bluuebunny/crossref_metadata_2025_split huggingface dataset:
The impact of olanzapine on attitude to medication and quality of life in schizophrenia
Authors: Stallard James , Joyce Eileen 
Published: September 2002

AIMS and MethodThis study aimed to compare the subjective quality of life and attitudes to medication between groups of patients with schizophrenia taking either olanzapine or traditional antipsychotic medication.ResultsThe two groups were matched for age, gender, length of illness and antipsychotic group demonstrated more extrapyramidal side-effects (EPS) and akathisia. Within this group, those with EPS scored lower on the affect balance scale of the Lancashire Quality of Life Scale than those without. More patients in the olanzapine group reported that medication was taken to prevent symptoms returning.Clinical ImplicationsThese results lend support to the hypothesis that the presence of EPS impairs quality of life and suggest that olanzapine therapy may improve patients' attitudes to medication.
From pillar to post – a study of younger people with dementia
Authors: Williams Tim , Dearden Anthony M. , Cameron Ian H. 
Published: September 2002

AIMS and MethodA health needs assessment was undertaken to evaluate current provision and to help inform the future development of services for people under the age of 65 years with dementia in Leeds.ResultsThe prevalence rate for early onset dementia in Leeds was found to be 42 per 100 000 aged 30–64 years, and 78 per 100 000 aged 45–64 years. Four main gateways for specialist investigation and care were identified and 38 referral pathways were identified in total. Carers had difficulties accessing information and services and they, along with the patients, valued, in particular, both the coordinated service provided by the specialist early onset dementia team and the dedicated day care facility available in Leeds.Clinical ImplicationsYounger people with dementia can have very different needs to older people. The prevalence rate and the experiences of carers and patients clearly justifies the existence and further development of a specialist early onset dementia service. Such a service should provide a single gateway to coordinated service provision and ensure continuity of care. It should provide sufferers and carers with information, advice and expertise.
Ambiguity in Section 136 of the Mental Health Act 1983
Authors: Ogundipe Laofe , Oyebode Femi , Knight Amanda 
Published: September 2002

AIMS and MethodTo investigate the interpretation of Section 136 of the Mental Health Act 1983 by Section 12(2) approved doctors and to describe a pathway that facilitates early assessment of people detained under Section 136. We surveyed a random sample of Section 12(2) approved doctors in the West Midlands.ResultsA response rate of 70% was achieved. Approximately 65% believe that it would be illegal to transfer a person under Section 136 from the police station to a further place of safety, such as hospital. Thirty-five per cent believed that this could be done legally or were unsure.Clinical ImplicationsAmbiguity still remains about the legal interpretations of the provisions of Section 136 of the Mental Health Act 1983, which needs to be rectified.
Structured psychiatric assessment schedules – treating the case notes and the patient
Authors: Lyons Declan , Amos Mark , Mathew V. M. 
Published: September 2002

Aims and MethodWe surveyed the usefulness of a structured method of recording history and mental state examinations with a treatment plan in terms of conveying information about diagnosis and management, compared with informal methods of recording data. A survey of admission records by nursing and medical raters was followed by introduction of a standardised assessment format for use by trainees and a re-audit. Initial psychotropic medication was also scrutinised.ResultsThe assessment schedule improved clarity of diagnosis for the medical and nursing raters alike, but improvement in management plan quality was mainly apparent for the medical rater. The audit also exposed widespread use of hypnotic agents.Clinical ImplicationsIt is suggested that structured assessment schedules facilitate adherence to good standards of clinical practice and may benefit trainees undertaking professional exams as well as having a multi-disciplinary and medico-legal relevance.
HoNOS–ABI; a clinically useful outcome measure?
Authors: Coetzer R. , Du Toit P. L. 
Published: September 2002

Aims and MethodOutcome measurement has become increasingly important in brain injury rehabilitation. Health of the Nation Outcome Scale-Acquired Brain Injury (HoNOS–ABI) is a new outcome measure targeting psychiatric and other sequelae of brain injury. Forty patients' scores on three outcome measures and other ecologically valid markers of outcome were compared.ResultsSignificant correlation coefficients between HoNOS–ABI and two other outcome measures were found. Post-injury employment status correlated with HoNOS–ABI rating. Although there was a significant increase in need for psychiatric intervention following brain injury, this did not correlate with HoNOS–ABI ratings.Clinical ImplicationsHoNOS–ABI may be a useful additional measure of outcome following brain injury, specifically identifying the often missed psychiatric sequelae of a brain injury.
The public's knowledge of psychiatrists: questionnaire survey
Authors: Williams A. , Cheyne A. , MacDonald S. 
Published: September 2002

Aims and MethodOne objective of the Royal College of Psychiatrists' stigma campaign is to improve the public's knowledge about psychiatric illness. There has been little work in the UK on the public's knowledge of the training of psychiatrists and the treatments they use. Using a questionnaire, we compared a sample representing the general population (n=223) with a sample attending psychiatric outpatients (n=67) to assess their level of knowledge.ResultsHalf of the general population sample did not know that psychiatrists were medically qualified, and 80% underestimated the length of psychiatric training. There was variable knowledge of the conditions treated by psychiatrists and treatment methods used, with the outpatient group having better knowledge of drug treatments.CLINICAL IMPLICATIONIf the general public do not know about the training and expertise of psychiatrists, this is likely to limit their willingness to seek treatment for mental illness.
Electroconvulsive therapy – attitudes and practice in New Zealand
Authors: Strachan John A. 
Published: September 2002

Aims and MethodThe clinical practice of electroconvulsive therapy (ECT) by New Zealand psychiatrists was surveyed by questionnaire. This paper compares the findings with national and regional surveys conducted in Great Britain, and considers the influence on clinical practice in New Zealand of the Royal College of Psychiatrists' ECT Handbook.ResultsECT has the same level of support from psychiatrists in New Zealand as in Britain, but is less frequently used. Modern brief pulse machines are used by 16 of 19 (84%) services from which data were received. The ECT Handbook was the most nominated source of information on ECT. Most (87%) respondents were aware of at least one set of ECT guidelines. However, these have apparently failed to influence some important aspects of practice. In particular, many medical conditions are still perceived as absolute contraindications.Clinical ImplicationsThe Royal College of Psychiatrists and the Royal Australian and New Zealand College of Psychiatrists need to place even greater emphasis on the importance of training in ECT for both trainees and qualified psychiatrists, and on the promotion of approved guidelines.
Pain clinics, a new role for psychiatrists
Authors: Wallace John , Panch Gnanie 
Published: September 2002

Aims and MethodThe aim of this study was to find out the extent of psychiatric involvement in pain clinics and also clarify the treatment approaches taken for the significant psychiatric comorbidity reported in these clinics. A questionnaire survey was conducted, by a psychiatrist and an anaesthetist, of the 31 pain clinics in the Greater London area.ResultsPsychiatric involvement in the management of patients with chronic pain is extremely limited, despite the extensive psychiatric morbidity associated with these patients (response rate, 74%). The majority of surveyed pain clinics wish to provide a multi-disciplinary approach to these patients, utilising the skills of a psychiatrist for both assessment and management. Only a small minority of pain clinics, however, have sufficient access to a liaison psychiatry service that could provide the broad multi-disciplinary approach and the psychiatric treatment options that they believe chronic pain patients require.ImplicationsThe involvement of psychiatrists in pain clinics is very limited. Increased involvement is desired and would likely lead to an improved profile of pain clinics, a more realistic and comprehensive treatment approach and, in turn, enhanced patient care.
A survey of psychiatrists' and nurses' views of mental health advocacy
Authors: Lacey Yvonne , Thomas Philip 
Published: September 2002

Aims and MethodAdvocacy is assuming an increasingly important role in the delivery of mental health services, but many psychiatrists feel threatened by it. This study was performed to ascertain how much doctors and nurses know about advocacy and their attitudes towards it. We interviewed five senior house officers, five staff nurses and four community psychiatric nurses (CPNs) to examine their understanding, experience and opinions about advocacy. A full-time advocate was also interviewed to establish his views about how well staff understood his role.ResultsIn general there was poor understanding of the background and training of advocates, and their Code of Practice. There were also important differences in the way in which different groups of staff saw advocacy, with CPNs having the best understanding. Experiences of advocacy were positive and it was seen as being helpful both for clients and staff, despite fears that advocates might work to their ‘own agendas'.Clinical ImplicationsThere is a need to improve psychiatrists' understanding of what advocacy is, through the involvement of advocates and service users in their training. This would help to allay their anxieties about the role of advocates.
Residential care homes for the mentally ill
Authors: Kinane C. , Gupta K. 
Published: September 2002

Aims and MethodThis study describes residents in seven care homes, reviews their usage of mental health services and evaluates cost implications of psychiatric health care provision.ResultsThe patients are predominantly male with multiple diagnoses who are receiving psychiatric health care, but in general lack structured rehabilitation services. Forty-seven per cent of the residents moved into the trust catchment area in order to occupy the placement.The cost associated with the provision of differing models of out-patients care varies considerably.Clinical ImplicationsThese vulnerable residents are costing the mental health service relatively little, although the total cost to society is higher.This study points to the necessity of multiagency planning for 'new long-stay' patients.
A review of the treatment options for clozapine-induced hypersalivation
Authors: Cree Adrian , Mir Shameem , Fahy Thomas 
Published: September 2002

Aims and MethodTo develop and introduce an evidence-based drug treatment protocol for clozapine-induced hypersalivation, a review of published literature relating to clozapine-induced hypersalivation and its treatment was undertaken in March 2000. The databases searched were Medline, EMBASE and PsychLit, from 1966 to the present.ResultsThis paper reviews the evidence of the benefit of using antimuscarinic agents, adrenergic antagonists and adrenergic agonists. There is alack of good-quality controlled-trials, with most papers reporting aseries of uncontrolled cases dependent on subjective measures of improvement reported by the patients. However, the published literature suggests a benefit for all of the drug categories reviewed. The most effective treatment may be acombination of terazosin and benzhexol.Clinical ImplicationsClozapine-induced hypersalivation is not only an embarrassing problem, but can be difficult to treat. An evidence-based prescribing protocol will encourage the use of those drugs found to be the most effective in treating this problem. It will also offer alternatives if acertain treatment is ineffective or intolerable.
Assaults and threats on psychiatrists
Authors: Davies Stephen 
Published: September 2002

Aims and MethodTo determine the annual rates of assaults and threats to psychiatrists, describing the situations and staff involved, using a retrospective postal questionnaire of 139 doctors working in South Wales.ResultsOver the year, 17% of respondents reported one or more assaults (of these, 42% were assaulted more than once) and 32% reported one or more threats. The most junior senior house officers (SHOs) were significantly more likely to have experienced an incident, regardless of the individual's gender or attendance at a course in managing aggression. Most assaults (61%) were committed by patients from general adult psychiatry, and half occurred during urgent assessments. Eighteen (58%) of the assailants were known to have previously assaulted amember of staff, and this information was known to the doctor before the assault for 16 (88%). Five (16%) of the assailants had been drinking alcohol prior to the assault. Twenty-nine (78%) of the assaults were documented in the case notes and 6 (19%) were reported to management.Clinical ImplicationsSome staff (in particular, inexperienced SHOs) are at greater risk, and efforts should be made to identify and help these individuals and/or grades to deal with aggression. All psychiatric staff should be trained to manage violence. Staff should be encouraged to report incidents to management, so that employers can identify and address problem areas.
Survey of psychotherapy training for psychiatric trainees in South-West England
Authors: McCrindle David , Wildgoose Joanna , Tillett Richard 
Published: September 2002

Aims and MethodA telephone questionnaire to assess psychotherapy training in the 12 psychiatric training schemes in South-West England was conducted in April 1999. The findings were compared with the 1993 guidelines recommended by the Royal College of Psychiatrists.ResultsOnly one scheme was achieving the standards set by the College guidelines. The majority of trainees in this region were not receiving adequate psychotherapy training.Clinical ImplicationsPsychotherapy training for psychiatric trainees needs urgent review in South-West England.
Oral health of psychiatric in-patients
Authors: Mirza Ilyas , Day Rachel , Phelan Michael , Wulff-Cochrane Victor 
Published: September 2002

Aim and MethodThe aim of the study was to get an estimate of oral health needs of in-patients on acute general adult wards in an inner-city psychiatric unit. Information was collected by means of a cross-sectional survey with patient interviews and a brief oral examination.ResultsA significant majority of patients had carious teeth, inflammation of gums and oral plaque. A majority of patients complained of pain during the preceding 3 months and problems with teeth.Clinical ImplicationsOral health of patients admitted to an acute psychiatric unit is worse than compared to the general population. There appears to be a need for basic dental health education and easy access to dental care on psychiatric wards.
The use of operationalised criteria for inclusion on a Care Programme Approach register
Authors: Phipot M. , Hales H. , Sheehan B. , Reeves S. , Lawlor M. 
Published: September 2002

Aims and MethodTo determine the rates at which clinical teams within one NHS trust placed older people on a Care Programme Approach (CPA) register and to examine the degree to which clinicians' use of the register conformed to trust policy. Two retrospective case notes surveys were carried out 6 months apart within a completed audit cycle.ResultsConsultant teams varied considerably in their application of the CPA policy. Feedback to clinicians after the first survey had a variety of effects on subsequent use of the CPA register.Clinical ImplicationsHealth service policies exist to reduce variation in clinical practice and to ensure minimum standards. Clinical audit may be a useful tool in identifying irrational variation within the framework of clinical governance.
High dose neuroleptics – who gives them and why?
Authors: Wilkie Alcuin , Preston Neil , Wesby Roger 
Published: September 2002

Aims and MethodNeuroleptic medication is often used in excess of the BNF maximum. The purpose of this study was to examine the relationship of neuroleptic dose to patient, prescriber and environmental factors, by using a cross sectional ‘snapshot’ study of psychiatric in-patient prescriptions combined with a retrospective case note survey.ResultsIt was found that certain consultants prescribe higher doses of neuroleptics than others. Patients with a history of aggression had a nine and a half times higher chance of being prescribed higher doses of neuroleptics. Patients with a greater than 5-year history of neuroleptic prescription received higher doses.Clinical ImplicationsHigh neuroleptic prescription is related more to patients' past reputation and prescriber differences than to patients' current behaviour.
Senior house officer training in liaison psychiatry – are College guidelines being implemented?
Authors: Surlinson S. , Guthrie E. 
Published: September 2002

Aims and MethodsTo determine whether the College guidelines in liaison psychiatry are being implemented, a survey of training opportunities at senior house officer (SHO) level was undertaken. A detailed postal survey was conducted in January 2000. Information was collected about the number and nature of SHO liaison psychiatry posts from a wide range of sources.ResultsNationally, 45.5 SHO posts in liaison psychiatry were identified. These were unevenly distributed, with a high number in London. Only five posts were available to general practitioner trainees. Nine regions anticipated an increase in training opportunities. Regional liaison representatives had incomplete knowledge of the availability of liaison training opportunities in their region.Clinical ImplicationsThe College guidelines to incorporate liaison experience into all training schemes have not been implemented. In four regions no training opportunities were identified whatsoever. A national database is needed to monitor training opportunities and inform further development of training posts.
Introducing a nurse-led deliberate self-harm assessment service
Authors: Griffin Gill , Bisson Jonathan I. 
Published: September 2002

Aims and MethodThis study considered patients admitted to hospital following deliberate self-poisoning. The characteristics of the patients and the outcomes of assessments by trainee psychiatrists and a mental health nurse were compared.ResultsThere were no significant differences in the outcome of 68 assessments performed by a trainee psychiatrist and 77 by a mental health nurse. The nurse assessment service was well-received by the poisons unit, a medical ward specialising in overdose treatment, and trainee psychiatrists.Clinical ImplicationsPsychosocial assessments following self-poisoning can be provided by appropriately trained and supervised mental health nurses. The introduction of a nurse-led service should enhance relationships with the local poisons unit and reduce the workload of junior doctors without compromising their training needs.
Audit of an electroconvulsive therapy clinic's missed-fit rate
Authors: Davies Richard Huw , Wilson Rowan 
Published: September 2002

Aims and MethodTo audit the missed-fit rate of a consultant-led electroconvulsive therapy (ECT) clinic adhering to a stimulus dosing policy. After an initial first audit a standard for the missed-fit rate was set at ≤ 5%. A second and third audit examined whether the standard was met and then maintained over time.ResultsThe audit standard of maintaining a missed-fit rate ≤;5% was achieved in the second audit and maintained in the third audit. The missed-fit rate dropped from 5% in the first audit, to 2% in the second audit and to 1.8% in the third audit.Clinical ImplicationsA missed-fit rate of ≤ 5% was achieved and maintained over a 6-year period with rigorous adherence to a stimulus dosing policy in a consultant-led ECT clinic. This compares favourably with missed-fit rates of 25% found in national audits of ECT. A missed-fit rate of ≤ 5% might provide one possible standard for the efficiency of ECT clinics nationally.
How much risk training takes place in mental health services?
Authors: Davies Sue , Amos Tim , Appleby Louis 
Published: September 2002

Aims and MethodThe main aim of the study was to establish the proportion of hospital trusts in England and Wales in which training in the assessment of suicide risk and risk of harm to others is available to mental health professionals. A questionnaire was sent to clinical directors covering training on these subjects and in mental health legislation, details of training and the existence of risk-related policies.ResultsSeventy-six per cent of trusts said they provided training in suicide risk assessment for junior psychiatrists; for hospital and community nurses, the figure was just over 50%. Between 50% and 60% of trusts said they provided training in the assessment of risk of harm to others. Provision of training in mental health legislation was said to occur in most trusts. In some key areas of risk management, hospital policies were uncommon.Clinical ImplicationsDespite the current importance of risk assessment in mental health services, many hospital trusts do not provide their staff with relevant training.
Psychiatrists' views of in-patient child and adolescent mental health services: a survey of members of the child and adolescent faculty of the College
Authors: Worrall Adrian , O'Herlihy Anne 
Published: September 2002

Aims and MethodTo obtain a prioritised list of psychiatrists' concerns relating to in-patient child and adolescent mental health services. Four-hundred and fifty-four members of the child and adolescent faculty of the Royal College of Psychiatrists were asked to list their main concerns.ResultsTwo-hundred and seventy-four members responded. The most reported themes included lack of emergency beds; lack of services for severe or high-risk cases; lack of beds in general; poor liaison with patients' local services; lack of specialist services; and poor geographic distribution of services.Clinical ImplicationsThe range of themes identified from this survey have served to focus the National In-patient Child and Adolescent Psychiatry Study (NICAPS) and several design changes have been made to NICAPS as a result.
Clozapine-induced nocturnal enuresis: diagnostic and treatment issues
Authors: Kho King Han , Nielsen Olaf 
Published: September 2002

Aims and MethodTo report the management of three cases of clozapine-induced enuresis, by description of these cases and literature review.ResultsHeavy sedation, generalised epilepsy and diabetes mellitus induced by clozapine are some of the mechanisms that underlie the emergence of this side-effect.Clinical ImplicationsThese cases illustrate several different pathophysiological mechanisms necessitating further diagnostic investigations before adequate treatment can be started. Clozapine-induced enuresis is probably under-reported owing to the embarrassing nature of this side-effect.