bluuebunny/crossref_metadata_2025 huggingface dataset:
Distinct transcriptional MYCN/c-MYC activities are associated with spontaneous regression or malignant progression in neuroblastomas
Authors: Westermann Frank , Muth Daniel , Benner Axel , Bauer Tobias , Henrich Kai-Oliver , Oberthuer André , Brors Benedikt , Beissbarth Tim , Vandesompele Jo , Pattyn Filip , Hero Barbara , König Rainer , Fischer Matthias , Schwab Manfred
Published: October 2008

Background

Amplified MYCN oncogene resulting in deregulated MYCN transcriptional activity is observed in 20% of neuroblastomas and identifies a highly aggressive subtype. In MYCN single-copy neuroblastomas, elevated MYCN mRNA and protein levels are paradoxically associated with a more favorable clinical phenotype, including disseminated tumors that subsequently regress spontaneously (stage 4s-non-amplified). In this study, we asked whether distinct transcriptional MYCN or c-MYC activities are associated with specific neuroblastoma phenotypes.

Results

We defined a core set of direct MYCN/c-MYC target genes by applying gene expression profiling and chromatin immunoprecipitation (ChIP, ChIP-chip) in neuroblastoma cells that allow conditional regulation of MYCN and c-MYC. Their transcript levels were analyzed in 251 primary neuroblastomas. Compared to localized-non-amplified neuroblastomas, MYCN/c-MYC target gene expression gradually increases from stage 4s-non-amplified through stage 4-non-amplified to MYCN amplified tumors. This was associated with MYCN activation in stage 4s-non-amplified and predominantly c-MYC activation in stage 4-non-amplified tumors. A defined set of MYCN/c-MYC target genes was induced in stage 4-non-amplified but not in stage 4s-non-amplified neuroblastomas. In line with this, high expression of a subset of MYCN/c-MYC target genes identifies a patient subtype with poor overall survival independent of the established risk markers amplified MYCN, disease stage, and age at diagnosis.

Conclusions

High MYCN/c-MYC target gene expression is a hallmark of malignant neuroblastoma progression, which is predominantly driven by c-MYC in stage 4-non-amplified tumors. In contrast, moderate MYCN function gain in stage 4s-non-amplified tumors induces only a restricted set of target genes that is still compatible with spontaneous regression.
Improved genome assembly and evidence-based global gene model set for the chordate Ciona intestinalis: new insight into intron and operon populations
Authors: Satou Yutaka , Mineta Katsuhiko , Ogasawara Michio , Sasakura Yasunori , Shoguchi Eiichi , Ueno Keisuke , Yamada Lixy , Matsumoto Jun , Wasserscheid Jessica , Dewar Ken , Wiley Graham B , Macmil Simone L , Roe Bruce A , Zeller Robert W , Hastings Kenneth EM , Lemaire Patrick , Lindquist Erika , Endo Toshinori , Hotta Kohji , Inaba Kazuo
Published: October 2008

Background

The draft genome sequence of the ascidian Ciona intestinalis, along with associated gene models, has been a valuable research resource. However, recently accumulated expressed sequence tag (EST)/cDNA data have revealed numerous inconsistencies with the gene models due in part to intrinsic limitations in gene prediction programs and in part to the fragmented nature of the assembly.

Results

We have prepared a less-fragmented assembly on the basis of scaffold-joining guided by paired-end EST and bacterial artificial chromosome (BAC) sequences, and BAC chromosomal in situ hybridization data. The new assembly (115.2 Mb) is similar in length to the initial assembly (116.7 Mb) but contains 1,272 (approximately 50%) fewer scaffolds. The largest scaffold in the new assembly incorporates 95 initial-assembly scaffolds. In conjunction with the new assembly, we have prepared a greatly improved global gene model set strictly correlated with the extensive currently available EST data. The total gene number (15,254) is similar to that of the initial set (15,582), but the new set includes 3,330 models at genomic sites where none were present in the initial set, and 1,779 models that represent fusions of multiple previously incomplete models. In approximately half, 5'-ends were precisely mapped using 5'-full-length ESTs, an important refinement even in otherwise unchanged models.

Conclusion

Using these new resources, we identify a population of non-canonical (non-GT-AG) introns and also find that approximately 20% of Ciona genes reside in operons and that operons contain a high proportion of single-exon genes. Thus, the present dataset provides an opportunity to analyze the Ciona genome much more precisely than ever.
The provision of psychiatric treatment for mental health colleagues in the new market economy
Authors: Brown Ray , Russell Hilary
Published: October 2008

This article outlines a problem in the referral pattern for mental health workers on the Isle of Wight, when they require psychiatric or psychological help. The authors are concerned that treatments are offered by colleagues. A survey undertaken of 12 community mental health units in Wessex seems to indicate that there are no dear policies or financial arrangements for referrals to other units. The authors agree that the treatment of mental health workers everywhere may be compromised in the market economy, if trusts start to function, because of economic pressures, as islands.
Supervision registers
Authors: Holloway Frank
Published: October 2008

With the possible exception of the proposed supervised discharge, the supervision register is the most controversial current government initiative within the mental health field. This paper presents both the guidance issued by the NHS Executive and the concerns that the psychiatric profession has expressed. Time will tell whether the supervision register turns out to be a visionary policy that successfully allays public concerns over community care or an example of a bureaucratic response to an issue of inadequate resources.
How do clinicians choose antidepressants?
Authors: Macpherson Rob , Robson Ed
Published: October 2008

A survey of the prescribing practice of a group of psychiatrists working in a Bristol NHS trust found that their preferred choice of antidepressants was surprisingly similar, but reported doses of antidepressants often fell below generally accepted minimum levels. Clinicians used mainly newer antidepressants rather than tricyclics. The choice of antidepressant was based on side effect profile, overdose danger, training and personal experience of efficacy. Cost and drug company advertising had little effect on choice. Difficulties in involving depressed patients in treatment decisions are discussed.
Links between fund-holding general practices and mental health professionals
Authors: Mutale T. I. R.
Published: October 2008

A postal questionnaire was sent to a random sample of 300 fund-holding general practices. Respondents were asked to indicate if they had links with a psychiatrist, community psychiatric nurse or psychologist; 210 (70%) general practitioners returned completed questionnaires. Out of 210 practices 161 (77%) had links with at least one specialist mental health professional. Community psychiatric nurses had links with more practices than psychiatrists or psychologists. Problems with time or space made it difficult for practices to form links.
Adolescents with a learning disability
Authors: Brooks David , Bouras N.
Published: October 2008

The adolescents (n=57, age 13–19 years) attending the special schools for moderate and severe learning disabilities in a South East London health district and their families were assessed. The mothers of adolescents with severe learning disabilities in the transitional stage to adult services and development reported greater behaviour problems in their offspring, greater stress, more negative psycho-social family effects and more negative attitudes. Implications of the results for interventions, needs assessment and future research in family and adolescent functioning and the origins of psychiatric morbidity in young people with learning disabilities were discussed.
‘But will it satisfy Mrs Prosser from Pontlottyn?’
Authors: Shooter Michael
Published: October 2008

In April 1987, in a back-street bar in Cardiff, the rebel regime at Radio Wales were plotting a coup. Their secret weapon was a daily magazine programme of music and current affairs called Streetlife. The would-be front-men, Ray Gravell (British Lions centre) and Frank Hennessy (Cardiff-Irish folk singer) had just persuaded the Editor that it needed an ‘agony uncle'… when I walked in.
East and west, old and new: The College tour of Germany
Authors: Martin S.D. , Bende B. , Breitner B. , Laker M. , Leslie F.
Published: October 2008

German psychiatry is emerging from a black past to a challenging future. Under the Nazis it is thought that about 100,000 psychiatric patients were killed and 300,000 were compulsorily sterilised. Services for the mentally ill had also been adversely affected by two world wars and recession. For 50 years there was little progress. By the 1970s, the government and other institutions took more interest in mental health. Community facilities began to appear such as day centres. Long-stay patients are now being discharged from hospitals and asylums have closed in some states.
Psychiatric training
Authors: Dunn John
Published: October 2008

The arrangement of medical services in Brazil is more akin to that of the USA than the UK. Private practice predominates but with a safety net of state funded hospitals. The majority of doctors working in state hospitals have contracts for 20 hours per week and are very poorly paid and they often have two or three jobs to compensate. These usually include working in a private clinic for part of the week and perhaps doing a period of on-call at another hospital. Some state hospitals are unable to fill vacant posts and there are frequent television reports of casualty departments having to close due to a lack of medical staff.
[No Title]
Authors: Valmana A. , Potter M.
Published: October 2008

Sir: We welcome the recent Consensus Statement on the Use of High Dose Antipsychotic Medication (Thompson, 1994) but would welcome further guidance on the use of high dosages, particularly when polypharmacy is involved.
Lundbeck Teaching Fellowship
Authors: Cox John
Published: October 2008

Fellows and Members of the Royal College of Psychiatrists, working overseas, are invited to apply for a Teaching Fellow from the UK to come to their country to provide a course of teaching in a designated specialist psychiatric subject. Overseas Fellows and Members may suggest a named teacher, but more importance will be given to the topic of their choice than to any individual.
Recent government policy and legislation: an overview
Authors: Davies Sara , Peck Edward
Published: October 2008

There has been much recent government legislation affecting mental health services. Some relates to the delivery of general health and social services, of which mental health care forms only a part, and some specifically to the delivery of mental health care. The complex interplay of the legislation is explored and there are suggestions for the further involvement of psychiatrists.
Reflections on the teaching of systems thinking to psychiatric registrars
Authors: McFadyen Anne , Roberts Jane
Published: October 2008

Registrars in psychiatry do not routinely have the opportunity to learn about systems theory and its application to psychiatric practice. The authors describe their experience of organising and teaching a course on the application of systems thinking to psychiatry and family therapy. The trainees and their tutor welcomed the broad and interactive approach to teaching which was thought to be very relevant to training in all psychiatric sub-specialities.
An induction day for trainees in psychiatry
Authors: McLaren P. , MacDermott P. , Wood S.
Published: October 2008

The importance of thorough induction courses for junior doctors when they start new Jobs has been highlighted. This paper describes an induction course for trainees in psychiatry starting work in a community trust which included information on how to interact with the personnel department, on the services provided by the trust and on the organisation of education within the trust. The results of feedback from the trainees are presented showing that they found it a valuable experience.
The Health Service Ombudsman
Authors: Oswald R.A.
Published: October 2008

“We have no credibility”. That was the response of a woman with a mental illness who put a complaint to the Health Service Ombudsman. Unlike many – not just patients but also a significant number of NHS staff – she had heard that the Ombudsman could carry out a completely independent investigation of complaints although she was not clear about the extent of his jurisdiction. Some people feel intimidated when trying to take on what they see as a powerful and defensive NHS and others experience a sense of despair that because of their illness their concerns have no validity. Those providing care and treatment generally do the best they can to attain high professional standards but delivery does not always match expectations and the outcome can be a complaint. Services for the mentally ill are not immune from shortcomings and, if local management fails to satisfy the complainant, the Ombudsman can step in.
The role of the psychogeriatric day hospital
Authors: Rosenvinge H.P.
Published: October 2008

In the currant climate of the implications of the Community Care Act and health service reforms, defining the role and function of the psychogeriatric day hospital is crucial, particularly its distinction from day centre care. This paper describes this role and key issues in day hospital planning. It was presented to the Wessex Specialists in Old Age Psychiatry and accepted by them as a consensus document.
Child in-patient treatment and family relationships
Authors: Green Jonathan
Published: October 2008

Residential child psychiatry units inevitably offer a form of temporary parenting to their patients. This paper explores various effects of this ‘parenting’ task on the treatment process itself and on a unit's relationship with parents. The potent therapeutic opportunities as well as potential unwanted effects deriving from this role are described. An awareness of the processes involved along with appropriate case management can maximise the benefits and minimise the unwanted effects of this factor within in-patient treatment.
Are there really new clothes in the NHS wardrobe?
Authors: Forster D.P.
Published: October 2008

Much of psychiatric practice involves understanding a patient's perception of reality and the influences that may affect this perception, including those of the environment. In organisations, such as the National Health Service, the need for consensus and approval within the organisational culture and environment may influence the publicly expressed views of employees, a process encouraged by short-term contracts and performance related pay. This article briefly describes some diverse experiences relevant to interpreting the real and the apparent.
Lunar talk
Authors: Appleby Louis
Published: October 2008

It can't be easy being the answer to the world's most obvious quiz question but Buzz Aldrin, the second man on the moon, seems to take it in his stride. Or at least he does now – there was a time when drinking and disappointment made it hard to tell what he thought. According to One Small Step, a superb mini-series of documentaries put out by BBC2 in July to commemorate Apollo 11's historic landing 25 years ago, returning from the moon left him let down and lacking direction. But that was the aftermath of the mission as a whole, Aldrin insisted, and nothing to do with having to follow Neil Armstrong out of the lunar module.
The Sesquicentennial Celebration of the American Psychiatric Association
Authors: Brandon Sydney
Published: October 2008

The annual meeting of the American Psychiatric Association is always something of a jamboree but this year its Sesquicentennial Celebration (1844–1994), held in its birthplace Philadelphia PA, was especially splendid with a birthday gala held in the elegant and richly endowed Art Gallery. However, attendance at the Philadelphia meeting was disappointing with only 15,000 delegates.
Pseudopatients in pharmacies
Authors: Dunn John
Published: October 2008

In 1973 Professor D.L. Rosenhan published his classic paper ‘On Being Sane in Insane Places' (Rosenhan, 1973). In this study eight ‘normal’ researchers presented themselves on 12 separate occasions to a range of psychiatric hospitals in the USA. These ‘pseudopatients' complained of one symptom only, that of hearing a voice saying ‘empty’, ‘hollow’ and ‘thud’. No other psychiatric symptoms were described; the pseudopatients gave their own ‘normal’ personal histories and after admission to hospital the researchers ceased simulating any symptoms and apart from taking notes on their experiences acted normally.
Diary of an exam failure
Authors: Clifford Elizabeth
Published: October 2008

Should have noticed the portent of doom heralded by the fact that the results did not arrive in the post when everyone else's had. Should have noticed the warning signs when the man down the road knocked on the door holding a suspiciously fat-looking dog-eared envelope in his hand. Results delivered to the wrong address.
The market for a community rehabilitation service
Authors: Spurrell M.T. , Thomas C.S.
Published: October 2008

Fifty-two mental health workers in South Manchester were asked to complete a survey to try to identify patients with chronic mental health problems who would benefit from home-based rehabilitation. These patients were known to the services but were unwilling to attend activities in the day hospital or day centre or come into hospital for in-patient rehabilitation. Seventy per cent of the mental health workers who comprised psychiatrists, social workers and community psychiatric nurses completed the survey. Overall 68 patients were identified. Negative symptoms or defect state were the most frequently reported problems with difficulties with engaging or poor compliance being the next most frequently reported problem. There were some differences in the ranking of the order of problems by different professional groups.
Quality in a psychotherapy service
Authors: Denman F.
Published: October 2008

General audit of psychotherapy services is slowly becoming a more regular part of practice in psychotherapy departments. Parry (1992) in her key review article states that “unmonitored practice is no longer defensible”. Audit specifically targeted at the quality of psychotherapy performed has been recommended (Fonogy ft Higgitt, 1989) but it is not often reported in psychotherapy (although a notable exception is Feldman, 1992). The beneficial effects of an ad hoc audit of the quality of psychotherapy using tape recorded sessions are reported.
Organising induction courses in psychiatry
Authors: Slatford Ken
Published: October 2008

Induction courses can offer trainees many benefits. These include a feeling of being welcome, a sense of belonging, reduced anxiety and increased confidence about the work ahead. The benefits to services include increased morale and efficiency brought about the trainees' quick orientation to their clinical roles and the organisation of services. This article considers induction to a hospital unit, to a hospital, and to regional services.
Psychodynamic supervision for junior hospital doctors
Authors: McGinley Eileen , O'Reilly Josephine
Published: October 2008

This paper describes a supervision group for senior house officers which focused on the psychodynamics of their working relationships with patients. The SHOs worked in a variety of hospital specialties as well as general practice. The description includes details of how such a group was set up and some of the practical difficulties in maintaining the SHOs' attendance. Brief details are given of the types of cases the SHOs were most eager to discuss, and the nature of the leading anxieties connected with the cases. The SHOs found this type of supervision supportive and enlightening as they developed and improved their clinical skills.
Review of the early discharge summary in the Grampian area
Authors: Walker Shona A. , Eagles John M.
Published: October 2008

The psychiatric discharge summary is an important means of communication between general practitioners (GPs) and psychiatrists and invaluable in the continuity of patient care. The early discharge summary therefore needs to provide relevant information for GPs during this vulnerable period. We surveyed GPs in the Grampian area in order to obtain information felt to be most relevant and the results were incorporated into a new semi-structured format which is now currently being used in the Grampian area.
Patients or clients? – a hospital survey
Authors: Upton Mark W.M. , Boer G. Harm , Neale Alastair J.
Published: October 2008

The use of the term client, rather than patient, has become frequent in psychiatric hospitals. There is little evidence to justify this change, so this study surveyed the views of the in-patients in a community based psychiatric hospital to establish the term they prefer. It concludes that a dear majority of people admitted to a psychiatric hospital think of themselves as patients, not clients.
The Mental Illness Specific Grant in Scotland
Authors: Coia D.A. , McKillop A. , McCreadie R.G.
Published: October 2008

Our objectives were to identify and assess the services provided by the Mental Illness Specific Grant in Scotland and to determine whether they meet government aims for the grant. Scottish Office information proved to be inaccurate on what projects are funded and currently running. Slippage was common with 39% of projects failing to start in Year 1 and 23% in Year 2. The grant appears to have funded easy option services, self-help, drop-in, which are less expensive and only require short-term planning. Despite being given priority by the Scottish Office, housing, supported accommodation and occupation remain unmet needs.
Fund-holding and commissioning general practitioners
Authors: Kendrick Tony
Published: October 2008

General practice fund-holders purchase secondary care for their patients directly, encouraging competition between providers. The scheme now includes almost all community mental health services. Practice counsellors may now be funded from secondary care budgets. Fund-holders may use their purchasing power to influence out-patient policies, have consultant sessions in their surgeries, gain direct referral to community psychiatric nurses, resist sectorisation, or change to a different provider altogether. The implications for mental health teams and their patients are discussed. Mental health workers must define their roles very dearly, and get involved in negotiating contracts now, to influence future service provision.
Ethical dilemmas in drug treatments
Authors: Tyrer Peter , Smith Jeanette , Adshead Gwen
Published: October 2008

A 45-year-old woman with a long history of schizoaffective symptoms associated with disruptive and antisocial behaviour refused to cooperate with out-patient treatment and particularly medication, having developed a strong distrust of psychiatrists. After discussions with the multidisciplinary team, the psychiatrist agreed to share treatment decisions with the patient and accepted her refusal of medication. This course of action is not always comfortable for professionals, especially when a patient challenges clinical judgement. However, this case illustrates how, by adopting a less paternalistic approach, the therapeutic alliance developed and, most importantly, the patient's health improved. The scenario described raises similar issues to those explored in the play Whose Life Is It Anyway?
Mental disorder and driving
Authors: Lawrie Andrew , Milne Steven
Published: October 2008

A one day census of patients on the acute wards at a psychiatric hospital revealed that approximately 40% of in-patients were holders of driving licences and that the majority of them would be affected by the current regulations regarding fitness for driving. Despite this, few patients could recall being given medical advice regarding their driving. In only one case was any advice documented in the case-notes. Psychiatrists' responsibility for ensuring that patients are given appropriate information regarding the effects of their illness or medication on their driving performance is discussed.
A survey of referrals to a special hospital (Rampton Hospital)
Authors: Close A.A. , Larkin E.P.
Published: October 2008

The three special hospitals of England and Wales are provided for patients subject to detention on account of their dangerous, violent or criminal properties. Special hospital psychiatrists cannot admit patients directly to hospital – the psychiatrist's recommendations can be overturned by a local admissions panel. A two year retrospective study in Rampton Hospital compared the outcomes of the psychiatrists' recommendations to admit or not to admit, with the decisions of the local admissions panel. There was complete agreement in over 90% of cases. This survey lends support to the view that special hospital psychiatrists could admit patients directly to hospital.
Continuing medical education
Authors: Tait David
Published: October 2008

Continuing medical education (CME), or continuing professional development, will now receive special attention in the Psychiatric Bulletin (Kerr, 1994). A report from the Special Committee (of Council) on CME examining consultant psychiatrists' experiences and opinions on CME has already been published (Sensky, 1994). Two further aspects of the work of the Committee are now reported.
Direct consultant supervision of higher trainees in child and adolescent psychiatry
Authors: Kingsbury Stephen , Allsopp Mark
Published: October 2008

Higher trainees in child and adolescent psychiatry and their consultant trainers reported high levels of compliance with existing JCHPT guidelines on the structure of direct supervision. There was a consensus about the ideal content of supervision sessions but disparity about whether this is achieved in practice and over issues of responsibility for raising certain topic areas. These findings are discussed and some questions to be addressed by trainee and trainer at the outset of the supervision process are suggested.
The cost of Mental Health Review Tribunals
Authors: Blumenthal Stephen , Wessely Simon
Published: October 2008

There has been a substantial increase in the number of Mental Health Review Tribunals (MHRTs) and hence the cost of administering the tribunal system. We report an estimate of the cost of MHRTs taking account, for the first time, of both direct and indirect costs to the various government departments. We estimate that the total cost is currently £12,274,380 per annum.
Consent to emergency detention in Edinburgh
Authors: Deering Alistair
Published: October 2008

Circumstances surrounding emergency detention under the Mental Health (Scotland) Act were examined, with particular regard to whether consent was obtained from a third party. Twenty-eight ot 100 consecutive detentions occurred without consent. These patients were more likely to exhibit aggressive behaviour and be detained by a psychiatric registrar or senior registrar. Mental disorder was doubted more often and detention was less often continued. Reasons given for failing to obtain consent were frequently inadequate and possible explanations are discussed. Increased education and supervision of trainees resulted in a substantial fall in cases of non-consent in a follow-up sample.
Special Committee on Continuing Medical Education
Authors: Tait David
Published: October 2008

The idea for this committee of Council came from Professor Andrew Sims when President of the College. A Working Group of the Education Committee produced a report on continuing medical education (CME) and the first meeting was held in February 1992 under the chairmanship of Dr Fiona Caldicott, then Dean. Following her election to the Presidency in 1993 Professor Sims took on the chairmanship and the committee has now met ten times to date.
Psychological treatments course for senior registrars in child psychiatry
Authors: Etchegoyen Alicia , Cassell Diana
Published: October 2008

We have written this paper trom the perspective of a trainer and a trainee who have each participated in the psychological treatments course run for senior registrars training in child psychiatry on the North West Thames Rotation. The course aims to provide senior registrars with an integrated training in the three major psychological therapies: systemic family therapy, cognitive-behavioural and psychodynamic therapy. It was hoped that, by the end of the course, trainees would have a good theoretical and clinical grounding in each model at a medium level of expertise.
Perception of equivalent doses of neuroleptic drugs
Authors: Mullen R. , Caan A.W. , Smith S.
Published: October 2008

An anonymous questionnaire was sent to 67 senior and junior psychiatrists enquiring about their perception of equivalent antipsychotic dosages of three commonly used neuroleptic drugs. Thirty-one questionnaires were returned and revealed a wide variation in perceived potencies for the specific drugs. Increased experience in psychiatry was not associated with a decreased variation. On average clinicians saw haloperidol and flupenthixol decanoate as substantially less potent, relative to chlorpromazine, than the available literature would suggest.
The attitudes of psychiatrists to philosophy
Authors: Fulford K.W.M. , Adshead G.
Published: October 2008

Questionnaires exploring the attitudes of psychiatrists to philosophy were distributed at two meetings of the Royal College of Psychiatrists. Out of a possible 240, 126 questionnaires were returned (53%). The results showed a surprisingly high level of interest in and support for philosophy. Over 50% of respondents indicated that they considered conceptual analysis, ethics, jurisprudence, the philosophy of science and the philosophy of mind to be practically important in psychiatry. Similarly, 89% believed that ethics, and 72% that other areas of philosophy, should be included in the MRCPsych syllabus. The significance of the study is reviewed briefly.
European Union government legislation affecting psychiatric practice
Authors: van Os Jim , Neeleman Jan
Published: October 2008

Although the process of psychiatric reform is taking place across Europe, national political, economic and historical factors determine to a large extent the manner and pace of its implementation as well as its final shape. The degree of centralisation of health care systems and the degree of prominence of primary care affect how efficiently change can be achieved. Various forms of professional resistance may, in different degrees in European countries, hamper the implementation of community care. The widely varying contexts in which psychiatric reform takes place throughout Europe, should provide a fertile area for future comparative research.
The Calman Report: does training matter to trainees?
Authors: Evans Mark , Johnson Christine
Published: October 2008

One hundred and fourteen psychiatric trainees in the South Western region were canvassed by questionnaire concerning their knowledge of and attitudes towards the recommendations of Caiman Report, (DOH, 1993). Of the 78% of senior registrars and 80% of registrars who replied, the majority knew of the major recommendations mainly from reading articles and talking to colleagues. The 50% response rate from the senior house officers perhaps reflected a lack of knowledge and an erroneous perception that the report was of less relevance to them. The article reports responses to both structured questions concerning the facts, and comments received on more controversial aspects.
Not so smart drugs
Authors: McKenzie Kwame
Published: October 2008

Dr Kwame McKenzie of the Institute of Psychiatry contrasts the publicity and the evidence behind drugs that are claimed to make us brighter.
Supervision of trainees
Authors: Herriot Peter , Bhui Kamaldeep , Lelliott Paul
Published: October 2008

The Royal College of Psychiatrists specifies that supervision of trainees is the single most important ingredient of training. This paper reports the results of a pre-audit survey about trainee supervision. Eighty-three per cent of consultants (n=52) and 67% of trainees (n=51) responded to a 21-item Likert questionnaire. There was unanimous agreement for seven items. A significant number of consultants and trainees were dissatisfied with the existing arrangements despite the majority being involved in weekly supervision. The minimum standards proposed served as the basis for providing guidelines against which practice may be audited.
Processing and assessing psychiatric referrals
Authors: Naik Prakash , Lee Alan
Published: October 2008

Referrals from general practitioners to a sectorised mental health team were audited for time delays and quality over three months. A referrers' guide was then designed to reduce referral delays and improve their quality. This was sent to all GPs. Referrals were again audited over two three month periods. There was no significant difference between corresponding time delays in the three periods. Only one item, the presence or absence of past history, was significantly improved in the third period. These results and their implications are discussed.
MCQ technique
Authors: Dalal Brian
Published: October 2008

Candidates taking multiple choice question (MCQ) examinations are often unsure of the best strategy to use when uncertain of the answer to a question. Some authorities advocate a cautious ‘never guess' strategy and others suggest a bold ‘guess everything’ approach. In this study, candidates who had taken a MCQ paper were asked to go back and guess the questions initially marked ‘don't know’. The resultant ‘guess scores' ranged from −0.6% to 6%. It was concluded that many candidates could substantially increase their scores by adopting a bolder approach. It is proposed that the guess score is a useful measure of the effectiveness of the candidate's MCQ technique.
What the papers say
Authors: Scott Jan
Published: October 2008

Professor Jan Scott conducts a prospective survey of the ways psychiatry is presented in the media.
Lunacy in the Stoke-upon-Trent workhouse 1834–1900
Authors: Myers Edward
Published: October 2008

The New Poor Law Amendment Act of 1834 led to the admission of considerable numbers of pauper “lunatics, idiots and imbeciles” to parish workhouses. The Stoke-upon-Trent workhouse, erected in 1832, had progressively to increase its accommodation for this class of inmate who, by 1899, numbered about 100. Brief details are given of nursing staff and of improvements in conditions of care following recommendations of the Lunacy Commissioners. Primary sources of information are indicated and emphasis is laid on the importance for the history of English psychiatry of documenting the care of the mentally ill and mentally impaired in Union workhouses.
Consultant-liaison psychiatrists and euthanasia in the Netherlands
Authors: Huyse Frits J. , van Tilburg Willem , Klijn Ine , Casteelen Gertie
Published: October 2008

On 30 November 1993 a nine year political debate on euthanasia closed; the first chamber of the Dutch parliament ratified the law on undertaking, including euthanasia regulations. This political step concluded, for the time being at least, a legal, public, political and medical debate, which started in 1973, when a medical doctor was convicted for performing euthanasia on her mother. In a first effort in 1983, parliament failed to legalise euthanasia. In 1989 a new government introduced an initiative to improve the existing law in this regard. As a part of the process, empirical data on the extent of euthanasia in The Netherlands were required. Therefore, the Minister of Justice installed a committee. Its findings have been reported nationally and internationally (van der Maas et al, 1991a, 1991b); about 2,300 euthanasia cases in 1990, being 1.8% of all deaths. These empirical findings reduced the uncertainties about the extent of euthanasia, thereby providing a sound basis for the parliamentary decision-making process. Although by the current law euthanasia and assisted suicide still remain illegal, under strict guidelines for behaviour provided by the Ministry of Justice in November 1990 and distributed among physicians in January 1991, euthanasia can be exempted by the public prosecutor from criminal punishment on the basis of the ‘opportunity’ principle, this being the opportunity for the public prosecutor not to bring all reported crimes to court (Letter of the Minister of Justice to Parliament, 1990).
Mental cultivation (meditation) in Buddhism
Authors: Dwivedi Kedar Nath
Published: October 2008

Buddhism started in India in the 6th century BC. It is not a faith, but a way of life that includes maintaining virtuous and moral conduct (Sila), improving the concentration of the mind (Samadhi) and developing insight or wisdom (Panna).
The health service contacts of 87 suicides
Authors: Evans Josie
Published: October 2008

The Health of the Nation asserts that the suicide rate in England and Wales can be reduced by the provision of better health care services. In a sample of suicides in one district health authority, 61% had had contact with health services during the year prior to death, suggesting that improvements in these services could have an impact on the overall suicide rate. However, the proportion who had had prior contact varied between different age and sex groups and individuals in groups with the higher suicide rates tended to have the least contact. Therefore, the impact of health service improvements on the overall suicide rate may be limited.
Publication by junior doctors: why do they do it?
Authors: Duffett Richard
Published: October 2008

This paper examines the experience and motivation of junior doctors who successfully published in the Psychiatric Bulletin and The British Journal of Psychiatry, over a four month period. Most articles took over a year from first involvement to successful publication, although this varied according to the type of article. While having published is recognised to increase the likelihood of appointment to registrar and senior registrar posts, interest in the subject is frequently cited as a more important reason to publish among authors than enhancement of their curriculum vitae.
The place of the psychiatrist in the new undergraduate medical curriculum
Authors: Sensky Tom
Published: October 2008

This paper summarises some of the key points raised at a workshop held in 1993 on the new undergraduate medical curriculum. At the workshop, the General Medical Council's recommendations were summarised, and examples were presented of current undergraduate courses which met them. There was widespread support among workshop participants for psychiatrists having an expanded role in the new curriculum, beyond a single clinical attachment, particularly in the teaching of communication skills and in collaborative teaching with other medical specialties.
Killers and victims
Authors: McKenzie Kwame
Published: October 2008

At a time when children who kill are in the news, a play at London's Cockpit Theatre portrays their disaffected world. Kwame McKenzie reviews.
A visit to Argentina
Authors: McClelland Roy
Published: October 2008

Argentina, a country about the size of Europe, has a population of approximately 30 million people. Over 80% of the inhabitants occupy the few large cities. About 12 million people live in the neighbourhood of the capital, Buenos Aires. Unlike many other South American countries, it has a large middle-class population and a well developed social infrastructure and industry. However, the country has been the subject of considerable political instability with many recent changes in government including several revolutions. These have resulted in many changes of leaders of institutions including senior members of the medical profession. Psychiatry has been particularly vulnerable because of its social identity and social function. As a consequence most of the leaders of psychiatric institutions and services, including the Professor of Psychiatry, have been dismissed from office following changes in government. This has greatly impeded the development of psychiatric services and academic psychiatry. Despite many natural resources, the political upheavals have resulted in a considerable weakening in the economy with inevitable consequences on the funding of health care and the universities and the creation of a large poverty trap for the most vulnerable.
Response from Professor R.G. Priest
Authors: Priest R.G.
Published: October 2008

Jadhav & Littlewood make some interesting and thoughtful points, but I cannot agree with some of their syllogisms. I certainly do not sympathise with the pejorative tone of their comments (“to mount a glossy [sic] campaign … is frankly disturbing”) nor accept what appears to be their principal conclusion that “the proposed educational programme is premature”.
Innocent bystanders?: observation in psychotherapy
Authors: Dorkins Eluned , Aylard Paul
Published: October 2008

We describe the operation of a psychotherapy clinic where a one-way screen is used in the assessment of adults for a range of dynamic therapies. While observation of psychotherapeutic encounters remains contentious as an activity in its own right, we attempt to illustrate how such a way of working can be helpful to patients and staff. The potential drawbacks of this approach are discussed and ways of minimising these are explored.
How to do a research fellowship in psychiatry in the USA
Authors: Flaithbheartaigh Séamus Ó
Published: October 2008

This article offers suggestions to psychiatric trainees who might be interested in spending a period of training in the USA, including ideas about employment, qualifications, differences in practice, and useful addresses and sources of information.
Involuntary community treatment in New South Wales, Australia
Authors: Hambridge John , Watt Nicola
Published: October 2008

The New South Wales Mental Health Act (1990) heralded a number of important changes to mental health legislation in the state. One of these was the option to give compulsory treatment to mentally ill clients living in the community. This article briefly explains community treatment under the Act, and the perceived benefits and the limitations of such legislation. A case example is used to illustrate some of these points. Involuntary community treatment is seen as a less restrictive alternative to hospitalisation for a number of mentally ill clients, but the use of such provisions demands significant resources from the supervising agency.
Psychiatry in Libya: eastern region
Authors: El-Badri Selim M.
Published: October 2008

Libya occupies an approximate area of 1.8 million sq. km in the northern part of Africa, with a population of 4.5 million. of the population, 97% are Muslims, 46.5% are under 15 years and only 2.3% are over 65 years of age. Sixty-four per cent of the population live in urban areas and the literacy rate is 60%. Tripoli, situated in the west, is the capital city of Libya and Benghazi, the second biggest city, is situated in the east of the country and the distance between the two cities is about 1000 km. The population of Benghazi and eastern Libya is about 2 million.
The Sainsbury Mental Health Initiative Awards
Authors: Davies Sara
Published: October 2008

In February 1994 the Sainsbury Mental Health Initiative was launched by the Sainsbury Centre for Mental Health (formerly Research and Development for Psychiatry) in conjunction with the Department of Health and the Welsh Office to make available £3 million for selected community based mental health services. On 10 October 1994, as part of the World Mental Health Day, the eight winners were announced and invited to receive their awards at a prestigious ceremony attended by the Secretary of State for Health and many of the great and good from the British mental health scene.
Social deprivation, ethnicity and violent incidents on acute psychiatric wards
Authors: Sheehan John D. , Hardie T. , Watson J. P.
Published: October 2008

A retrospective comparative study of violent incident forms covering the acute general adult wards at a London teaching hospital and a district general hospital was performed. Although no significant difference was observed between the overall rates of reported violent incidents, there was a significant increase in the proportion of violent incidents directed at persons in the inner city hospital. Grade 3 incidents were rare. Caribbean patients were over-represented among the perpetrators.
Reducing violence on a secure ward
Authors: Mortimer Ann
Published: October 2008

Prediction of in-patient psychiatric violence is difficult: longitudinal appraisal during environmental change may identify Influential factors. Incidents on a secure ward fell substantially in number and severity over 31 months during which staff were trained in control and restraint techniques (CAR) and a monthly audit of incidents was carried out. A few patients caused many incidents. Women were disproportionately violent: both sexes preferred a victim of the same gender. Most incidents occurred in clusters by the same patient. Perceived antecedents were patients' psychosis, inadequate CAR and other staff. Increasing C&R staff was the only factor associated with reducing violence. Patients attacked each other rather than nurses as violence decreased.
The changing role of Ards Mental Health Day Hospital
Authors: Harbinson Helen J.
Published: October 2008

There has been a great deal of debate and uncertainty about the role of day hospitals. The current emphasis is on their use as an alternative to acute-in-patient care. There are, however, difficulties with this approach. This paper looks at developments in service provision in a day hospital in Northern Ireland, where the focus is on multidisciplinary assessment and group and sessional treatment, rather than day care.
[No title]
Authors: Singh Swaran P.
Published: October 2008

Depression is the commonest psychiatric disorder in the industrialised world. Many patients are now diagnosed and treated with effective antidepressants by primary care physicians. A large proportion of depressed individuals fail to reach their premorbid level of functioning following a course of treatment; estimates vary from 10% to 30% (Nierenberg & Amsterdam, 1990). These individuals require a major input from the services and suffer prolonged distress, with many adverse personal, social and economic consequences.
Continuing educational forum in psychogeriatrics for professional carers in the community
Authors: Cybulska E.
Published: October 2008

It has been common knowledge that professional carers in the community, institutions, and perhaps also in hospitals lack appropriate training in issues related to mental health problems in the elderly. Many crises in the community appear to be precipitated not so much by the gravity of the problems the elderly pose, but by panic or the fear of the unknown among the carers. Arie et al (1985) postulate that the joint teaching of different professions can be a fruitful training for subsequent team work, while Beynon & Croker (1983) reported that shared tutorials in geriatrics at the Middlesex Hospital in London were very successful. The negative features of institutionalised care can be counteracted through training and management (Wilkin et al, 1985).
Subtle thought disturbance in schizophrenia
Authors: Rollin Henry R.
Published: October 2008

Thought disorder, perhaps the most telling symptom of schizophrenia, presents itself in an infinite variety of ways. This ranges from unintelligible gibberish on the one hand to far more subtle disturbances on the other, disturbances which in other circumstances might be construed as examples of donnish games with twisted logic. Here is one that sticks in my memory.