied. The service variables associated with increased satisfaction were comfortable waiting areas, punctuality and good communication with the doctors.
Quality of life in a new hospital hostel
Authors: Simpson C. J.
Published: October 2008

Quality of life scores were measured In a new hospital hostel in a rural community. These scores were compared to scores on patients in a similar hospital hostel in an inner city area in the United Kingdom and also scores on patients living in a range of different facilities in the community In the United States.
Setting up stall in the market place: psychotherapy in a state health service
Authors: Maloney Christopher
Published: October 2008

Public sector psychotherapy differs from private practice in its explicit responsibility for a population. This has major implications, with the need to ration a scarce resource inevitably affecting clinical practice. De facto rationing has existed within the National Health Service (NHS) for years, and the ‘unconscious' processes involved must be made explicit if NHS psychotherapists are to deal with their broader responsibilities, and influence current changes in the Health Service. Resource issues and the related psychological conflicts shape clinical practice and thus theoretical concepts. The effects on practice could be seen as a series of unhappy compromises, or a stimulus to the creative development of a specific NHS psychotherapy, as envisaged by Sigmund Freud.
Current use of treatment groups for parents and their preschool children
Authors: Morrell J. E.
Published: October 2008

Despite the apparent advantages of group treatment for parents and their preschool children, this technique is not widely used in child psychiatry departments. Those units that have groups find them useful resources for the assessment and treatment of families with a wide variety of presenting problems. Experience is leading clinicians to run groups that are (a) time limited and closed; and (b) structured and focused in their work. Audit projects are being conducted in some centres to evaluate their usefulness, but no studies have been undertaken of groups using random allocation of patients. This should be done before their efficacy can be assured compared with other treatment models.
A course for recently appointed consultants
Authors: Harrison Judy , Creed Francis
Published: October 2008

Becoming a consultant is often viewed as the final hurdle in our lengthy professional training. Yet the consultant role carries with it additional responsibilities and stresses for which the recent appointee may feel ill-prepared. This paper describes a two-day course for recently appointed consultant psychiatrists. Feedback from the 24 offenders suggested the course was greatly valued.
Homicide, inquiries and scapegoating
Authors: Bennett D.
Published: October 2008

Homicide is in the news and community care is being blamed, a view not justified by the facts. Much has been written about the homicides of Johnathan Zito and Georgina Robinson and there has rightly been considerable public and professional concern. There have been other reports on the murder of Johnathan Newby in October 1993 and William Bennett in July 1994. Yet another case is currently the subject of an inquiry and again the press is expressing indignation and horror. The anxiety and concern are natural but the reactions are not justified.
DVLA regulations concerning driving and psychiatric disorders
Authors: Thompson Paul , Nelson Deborah
Published: October 2008

Driving during and after a psychiatric illness is an important area about which relatively little has been written. This paper reports on a questionnaire study aimed at seeking psychiatrists' knowledge and views on this issue. Of 187 questionnaires distributed 101 were returned, and replies indicated that psychiatrists are generally unaware of regulations currently in force. Suggestions on how to improve matters are mode.
An investigation into lithium monitoring
Authors: Myers D. H. , Hallworth M. J.
Published: October 2008

The quality of lithium monitoring in a health district serving a population of 450 000 was studied over a period of a year. The following instances of poor monitoring were found: too frequent monitoring in stabilised patients, and failure to take action when lithium values fell below 0.3 mmol/l or rose above 1.0 mmol/l. Ways of improving the standard of monitoring are considered.
Access to records and client held records for people with mental illness
Authors: Laugharne Richard , Stafford Anna
Published: October 2008

Increasing involvement of users in health service planning has led to a movement towards patients having more information about their care. Some have advocated patients having access to their medical records and this is now a statutory right. There has been concern as to whether this is suitable in mental health. An addition or alternative to access to medical notes is a client held record which might increase the patient's feeling of autonomy while also improving communication and compliance. In studies on access most patients and staff have found this beneficial. Client held records have also been positively received in the few studies reported but more evaluation in routine practice Is needed.
Patients repeatedly admitted to psychiatric wards: a four-year follow-up
Authors: Davies Steffan , Payne Simon
Published: October 2008

Previous studies have looked of repeated admissions and failed discharges but none have followed up a group of patients requiring multiple admissions over several years. We found that of the 42 patients admitted three or more times to acute wards in 1990, half were having a bad year and did not require this level of inpatient care in succeeding years; one-quarter continued to use acute services heavily but none required three or more admissions in every year of follow-up; one-quarter did badly and required prolonged in-patient care or died.
From inter-agency to multidisciplinary work in a sector generic mental health team
Authors: Marriott S. , Hassiotis A. , Ray J. , Tyrer P.
Published: October 2008

The effects of establishing a full multidisciplinary community psychiatric team in central London are described. The nature of referrals, and referrers' satisfaction with the service were examined during two comparable six-month periods, before and after the changes. The number and severity of referrals increased, and referrers were more satisfied with the new service. In contrast to the inter-agency model, the new multidisciplinary team was associated with more appropriate referral of those patients with the greatest need for specialist services. Clinical skill mix in the team and referrer education are the two factors most likely to have promoted these important changes. The key role of the psychiatrist in a full multidisciplinary team who can empower multi-professional case managers in their day-to-day management of severely ill patients is highlighted.
College approval visits – a perspective on trainee participation
Authors: Warrington J. , Edmonstone Y. G. , Strachan J.
Published: October 2008

This text discusses whether senior trainees should endeavour to Join a College Approval Panel as one of the visiting team, what the advantages would be to the trainees being visited of having a senior trainee representative as a member of the assessing group and what the benefits are to senior trainees in terms of training and broadening their own curriculum vitae.
Trainees' experience and attitudes to behavioural–cognitive psychotherapy training
Authors: Drummond Lynne M. , Ramsay Rosalind L.
Published: October 2008

We performed a survey to examine the behavioural–cognitive psychotherapy teaching and experience of trainee psychiatrists in the South Thames (West) Region. Sixty-four per cent of the whole sample who responded to the survey, including 90% of the registrars who responded, had treated at least one patient using behavioural cognitive methods. Few trainees reported no experience of behavioural cognitive psychotherapy with almost all attending some form of teaching. Trainees generally reported that they valued this experience.
Clinical practice guidelines: on what evidence is our clinical practice based?
Authors: Marriott Sarah , Palmer Claire
Published: October 2008

Many sources of evidence inform clinical practice, including research findings, patients' views, and clinical experience. This article describes recent progress in developing what will be the College's first guideline, The Assessment and Management of Violence In Clinical Settings. The design of the programme acknowledges the diversity of evidence in this area, by drawing a distinction between different types of evidence. Evidence is systematically identified and its quality appraised by the Work Group, through commissioning literature reviews. Initial recommendations will be based on experimental data. The methods used to consider non-experimental data, particularly expert opinion, will be described in more detail in a later article in this series.
Newly appointed consultants in old age psychiatry and the adequacy of higher training
Authors: Loane Ruth , Barker Andrew
Published: October 2008

This paper reports on a survey of newly appointed consultants in old age psychiatry. The Questionnaire asked for opinions on the adequacy of higher training in a number of areas such as clinical, management, teaching, supervision and research. In addition views were sought on particularly valuable experiences in preparation for consultancy. The results show that overall clinical training was judged to be good, while training in some non-clinical areas, especially management, was found to be insufficient. The importance of management training Is emphasised and some valuable training experiences are highlighted.
Pre-registration house officers' psychiatric knowledge in practice
Authors: Williams Chris , Wilson Simon
Published: October 2008

Psychiatric distress is commonly found in general hospital patients and is associated with a poorer outcome and increased complexity of care. It is important for non-psychiatric hospital doctors to possess skills of assessment and treatment of common psychiatric problems. This survey of all house officers in their first pre-registration posts in three large teaching hospitals found that Junior doctors rarely ask about or consider the presence of psychiatric problems in their patients. Where psychiatric problems are found, house officers often feel they lack the appropriate skills of assessment and management. This has important implications for medical school course content and emphasis.
The role of a psychosis workshop in general psychiatric training
Authors: Garelick Antony , Lucas Richard
Published: October 2008

A psychosis workshop and its clinical role are presented. The workshop's mode of operation utilising basic psychodynamic concepts is described with related clinical illustrations. The value of the workshop in implementing College guideliness for general professional psychiatric training and the integration of psychotherapeutic skills into psychiatric practice is discussed.
Changing medical students' attitudes to learning disability
Authors: Hall Ian , Hollins Sheila
Published: October 2008

The Strathcona Theatre Company is made up of professional actors with a learning disability and two directors. As part of the teaching course in the Department of Psychiatry of Disability at St George's Hospital Medical School, the medical students participate in a workshop given by the Company, near the beginning of their attachment in psychiatry. During the two-hour workshop the students are taught a variety of ‘ice breaking’ games and mimes by members of the Company. This means that early on in the course, students have face to face contact with adults with a learning disability, and furthermore see them in a socially valued role as teachers and leaders. The students usually find the workshop enjoyable, and give positive feedback although they were unsure how successful the workshop was in changing medical students' attitudes towards people with learning disability. We report an evaluation of students' attitudes before and after the workshop, and show statistically significant changes in attitudes towards people with a learning disability.
Mental health aspects of incapacity benefit
Authors: Measey Laurence G.
Published: October 2008

In February 1994 the Royal College of Psychiatrists contacted the Benefits Agency Medical Services (BAMS) to take part in their consultation exercise before bringing in the new Incapacity Benefit (IB) in April 1995. This new benefit was to replace the then existing Invalidity Benefit which was being paid to over 250 000 people with a primary diagnosis of mental illness. The main changes were that a patient's own general practitioner (GP) would certify incapacity for work for the first 29 weeks of sickness and after this the continuation of benefit (IB) would require assessment by a BAMS doctor, with some illness categories being exempt from medical examination. The aim was to create standardised criteria across the UK and to do so in an objective fashion, based on function rather than diagnosis. The test is designed to look at ability to work in any capacity rather than the claimant's own work which is the criterion for the first 29 weeks.
Antipsychotic dose: from research to clinical practice
Authors: Chaplin Robert , McGuigan Sean
Published: October 2008

A case note study of antipsychotic prescribing in an inner London hospital showed that although doses of individual drugs were below the British National Formulary limits, polypharmacy occurred in a third of cases. Multiple regression analysis showed high doses were associated with a current risk to the self or others and increasing number of previous admissions in patients with mania and treatment non-responsiveness in schizophrenia.
A Speciality Register: uses and limitations
Authors: Benbow Susan M. , Jolley David J.
Published: October 2008

The Section of Old Age Psychiatry has compiled an informal register of old age psychiatrists using regional representatives as informants. This has been found to have a number of uses, but has also aroused concerns.
Psychiatry in Rotterdam's University Hospital
Authors: Hall Annie , Robertson John R.
Published: October 2008

Following a visit to the Royal College of Psychiatrists by Professor W. J. Schudel, it was decided to visit The Netherlands with a view to gathering information about the organisation of postgraduate medical education In psychiatry there. Several Dutch psychiatrists were interviewed during the visit. The ‘Calman’ Report recommends limiting the period of training for British trainees. Formative methods of assessment are to be introduced, with a review of progress at regular intervals. The present Dutch system relies solely upon formative assessment.
The ethics of continuation studies in dementia
Authors: Kellett John M.
Published: October 2008

At least one ethical committee is not prepared to approve open continuation studies of treatments for dementia. The author considers that such studies are an ethical necessity if patients are to give six months of their illness to trying out what may be placebo. The reasons for this conflict are discussed. In particular, it is suggested that such studies contribute real scientific information.
Effects of changes in practice of electroconvulsive therapy over a 2 year period
Authors: Trezise Kate , Conlon Bill
Published: October 2008

The administration and outcome of electroconvulsive therapy (ECT) were studied retrospectively over two successive periods of 12 months, before and after replacement of our Ectron Series 5 ECT machine by a Thymatron DGx. It was found that using the Thymatron enabled the same outcome of ECT to be achieved, while administering significantly fewer treatments per patient. Possible explanations for this finding are discussed.
Intake of and attitudes to alcohol and alcoholism
Authors: Sharkey John J. , Patterson Diana
Published: October 2008

We examined the extent of alcohol misuse among final year medical students and explored their attitudes to their drinking and the drinking of others in order to gain insight into why junior doctors frequently fail to identify alcohol misusers. The questionnaire included AUDIT (Alcohol Use Disorders Investigation Test), personal details and an attitudinal component. Response rate was 92%. Forty-six students (37.8%) scored as alcohol misusers. Teetotallers had a more judgmental attitude towards ‘alcoholism’. Extremes of drinking behaviour among students may affect later patient care.
Implementing the OSCE in Nottingham
Authors: Brewin John , Cantwell Roch
Published: October 2008

The undergraduate medical curriculum in Nottingham has recently undergone dramatic change in response to General Medical Council recommendations. As part of the changes, the examination procedure in psychiatry has been altered, replacing the clinical ‘long case’ with an objective structured clinical examination (OSCE). The OSCE has long been seen as a valuable assessment tool in more ‘procedure-orientated’ specialities, but its use in psychiatry is not widely reported. This paper discusses the reasons behind the change, the design and implementation of the OSCE, and benefits and problems encountered during its first application.
Psychotropics and hyponatraemia
Authors: McAskill Robyn , Taylor David
Published: October 2008

Hyponatraemia is usually defined as a serum sodium concentration below 135 mmol/1. The condition is rarely symptomatic until serum sodium falls below 120 mmol/1 and symptoms are more usually associated with values around 110 mmol/1. These symptoms include confusion and restlessness, progressing to drowsiness, myoclonic jerks, generalised convulsions and eventually coma. In a general hospital population about 1% of patients develop hyponatraemia (Rutsky, 1992), whereas in psychiatric patients the prevalence has been reported to range from 3.3% to 12.2% (Ohsawa et al, 1992).
Visit to Abbasiah Hospital, Egypt
Authors: Mahmood Rafeek , Thompson Chris , Robertson John
Published: October 2008

At a Regional meeting of Members and Fellows of the Royal College of Psychiatrists, held in Cairo in April 1994, a strong initiative to promote Abbasiah Psychiatric Hospital as a teaching centre was put forward. The President, Registrar and Dean made a preliminary visit to the hospital and met with Dr S. Al-Kott, the Medical Director, and agreed to offer assistance on behalf of the Royal College of Psychiatrists. It was anticipated that Abbasiah would benefit through improved recruitment into medical and nursing posts, and by the injection of renewed interest in its large patient population.
Teaching group and organisational dynamics to psychiatric trainees
Authors: Cawthra R. , Porter R. , Kathriarachchi S. T.
Published: October 2008

Junior psychiatrists in the UK often receive only minimal training in psychodynamic aspects of group processes, especially as applied to the understanding of organisational dynamics. Yet these processes may be an important force operating in clinical teams, in both hospital and community settings.
Razor head
Authors: Spence Sean
Published: October 2008

In psychiatric studies of artists, performance art has been relatively neglected. The work of Marina Abramovic places emphasis upon the crossing of limits: both physical and mental. Here the self-wounding which occurs in such a context is contrasted with that seen in the psychiatric setting, among those diagnosed as having ‘personality disorders'.
Providing a psychiatric service to liver transplant patients
Authors: Mitchell John R. , Lang Fiona H. , Masterton George
Published: October 2008

The Scottish Liver Transplantation Unit (SLTU) opened in the Edinburgh Royal Infirmary in November 1992. We describe the liaison psychiatric input during its first 23 months. Sixty-five patients were seen from 69 referrals and their case notes were studied retrospectively to obtain information on patient demographics and details of each psychiatric involvement. A high level of psychiatric morbidity was found and psychiatric opinion contributed to the transplant assessment procedure. Our results indicate the need for good liaison psychiatric input with subsequent resource implications.
Emergency admissions to a regional adolescent unit: piloting a new service
Authors: Cotgrove Andrew
Published: October 2008

Adolescent in-patient units within the NHS generally provide a broad range of services to large catchment areas and populations. ‘Pine Lodge’ Young People's Centre in Chester has piloted a new emergency admission service which it has run in conjunction with its existing treatment service. This paper sets out to discuss the potential difficulties in providing such a service in the setting of a general purpose adolescent unit; describe the specification of the piloted emergency service; and present the results of monitoring its use and efficacy during the first six months.
Health in hostels: a survey of hostel dwelling women
Authors: Marriott Sarah V. L. , Harvey Richard H. , Bonner Deirdre
Published: October 2008

Direct access residents in an inner London homeless women's hostel were interviewed and asked to provide information on medical, personal and social history. For each a DSM–III–R diagnosis, General Health Questionnaire, CAGE and Global Assessment Scale score was assigned, and their views on future housing were sought. The effect of severe mental illness (SMI) and age on dependent variables was examined. A third of the sample (n=14) suffered from SMI, and a further quarter from other mental illness (n=10). A quarter had a DSM–III–R substance misuse disorder. The prevalence of SMI was similar across age groups. Younger women had a different pattern of service needs, with greater levels of psychological distress, substance misuse and residential instability, than older residents.
Psychiatric presentations to an A&E department
Authors: Ellis David , Lewis Simon
Published: October 2008

A survey is described of people presenting with psychiatric problems to a north London accident and emergency (A&E) department over three months. Forty per cent presented with deliberate self-harm and 25% of these left before being assessed. Twenty per cent of those with problems compatible with a diagnosis of severe mental illness also left before being seen by a doctor. Differences between presentations ‘out-of-hours' and ‘in-hours' are described. Factors predicting admission were: previous psychiatric admission, symptoms of a psychotic or affective disorder and non-permanent accommodation. The survey has implications for the process of triage in A&E departments and the organisation of mental health liaison services.
Evaluation of moving an acute psychiatric ward from a psychiatric hospital to a general hospital setting
Authors: Rothwell Neil , McManus Pauline , Higgon John
Published: October 2008

This study evaluates the effects of moving an acute psychiatric ward from a psychiatric hospital to a district general hospital. A repeated measures design is used covering the three phases of shortly before and after the move and a follow-up 10 months after the move. Eleven measures were used including daily measures of patient disturbance and staff stress, length of stay, diagnosis and a consumer survey. Overall there was little change from before the move to follow-up. Two second-order variables relating to staff stress did, however, show a clear reduction.
Consultant psychiatrists who retired prematurely in 1995 and 1996
Authors: Kendell R. E. , Pearce Alison
Published: October 2008

Owing to the large and increasing number of vacant consultant posts in psychiatry, and the suspicion that premature retirement was an important cause of this problem, a questionnaire was sent to all consultants who were believed to have retired from their National Health Service (NHS) posts before their 65th birthday during 1995 or 1996. One hundred and forty-two (82%) of 173 questionnaires were returned. Responses to these Indicated that disenchantment with some aspect of the previous Conservative Government's ‘NHS Reforms' was a more important reason for retirement than ill health, a wish to devote more time to other interests, or even bed closures. Increasing bureaucracy and paperwork was a key factor for many.
Asylum seekers: self-referrals to a large psychiatric hospital
Authors: Gray Nicola , Salib Emad
Published: October 2008

We reviewed, prospectively, all patients who presented themselves at the reception of a large psychiatric hospital, which had no casualty department, to assess the extent and value of a long standing ‘unofficial emergency service’ that has been provided for decades. We found no evidence that the service was abused or that it led to unwarranted admissions. The service could provide a useful point of entry to mental health services for certain patients. The ‘ad hoc’ emergency service described here is hoping to become a recognised ‘Emergency Clinic’ in the reprovided service, after the closure of this 100 year old psychiatric institution in the very near future.
Group therapy in the treatment of childhood sexual abuse
Authors: Boakes Janet
Published: October 2008

Group psychotherapy for adults reporting childhood sexual abuse is a well recognised form of treatment but little attention has been given to the possible adverse effects. This paper reports on three patients seen within a NHS trust department of psychotherapy who had taken part in an incest ‘survivor group’. They described individual satisfaction with their improvement but appeared, when viewed externally, to have deteriorated.
Psychotic patients and patent applications
Authors: James David V. , Gilluley Paul L.
Published: October 2008

The clinical observation that some psychotic patients were attempting to register their ideas as patents prompted a survey of published patents. The hypothesis was that, given supposed links between creativity and mental illness, the Patent Office might be a repository of psychotic ideas. Searches were made on specific topics suggested by our patients' applications. A survey was undertaken of unusual patents in the collection as a whole, and of authors with unusual track records. Bizarre and eccentric patents were identified, but patents of the sort that our patients attempted to register were absent. Possible explanations for this result are discussed.
Psychiatry and the WWW: some implications
Authors: Senior C. , Phillips M. L. , David A. S.
Published: October 2008

This paper highlights the role that the World Wide Web (WWW) has to play as an aid to psychiatry. A basic history of the WWW is provided as is an introduction to some search techniques involved with the WWW. The literature on applications potentially relevant to psychiatry is reviewed using computer search facilities (BIDS, PsychLit and Medline). The WWW is one of the aspects of the Internet that possesses a huge potential for exploitation, both the clinical and research psychiatrist are able to benefit from its use.
Psychiatry in Vietnam: a personal impression
Authors: Wallace John
Published: October 2008

After the fall of South Vietnam to North Vietnamese forces in 1975, Vietnam has remained virtually isolated from the rest of the world. With the global political changes of the past 10 years. the Hanoi Government succeeded in reducing Vietnam's international isolation in part by attempting to open the country's door to foreign visitors. The country stretches along the eastern coast of the Indo-Chinese peninsula and is slightly larger than Italy. It is ‘S-shaped’, broad in the north and south and very narrow in the centre (Fig. 1). The country's main cultivated areas are the Red River delta in the north and the Mekong delta containing Ho Chi Min city (Saigon) in the south.
Survey of roles of community psychiatric nurses and occupational therapists
Authors: Filson Pam , Kendrick Tony
Published: October 2008

The roles of community mental health professionals may overlap and need clarifying. A survey is described of 95 occupational therapists (OT) and 200 community psychiatric nurses (CPN), of their views on their respective roles, and information on current practices. Administering medication and crisis intervention were regarded as specifically CPN roles, yet 26% of CPNs did not regularly administer medication. Half of the CPNs' clients were not chronically mentally ill, and over two-thirds of the nurses regularly carried out counselling and anxiety management. Assessing activities of daily living and work skills were seen specifically as OT tasks, yet 60% of the OTs did not usually assess work skills in practice. Roles overlapped considerably, suggesting that a more efficient approach might be to develop a generic core training for community mental health workers.
A community mental health team for the elderly: a survey of GPs' views on the service
Authors: Eastley Rebecca , Nowers Mike
Published: October 2008

This paper reports the results of a postal survey conducted to ascertain the views of general practitioners on the service provided by a newly established community mental health team for the elderly. The possible implications of GP fundholding for specialist provision of mental health services are discussed.
A survey of the use of the electrocardiogram in psychiatry
Authors: Henderson Tom , Gallagher Dominic , Stark Cameron
Published: October 2008

A survey was undertaken to ascertain if doctors working in psychiatry knew when to perform electrocardiograms (ECGs) prior to and during psychiatric treatments where indicated, and to investigate the training, confidence and ability of doctors in ECG interpretation. Half had received no training in the indications for performing an ECG. Opinion differed widely as to when to perform an ECG, with 54% stating an ECG was required before treatment with pimozide and only 19% and 11% stating ECGs were required during the course of treatment with pimozide and high dose antipsychotic medication respectively.

Ability in ECG interpretation correlated negatively with time spent in psychiatry but no correlation existed between grade and ability to identify an ECG as normal or abnormal.
Study of effects of constant observation of psychiatric in-patients
Authors: Ashaye Olakunle , Ikkos George , Rigby Elizabeth
Published: October 2008

Constant observation is used in psychiatric practice mainly to prevent acutely III in-patients from self-harm. All in-patients in a psychiatric hospital and a general hospital psychiatric unit who had been on constant observation over a 6 month period were identified (13 patients). These patients and their primary nurses were interviewed using different questionnaires. Most patients felt they had benefited from being on constant observation, but disliked the intrusion on their privacy. The nurses agreed that it had helped most patients, but a significant number of nurses found it frustrating and stressful. Our results suggest a need for an information sheet to be given to patients placed on constant observation; that the period on constant observation should be reduced where possible, and that support should be provided for the nurses involved.
Clinical risk management: an emerging agenda for psychiatry
Authors: Roy David
Published: October 2008

Health professionals are increasingly expected to take a share in the management of risk in a systematic manner. At its most blunt, clinical risk management is defined as the identification and planned response to negative events that occur during the provision of clinical care and can lead to litigation, the cost of this to the NHS is rapidly rising (Vincent & Clements, 1995). There are, of course, much broader risks to any healthcare organisation, and the approach to risk management in any organisation needs to be systematic. At the start of the process the development of a list of clinical and non-clinical areas in which failures might occur can be overwhelming to clinicians and support staff alike. Rigorous prioritisation of the process is essential, and for practitioners the first rule of sound clinical risk management is common sense.
Cognitive-behavioural therapy training for junior psychiatric trainees
Authors: Brittlebank Andrew , Owens Julie
Published: October 2008

There is an identified need for more psychiatrists who have been trained in cognitive-behavioural therapy (CBT). The Royal College of Psychiatrists' guidelines for psychotherapy training recommend that all psychiatric trainees receive CBT training. This paper describes a brief programme of CBT training for psychiatric senior house officers (SHO) which demonstrates a viable model achieving limited training objectives.
Changing media representations of mental health
Authors: Philo G.
Published: October 2008

The Glasgow Media Group has published the first major study in this country on media coverage of mental health (Philo, 1996). This research examines both the content of press, television and films and how these relate to public beliefs about mental illness. It involved an extensive content analysis plus a series of focus group interviews. The results show clearly that ill-informed beliefs on, for example, the association of schizophrenia with violence can be traced directly to media accounts.
Trainspotting and the depiction of addiction
Authors: Byrne Peter
Published: October 2008

Trainspotting, the “best British film of the decade”, arrived on 23 February 1996. Such were the expectations of the film (1996) that the face of its narrator-hero Renton (Ewan McGregor) appeared that month on the front cover of two influential London-based film magazines, Premiere and Sight and Sound. One year after its release, the film stands as both a critical and commercial success. The total Box Office receipts for Ireland, at IR £800 000 in the first 3 months, were comparable to a major Hollywood blockbuster. The film was still being screened 10 months later in Dublin's north inner city, the heartland of Dublin's heroin epidemic. Given its subject-matter, it is important to examine both the film itself, and its points of contact with the realities of drug addiction. In this respect, three questions suggest themselves: is the film showing anything new (representation), is it doing anything new (technique), and what is the film saying (ideology)?
Survey of services for adults with learning disabilities
Authors: Gravestock Shaun , Bouras Nick
Published: October 2008

Questionnaire data are presented from a national multi-professional survey. Only 12% of respondents had local quantitative data on adults with learning disabilties (LD) and mental health needs (MHN). More described local provision as part of specialist LD services than integrated with generic mental health services. LD services were rated as more accessible and more available than generic mental health services. Clinicians agreed about the important elements of psychiatric assessment, treatment and their preference for using the ICD–9 and ICD–10 diagnostic classifications. The planning, delivery and evaluation implications for psychiatric services for adults with LD are outlined.
Consent to treatment
Authors: Davies Teifion
Published: October 2008

The legal and moral status of the concept of consent are examined. The notion of informed consent as the sole basis for acceptable treatment is found to raise moral difficulties and to have potentially damaging side-effects on the relationship between doctors and patients. It is argued that developing trust between doctor and patient is crucial to obtaining valid consent.