bluuebunny/crossref_metadata_2025_split huggingface dataset:
New eating disorder service
Authors: Millar Harry R. 
Published: October 2008

Aims and methodThe paper describes the first three years experience of a new out-patient eating disorder service for adults. Clinical data on referrals using standardised assessments are presented.ResultsThe referral rate rapidly rose to over 200 patients per annum. Forty-nine per cent of referrals were bulimic disorders and 26% had either anorexia nervosa or atypical anorexia nervosa. Seventy per cent were directly referred by general practitioners.Clinical implicationsThe creation of a specialist eating disorder service quickly leads to a high referral rate suggesting a previously unmet need. A service based on assessment and treatment by nurse therapists is acceptable and feasible with appropriate training and support from psychiatry, clinical psychology and dietetics. Expectations of a specialist service include teaching, consultation, research and audit as well as the provision of direct clinical care.
How to appraise clinical guidelines
Authors: Warner James P. , Blizard Robert 
Published: October 2008

Aims and methodWe critically appraised clinical guidelines for the use of antidepressants, using an evidence-based approach.ResultsWe were unable to identify recent guidelines. The appraisal tool we used failed to identify some of the difficulties now apparent when considering the validity and utility of guidelines.Clinical implicationsCritical appraisal tools are useful in providing a framework for assessing published material, but run the risk of blinding us with their simplicity.
The College: an analysis of members' views
Authors: Kendell R. E. , Duffett R. 
Published: October 2008

Aims and methodIn November 1997 a questionnaire was sent to a large random sample of members, fellows, affiliates and inceptors living in the UK or the Republic of Ireland.ResultsOne thousand four hundred and seventy-six completed questionnaires were available for analysis, a response rate of 63%. The College was complemented for raising standards of education and training in psychiatry and criticised for not trying hard enough, or failing, to influence the policies of the Department of Health. A high proportion of respondents highly valued the British Journal of Psychiatry and Psychiatric Bulletin but few made use of the library. A high percentage of Irish, Welsh and Scottish members, and of members of the five smaller faculties, participated in and expressed their appreciation of the activities of the College.ImplicationsWhatever its other failings the College is not dominated by general psychiatrists and their interests, or by London-based psychiatrists. It is surprisingly successful at involving Scottish, Welsh and Irish psychiatrists, and members of the smaller faculties, in its activities. To some extent, however, the faculties are thriving at the expense of the English divisions.
HoNOS: a cautionary tale of their use in a rehabilitation service
Authors: Chaplin Robert , Perkins Rachel 
Published: October 2008

Aims and methodHealth of the Nation Outcome Scales (HoNOS) were piloted in 248 patients with serious persistent mental health problems. Staff were trained by a cascade approach and rated patient outcome after six months.ResultsThere was poor interrater reliability between nurses and psychiatrists/psychologists. Outcome measured by HoNOS often contrasted with clinical experience.Clinical implicationsHoNOS were not a reliable or valid measure of outcome. The scales are now completed only under supervision.
Profile of staff grade psychiatrists
Authors: Blower Aileen 
Published: October 2008

Aims and methodStaff grade psychiatrists working in Scotland were surveyed by postal questionnaire in order to determine their demographic profile, career aspirations and experience of the grade.ResultsA heterogeneous group of doctors was identified, from a variety of professional backgrounds, and with a range of ambitions. Respondents generally held a favourable view of the grade, but expressed concern over perceived lack of opportunities for training, education and career progression. This is despite considerable recent efforts by the College to include non-consultant career grades in its programme for Continuing Professional Development.Clinical implicationsThere remains scope for imaginative development of the grade. In particular, staff grade psychiatrists might benefit from a more individualised approach to, and support for, all areas of their professional development. Such ‘mentoring’ may be especially beneficial for staff grades in Scotland, for whom geographical, as well as professional isolation, can be problematic.
Sweets, newspapers and analgesics: patients' purchases from hospital shops
Authors: Somerfield David 
Published: October 2008

Aims and methodThe study was undertaken to examine over the counter drug sales from hospital shops. One hundred hospital shops were sent a questionnaire asking for details of drugs sold and any policy to prevent sales to patients.ResultsSeventy-three shops replied, 20 of which sold medication. Most had policies which would allow sales to patients. Three shops had sold medication which was subsequently used for self-poisoning by in-patients.Clinical implicationsHospital managers and clinicians should ensure hospital shops have effective policies to prevent medication sales to patients.
Specialised in-patient psychiatric service for women
Authors: Kohen Doro 
Published: October 2008

Aims and methodTo describe one of the first psychiatric services in the inner-city especially designated for female psychiatric patients with severe mental illness.ResultsThe referral system, the staffing levels and the admission criteria have been established following needs of the patients, especially young women with perinatal problems and women from ethnic minorities.Clinical implicationsThis single gender acute psychiatric ward has received welcome attention from mental health professionals and management at every level, and it is hoped that further discussion will help to clarify future policies and guidelines on all aspects of this venture.
Bridging the psychotherapy divide
Authors: Monaghan Mary T. , Moorey Stirling 
Published: October 2008

Aims and methodAll consultant psychotherapists should be sufficiently familiar with the three major branches of psychotherapy, to appropriately match therapy with their assessment of the patients' needs. This requires that specialist registrars training in psychotherapy acquire skills in psychodynamic/interpersonal, cognitive-behavioural and systems-based therapies.ResultsWhile acknowledging the benefit for the trainee of being familiar with more than one model of psychotherapy the practicalities of incorporating different models in to training is likely to be problematic, at least initially, for both trainees and trainers.Clinical implications In this article the experience of a senior registrar who completed a training in psycho-analyticpsychotherapy prior to gaining experience in cognitive-behaviour therapy is examined from the perspective of both the trainee and cognitive-behavioural trainer.
Treatment of the mentally ill in the Federal Republic of Germany
Authors: Röttgers Hanns Rüdiger , Lepping Peter 
Published: October 2008

Aims and methodThe legal provisions concerning the admission to hospital, holding powers and compulsory treatment of the mentally ill in Germany are illustrated. The essential legal concepts are compared to the situation in Great Britain.ResultsWhereas British law gives key powers to multi-professional decision-making and relatives, German law requests formal court decisions even in routine cases. This reflects a different understanding of individual rights and their protection. German mental health law is motivated by the experiences of the totalitarian national socialist regime. It tries to protect patients' rights by restricting physicians', hospitals' and family members' Influence. British law, on the other hand, assumes that experts as well as family members act benevolently in the patient's Interest, prefers less formal mechanisms and expresses more trust in professional ethics.ConclusionFurther research is desirable to analyse the situations in other countries and to determine which of these approaches is the most adequate from the point of view of the mentally ill. This is even more important in view of further European integration which will undoubtedly touch these questions and accelerate a convergence in medico-legal issues.
Is specialist registrar training in cognitive therapy effective?
Authors: Moorhead Steve , Scott Jan 
Published: October 2008

Aims and methodThis paper describes the characteristics and outcome of the first 20 patients seen by a newly appointed specialist registrar in cognitive therapy. The outcome of the first (cases 1–10) and second (cases 11–20) cohorts were evaluated to assess if training had any impact on clinical effectiveness.ResultsComorbidity was common, but more patients improved following the intervention (effect size=0.64–1.34). The 25% therapy drop-out rate was comparable with previously reported rates. Four out of five patients who dropped out had Cluster B personality disorders. The two cohorts showed similar baseline characteristics, but the second cohort showed improved outcome (effect size of training=0.89–1.04) and had a significantly shorter course of therapy (P=0.02).Clinical ImplicationsSpecialist registrar training in cognitive therapy provides experience in treating a wide variety of mental disorders. The routine collection and analysis of clinical and psychometric data helps identify training effectiveness and training needs. The data demonstrate that training was associated with improved patient outcomes.
Flexible higher training in psychiatry
Authors: Dean Anne , Abd Samaa El , York Ann 
Published: October 2008

Aims and methodThis survey was commissioned and funded by the Department of Health to examine perceptions of training by flexible trainees in higher psychiatric training. A total of 214 trainees were surveyed using a postal questionnaire.ResultsOne hundred and thirty-five questionnaires were returned (response rate 63%). In general, flexible trainees valued the opportunity to train part-time and perceived the quality of their training to be high. However, there were drawbacks such as: perceived lack of status, restricted training opportunities and a lack of part-time consultant posts at the end of training.ImplicationsFlexible training plays a major role in maintaining doctors in the workforce. However, there is a need for part-time opportunities to extend beyond the training grades and into consultant posts.
A course for parents of troubled adolescents: some observations
Authors: Goldberg David , Garside Eileen 
Published: October 2008

Aims and methodAn education-based course for parents of adolescents with mental health problems is described.ResultsThe structure of the 12–week course evolved in response to parental requests. Parents were enabled to access support which they felt was inaccessible before the course.Clinical implicationsBasing an intervention for parents of distressed adolescents in an educational frame may be more acceptable currently than using a psycho-educational frame.
What psychiatrists think about Part III of the Mental Health Act 1983
Authors: Buchanan Alec , Gunn John 
Published: October 2008

Aims and methodThe government has proposed a ‘root and branch’ review of the Mental Health Act 1983 to be conducted by the end of 1999. The aim of the study was to establish the views of general and forensic psychiatrists as to the adequacy of present legislative provision for England and Wales. The study was carried out by postal survey.ResultsThe response rates were 82%, for forensic psychiatrists and 67%, for general psychiatrists. Most respondents considered most of present provision satisfactory. Areas considered in need of amendment were: the term ‘psychopathic disorder’; the requirement for an offence punishable by imprisonment before a hospital order can be made, provision for remands to hospital and the loss of clinical independence consequent upon the making of a restriction order.Clinical implicationsForensic psychiatrists seem more willing than general psychiatrists to see their clinical discretion limited by the courts. Most of the suggestions were for changes to individual aspects of the present legislation rather than radical reform.
Serotonin syndrome
Authors: Mir Shameem , Taylor David 
Published: October 2008

Aims and methodTo define serotonin syndrome and its symptoms and to discover which drugs or drug combinations are likely to cause it. A review of literature (including case reports) relating to serotonin syndrome collated from searches of MedLine and Micromedex covering the period January 1991 to July 1998.ResultsMost of the data found were either individual case reports or reviews of case reports. Reports of serotonin syndrome seem to be growing, certainly since the introduction of selective serotonin reuptake inhibitors. Particular combinations seem most likely to induce serotonin syndrome. Awareness of this syndrome as a distinct clinical entity seems to be growing.Clinical implicationsSerotonin syndrome is more likely to occur with drug combinations, especially those involving monoamine oxidase inhibitors. It can also occur when swapping antidepressant therapy, especially If changing from a long acting antidepressant such as fluoxetine. Caution is needed when changing antidepressants and particularly when they are used in combination.
Psychopathy in Scotland
Authors: Humphreys Martin 
Published: October 2008

Aims and methodThe aim was to examine why the legal category of psychopathic disorder does not appear in the Mental Health (Scotland) Act 1984 and to review selected literature relating to differences between prison and special hospital populations in Scotland from those elsewhere.ResultsThere is now some emerging evidence to suggest that the legislation north of the border might reflect the notion that there may be fewer people with psychopathic disorders in Scotland.Clinical implicationsWith devolution and the advent of a Scottish Parliament the Mental Health (Scotland) Act 1984 is likely to be reviewed. At that time it would be inappropriate to consider including ‘psychopathic disorder’ but some alternative to the current rather narrow definition of ‘mental disorder’ may be required.
Therapeutic community provision at regional and district levels
Authors: Davies Steffan , Campling Penelope , Ryan Kerry 
Published: October 2008

Aims and methodThe aim of the study was to investigate changes in service utilisation following therapeutic community treatment for patients with severe personality disorder. The study examined service usage, in the form of acute psychiatric admissions, of a series of 52 admissions to a residential therapeutic community in the three years before and year after admission.ResultsThere was a reduction in the mean duration of acute psychiatric admissions after treatment, this was greater for extra-contractual referral patients than local district patients.Clinical ImplicationsThis study replicates results from previous studies. It also suggests that more accessible local services may be able to intervene earlier in patients' psychiatric careers preventing heavy use of acute services. We argue for greater provision of therapeutic community treatment for severe personality disorder.
Trainee attitudes within the Faculty of the Psychiatry of Learning Disability
Authors: Carvill Sue , Marston Geoff , Hollins Sheila 
Published: October 2008

Aims and methodRecruitment of trainees and consultants into psychiatry is a major concern. A questionnaire survey of trainees within the psychiatry of learning disability was conducted to highlight attitudes about training and career issues.ResultsNinety per cent of trainees decided on a career in learning disability as a result of completing a junior post in this speciality. Forty-three per cent were seeking dual accreditation and nearly half of these were experiencing problems relating to this; 84% expressed fears about becoming a consultant; and 63% felt they needed more advice on how to find a consultant post.Clinical implicationsIncreased exposure to learning disability at the basic training grade is required to ensure recruitment. In addition issues related to dual accreditation and anxieties about consultant posts need to be addressed.
Liaison-consultation meetings in general practice
Authors: Tipper Rebecca J. , Pullen Ian M. 
Published: October 2008

Aims and methodAudio-recordings were made over a period of six months of liaison–consultation meetings between general practitioners and a community mental health team in the Scottish Borders to show general trends in length of discussion and information exchange.ResultsMeetings were predominantly supportive, with high levels of shared information, but little educational content. Some trends in discussion time are shown.Clinical implicationsAudio-recording could form the basis for reviewing the function of liaison-consultation meetings.
Serving the Mental Health Review Tribunal 1966–98
Authors: Woolf P. Grahame 
Published: October 2008

In a lecture to the Royal College of Psychiatrists, published as an editorial in the British Journal of Psychiatry, Sir John Wood recommended a review of the structure and details of the Mental Health Review Tribunal (MHRT) system (Wood, 1995). The present article is a personal contribution to that review and describes aspects of the MHRT during 30 years of continual change.The roles of doctors in relation to the MHRT have been reviewed in the Psychiatric Bulletin by Woolf (1991). Despite flurries of lively correspondence during 1994–95, there has been no discussion of the working conditions of medical members.
Performance in psychiatry undergraduate finals
Authors: Cullivan Rachael , Rooney Siobhan , Kelly Gabrielle , Walsh Noel 
Published: October 2008

Aims and methodThis study investigated the effects of gender and nationality on performance in various aspects of the undergraduate final examination in psychiatry. Results in all sections of the final examination were analysed in the case of 140 students from the same year.ResultsThere were no statistically significant differences between performances by males and females, however non-nationals performed less well in all aspects of the examination.Clinical implicationsTeaching programmes need to identify which aspects of the undergraduate course cause particular difficulty for non-nationals. This information would usefully inform future developments in undergraduate teaching.
Psychiatric training of pre-registration house officers
Authors: O'Dwyer J. M. 
Published: October 2008

Aims and methodThe aim of the paper is to describe the pre-registration house officer training in psychiatry available in Sheffield. The report is the result of a postal questionnaire, involving all of those who undertook pre-registration house officer training in psychiatry, since the inception of this option.ResultsThe results suggest that the psychiatry option as part of pre-registration house officer training was regarded as useful by almost all undertaking this training. Some of the suggestions to improve the experience are already incorporated into the current posts.Clinical implicationsThe findings support the development of further posts of this type, and such developments may assist in overcoming some of the difficulties in recruitment into psychiatry as a career.
Enforcing treatment with clozapine: survey of views and practice
Authors: Pereira Stephen , Beer Dominic , Paton Carol 
Published: October 2008

Aim and methodThe aim of the study was to survey strategies for dealing with patients who refuse clozapine blood tests or tablets. One hundred and twenty-five psychiatric intensive care unit consultants were sent a questionnaire.ResultsThirty-nine (31%) questionnaires were returned. Opinions and practices were diverse ranging from uncertainty around the legal right to enforce venepuncture, to the practice of slipping clozapine into a patient's drink without their knowledge.Clinical implicationsThere is need for an open debate of the relevant legal and ethical issues.
GPs' views on discharge summaries
Authors: Dunn John , Burton Stephen 
Published: October 2008

Aims and methodAfter gaining the impression that our discharge summaries were too long for local general practitioners (GPs), we proposed to produce an abbreviated summary. We sent a questionnaire to a sample of GPs asking which aspects of the current summary were helpful.ResultsAlthough many GPs considered the summary overly long, a majority considered all the items to be at least Very helpful’.Clinical implicationsAlthough previous work on discharge summaries has indicated a demand for brief, focused reports it is important to establish local GP priorities before planning changes.
Working in partnership with probation
Authors: Cohen Andrea , Bishop Nick , Hegarty Matthew 
Published: October 2008

Aims and methodTo describe the characteristics of probationers assessed (n=83) and supported (n=31) by a mental health worker (MHW) attached to a probation service. A survey of cases and case descriptions.ResultsReferrals were predominantly White, unemployed males on probation orders. Most had acquisitive/property and violent convictions along with substance misuse problems and personality disorder diagnoses. The MHW supported probationers already in contact with psychiatric services and provided a safety net and sometimes sole support, to those who were not.Clinical implicationsThe MHW helped to bridge the gap between criminal justice and mental health systems by facilitating contact between probationers and psychiatric services. The clinical effectiveness of the scheme should now be examined.
Early experience of the use of olanzapine across three rehabilitation services
Authors: Wolfson Paul , Paton Carol , Steadman Phillip , Needham-Bennett Humphrey , Cope Susan 
Published: October 2008

Aims and methodTo monitor the effect of the introduction of olanzapine under naturalistic conditions to patients with severe and enduring mental Illness in three rehabilitation services.ResultsThirty patients were prescribed olanzapine during the first six months of its launch. Objective ratings were used. Six months later, one-third were no longer on treatment one-third were unchanged and one-third had made useful clinical gains.Clinical implicationsPatients who have suffered from neurological or prolactin-related side-effects may benefit from treatment with olanzapine. Attitudes to treatment and adherence may improve.
Effect of increased antidepressant prescribing on suicide rate in Northern Ireland
Authors: Kelly Christopher B. , Rafferty Thérèse 
Published: October 2008

Aims and methodTo investigate whether changes in antidepressant prescribing have been associated with alteration in suicide rate for the period 1989–1996 in Northern Ireland. Data for antidepressant prescribing were obtained from a central unit, for Northern Ireland, using the defined daily dose system for each of the above years. The number of recorded cases of suicide and undetermined death were also obtained for this period, from Northern Ireland coroners.ResultsThere was no evidence of an association between suicide rate and antidepressant prescription (r2=0.019, F test=0.115, P=0.74), despite antidepressant use more than tripling over the study period.Clinical implicationsEven substantial increases in detection and treatment of depressive Illness may not impinge on suicide rate. It Is also possible that suicide rate may be a very poor marker of the benefits of antidepressant treatment.