bluuebunny/crossref_metadata_2025_split huggingface dataset:
Newspaper coverage of psychiatric and physical illness
Authors: Lawrie Stephen M. 
Published: September 2002

Aims and MethodTo compare how newspapers cover psychiatric and physical illness. We conducted a survey of relevant headlines in nine daily newspapers over a one-month period and judged whether the content was essentially positive, neutral or negative.ResultsOver the one-month period, 213 article headlines about various aspects of medicine and 47 on psychiatry were identified. Ninety-nine (46%) of the former were critical intone as compared with 30 (64%) of the latter (odds ratio=4.42, 95% CI 1.64–11.94).We gained the impression that negative articles about physical medicine tended to criticise doctors whereas negative articles about psychiatry tended to criticise patients. Tabloid and broadsheet newspapers did not differ in their rates of negative coverage.Clinical ImplicationsPsychiatry, psychiatrists and particularly psychiatric patients tend to be represented negatively in the newspapers. Psychiatrists should strive to influence the news agenda by proactively reporting positive messages, such as treatment advances.
Prescribing in schizophrenia
Authors: Taylor David , Mir Shameem , Kerwin Robert 
Published: September 2002

Aims and MethodTo develop and introduce a drug treatment protocol for schizophrenia and to evaluate its effect on prescribing. Prescribing of antipsychotics was audited in January 1998. A prescribing protocol was then developed by a collaborative process involving all medical staff, and introduced in September1998. A second prescribing audit was conducted in February 1999.ResultsThe proportion of patients prescribed atypical drugs increased from 16.6% to 25.5%. Co-prescription of atypical and typical drugs was relatively uncommon compared with findings of other prescribing surveys. The use of anticholinergic medication was significantly more likely in patients receiving regular typical drugs alongside atypical agents than in those receiving atypicals alone.Clinical ImplicationsWidely agreed prescribing protocols may promote improved prescribing practices. Co-prescription of atypical and typical drugs should be discouraged.
Outcome of clozapine treatment for patients with treatment-resistant schizophrenia in a local clinical service
Authors: Rastogi Sudhir , Mynors-Wallis Laurence 
Published: September 2002

Aims and MethodsThe aim of this study was to examine the impact of prescribing clozapine for a cohort of patients with treatment-resistant schizophrenia in a local clinical service. Information was collected about the use of health care resources in the six months before and the six months after starting clozapine. Information was also recorded as to the effect of clozapine on daily living skills and overall clinical improvement.ResultsThe introduction of clozapine was associated with clinical befefits both in terms of overall clinical improvement and daily living skills. The introduction of clozapine was cost neutral in the first six months when taking into account both drug costs and total health care costs. The reduction in hospital bed usage did not occur untill the third and fourth year following the introduction of clozapine.Clinical ImplicationsAlthough the drug costs of clozapine are higher than the use of traditional neuroleptics for treatments-resistant schizophrenia, the immediate overall costs of introducing colzapine were no higher than before the drug was introduced. Saving in hospital bed usage did not occur until after a period of hehabilitation. It is our impression that the clinical improvement brought about by clozapine enabled patients to benefit from the rehabilitation service to a greater extent than before the drug was started.
Chlorpromazine equivalents and percentage of British National Formulary maximum recommended dose in patients receiving high-dose antipsychotics
Authors: Yorston Graeme , Pinney Alison 
Published: September 2002

Aims and MethodsThe study compared two methods of identifying patients prescribed high doses of antipsychotic medication among in-patients and out-patients in Buckinghamshire. High doses were defined as those in excess of 1000 mg chlorpromazine equivalents (CPZE) per day or more than 100% of the maximum recommended dose in the British National Formulary (BNF).ResultsA total of 258 patients were identified as being prescribed antipsychotics, 30 of whom received high doses. There was 93% concordance between the two methods for identifying these patients. Nine of the 12 patients who had been prescribed high potency (> 1000 mg CPZE/day) but low toxicity (> 100% BNF maximum) therapy were receiving flupenthixol decanoate.A group of six high-risk patients were identified who had been prescribed lower potency drugs at supra-maximal doses.Clinical ImplicationsExpressing total antipsychotic dose as a percentage of the BNF maximum is easy to understand and calculate. It helps to ensure patients at risk of antipsychotic toxicity are easily identified to ensure monitoring guidelines can be followed.
Risky presentations
Authors: Subotsky Fiona , Santhouse Alistair 
Published: September 2002

Aims and MethodsThe aim was to review the assessment and management of the psychosocial risk (including substance misuse) of older children presenting to the accident and emergency department, with a view to making recommendations to improve services. The method used was to inspect casualty records of attendances over two weeks of 11-16-year-olds.ResultsIn no cases was any note made of whether substance misuse might have occurred. Cases of apparent psychosocial risk were, however, dealt with appropriately in the main.Clinical ImplicationsBrief advisory guidelines were written for accident and emergency staff to promote consideration of the misuse of substances in older children, and an information leaflet was developed for young people and their parents.
Adult psychotherapy and child and family psychiatry
Authors: Pollet Sheena , Bamforth Margaret , Collins Gloria 
Published: September 2002

Aims and MethodsThis paper describes a 10-year alliance between an adult psychotherapy service and a child and adolescent mental health service to bring psychotherapeutically-informed help to families in difficulties early in the lives of their children.ResultsIt outlines staff training, the development of the unit into a significant training resource, the unit's underlying philosophy, its therapies and the key inter-relationships between teams and with health visitors to enable mutual teaming and the rapid access of families to assessment and treatment of the parent-child relationship.Clinical ImplicationsFunding, future plans and the preventive and economic implications of such work are mentioned.
Prescribing and monitoring of carbamazepine and valproate – a case note review
Authors: Taylor David M. , Starkey Kate , Ginary Saira 
Published: September 2002

Aims and MethodTo evaluate prescribing and monitoring of carbamazepine and valproate to patients in secondary care psychiatric units. Review of prescription cards and medical case notes.ResultsPrescribing details for 433 patients were recorded. Both carbamazepine and valproate were widely prescribed for indications not listed in their product licences. Plasma level monitoring was not frequently undertaken, particularly with valproate. Where plasma levels were measured, apparently sub-therapeutic prescribing was found to be common. For the majority of samples, it could not be established that a true trough level had been taken. Monitoring of blood function was highly variable. Overall, the quality of both prescribing and monitoring was poor.Clinical ImplicationsPatients may receive sub-therapeutic treatment or experience unnecessary adverse effects. Prescribing and monitoring need to be more evidence-based in line with the ideals of clinical governance.
Delay in the discharge of psychiatric in-patients with learning disabilities
Authors: Watts R.V. , Richold P. , Berney T. P. 
Published: September 2002

Aims and MethodThe study aimed to identify factors delaying discharge of psychiatric inpatients from a learning disability service. A census was completed, categorising in-patients as unready for discharge (n=181); discharge planned within 12 weeks (n=22); or ready for discharge but experiencing delay (n=44), the latter were followed-up 16 months later.ResultsDelayed patients were more disabled or disturbed and often awaiting adequate community provision. They were older, had been in hospital longer and were ‘informal’ admissions. At follow-up 23 remained in hospital, 21 of whom had been delayed by lack of placement.Clinical ImplicationsDe-institutionalisation has led to the expectation that more complex and challenging people be placed in the community. This study suggests the community to be, as yet, unready to cope with the needs of these service users.
A comparison of stimulus dosing methods for electroconvulsive therapy
Authors: Laidlaw J. , Bentham P. , Khan G. , Staples V. , Dhariwal A. , Coope B. , Day E. , Fear C. , Marley C. , Stemman J. 
Published: September 2002

Aims and MethodsA prospective study comparing initial electroconvulsive therapy treatment doses determined by empirical dose titration with estimates derived from two simple dose prediction methods and a fixed-dose regimen (275 mC).ResultsThirty-three patients had seizure thresholds between 25 mC and 403 mC. The dose titration method led to a mean initial treatment dose of 195 mC that was intermediate between those predicted by the age method (275 mC) and the half-age method (137 mC). Estimates were within acceptable limits in 33% of cases for the age method, 64% for the half-age method and 40% for the fixed-dose method.Clinical ImplicationsEither dose prediction or dose titration methods may be more appropriate in different clinical situations. The half-age method appears to be a more accurate predictor of optimum initial treatment dose.
Special interest sessions in psychiatry
Authors: Stephenson Matthew , Puffett Alison 
Published: September 2002

Aims and MethodWhile specialist registrars in psychiatry are entitled to spend one-fifth of their working week engaged in special interest sessions, little has been published on how the time is used. In order to describe what happens in practice, we conducted a semi-structured telephone survey of trainees on the South-East Thames Higher Training Scheme in psychiatry.ResultsThe results indicate that while most trainees (78%) were satisfied with their use of special interest time, those using two sessions regularly for a defined training purpose were in the minority.Clinical ImplicationsUse of special interest sessions is generally good in the scheme surveyed. If uptake of sessions is to be improved, there needs to be even better local support as well as existing national recognition of the educational rights of trainees. The local support should be at the level of both trust and training scheme.
How long can a waiting list be?
Authors: Foreman D. M. , Hanna M. 
Published: September 2002

Aims and MethodQuantifying the relationship between waiting time and clinic attendance in child and adolescent psychiatry would allow better estimation of the resources needed to eliminate waiting lists in specific initiatives. All cases on a waiting list were sent a questionnaire, return of the questionnaire being necessary for an appointment to be made. Those who did not return the questionnaire or did not attend were contacted and a reason obtained whenever possible. The data were analysed using Cox regression.ResultsMost who did not return their questionnaires had been waiting less than four weeks or longer than 30 weeks. Questionnaire return seemed a good estimate of intention to attend. Other factors improving questionnaire return were younger patient age, previous experience of the service, a clear common reason for referral, and a non-general practitioner referral source.Clinical ImplicationsWaiting lists in child and adolescent psychiatry may have a natural ‘endpoint’ at 30 weeks beyond which families give up, while waiting lists of less than one-month may be too short to lose transient problems. Failure to include this and other indicators of non-attendance may lead to overestimates of resources needed to remove queues for treatment. Questionnaires may be useful in identifying those intending to attend.
The use of St John's Wort in the treatment of depression
Authors: Maidment Ian 
Published: September 2002

Aims and MethodTo assess and update the data on the use of St John's Wort as an antidepressant. A Medline search was conducted for the period January 1985 to December 1999. The search included other aspects of the usage of St John's Wort, such as side-effects, mechanism of action and drug interactions.ResultsWhile two overviews and four clinical trials have recently been published, there is little data comparing St John's Wort against therapeutic doses of standard antidepressants.Clinical ImplicationsSt John's Wort is generally well tolerated, and an effective antidepressant. The current evidence indicates that it is less effective than standard antidepressants for severe depression. While some of the available data suggests equivalent efficacy as subtherapeutic doses of tricyclic antidepressants in mild to moderate depression this requires further confirmation. One recently published paper suggests that St John's Wort has equivalent efficacy to fluoxetine in mild to moderate depression. The appropriate therapeutic dose needs clarification.
What do inner city general practitioners want from a child and adolescent mental health service?
Authors: Weeramanthri Tara , Keaney Francis 
Published: September 2002

Aims and MethodWe surveyed 25 general practitioners (GPs) on their needs from their local child and adolescent mental health services (CAMHS) to improve liaison and inform service development.ResultsMost GPs refer to specialist services. Only a quarter deal with problems themselves. The top priority was easy and quick access to services. The most popular topics for GP training were interactions between teenagers and their parents, child abuse and eating disorders. No GP had formal training in child and adolescent psychiatry and further training was a low priority.Clinical ImplicationsSuch a survey has helped to develop a closer partnership between GPs and their local CAMHS using a service–response model. It has raised concerns about the under-identification of child mental health problems. It has informed CAMHS of the service and training needs of local GPs.
Triage in emergency psychiatry
Authors: Morrison Audrey , Hull Alastair , Shepherd Beryl 
Published: September 2002

Aims & MethodPsychiatric emergencies constitute a large proportion of psychiatric referrals, with the response to this need therefore of great importance. The impact of the introduction of a telephone triage system on such factors as speed of response, assessment site, outcome and the personnel performing the assessment is examined within the context of closing of a 24-hour open access emergency system. Information was gathered from all emergency referrals, with 80 subjects randomly chosen and studied in depth.ResultsThe triage system afforded a greater flexibility of response, and the involvement of more experienced clinicians. It did not reduce the overall referral or admission rates.Clinical ImplicationsTriage was found to be an effective method of introducing flexibility of response to emergency referrals while encouraging continuity of patient care.
In-patient neuropsychiatric brain injury rehabilitation
Authors: Lazaro Fernando , Butler Rob , Fleminger Simon 
Published: September 2002

Aims and MethodTo discuss the service offered by an in-patient neuropsychiatric brain injury rehabilitation unit. To examine the demographic details of patients admitted to the unit. To find the commonest reasons for referral.ResultsThe notes of 78 patients admitted to the unit, over a two-year period, were examined. Seventy-three per cent were male and the mean age was 45 years. Seventy-five per cent of admissions had a severe brain injury. Two-thirds of the patients were admitted within six months of their injury. The most common reasons for referral were memory difficulties (n=61), verbal aggression (n=31) and temper control(n=25).Clinical ImplicationsIn-patient neuropsychiatric brain injury rehabilitation units offer management of patients referred with a wide range of cognitive, behavioural, functional and physical problems.
Anorexia nervosa: service consumption and outcome of local patients in the Leicester service
Authors: Palmer R. L. , Gatward N. , Black S. , Park S. 
Published: September 2002

Aims and MethodA retrospective case note study provided data on the service consumption and outcome of treatment for a cohort of adult anorexia nervosa sufferers treated in a specialised secondary service.ResultsA cohort of 106 patients was studied. Only just over a quarter were ever admitted. Of a subset of 78 patients, first seen before 1994, nearly one-fifth failed to engage in treatment. Those who were admitted spent on average a total of 10 months in hospital, were in touch for four years and had over 100 therapy sessions. The majority who were treated solely as out-patients remained in touch with the service on average for over two years.Clinical ImplicationsServices for anorexia nervosa sufferers need to plan for prolonged contact with their patients and high rates of service consumption.
Driving in Somerset
Authors: Kolowski Stefan Jan , Rossiter Jackie 
Published: September 2002

Aims and MethodsThe number of drivers on our roads with dementia is likely to increase as the elderly population grows. We performed a retrospective analysis of patients referred to our Memory Clinic in Taunton who were still driving despite a high suspicion of dementia.ResultsTwenty per cent of the patients were still driving at the time of their assessment. Ten per cent had a diagnosis of Alzheimer's disease and 10% mild cognitive impairment. The patients and/or carers stated that the patient had not been told to stop driving and none of the referral letters documented any advice about driving.Clinical ImplicationsReferrers should advise all patients with possible dementia to refrain from driving until assessment by a specialist team is completed. They should be informed of the risk of medico-legal consequences if they continue to drive.
Implementing the Royal College of Psychiatrists' guidelines for the practice of electroconvulsive therapy
Authors: Brookes Guy , Rigby John , Barnes Richard 
Published: September 2002

Aims and MethodTo implement the Royal College of Psychiatrists' guidelines for the practice of electroconvulsive therapy (ECT) and measure the impact of such implementation on the quality of treatment. Treatment of ECT for periods of six months before and after implementation of the guidelines were studied. The effect on producing adequate treatments and the actions taken by the administrating doctor were noted.ResultsOnce the guidelines were in place there was a slight improvement in the proportion of treatments considered therapeutic and the doctor was more likely to take appropriate action following an inadequate treatment. However, it was also clear that despite the guidelines being available they were not followed in a significant number of instances.ConclusionsImplementation of the guidelines is not easy and there needs to be considerable effort to ensure they are used. When they are followed there is an improvement in the practice of ECT.
Trainee views on active problems and issues in UK psychiatry
Authors: Wilson Rowan , Corby Catherine L. , Atkins Maria , Marston Geoff 
Published: September 2002

Aims and MethodA questionnaire sent to trainees in three regions of the UK asked them which current issues they felt were most important in psychiatry. Comments were invited of ways to improve the UK practice of psychiatry.ResultsTrainees from each of the regions were concerned about inadequate resourcing, public expectations, manpower and quality of training. Solutions to these problems were collated.Clinical ImplicationsThe opinion of trainees reflects the recent initiatives undertaken by the Royal College of Psychiatrists to improve recruitment and retention. Consultants and trainees have similar concerns, which need to be addressed and monitored at a local and national level.
Prevalence and patterns of substance misuse in schizophrenia
Authors: Condren Rita M. , O'Connor John , Browne Roy 
Published: September 2002

Aims and MethodTo identify the prevalence and patterns of substance misuse in patients with schizophrenia in a catchment population in Dublin, and to compare this with that of a control group from general practice. Ninety-nine patients and 75 controls were interviewed using a semi-structured technique. Urine samples were obtained from all patients and controls were analysed for illicit substances.ResultsPrevalence of illicit substance and alcohol misuse was similar among patients (illicit substances, 45%; alcohol, 33%) and controls (illicit substances, 43%; alcohol, 25%). Patterns of substance misuse were similar, apart from ecstasy, which was used more commonly by controls. Discrepancies were found between histories of drug use and urinalysis.Clinical ImplicationsIllicit substance misuse in patients with schizophrenia may mirror usage in the general population, rates of misuse reflecting cultural factors rather than illness and patterns of misuse reflecting geographical variations in the availability of drugs. A combination of screening methods is more effective than the use of a single source of information.
Questions patients ask psychiatrists
Authors: Llewellyn-Jones Sian , Jones Gill , Donnelly Peter 
Published: September 2002

Aims and MethodTo identify the questions patients most commonly ask their psychiatrist. For 200 consecutive psychiatric patient consultations, answers to the invitation, “Do you have any questions you wish to ask me?” were recorded along with diagnosis. The most frequently asked questions were noted and compared across patient groups.ResultsMost patients wanted to know when medication could be reduced or stopped. Some patients asked for more medication. Concerns about side-effects and fitness to drive were also common. A high proportion of patients (21–57%) asked no questions.Clinical ImplicationsPsychiatrists must be prepared to answer questions effectively on the necessity and benefits of long term medication. These may be useful facts to include in a patient information leaflet. Side-effects of medication should also be taken seriously. Many patients lead impoverished social lives, with low levels of interpersonal interaction. This may be a barrier to participation in the clinical interview, and diminish the likelihood of posing questions.
Out of area hospitalisations – the view from current routine statistics
Authors: Glover Gyles R. , Bindman Jonathan 
Published: September 2002

AIMS and MethodTo examine what current routine statistics could show about the extent to which patients are admitted to hospital beds ‘out of area’, a quality indicator proposed in the National Service Framework.ResultsAvailable data record that, on average, at least 6.9% of acute general psychiatry admissions in the English NHS happen outside the normal catchment area arrangement of a patient's health authority. However, deficiencies in the calculation – arising from lack of data, mainly about private sector admissions – and the absence of a central registry of NHS trust catchment areas suggest this is a substantial underestimate.Clinical ImplicationsThe most useful way for this issue to be examined is from year to year for individual trusts.