bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of antipsychotics by child and adolescent psychiatrists
Authors: Slaveska Karmen , Hollis Chris , Bramble David 
Published: October 2008

Aims and methodsA postal questionnaire of Trent Region's consultant child and adolescent psychiatrists was used to investigate the two-year period prevalence rates of antipsychotic medication prescription, and the ICD–10 psychiatric disorders it was used to treat.ResultsThe response rate was good (92.3%) and 78% of respondents had prescribed antipsychotic medication for a range of conditions over the period, albeit very infrequently. Antipsychotics were used for a range of psychotic and non-psychotic disorders. The older antipsychotic agents (thioridazine, chlorpromazine and haloperidol) comprised the bulk of prescriptions. Newer, atypical, antipsychotics were prescribed only four times over the period and no patients in residential in-patient units received this form of treatment.Clinical implicationsThese results highlight a pressing need to address antipsychotic prescribing in children and adolescents and, especially, the role of new antipsychotic drugs.
Changes in practice of ECT: a follow-on study
Authors: Trezise Kate 
Published: October 2008

Aims and methodA retrospective case note study examining the effects of increased supervision on practice of electroconvulsive therapy (ECT).ResultsIncreasing the level of supervision of ECT sessions was associated with patients receiving on average almost two fewer treatment applications per course of ECT.Clinical implicationsThe risk of treatment is reduced because patients receive fewer anaesthetics, and they may be discharged home sooner. Such improvements in ECT practice should be relatively easily achievable in many ECT clinics.
Appraisal of meta-analysis
Authors: Chakraborty Apu , Warner James P. , Blizard Robert 
Published: October 2008

Aims and methodPrompted by a clinical question, we critically appraised a meta-analysis of neuroimaging in our evidence-based journal club.ResultsThe results of the meta-analysis suggested differences in ventricular size and sulcal width between controls and people with schizophrenia and mood disorders. However, we were unable to answer the question that prompted this exercise.Clinical implicationsAlthough the evidence-based medicine approach facilitates appraisal of complex articles, some clinical questions are not yet answerable.
Assessment of psychiatric teaching: examining examinations
Authors: Livingston Gill , Cox Stuart , Katona Cornelius , Robertson Mary 
Published: October 2008

Aims and methodThe study set out to consider whether the ‘end-of-firm’ examination in psychiatry fulfils its goals by examining the internal consistency of the end-of-firm examination and final medical board examination and the correlation between these examinations' scores and sub-scores. Students who failed their end-of-firm examination were followed to monitor their progress at final medical board examinations.ResultsOne hundred and eighty students sat end-of-firm examinations and final medical board examinations. All the components of the end-of-firm examinations and the final correlated significantly with the total mark. The psychiatric essay was less well correlated with the final mark but correlated well with total essay marks. Students who failed their end-of-firm psychiatry examination at first attempt received extra tuition and only two failed finals.Clinical implicationsEssay writing ability may not carry over into high performance in other areas tested and may be a test of other skills. Extra tuition benefited failing students whose results fell outside the pattern of prediction. Thus the end-of-firm examination may be a useful tool if acted on to prevent student failure.
Twenty-eight years of liaison psychiatry at a general hospital
Authors: Carson A. J. , Dawson H. , Marshall D. , Stafford K. 
Published: October 2008

Aims and methodA questionnaire was used to measure physician satisfaction with the unit and comparison of referral numbers and diagnoses with 1967, when the unit was new, and in 1985 when it was re-audited.ResultsDespite physicians' satisfaction with the service, the referral rate remains unchanged.Clinical implicationsLiaison psychiatry should not concern itself with trying to increase referral rates. Research into patient outcome should be a priority and guide its future direction.
The supervision register: 19 months after its introduction
Authors: Hindler Charles 
Published: October 2008

Aims and methodTo examine whether, 19 months after its introduction, the goals of the supervision register have been met. A matched case-control study of patients on the supervision register and Care Programme Approach was conducted.ResultsCases and controls demonstrated similar socio-demographic characteristics, primary diagnoses and community psychiatric care. The supervision register group were more likely to use concurrent alcohol and/or illicit drugs (P=0.001) or suffer with an accompanying personality disorder (P=0.0001), and were less likely to have experience of a long-term relationship (P=0.003). Nineteen months after registration, the supervision register group were more likely to be violent to others (P=0.002) or involved in serious threatening behaviour to others (P=0.0007). Relapse of mental illness was the only significant predictor of future violence in the supervision register group (P<0.01).Clinical implicationsPatients with a history of violence to others were found to be appropriately placed on the supervision register but continued to demonstrate aggressive behaviour after registration, indicating that the goal of the supervision register to prioritise most appropriate care and treatment for this group of patients has not been met.
Over-occupancy in London's acute psychiatric units – fact or fiction?
Authors: Audini Bernard , Duffett Richard , Lelliott Paul , Pearce Alison , Ayres Catherine 
Published: October 2008

Aims and methodInner London psychiatric services face particular pressures. One measure of this is over-occupancy of acute psychiatric beds. Seven census-based surveys were conducted between June 1994 and January 1999 to quantify and monitor problems of inner London acute psychiatric bed provision. The censuses involved 14 inner London mental health services with a combined catchment population of approximately three million. Measures included levels (and changes over time) of occupancy, detention under the Mental Health Act, prolonged hospital stays and ward violence.Results‘Minimum’ occupancy levels for the combined services were above 100% at all census points. Occupancy level fell from 122% to 112% between the first and seventh census. This was associated with an increase in bed numbers of 2.5 per 100000. Levels of detention were consistently at around 50% and violent incidents were high at all census points.ConclusionsCurrent provision of acute beds remains insufficient to meet service demand. To meet the 85% ward occupancy level recommended by the Royal College of Psychiatrists a further 14 beds or community alternatives per 100000 population would be required.
Effect of treatment in an active rehabilitation hostel on the need for hospital treatment
Authors: Macpherson Rob , Butler Julian 
Published: October 2008

Aims and methodTo describe the work of the ‘Vron’, a seven-bed active rehabilitation hostel which has operated in Gloucester for the last 15 years. Such units have been acknowledged as a successful alternative to hospital care for patients with severe mental illness, but nationally are grossly under-provided.ResultsDemographic details, admission and discharge data were described for all 103 patients admitted over a 12–year period up to January 1996. Duration of hospital treatment fell from mean 105.8 days one year before and 138.0 days two years before admission to the Vron to: mean 28.6 days one year after and 57.1 days two years after discharge from the Vron. The change was highly significant for both one and two year analyses.Clinical implicationsResidential rehabilitation, provided as part of a comprehensive rehabilitation service, was effective at reducing requirement for hospital care. Clinical approaches which contributed to this success were described. The results point to the value of a range of residential hostels, which can through skilled deployment effectively target individual needs for a wide ranging, heterogeneous population.
Electroconvulsive therapy in Wales
Authors: Duffett Richard , Siegert Drew Ridley , Lelliott Paul 
Published: October 2008

Aims and methodThe use of electroconvulsive therapy (ECT) was surveyed over the first six months of 1996 in Wales. Data on the indications for ECT and clinical outcome were collected in the first three months.ResultsThe computed annual rate was 22 patients treated with ECT per 100 000 population. Women constituted 71% of those receiving ECT (236/321). Eighty-three per cent had an affective disorder, and 80% had failed to respond to previous treatments. Only 33% of patients had been prescribed more than one class of antidepressant and only 25% had received augmentation with lithium or an alternative drug before being given ECT.Clinical implicationsECT is mostly used after a failure of patients to respond adequately to a course of antidepressants.
When all else fails
Authors: Pereira Stephen , Beer Dominic , Paton Carol 
Published: October 2008

Aims and methodA small minority of treatment-refractory patients who could benefit from treatment with clozapine, refuse to comply with blood tests or oral treatment. Treatment with clozapine can be enforced under the Mental Health Act.ResultsAn aide memoire was developed locally to guide clinicians through the process of enforcing clozapine treatment.Clinical implicationsIt is possible to enforce treatment with clozapine under the Mental Health Act and so offer a valuable treatment option.
High-dose antipsychotic treatment in clinical practice
Authors: Tyson Philip J. , Mortimer Ann M. , Wheeler Jason A 
Published: October 2008

Aims and methodA trust-wide audit of antipsychotic prescription was conducted in order to investigate the prevalence of high-dose treatment in a population with schizophrenia and assess compliance with Royal College of Psychiatrists' guidelines on the use of high doses. Details of antipsychotic medication were recorded and in cases of high-dose treatment compliance with the College's guidelines was assessed.ResultsSixteen out of 361 patients (4%) were receiving high-dose medication. At re-audit this figure fell to four patients (1%). High-dose treatment comprised of a combined depot and oral medication in most cases. There was poor compliance with the College's guidelines.Clinical implicationsThe study stresses the importance of monitoring patients on high-dose antipsychotics, particularly when taken in combination.
Perceived role of psychiatrists in the management of substance misuse a questionnaire survey
Authors: Day Edward , Arcelus Jon , Kahn Ashraf 
Published: October 2008

Aims and methodsA postal questionnaire sent to all psychiatrists working in four NHS trusts in and around Birmingham was used to survey the number of new cases of drug and alcohol misuse identified in the previous month and the degree of postgraduate training in the management of such cases. Attitudes and beliefs about substance misuse problems were also elicited.ResultsA response rate of 70% was achieved across six sub-specialities in psychiatry and four levels of training. Of the 143 respondents, over half had identified at least one new case of alcohol (61%) or drug misuse (55%) in the previous month. Approximately half of the sample admitted to having received no training in management of substance misuse cases in the previous five years (45% alcohol 50% drugs). There was general agreement about the potential management role of the doctor in the field, but less consensus on whether the clinician had a responsibility to intervene in such cases. A clear discrepancy was demonstrated between psychiatrists' perceptions of the evidence supporting various treatments and the actual evidence base.Clinical implicationsThe study highlights the pressing need for training psychiatrists at all levels and in all sub-specialities in the management of substance misuse.
Attitudes of the general population to psychiatric and physical illness
Authors: Lawrie Stephen M. 
Published: October 2008

Aims and methodThe attitudes of members of the general population to people with psychiatric and physical illnesses were examined. We took a random sample of 280 members of the general population listed in the phone directory and sent them a brief clinical vignette about a neighbour with either schizophrenia, depression, diabetes or no illness.ResultsOnly 103 (41%) of the surveyed general population responded. Some unsolicited comments revealed negative attitudes from a small number of subjects. There were, however, no statistically significant differences in general attitudes to sufferers of psychiatric and physical illnesses suggestive of discrimination against the former. Indeed, respondents showed a general tendency to be more supportive of a neighbour with any illness than to those without. In a sub-analysis, however, those who knew someone with schizophrenia were significantly less likely to be sympathetic towards them.Clinical implicationsWe have not detected any general stigmatisation of those with psychiatric disorders, but our results may be attributable to response bias. Discrimination against those with psychiatric disorder may be limited to a relatively small sector of society or may only be manifest in relatively close relationships.
Regional review of psychiatric training
Authors: Herzberg Joe , Fergus Karen , Paice Elisabeth 
Published: October 2008

Aims and methodTo investigate whether psychiatry training in North Thames met standards set by the Royal College of Psychiatrists and North Thames Deanery. Visits to individual sites to inspect the training programmes and facilities were carried out. A speciality-specific trainee survey (paper questionnaire) was carried out and results from a general trainee satisfaction survey (electronic survey units) are given.ResultsWe visited all 43 sites. The 207 psychiatry trainees completed the speciality-specific questionnaire (response rate 40%) and 2947 trainees completed the general survey (response rate 71%) of which 280 responses were from psychiatry trainees. Trainees in psychiatry expressed greater satisfaction with their training than trainees in other specialities. However, we identified deficiencies in suitability of general practitioner posts, safety issues, electroconvulsive therapy supervision, access to multi-disciplinary training and consultant supervision.Clinical implicationsAlthough trainees in psychiatry were generally satisfied with their training, the educational and safety standards set by the Royal College of Psychiatrists and the North Thames Deanery were not always met.
Desmond Kelly: in conversation with David Tait
Authors: Tait David 
Published: October 2008

Desmond Kelly's decision to enter psychiatry was finally settled while dining with the late Dr William Sargant at his club. After National Service he returned to St Thomas' to do his MD and, after six months at the Maudsley Hospital spent a year at Johns Hopkins, Baltimore on a Nuffield Fellowship. His consultant career began with 10 years at St George's where, in addition to extensive teaching and committee duties, he published over 50 papers and his book Anxiety and Emotions. He then became Medical Director at Roehampton Priory Hospital.He established links between the Priory and Charing Cross, University College London and St George's. These links with medical schools culminated in accreditation by the Royal College of Psychiatrists. In 1992 he became a Visiting Professor at University College London. Dr Kelly's involvement with issues in addition to his clinical and management responsibilities have included the College's ‘Defeat Depression’ campaign. He is currently Patron of ‘The National Depression Campaign’, its successor.It is his involvement in independent practice, however, which sets him apart. His leadership grew from Medical Directorship of a single hospital to becoming Group Medical Director of a score of hospitals throughout the UK, with a seven-fold increase in bed provision and a steady development of specialist services. During this time he became a Board Member of the parent company and was also Chairman of the group for five years.Desmond Kelly retired this year.
Psychiatrists' attitudes to maintenance drug treatment in depression
Authors: Jackson Graham A. , Maciver Ishbel 
Published: October 2008

Aims and methodThe recurrence rate of major depression can be decreased by the use of maintenance drug treatment. This paper describes a survey of Scottish psychiatrists' attitudes to prescribing maintenance therapy. Questionnaires were sent to all Scottish psychiatrists at consultant and associate specialist grade.ResultsIt is evident that there are major differences in prescribing practices. How patients are managed would appear to depend on to whom they are referred.Clinical implicationsPsychiatrists do not appear to be practising evidence-based medicine in this context. There is perhaps a need for greater consensus on the prevention of recurrence.
A follow-up study of people with severe mental illness treated by a specialist homeless team
Authors: Odell Sue , Commander Martin 
Published: October 2008

Aim and methodTo follow up homeless people with psychoses treated by a dedicated team; changes in accommodation, risk behaviour, mental state and psychiatric care were examined.ResultsService uptake improved as did symptomatology and residential stability. However, substance use and criminality continued to be prevalent and a minority remained homeless.Clinical implicationsSpecialist psychiatric teams are a valuable adjunct to mainstream services in areas with high levels of homelessness.
Psychiatric morbidity in patients referred for individual psychotherapy within and outwith the NHS
Authors: Mitchell John R. , Freeman Chris P. 
Published: October 2008

Aims and methodDemographic and medical characteristics of waiting list patients for National Health Service (NHS) psychotherapy, non-NHS psychotherapy or NHS general adult psychiatry were compared by postal questionnaires.ResultsOne hundred and eighty-three subjects replied. High rates of psychiatric morbidity were reported in both psychotherapy populations but general psychiatric referrals were more disturbed, taking more psychotropic medication than non-NHS psychotherapy but not NHS psychotherapy subjects. The biggest referral source to non-NHS psychotherapy was general practitioners.Clinical implicationsNon-NHS psychotherapists should be able to recognise severe mental illness and have a basic understanding of psychotropic medication and psychiatric services.
Psychotherapy and old age psychiatry
Authors: Garner Jane 
Published: October 2008

Aims and MethodsThis report was prepared as the basis for wider consultation within the Old Age Faculty and the College. Some literature and practice is reviewed and practical suggestions made for the future in this area.ResultsAlthough older patients are less likely to be refused for psychological intervention attitudes are slowly changing.Clinical implicationsThe clinical implications of this development include a greater consideration of the unique emotional life of each of our patients and an improved understanding of our reluctance to engage in psychotherapeutic work with older people.
Role and responsibility of the speciality tutor
Authors: Garner Jane , Ong Yong Lock 
Published: October 2008

Aims and methodIn order to identify the role and responsibility of the speciality tutor, the tutors' post in old age psychiatry was compared across two regions.ResultsThe role was narrow; but different in the two regions depending on training programmes.Clinical implicationsTutors in all faculties should have an expanded and standardised job description, separate from the role of the regional representative, in order to strengthen the input of the specialisms to training at all levels.
Sources of stress, psychological distress and burnout in psychiatrists
Authors: Guthrie Elspeth , Tattan Teresa , Williams Edwina , Black Dawn , Bacliocotti Himant 
Published: October 2008

AimsTo assess the degree of psychological morbidity and burnout in 138 psychiatrists in three Manchester teaching hospitals.ResultsThe results for senior house officers (SHOs), registrars, senior registrars and consultants were compared. The overall response rate was 76.8%. There was no significant difference in psychological morbidity between the three training grades, but SHOs and registrars reported significantly higher levels of burnout than either senior registrars or consultants. Dealing with violent patients was stressful for all psychiatrists, no matter what the grade.Clinical implicationsFactors related to job stress in psychiatry need to be addressed. In particular, the provision of safer working environments needs to be considered for psychiatrists at all levels of training.
First psychosis liaison unit family education programme
Authors: Morris Eric , Harris Catie , Nolan Lynley 
Published: October 2008

Aims and methodsThis study presents an evaluation of an education programme for families whose relative has experienced a first episode of psychosis. Participants attended a five-week programme and were asked to rate their level of knowledge and confidence in managing the illness before and after the education sessions.ResultsTwo consecutive groups of relatives (n=9; n=11) attended the programme. Comparison of knowledge and confidence ratings before and after the education sessions demonstrated significant levels of change at the final session for both groups.Clinical ImplicationsEducation for relatives of people experiencing psychosis for the first time is an important component in community management. Such education improves the knowledge and confidence of relatives in coping with the illness, possibly leading to a more accepting and less stressful family environment reducing the risk of relapse and promoting the psychological health of the patient.
Making sense of child and adolescent mental health services
Authors: Stallard Paul , Potter Robert 
Published: October 2008

Aims and methodA prospective audit of the 425 referrals made to a community child and adolescent mental health service over a three month period was undertaken. Standardised data were collected about the referrer, reason for referral problem chronicity and complexity, service response and first appointment attendance.ResultsThe service is currently seeing less than one in five of the children conservatively estimated to require specialist mental health services. The majority of those referred were appropriate, identifying multiple problems of longer than six months' duration presenting within a complex context.Clinical implicationsThe results have provided commissioning authorities with a clear specification of the current service. This can inform decisions about resource reallocation, prioritisation and future service development. Clinicians feel that the complexity of their work is now understood and various audit projects and initiatives have been established in order to explore alternative ways of responding to referrer demands.