bluuebunny/crossref_metadata_2025 huggingface dataset:
Atypical Benign Epilepsy of Childhood With Rolandic Spikes
Authors: Al-Twaijri W.A. , Shevell Michael I.
Published: May 2008

The objective of this study was to compare the clinical and electrographic features of two groups of children with benign epilepsy of childhood with rolandic spikes: those in whom seizure control was attained either without the use of medication or with a single medication (group1) and those requiring two medications for seizure control (group 2). A consecutive series of children with benign epilepsy of childhood with rolandic spikes were identified in a single pediatric neurology practice. Medical charts were then systematically retrospectively reviewed. A total of 66 children with benign epilepsy of childhood with rolandic spikes were identified; 52 (78.8%) required either no medication ( n = 7) or a single medication ( n = 45) for seizure control, whereas 14 (21.2%) required two medications. The two groups did not differ with respect to gender, age of onset, type (generalized or partial) of initial seizure, or whether EEG abnormalities were unilateral or bilateral. They did differ significantly with respect to the mean number of seizures experienced prior to initiating treatment (group 1, 2.06, versus group 2, 4.36; t = 3.40, P = .005). In those treated ( n = 59), the initial medication selected (carbamazepine versus noncarbamazepine) in the two groups was significantly different: group 1, 40 (carbamazepine)/45, versus group 2, 9 (carbamazepine)/14; χ 2 = 4.59; P = .03. The difference in frequency between the two groups of associated comorbid conditions (tics, attention-deficit hyperactivity disorder [ADHD], learning disability) almost reached the threshold of statistical significance: group 1, 7/52, versus group 2, 5/14 (χ2 = 3.67, P = .06). A subset of children with benign epilepsy of childhood with rolandic spikes may require more than one medication for effective seizure control. This subset experiences more seizures prior to the initiation of treatment, is more likely to be treated initially with a noncarbamazepine medication, and tends to have a higher frequency of associated conditions. ( J Child Neurol 2002; 17: 900—903).
Congenital Microcephaly in Two Infants With the Factor V Leiden Mutation
Authors: Voudris Konstantinos A. , Skardoutsou Angeliki , Vagiakou Eleni A.
Published: May 2008

Two infants with congenital microcephaly associated with the factor V Leiden mutation are described. In both cases, brain magnetic resonance imaging (MRI) revealed cerebral atrophy and porencephalic cystic lesions, which were probably attributable to prenatal cerebral vascular events. These findings suggest that assessment for this mutation is an important part of the evaluation of infants with unexplained congenital microcephaly, especially in cases with infarcts and/or porencephalic cysts on brain MRI. ( J Child Neurol 2002;17:904—906).
Experiences of College Students With Disabilities and the Importance of Self-Determination in Higher Education Settings
Authors: Getzel Elizabeth Evans , Thoma Colleen A.
Published: May 2008

Although the literature is clear that self-determination is an important component of the transition planning process for students with disabilities preparing for postsecondary education, further studies are needed to explore what self-determination strategies these students use to remain in college and successfully meet the challenges in postsecondary education settings. This article describes a study conducted with postsecondary education students in 2- and 4-year college settings to (a) identify skills that effective self-advocates use to ensure they stay in college and obtain needed supports and (b) identify the essential self-determination skills needed to remain and persist in college. Findings from the study and implications for postsecondary education and secondary education are discussed.
Civil Protective Order Outcomes
Authors: Logan TK , Walker Robert
Published: May 2008

This study examined protective order (PO) outcomes for a period of 12 months for 698 women from multiple jurisdictions. Overall, results indicate that 2 out of 5 women did not experience violence after the PO was issued; however, 3 out of 5 women did experience ongoing violence. Two key risk factors were associated with PO violations and are examined. Further, only 9% of women dropped the order, and the vast majority of women perceived the PO was effective and that they felt safe. Results from this study suggest that POs are an important avenue for women's safety. However, results also suggest that PO effectiveness can be increased by attending to specific risk factors, crafting POs to meet individual needs, and by appropriate enforcement.
Interest Profile Elevation, Big Five Personality Traits, and Secondary Constructs on the Self-Directed Search
Authors: Bullock Emily E. , Reardon Robert C.
Published: May 2008

The study used the Self-Directed Search (SDS) and the NEO-FFI to explore profile elevation, four secondary constructs, and the Big Five personality factors in a sample of college students in a career course. Regression model results showed that openness, conscientiousness, differentiation high-low, differentiation Iachan, and consistency accounted for significant variance in profile elevation. A significant correlation was found between profile elevation and extroversion. A unique relationship between the two measures of differentiation and profile elevation was found. A multi-variate analysis of variance and orthogonal contrasts, using the five personality factors as dependent variables and profile elevation as the independent variable, was conducted as a partial replication of an earlier study. The findings provide potential interpretive ideas for a therapist using the SDS and suggest that profile elevation explains some aspects of a client's results not accounted for by the other secondary constructs.
Space, Großraum and Mitteleuropa in Some Debates of the Early Twentieth Century
Authors: Chiantera-Stutte Patricia
Published: May 2008

The idea of Mitteleuropa began to gain momentum in the German geopolitical science of the beginning of the twentieth century. German geopolitics, which became famous through the works of Karl Haushofer, had set out a geographical and political notion of Mitteleuropa that supported a political project based on German expansion. As such, Mitteleuropa developed as both a political and scientific concept, a project and a `reality'. With an analysis of the core elements defining the term Mitteleuropa one can begin to appreciate the characteristics that differentiate it from other geographical concepts, as well as the features which some conservative authors have promoted following the geopolitical scientists. As a `geopolitical idea', Mitteleuropa can be shown to designate a way of understanding politics, nature and culture, or more specifically, their relationship.
Mitteleuropa and the European Heritage
Authors: Vidmar-Horvat Ksenija , Delanty Gerard
Published: May 2008

The political significance of Mitteleuropa has grown in that much of it is now within the EU. Mitteleuropa is a discourse; it is not just a semantic term or a label to refer to a geopolitical region in which power and culture are interwined. Although people may identify with it, it is not primarily a term of identity but a cultural mode of interpretation. It can be called, along with other concepts of Europe, a conflicting field of interpretation. The concept reflects a civilizational context based on imperial models of modernity and cosmopolitan cultural resonances. Europe is an ongoing cultural battleground and the idea of Mitteleuropa is a reminder of a shift to the margins and the emergence of a multiperspectival Europe along with new notions of geopolitical space and historical-time consciousness.
The management of Clostridium difficile infection: using small-scale audit to indicate the knowledge of nursing and medical staff in an acute hospital setting
Authors: Madeo Maurice , Owen Elizabeth , Baruah Joy
Published: May 2008

An audit was undertaken in a large teaching hospital to assess the knowledge of healthcare workers about the management of patients with Clostridium difficile. One hundred and four questionnaires were completed by nurses (n = 46) and medical staff (n = 58). Knowledge on the microbiology of C. difficile appeared to be superior in medical staff, although nurses had more awareness of decontamination issues. The sampling strategy and definition of diarrhoea were found to be areas of poor knowledge as was the ability to identify the main route of spread of the bacterium.

This work resulted in a planned programme of interventions such as educational road shows, updating the C. difficile policy, increasing the stock of chlorine-based agents for cleaning, and the introduction of the Bristol stool chart. It is hoped that these interventions will have an impact on reducing the number of C. difficile cases.
Demystifying the Chameleonic Nature of Chinese Leadership
Authors: Canchu Lin
Published: May 2008

This article provides a survey of the scholarly literature on Chinese culture and leadership. Chinese culture has mainly been conceptualized as Confucianism, collectivism, and communist ideology in the literature. The influences and implications of each of the three value systems have been examined in the context of leadership practices. Future directions in this area of research have been discussed.
The Psychological Impact of Severe Hand Injury
Authors: GROB M. , PAPADOPULOS N. A. , ZIMMERMANN A. , BIEMER E. , KOVACS L.
Published: May 2008

The final outcome of severe hand injuries is not solely determined by the residual functional impairment, but is also a function of non-functional criteria, including the sequelae of the accompanying psychological trauma. This paper reviews the literature with respect to the psychological impact of severe hand injuries, including the special impact of amputations, adaptation processes, adaptation stages, prognostic criteria and aesthetic issues influencing the final individual outcome, including present recommendations for promoting a positive outcome. Motivated and psychologically stable people are reported to do well irrespective of the severity of a hand injury. In patients who find it difficult to cope mentally, successful treatment strategies have been proposed. Their implementation is in a constant state of evolution and includes not only improved surgical techniques and advanced pharmacological pain management but also early psychotherapeutic input and involvement of patients in decision making for treatment.
Intra-tendinous Gout in a Repaired Flexor Digitorum Profundus
Authors: SAINSBURY D. C. G. , HIDVEGI N. , BLAIR J. W.
Published: May 2008

A patient presented with decreased flexion and triggering following a zone IIc flexor digitorum profundus repair 7 years previously. Chalky-white deposits, confirmed histologically as gout, were present at the repair site.
Reduced-toxicity conditioning with fludarabine, BCNU, and melphalan in allogeneic hematopoietic cell transplantation: particular activity against advanced hematologic malignancies
Authors: Marks Reinhard , Potthoff Karin , Hahn Joachim , Ihorst Gabriele , Bertz Hartmut , Spyridonidis Alexandros , Holler Ernst , Finke Jürgen M.
Published: May 2008

Toxicity-reduced conditioning is being used for allogeneic stem cell transplantation in older and/or comorbid patients. We report on the treatment of 133 patients (median age: 55.6 years [23-73 years]) with acute myeloid leukemia (AML)/myelodysplastic syndrome (MDS; n = 81), myeloproliferative syndromes (MPS; n = 20), and lymphoid malignancies (n = 32) using conditioning with FBM: fludarabine (5 × 30 mg/m2), 1,3-bis(2-chloroethyl)-1-nitrosourea (or carmustine, BCNU; 2 × 200 mg/m2), and melphalan (140 mg/m2). Patients 55 years or older received fludarabine with reduced BCNU (2 ×150 mg/m2) and melphalan (110 mg/m2). After engraftment, chimerism analyses revealed complete donor hematopoiesis in 95.7% of patients. With a median follow-up of 58.5 months, 3- and 5-year overall survival (OS) was 53.0% and 46.1%, event-free survival (EFS) was 46.4% and 41.9%. No significant differences in OS and EFS were evident considering disease status (early vs advanced), patient age (<55 vs≥55 years), or donor type (related vs unrelated) in univariate and multivariate analyses. The cumulative 5-year incidence of death due to relapse was 20.1%. Nonrelapse mortality (NRM) after 100 days and 1 year was 15.8% and 26.3%. Among patients with AML/MDS, advanced cases (n = 64, including 61 with active disease) showed an OS of 44.6% and 42.4% after 3 and 5 years, respectively. Therefore, FBM conditioning combines effective disease control with low NRM.
Development of gene therapy for blood disorders
Authors: Nienhuis Arthur W.
Published: May 2008

The concept of introducing genes into human cells for therapeutic purposes developed nearly 50 years ago as diseases due to defects in specific genes were recognized. Development of recombinant DNA techniques in the 1970s and their application to the study of mouse tumor viruses facilitated the assembly of the first gene transfer vectors. Vectors of several different types have now been developed for specific applications and over the past decade, efficacy has been demonstrated in many animal models. Clinical trials began in 1989 and by 2002 there was unequivocal evidence that children with severe combined immunodeficiency could be cured by gene transfer into primitive hematopoietic cells. Emerging from these successful trials was the realization that proto-oncogene activation by retroviral integration could contribute to leukemia. Much current effort is focused on development of safer vectors. Successful gene therapy applications have also been developed for control of graft-versus-host disease and treatment of various viral infections, leukemias, and lymphomas. The hemophilias seem amenable to gene therapy intervention and informative clinical trials have been conducted. The hemoglobin disorders, an early target for gene therapy, have proved particularly challenging although ongoing research is yielding new information that may ultimately lead to successful clinical trials.
Characterization of immortalized MARCO and SR-AI/II-deficient murine alveolar macrophage cell lines
Authors: Zhou Hongwei , Imrich Amy , Kobzik Lester
Published: May 2008

Background

Alveolar macrophages (AM) avidly bind and ingest unopsonized inhaled particles and bacteria through class A scavenger receptors (SRAs) MARCO and SR-AI/II. Studies to characterize the function of these SRAs have used AMs from MARCO or SR-AI/II null mice, but this approach is limited by the relatively low yield of AMs. Moreover, studies using both MARCO and SR-AI/II-deficient (MS-/-) mice have not been reported yet. Hence, we sought to develop continuous cell lines from primary alveolar macrophages from MS-/-mice.

Results

We usedin vitroinfection of the primary AMs with the J2 retrovirus carrying thev-rafandv-myconcogenes. Following initial isolation in media supplemented with murine macrophage colony-stimulating factor (M-CSF), we subcloned three AM cell lines, designated ZK-1, ZK-2 and ZK-6. These cell lines grow well in RPMI-1640-10% FBS in the absence of M-CSF. These adherent but trypsin-sensitive cell lines have a doubling time of approximately 14 hours, exhibit typical macrophage morphology, and express macrophage-associated cell surface Mac-1 (CD11b) and F4/80 antigens. The cell lines show robust Fc-receptor dependent phagocytosis of opsonized red blood cells. Similar to freshly isolated AMs from MS-/-mice, the cell lines exhibit decreased phagocytosis of unopsonized titanium dioxide (TiO2), fluorescent latex beads and bacteria (Staphylococcus aureus) compared with the primary AMs from wild type (WT) C57BL/6 mice.

Conclusion

Our results indicated that three contiguous murine alveolar macrophage cell lines with MS-/-(ZK1, ZK2 and ZK6) were established successfully. These cell lines demonstrated macrophage morphology and functional activity. Interestingly, similar to freshly isolated AMs from MS-/-mice, the cell lines have a reduced, but not absent, ability to bind and ingest particles, with an altered pattern of blockade by scavenger receptor inhibitors. These cell lines will facilitatein vitrostudies to further define MARCO and SR-AI/II function, and may also be useful to identify other novel scavenger-type macrophage receptors and for additional studies of particle toxicology.
A Critique of the Report of the Committee of Inquiry, Warlingham Park Hospital
Authors: Glaister Brian
Published: May 2008

The Committee's terms of reference were ‘To inquire into the deaths by suicide of patients at Warlingham Park Hospital during 1974 and 1975 and to prepare a Report to the Area Health Authority on these and the wider significance in relation to psychiatric care facilities in Croydon.’ The 143-page Report (Committee of Inquiry, Warlingham Park Hospital 1976) is now being read by the local public who demanded the inquiry and by psychiatric hospital managers who expect to find causes and cures for suicides in their own hospitals. Unfortunately, the Report fails to reveal that the suicides were of doubtful significance; that the suggested causes are of even more doubtful validity; and that there was a period of abnormally low rate immediately prior to the period in question, the causes of which the Committee failed to investigate.
Experiences and Viewpoints of Psychotherapy Trainees
Authors: Tsoi Peter Ting-kwok , Lai Benjamin , Hong Kwai-wah
Published: May 2008

Psychotherapy is unpopular in Hong Kong for various reasons. There is a gross deficiency of psychiatrists in our population of five million, and individual psychotherapy, being time-consuming, is regarded as a luxurious treatment to be chosen as a last resort. Moreover, there seems to be some reluctance among psychiatrists to accept psychoanalytic theory as relevant to Chinese culture. Although experience in psychotherapy is regarded as essential in training, it has been difficult to learn psychotherapy in Hong Kong because good training programmes are impossible without the availability of qualified supervisors. In the past year, we have gone through a training programme in dynamic psychotherapy involving a series of seminars, individual supervisions and Balint groups. The programme was made possible by the joint efforts of the three senior lecturers in our Department, who all came from abroad and were experienced in teaching psychotherapy. We would like to report our experience of the training and give our viewpoints as trainees. It will be helpful to describe the training in stages which bear striking similarities to the actual psychotherapeutic processes of our patients.
Psychotherapy
Authors: Storr Anthony
Published: May 2008

On my retirement in the summer of 1984, Professor Gelder, in a generous valedictory speech, drew attention to the entry under my name in Who's Who. ‘You will notice’, he said, ‘that he has described himself as ‘Writer and Psychiatrist’, not ‘Psychiatrist and Writer’ The inference which Michael Gelder intended that his audience should draw is in fact justified. I have not whole-heartedly devoted myself to the practice of psychiatry to the exclusion of other pursuits; certainly not since I was 40, when my first book was published. I have contributed nothing to psychiatric research. If my psychiatric writings contain anything of value, it is because I have interleaved them with the fruits of reading from other disciplines.
Psychiatry in Ancient Egypt
Authors: Nasser Mervat
Published: May 2008

“No artist attains total excellence, but the strength of truth and justice is that it lasts and that man can say… this is the heritage of my father.”
Child Psychiatric Services in India
Authors: Bartlet L. B.
Published: May 2008

The evolution of general psychiatry in India has for many years followed the British pattern, stage by stage. Child psychiatry has followed much the same path and British influences are much in evidence.
A Psychotherapy Service
Authors: Reilly Stephen P.
Published: May 2008

Over recent years Central Manchester GPs have supplied over 50% of the referrals to the Gaskell House Department of Psychotherapy. Yet there is no formal channel for feedback from these GPs concerning the services provided and for opportunites for realistic enhancement of the relationship between them and the predominantly hospital-based psychotherapists. It would appear that this communication gap applies to many psychotherapy centres in the UK though Tyson and Reder1 have specified the opinions of GPs as one variable to be considered when planning psychotherapy service.
Notes on the Dynamics of Medical Student Teaching and Implications for Future Medical Practice
Authors: Wilson J.
Published: May 2008

I have recently addressed myself to the problems of teaching medical students. In my case it is that of teaching the principles of psychotherapy. It is difficult to teach about the doctor–patient relationship in the normally accepted lecture form. Definitions of transference, psychological defence mechanisms or empathy can be given, but this gives no impression of what is meant at an experiential level.
The Decision to close an Area Mental Hospital
Authors: Garelick A. I.
Published: May 2008

This paper has been prompted by the decision to close a large psychiatric hospital in its entirety and reprovide its services within the community. This was announced in 1983 with the aim that it would be effected within a ten year period. The hospital at that time had approximately 1,000 patients and the decision, which came as a shock to the staff, was taken not by the local management or clinicians but by the more distant administrative structure.
Trainees' Forum: Psychiatric Ward Rounds in Practice
Authors: McBride Andrew
Published: May 2008

Interest in all aspects of NHS management has increased recently, and senior registrar training schemes are becoming widespread.
The abuse of drugs
Authors: Beresford David
Published: May 2008

Recent Government policy has encouraged initiatives aimed at preventing the spread of drug misuse and improving treatment for those who already suffer the effects of dependence. There are probably up to 100,000 opiate addicts in the UK and dependence on prescribed drugs such as benzodiazepines presents a problem of increasing medico-legal significance. All doctors have a responsibility to ensure that drug misusers are offered treatment and should be prepared to assist them with withdrawal from drugs if requested to do so. Many doctors still fight shy of becoming involved, often through fear of contravening the controlling legislation.
A trip to Moscow
Authors: Beyaert F. H. L.
Published: May 2008

The history of this East German plane flight to Moscow is interesting enough to record. In 1983 the All Union Association of Soviet Psychiatrists and Neurologists left the World Psychiatric Association, when it became clear that a resolution condemning the abuse of psychiatry in the USSR was about to be adopted.
Credibility and resource
Authors: Lillington Brian
Published: May 2008

This article examines the background to the Mental Health Act Commission, its structure and function, and claims that its key resource is the skill and experience of its members.
Staffing a district psychotherapy service
Authors: Whyte C. R.
Published: May 2008

In 1975 the DHSS made psychotherapy one of the five psychiatric specialities. Since then, any comprehensive District mental health service has had to include a psychotherapy department.
Performance indicators and child sexual abuse
Authors: Wressell S. E. , Kaplan C. A. , Kolvin I.
Published: May 2008

Child sexual abuse has appeared as an epidemic of the 1980s. In our child psychiatry department we are acutely aware of the increased workload generated by referrals of complex and time-consuming cases. In this article we aim to look at the resource implications for a child psychiatry department which has teaching and regional commitments, as well as serving a district health authority.
The Edinburgh Lithium Register
Authors: Kehoe Robert E. , Mander Anthony J.
Published: May 2008

Lithium is widely used in psychiatry, mainly in the prophylaxis of manic-depressive illness. It is usually prescribed long term and because of its side effects, low therapeutic index and the possibility of toxicity, it is necessary to monitor serum lithium levels, thyroid function and renal status. Clinical guidelines are unclear; Vestergaard et al (1982) recommended that serum lithium and creatinine be checked every two to four months and thyroid function every six months. However, Crammer et al (1982) suggest that once stable levels are established, serum lithium need be checked only in response to clinical indications. The most recent edition of a widely read psychiatric text states that levels should be checked each six to eight weeks for as long as the patient continues on lithium (Loudon, 1988). Accepted standard clinical practice is thus unclear. It should be emphasised that these guidelines are not based on research evidence.
The uptake of social security benefits among psychiatric day hospital patients
Authors: Allen Daniel S. , West Renate
Published: May 2008

A leader in the British Medical Journal (BMJ) last year (Marks, 1988) suggested that the uptake of social security benefits among mentally ill people is low. However, this statement was based on the only data the writer could find – a study of 37 patients conducted in Islington based on the old social security system, prior to April 1988 (Linney & Boswell, 1987). Two weeks later, another BMJ leader (Marcovitch, 1988) bemoaned the fact that insufficient research had been conducted on the impact of changes in the social security system.
Metanoia
Authors: Freeman Hugh
Published: May 2008

Opportunities for training in psychotherapy have become more extensive in Britain over the last decade or so, though the increase – as always – has been seen mainly in London and its satellites. The diversity of these training organisations, most of which are outside the mainstreams of NHS and university courses, does not make it easy for their value to be assessed in conventional terms, as well as raising problematic issues about the interface between the public and private sectors.
The development of community based adult mental health services — a research contribution
Authors: Powell Jackie , Lovelock Robin
Published: May 2008

The desire to provide care and services for people with mental health problems in a community context, rather than in large institutions, is a long-established feature of Government policy. In the more local context of the Portsmouth and South East Hampshire District Health Authority, a strategy of decentralising both the organisation and the delivery of services for adults with mental health problems began to be implemented early in 1986. Five multi-disciplinary area community mental health teams would work with and alongside other service-providers in their localities to provide a range of support, including residential, day and other community and domiciliary services.
The Association of Consultant Psychiatrists, Yorkshire Regional Health Authority
Authors: Spencer Douglas A.
Published: May 2008

For 40 years it has been the custom in the Yorkshire Health Region for the consultant psychiatrists working in the Region to have the opportunity to meet together informally at regular intervals. Over the years different consultants have voluntarily acted as sole co-ordinator, convener and secretary of this Association of Regional Consultants. Sadly, for various reasons in changing times, the Association has recently decided to disband. In its lifetime the Association has made an important considerable contribution to the development of psychiatric services in the Yorkshire Region. It has influenced policies and it has inspired the continuing loyalty of many consultants. It is appropriate to acknowledge the place of this Association, unique in many respects, and supremely democratic in its organisation, in the history of psychiatry in the Region.
The Lockerbie air disaster
Authors: McCreadie Robin G.
Published: May 2008

I suspect I have a certain modest reputation in psychiatric circles as a “cautious researcher”. What follows is neither cautious nor research; it is an intensely personal account. I have no doubt that many of my colleagues, medical and non-medical, saw things in a very different way.
So you've heard of the Gaskell medal: but who was Gaskell?
Authors: Tantam Digby
Published: May 2008

The benefaction for the award of an annual medal and prize to a member of the Royal Medico-Psychological Association was made by Mrs Elizabeth Holland, in memory of her brother, Samuel. She was herself a remarkable woman, who married a banker, had ten children, translated poetry from the German, began a social club for unemployed men, founded a cottage hospital, and was well-known for her wit, conversation and unflappability. However, she came from a remarkable family. Her older brother, William, was a noted Unitarian minister, philanthropist, and writer. Her sister-in-law, William's wife, was Mrs Elizabeth Gaskell, author of North and South, Wives and Daughters, and a celebrated, and for a season notorious, Life of Charlotte Brontë, as well as several other novels and short stories. Two of Elizabeth and William's children, Meta and Julia, were so well-loved in Manchester that flags flew at half-mast on their deaths.
First steps in psychotherapy
Authors: Griffin Susanne
Published: May 2008

The Royal College of Psychiatrists (1986) recommends that psychotherapy be part of training in general psychiatry. The College suggests weekly specialist supervision with two individual patients for at least one year.
Comparison of ‘on-call’ experience in two different training schemes in psychiatry
Authors: Donnelly Peter , Rice Karl
Published: May 2008

The natural grouping of training rotations in psychiatry into those based on a central University Teaching Hospital and those in a peripheral location invites comparison between the two groups. Training perspectives in two neighbouring schemes, one in each category, have been explored recently (McWilliam & Morris, 1988). It was noticed that, although styles differ, resulting clinical competence is comparable. An important part of clinical training is out-of-hours experience. For approval of a rotational scheme, experience of on-call duties and emergencies is necessary (Royal College of Psychiatrists, 1987). We were interested in comparing on-call duties in two different types of scheme, one in Sheffield, the other in Chichester.
Locally based community care
Authors: Richardson Keith
Published: May 2008

A cynic might regard the plethora of reports on community care as a study in how to create the impression of activity while doing nothing. Demands or suggestions for action are easily deflected by holding up the spectre of a forthcoming inquiry – for example the Griffiths' report on community care. Only six months after its launch, one could be excused for thinking that Sir Roy's report never happened. But it would be short-sighted to view Griffiths as a non-event. It embodies a workable framework for implementing community care, emphasises the importance of individual choice and demonstrates the foolishness of relying on those above to wave magic wands and produce instant national solutions. Community care is about localising services and must evolve locally.
Co-ordinating care for people disabled by long-term mental illness living in the community
Authors: Rich Margaret , Ness Mary , Smyth Tom
Published: May 2008

The Community Psychiatry Research Unit at Hackney Hospital have established a support team for the care of people disabled by long-term mental illness living in the community. The work of the support team in coordinating and managing the care of their clients in supportive accommodation using a review system and an information package is described.
Crichton Royal Hospital 1839–1989
Authors: McCreadie R. G. , Tait A. C. , Williams Morag
Published: May 2008

On 4 June 1839 the first patient walked with friends the mile uphill to the new Crichton Institution from the lunatic wing of Dumfries and Galloway Royal Infirmary. Detailed clinical records support a diagnosis of melancholia; the patient was discharged well in 1844 and follow-up confirmed her recovery.
How useful is a six month research option for trainee psychiatrists?
Authors: Foerster Alice , Meadows Graham
Published: May 2008

Shiwach & Murray (1986) have outlined why research experience is desirable for trainee psychiatrists. The majority will use their experience to gain a better understanding of publications in professional journals; however, only a minority will become full-time researchers. Although most trainees have a positive attitude to research (Davidson & Abou-Saleh, 1987; Burford, 1987) only a few manage to complete a project before the second part of the Membership examination (Kendell, 1984; Davidson & Abou-Saleh, 1987; Burford, 1987). Kendell has highlighted some of the difficulties encountered on the Edinburgh MPhil degree course. He fears that “rising standards of the College's Membership examination” might deter even some of the more determined registrars to take on an extra commitment while preparing for the MRCPsych examination.
Dorothea Dix: When will we see your like again in Scotland?
Authors: Robinson A. D. T.
Published: May 2008

Community care around Edinburgh was very poor during the early 1850s. Insane paupers were often detained without warrant in poorhouses and private houses, with no official visits from the sheriff and no records of care kept. Accommodation was often bad, with scant furnishing, such that inmates might have to eat their meals off their knees. Where patients had dirty habits conditions were described as “very close and unpleasant”. Those who received a wash were those who were noisy or violent, using water that was likely to be cold. Only in the summer might a patient be allowed to bathe in the sea. Sexes were often imperfectly separated though restraints might be used, for example, to a bedstead at night. In some establishments, females might fare better in terms of clothing and food (Scottish Lunacy Commission 1857).
Compulsory admission to mental hospital in Thailand and England
Authors: Kupituksa P. , Macmillan J. F. , Soothill K. L.
Published: May 2008

There are national differences relating to compulsory admission to mental hospitals. As a visitor from Thailand, it was of interest to me (PK) to compare procedures relating to admission, treatment and aftercare of the mentally ill in England and Thailand. In Thailand there is no equivalent of the Mental Health Act 1983. Although there are some legal provisions affecting patients' rights in Thai law, there are no legal provisions concerning ‘detained’ patients in mental hospitals.
An Australian exchange
Authors: Harrison Judy
Published: May 2008

The opportunity to travel and practise one's skills in a variety of settings is an attractive aspect of the medical profession. However, in the current atmosphere of competition for jobs and structured career paths, deviation from which may mean losing one's place on the ladder, the prospects of working abroad are limited and the decision to do so often risky. One way round this is to arrange jobs on an exchange basis for a limited period. This is most convenient where the countries involved have similar teaching programmes and reciprocal arrangements for college recognition: in the case of psychiatry this includes Australia, New Zealand, USA, Canada and Hong Kong.
Keep up the pressure!
Authors: Short Renee
Published: May 2008

In politics some things can happen very quickly when a sufficient head of steam has been built up, as we have seen in the recent European Community election results. The message from the medical profession about the proposed changes in the NHS may now have been understood by politicians but we should never assume that governments will withdraw foolish or damaging proposals, so the time is ripe for renewed pressure for their withdrawal.
The Day House
Authors: Walters Ruth M.
Published: May 2008

There is increasing recognition that people with a mental handicap who also suffer from psychiatric disorder will need specialised services. Those with major psychiatric disorders may need periods of hospital in-patient care but treatment as out-patients or day-patients may be more appropriate for those with neurotic disorders, behaviour or conduct disorders, problems of adjustment or personality problems. Many such psychiatric difficulties are amenable to treatment by therapies commonly used in general psychiatry. However, the treatment process can be prolonged and may need modifying so that there is always a ‘concrete’ or ‘practice’ base for handicapped persons who may have limited or no ability to conceptualise abstract ideas, although able to gain insight and modify their behaviour when taught appropriate skills and strategies.
Black people and psychiatry in the UK
Authors: Francis Errol , David Jack , Johnson Nancy , Sashidharan S. P.
Published: May 2008

Our aim in this paper is to examine the current practice of psychiatry in relation to race or ethnicity in England. The problems that European psychiatry has in relation to black people in a white and predominantly racist society and the responses to these from within the professional sphere are only one aspect of our current topic. We merely mention these to contextualise the problems black people experience as a result of institutional psychiatry. Our main aim in this paper is to articulate the oppression black people experience in relation to conventional psychiatry and to seek ways of confronting and changing this, very much as part of the larger, black struggle in the UK. We believe that the alternative that we propose, based on black experience of psychiatry, is equally valid in other contexts where questions of disadvantage and discrimination are the overriding themes. Although the theoretical basis of our work is grounded on issues such as inequality and structural oppression and the need to confront and change them, a detailed analysis of these topics is beyond the scope of this paper. Instead, we examine the practice of professional psychiatry in relation to black people in the UK and argue that the model that is imposed on us is antithetical to the interests of black minority groups. We also look at practical ways in which our community is beginning to organise in challenging such professional orthodoxy.
Calculating the medical time required in the psychiatry of mental handicap
Authors: Piachaud J.
Published: May 2008

A method for estimating the psychiatric manpower needs of a district has been described in the Bulletin (Watson, 1986), and while the data presented in that article were for general psychiatry the approach to this issue can be modified for specialist services.
Services for pregnant drug users
Authors: London M. , Caldwell R. , Lipsedge M.
Published: May 2008

Drug and alcohol misuse during pregnancy poses a threat to the health of both the developing foetus and the mother yet this complex clinical problem often falls between different stools within the health services. A mother would first have to recognise herself as a drug or alcohol misuser needing help before she came within the ambit of the addiction services. On the other hand, the obstetric agencies, even when they identify a drug problem, usually do not regard themselves as having a role. General practitioners are most likely to have an overall view and therefore to be in the best position to manage the problem. However, many misusers do not register with GPs and, despite calls to the contrary, GPs have not become more widely involved in the management of addiction.
A mental health court hearing in Czechoslovakia
Authors: Mumford David B.
Published: May 2008

I was requested at short notice by Christian Solidarity International, a Swiss-based human rights group, to attend a court hearing in Czechoslovakia concerning a married couple who were being compulsorily detained in a psychiatric hospital. CSI had been alerted by a local Catholic activist, himself a former patient of the same hospital. The Czech authorities facilitated my attendance at the court hearing along with an English solicitor and provided an interpreter.
Current patterns of service provision for the psychiatric needs of mentally handicapped people: visiting centres in England and Wales
Authors: O'Brien Gregory
Published: May 2008

In 1988, the Cambridge Health Authority commissioned a working party of clinicians and NHS managers to visit a variety of different treatment services which cater for the psychiatric needs of mentally handicapped adults in England and Wales. This survey – part of an ongoing planning exercise – is now complete, new services are being planned in the light of the findings, and the experience may be of general interest to other clinicians and service planners throughout England and Wales.
Estimating quality of life
Authors: Roberts Glenn
Published: May 2008

Enoch Powell's famous ‘Water Tower’ speech, in which he described mental hospitals as, “Majestic, imperious, brooding institutions… rising unmistak ably and daunting out of the countryside”, inaugur ated the policy of successive governments to close the large mental hospitals and care for the chronically mentally ill “in the community”.
New lamps for old – job plans for consultants: HC(90)16 – Consultants' contracts and job plans
Authors: Tannahill M. M.
Published: May 2008

The White Paper (CM 555) Working for Patients DoH, 1989 and its associated Working Paper 7 recommended Regional Health Authorities to devolve everyday management of consultant contracts to Districts, with instructions that, by April 1991, hospital consultants must have job plans which reflect their main duties and responsibilities within the service. Health Circular HC(90)16 represents, in four pages, the outcome of the year-long negotiation between the Ministry and the medical profession's negotiators on the Central Consultants and Specialists Committee (CCSC). Honours are even. Government can claim that the profession's traditional autonomy, already weakened by the Griffiths NHS enquiry in 1983, has been brought further under its iron fist; on the other hand CCSC can justifiably pride itself on the preservation of a flexible professional contract (Havard, 1990). It has succeeded too in modifying the original proposals by winning rights to an appeals mechanism, and, of great importance to those involved in College activities, in preserving the opportunity for consultants to contribute to national and local professional committees within NHS time. The CCSC has also negotiated amendments to Terms and Conditions of Service for Consultants which allow those involved in management activities (UMRs, Clinical Directors, Resource Management Leaders and Audit Co-ordinators) either payment for up to two additional notional half days a week or relinquishment of equivalent clinical work, in which case a colleague may be paid to take this on. These are important concessions and will be welcomed by all consultants.
Observations on the management of depot neuroleptic therapy
Authors: Wright N. F.
Published: May 2008

For the past three years I have been involved in a study of the effects of depot neuroleptic therapy on the social functioning of chronic schizophrenics with Dr D. A. W. Johnson. Having had to screen the bulk of the depot patients of two Area Health Authorities (South and Central Manchester) in the search for possible study entrants, and then monitor a large group of patients for two years who were under the clinical control of a range of Consultant Units, I have been in a good position to make observations about depot management. These are generalisations and may not apply equally to other psychiatric services, but I suspect they will have some relevance.
Abuse of mentally handicapped adults
Authors: Cooke Leila B.
Published: May 2008

In spite of all the publicity in recent years about child abuse, very little mention has been made of another group of people who are also very vulnerable to abuse, namely adults with a mental handicap. Although chronologically adults, and therefore not susceptible to the laws designed to protect children, they may be functioning intellectually and emotionally at a much lower level. Because they are often dependent on other people for many aspects of their care, this makes them vulnerable to physical and sexual abuse and neglect. Difficulties with speech and communication may render them unable to inform anyone of their plight or ask for help, therefore many problems remain hidden. Personal involvement in one such case made me aware of this problem and the current lack of legal protection for this group of people. I therefore undertook a national survey in order to gain more information on the prevalence of abuse, factors associated with it, and possible legal solutions.
Child and adolescent psychiatry training schemes: recent developments
Authors: Reder Peter , Lucey Clare
Published: May 2008

Child and adolescent psychiatry training has progressed considerably in recent years. Additional training posts have been created, as well as senior academic appointments, and some pre-existing rotations have coalesced, allowing innovative schemes of high quality to evolve. CAPSAC (Child and Adolescent Psychiatry Specialist Advisory Sub-Committee) has continued to oversee established standards and encourage these changes.
Why do patients occupy acute psychiatry beds? A pilot study
Authors: Parikh Prakash , Stern Richard
Published: May 2008

The main aim of this pilot study was to identify factors influencing acute psychiatry bed use. The reasons for occupying a bed vary with time, so patients in the study were assessed on a weekly basis to monitor the changes in the factors thought to be responsible for continued stay. The reasons for bed occupancy also are often only known to those professionals directly involved in day to day care of patients, and it is suspected that the reasons often have little to do with manifest psychiatric illness. The reason for this study was to investigate this question.
Lunacy, insanity, and the purpose of psychiatry
Authors: Charlton Bruce G.
Published: May 2008

Within psychiatry there are two distinct tendencies. On the one hand there is the tendency for the subject to expand beyond its concern with psychological medicine and encroach upon diverse aspects of society. “The psychiatrist who believes that the phenomena of mental illness can be explained on the basis of a universal theory … finds little difficulty in inflating his theory to explain not only mental disease but also normal human behaviour, interpersonal relations, and ultimately human affairs” (Miller, 1970)
Everything you ever wanted to know about research but were afraid to ask
Authors: Guthrie Elspeth , Black Dawn
Published: May 2008

Trainees beginning their careers in psychiatry sometimes view research as an additional hurdle that they have to surmount in order to gain senior registrar or consultant status. Conversely, research enthusiasts may see research as an exciting and rewarding activity which enriches and informs clinical practice. The aim of this article is to strike a balance between these two divergent views to help trainees in their selection of the research option most suited to their temperament and aspirations. As a result of our own experiences of full-time and part-time research, in addition to research conducted during full-time clinical posts, we intend this article to be practically rather than theoretically orientated.
Management training – the experience
Authors: Richardson G. J. R.
Published: May 2008

A month's residence in an elegant stately home, situated among the manicured lawns and gardens of 150 acres of parkland, sounds ideal; when allied with comfortable accommodation, delicious food and thoroughly professional service, it sounds idyllic. When it is being paid for by Kenneth Clarke, it becomes irresistible.