bluuebunny/crossref_metadata_2025_split huggingface dataset:
An audit of risk assessment in an emergency setting
Authors: Stone James , Szmukler George 
Published: September 2002

Aims and MethodPatient records from the emergency clinic at the Maudsley Hospital were analysed from July 1999 to assess the standard of risk assessment for self-harm and for harm to others routinely recorded by junior doctors. The recorded risk factors for the consultation and the evidence that risk had been considered were noted. An intervention that comprised two seminars and two written reminders about the importance of risk assessment was made and the analysis of records in the emergency clinic repeated for July 2000.ResultsRisk factors were recorded more frequently for harm to self than for harm to others. There was little recorded evidence that consideration had been given to the overall risk of harm to self, and there was no evidence of this for harm to others. Recording of risk did not change significantly between 1999 and 2000.Clinical ImplicationsAssessment for risk of harm to others is not a part of the emergency consultation that is emphasised by the majority of junior psychiatrists. Changing practice will require a shift in the way that risk to others is presented in psychiatric teaching.
A survey of academic provision for old age psychiatry in the UK and Ireland
Authors: Lindesay J. , Katona C. , Prettyman R. , Warner J. 
Published: September 2002

Aims and MethodThis paper reports the findings of a 1999 survey of academic old age psychiatry staffing and teaching in UK and Irish medical schools.ResultsJust over half had staff established at the level of senior lecturer or above. These schools devoted more time to undergraduate teaching, covered more topics and used a wider range of teaching methods.Clinical ImplicationsThere is a need for further academic development in old age psychiatry to drive the development of the speciality, and to ensure that all medical undergraduates receive an adequate training in this subject area.
Evaluating the quality of educational materials about schizophrenia
Authors: Currie C. , Di Mambro P. , Joice A. , Mcglip R. , O'Neill M. , Ralston G. E. , Davidson R. , Scott J. 
Published: September 2002

Aims and MethodTo identify and evaluate the reliability and quality of educational materials provided to individuals with schizophrenia and their carers. Materials used by mental health professionals working in community and in-patient settings were collated. Two independent raters used the ‘Discern’ questionnaire to assess the publications.ResultsFifteen documents were identified, but only 11 were suitable for evaluation. Interrater reliability of ratings using the Discern tool was highly significant. No educational package scored maximum marks, but four scored in the good quality range. About a fifth of the materials in widespread use were assessed as of poor quality.Clinical ImplicationsThe use of a rating instrument to assess the quality of educational publications appears to be a reliable and acceptable way to identify the strengths and weaknesses of widely available materials. Staff can use these data to assess the quality of their preferred materials against other publications and make an informed selection.
Service innovations: a neuropsychiatry outreach clinic
Authors: Leonard F. , Majid S. , Sivakumar K. , Toone B. 
Published: September 2002

Aims and MethodWe describe the neuropsychiatry outreach clinic in west Kent and review referrals to the clinic over a 4-year period. By comparing the referral pattern of west Kent with adjacent health authorities we show how an outreach clinic can influence the number of neuropsychiatric referrals.ResultsReferrals from west Kent increased from 87 in the 4-year period prior to the outreach clinic to 255 in the 4-year period that the clinic has been in existence. Forty-nine of these patients were first assessed in the outreach clinic. The number of referrals from east Surrey and east Sussex remained low in the same period.Clinical ImplicationsAn outreach clinic provides access to specialist expertise and increases local awareness of specialist services. Similar outreach clinics in other areas may enhance the clinical care of patients who are currently not being referred to neuropsychiatry.
The interface between general and prison psychiatry – the consultant's perception
Authors: Smith Sara , Baxter Vincent , Humphreys Martin 
Published: September 2002

AIMS AND METHODA postal questionnaire was sent to 100 Section 12 (2) approved consultant psychiatrists in the West Midlands to ascertain their perceptions of the role of general psychiatric services in the care of imprisoned patients with mental disorder previously cared for by generic services.RESULTSOf 59 respondents 90% believed they could contribute to the care of imprisoned patients with mental disorders. Ten per cent would delegate total responsibility to specialist forensic services. Lack of awareness of imprisonment of patients was a common problem.CLINICAL IMPLICATIONSInsufficient liaison between prison and general psychiatric services may impede the provision of psychiatric care in prison and prevent discharge planning in line with the Care Programme Approach and current Government guidelines.
Mental health presentations to an inner-city accident and emergency department
Authors: Cassar S. , Hodgkiss A. , Ramirez A. , Williams D. 
Published: September 2002

AIMS AND METHODTo study the presentation, assessment and management of all patients attending St Thomas' accident and emergency (A&E) department with overt mental health problems. The method included a pragmatic definition of ‘overt mental health problems' and a range of strategies to maximise case ascertainment.RESULTSThe department saw 565 presentations in a 3-month period. Patients were predominantly young, male, single, unemployed, housed outside the area served by the local primary care group and presented outside normal working hours.CLINICAL IMPLICATIONSThis study confirms that A&E departments may be the most frequently used setting for urgent mental health assessments in central London. The patients attending differ from those using community mental health teams. It is argued that mental health liaison services based in inner-city A&E departments should be developed.
Problem of drawing from psychiatry for a fiction writer
Authors: McGrath Patrick 
Published: September 2002

Transcript of a talk given at the Annual Meeting of the Royal College of Psychiatrists, 10 July 2001My topic is the problem of drawing from psychiatry for a fiction writer. This is a subject on which I am eminently well-qualified to speak. I have written five novels and a short-story collection, all of which have dealt with minds in disorder. Two of my novels – one called Spider, the other Asylum – have been focused centrally on psychiatry and psychiatric illness, so it is about the writing of these two novels that I want to talk today.
Service innovations: attention-deficit hyperactivity disorder – development of a multi-professional integrated care pathway
Authors: Burgess Isabel C. 
Published: September 2002

AIMS AND METHODThere is a need for multi-disciplinary input into the diagnosis and management of attention-deficit hyperactivity disorder (ADHD). We describe the development of a multi-professional integrated care pathway incorporating education, community paediatrics, child and adolescent mental health services and general practice.RESULTSUsing parent-held documentation this pathway forms the bass of a community-based ADHD clinic.CLINICAL IMPLICATIONSA training programme for schools and health professionals raises awareness of the features of ADHD and covers appropriate management within schools.
Socio-economic deprivation and psychiatric referral and admission rates – an ecological study in one London borough
Authors: Soomro G. Mustafa , Burns Tom , Majeed Azeem 
Published: September 2002

AIMS AND METHODWe retrospectively investigated the association between the Jarman and Townsend indices of deprivation and referral rates to community mental health teams (CMHTs) and in-patient admissions rates, including the contribution of general practice factors to these rates. The samples consisted of all community/out-patient referrals and admissions to four CMHTs over 1 year.RESULTSLow positive correlation was found between community/out-patient referral rates for all diagnoses and psychosis with the Jarman index, and between both the indices and admission rates for all diagnoses and non-psychosis. Referrals from general practitioners (GPs) varied nearly 40-fold and were not related to either indices, fundholding status or having practice manager or practice nurse.CLINICAL IMPLICATIONSOverall, the Jarman index appears to be a more useful index for planning psychiatric service provision. However, because of the small correlation with referral and admission rates, deprivation indices in themselves would be of limited value, as there may be other relevant factors that require investigating. GP characteristics investigated did not predict referral rates.
Service innovation: the first year of a brief psychiatric screening clinic in primary care
Authors: Hamilton Ross , Gordon Peter , Naji Simon 
Published: September 2002

AIMS AND METHODTo introduce a monthly screening clinic for new patients referred to the community mental health team with less severe mental health problems.RESULTSSixty patients were selected for screening in the first year. Their non-attendance rate of 48% was more than double the rate for all new patients. We did not diagnose severe mental illness in any patients on first assessment or during the 6 months of follow-up.CLINICAL IMPLICATIONSPatients referred from general practice with minor psychiatric morbidity may have particularly high rates of non-attendance. The brief screening clinic model offered us considerable savings in consulting time. The outcome for our service is shorter waiting times for patients with more severe mental health problems.
Underdetection of comorbid drug use at acute psychiatric admission
Authors: Ley A. , Jeffery D. , Ruiz J. , McLaren S. , Gillespie C. 
Published: September 2002

Aims and MethodThe ability of routine clinical practice to detect drug use at acute psychiatric admission was assessed by comparing the results of urinalysis with information on drug use extracted from patient records (n=112).ResultsUrinalysis detected drug use in 23% of the sample. Cannabis was the drug most frequently found. Of the cases of drug use positively identified by urinalysis, 54% were not identified in the notes. Some information on drug use proximal to admission was found in 40% of patient records. Patients asked about proximal drug use were younger than those not asked.Clinical ImplicationsAll patients should be asked about drug use.
MIDAS: a new service for the mentally ill with comorbid drug and alcohol misuse
Authors: Bayney R. , St John-Smith P. , Conhye A. 
Published: September 2002

Aims and MethodTo describe the work and patient characteristics of one of the first combined mental illness and drug and alcohol services (MIDAS) in the UK. We examined MIDAS as an assertive community service, for individuals receiving long-term community care. We selected the case files of the first 80 patients accepted over a 10-month period and examined variables including demographic details, diagnosis, associated substance use and length of engagement with the service.ResultsOur findings show that there was no relationship between responders to the service and basic demographic data. Patients with bipolar affective disorder and personality disorders were more likely to use the service than patients with unipolar disorder or schizophrenia. Despite the use of an assertive service, there was difficulty engaging patients with schizophrenia and comorbid drug use. These same patients also had a high level of criminal convictions as well as a trend towards using alcohol and cannabis as their main substances of misuse. At 18 months 38% of patients had failed to remain engaged with the service.Clinical ImplicationsThis specialist type of service may be more useful than other services in engaging patients with comorbidity. Systematic research is required in the UK to explore the effectiveness of this type of new service. More innovative resources need to be identified to specifically deal with patients with severe mental illness and comorbid substance use.
The clinical management of a patient with depressive disorder: a case vignette study to examine general practitioners' views
Authors: Marriott Sarah , Wright Christine , Lelliott Paul 
Published: September 2002

Aims and MethodThe study aimed to examine general practitioner (GP) views about the appropriate management of a patient with a depressive disorder. A questionnaire based around a patient case history was sent to 188 GPs from 11 primary care groups nationally.ResultsThe response rate was 62%. At first presentation, a third of GPs offered ‘watchful waiting’ and a third prescribed medication. If the patient's condition deteriorated, nearly all GPs initiated therapeutic doses of antidepressant medication immediately. If the patient failed to respond, 60% of GPs commenced second-line antidepressant treatment. Following recovery, a quarter of GPs would continue antidepressant treatment for 4 months or more.Clinical ImplicationsGPs' interventions in the management of depression concur with expert national guidelines. There is scope for strengthening the effectiveness of pharmacological intervention in the later stages of treatment.
The relationship between medical school of training, age, gender and success in the MRCPsych examinations
Authors: Tyrer S. P. , Leung W.-C. , Smalls J. , Katona C. 
Published: September 2002

Aims and MethodFactors leading to success in the MRCPsych Part I and Part II examinations, including age, gender and original medical school of training, were examined in the 1999 MRCPsych examination entrants to determine how far they are associated with the results. The ethnic breakdown of examiners of the MRCPsych examinations was also determined and compared with the origin of all consultant psychiatrists.ResultsYounger age at taking the examination and training at a British or Irish medical school were found to be highly significant predictors of success in the MRCPsych examinations. When allowance was made for confounding variables, the gender of candidates did not contribute to success. There was no difference in ethnic background of examiners compared with consultant psychiatrists overall.Clinical ImplicationsFactors affecting trainees wishing to undertake a psychiatric career need to be more closely examined. To ensure fairness and transparency in future examinations the ethnicity of candidates taking the examination needs to be addressed.
Service innovations: development of a psychoeducational programme for patients with personality disorder
Authors: D'Silva Karen , Duggan Conor 
Published: September 2002

Aims and MethodThis study describes a survey of in-patients with personality disorder admitted to a specialist personality disorder unit, in terms of their knowledge and understanding of their diagnosis, and the subsequent development of a psychoeducational programme.ResultsOverall, patients had a poor knowledge and understanding of their diagnosis. Most had not had their diagnosis explained to them, and if they had, they had not retained the information. Consequently a structured psychoeducational programme was developed, incorporating diagnostic information obtained at the pre-admission assessment.Clinical ImplicationsDiagnostic information for those with personality disorder, even when it is available, is not transmitted to patients. Imparting this information through a psychoeducational programme is one way in which the therapeutic relationship between patient and clinician can be strengthened.
Research in psychiatric higher specialist training: a survey of specialist registrars
Authors: Allsopp L. , Allen R. , Fowler L. , Hall C. , Woodbury-Smith M. R. 
Published: September 2002

Aims and MethodSpecialist registrars (SpRs) in psychiatry spend only 3 years in this grade, with 1 day a week allocated to research. In view of this sizeable proportion of time designated for research, we undertook a postal survey of the experiences of and attitudes towards research of SpRs in developmental psychiatry.ResultsA high proportion of respondents were involved in research at the time of the study, although half described difficulty starting and a third described difficulty taking the day. The majority of respondents believed research to be important and about three-quarters found it enjoyable.Clinical ImplicationsWhile research remains a mandatory part of training it is important that trainers ensure that research time is protected.
Prescribing patterns for psychotic and behavioural symptoms in dementia: a national survey
Authors: Scott K. , Lawrence R. M. , Duggal A. , Darwin C. , Brooks E. , Christodoulou G. 
Published: September 2002

Aims and MethodTo compare current prescribing practice for psychotic and behavioural symptoms in dementia with the available research. An anonymous questionnaire was sent to all members of the Faculty of Old Age Psychiatry, enquiring about preferred drug treatments.ResultsClassical antipsychotics were chosen by 50% for psychotic symptoms over atypical antipsychotics (43%) and were preferred for aggression (48%) and sexual disinhibition (55%). Antidepressants were favoured in treating anxiety (41%) and lability (45%).Clinical ImplicationsAlternatives to classical antipsychotics, especially for behavioural symptoms, have yet to be researched satisfactorily. In view of the continued widespread use of classical antipsychotics and recent concerns about their safety, we call for this to be addressed.
Naturalistic study of the antipsychotic medication review service at the Maudsley Hospital
Authors: Stone James , Ohlsen Ruth , Taylor David , Pilowsky Lyn 
Published: September 2002

Aims and MethodTo evaluate the effectiveness of the antipsychotic medication review service (AMRS) at the Maudsley Hospital. Patient notes were analysed from the AMRS and estimates of Global Assessment Scale (GAS) scores were made from entries in the notes. Data on hospital admissions before and during attendance at the AMRS were obtained from the trust-wide computerised patient administration system.ResultsA statistically significant improvement in GAS scores was seen for patients who stayed in contact with the AMRS. Patients who did not respond to the first atypical drug often made a good response to an alternative atypical antipsychotic. Patients attending the AMRS had fewer hospital admissions than they did before attendance, although this was not statistically significant.Clinical ImplicationsAlthough more expensive on a dose-by-dose rate, atypical antipsychotics may be cost effective by improving compliance and reducing the number of relapses and hospital admissions. Specialised services with frequent patient contact can be effective in preventing relapse and improving global function.
Psychiatry of learning disability – a future with mental health?
Authors: Alexander R. , Regan A. , Gangadharan S. , Bhaumik S. 
Published: September 2002

Aims and MethodA postal survey was sent to all consultants in the psychiatry of learning disability from four English regions. Their views on job satisfaction, their core roles and the management re-structuring of services were elicited.ResultsThe proportion agreeing or strongly agreeing with each management option was 79% for integrated mental health–learning disability trusts, 61% for specialist learning disability trusts, 47% for care trusts, 10% for primary care trusts and 5% for social services. Only 34% felt consulted or able to influence the process of change and only 33% were satisfied with the current management changes within their trust but 67% were satisfied overall with their jobs.Clinical ImplicationsManagement from integrated mental health–learning disability trusts is the most preferred option for psychiatrists in learning disability. A large number of consultants, though otherwise satisfied with their jobs, feel excluded or unable to influence the current changes in management structures. A model of integrated service provision in line with the government's learning disability strategy is presented.
The research day: a suitable case for treatment?
Authors: Vassilas C. , Tadros G. , Day E. 
Published: September 2002

Aims and MethodThe research day accounts for 20% of time spent in higher training in psychiatry. We sought the views of both trainers and trainees through a postal questionnaire.ResultsTwenty-six schemes were identified nationally and replies were received from 93% of programme directors and 77% of specialist registrar peer group representatives. Only 38% of programme directors and 30% of trainees agreed with the statement that ‘specialist registrars use the research day satisfactorily’. Forty-six per cent of programme directors believed that the research day should be abolished in its present form.Clinical ImplicationsThis survey confirms widespread concern with the way that the research day is organised. We make some suggestions as to how it could be developed into a more effective part of the training process.
A Randomized Controlled Trial of Mist in the Acute Treatment of Moderate Croup
Authors: Neto Gina M. , Kentab Osama , Klassen Terry P. , Osmond Martin H. 
Published: September 2002

Abstract Objective: To determine whether the use of mist improves clinical symptoms in children presenting to the emergency department (ED) with moderate croup. Methods: Children 3 months to 6 years of age were eligible for the study if they presented to the ED with moderate croup. Moderate croup was defined as a croup score of 2‐7. The patients were randomly assigned to receive either mist (humidified oxygen) via mist stick or no mist. The patients had croup scores measured at baseline and every 30 minutes for up to two hours. At these intervals the following parameters were also measured: heart rate, respiratory rate, oxygen saturation, and patient comfort score. The patients were treated until the croup score was less than 2 or until two hours had elapsed. All patients initially received a dose of oral dexamethasone (0.6 mg/kg). Other treatments, such as racemic epinephrine or inhaled budesonide, were given at the discretion of the treating physician. The research assistants were unaware of the assigned treatments. Results: There were 71 patients enrolled in the study; 35 received mist and 36 received no mist. The two treatment groups had similar characteristics at baseline. The median baseline croup score was 4 in both groups. The outcomes were measured as the change from baseline at 30, 60, 90, and 120 minutes. The change in the croup score from baseline in the mist group was not statistically different from the croup score change in the group that did not receive mist (p = 0.39). There was also no significant difference in improvement of oxygen saturation, heart rate, or respiratory rate at any of the assessment times. There was no adverse effect from the mist therapy. Conclusions: Mist therapy is not effective in improving clinical symptoms in children presenting to the ED with moderate croup.