bluuebunny/crossref_metadata_2025_split huggingface dataset:
Developing a child and adolescent mental health service for children with learning disabilities
Authors: Green Kath , Williams Chris , Wright Barry , Partridge Ian 
Published: September 2002

Aims and MethodWe discuss the development of a service for children with learning disabilities within a child and adolescent mental health team using the Health Advisory Service Together We Stand tier system. The paper also includes an audit of the service 8 months after it was started.ResultsWe present a model of service that has proved successful to date. We give details from the audit of the service, its aims, funding, referral numbers, sources, types and criteria.Clinical ImplicationsThe audit suggests that the aims of the service are being achieved but given the fact that the numbers of new referrals significantly outweigh the discharge rate, it is concluded that a greater emphasis is placed on liaison, consultation and joint working with other agencies.
Characteristics and outcomes of patients admitted to a psychiatric intensive care unit in a medium secure unit
Authors: Dolan Mairead , Lawson Alan 
Published: September 2002

Aims and MethodThere have been no reports on psychiatric intensive care units (PICUs) in medium secure psychiatric facilities. Using case files, we retrospectively examined the characteristics and outcomes of 73 patients who were admitted to a PICU in a medium secure unit between 1 July 1994 and 30 April 1998.ResultsThe PICU population was predominantly male, suffering from illness and detained under Part III of the Mental Health Act, 1983. Although the mean length of stay was 75 days, the majority were ultimately transferred to less intensive nursing environments and only nine required transfer to maximum security. In 10% of cases PICU admission was owing to lack of appropriate facilities elsewhere.Clinical ImplicationsAlthough the PICU was intended as a crisis facility for the management of challenging behaviours, its function was affected by the lack of clear admission and discharge criteria and appropriate facilities for patients with diverse mental, physical and security needs.
A survey of forensic psychiatry teaching in UK medical schools
Authors: Reiss David , Chamberlain Sherelle 
Published: September 2002

Aims and MethodTo survey forensic psychiatry teaching in UK medical schools. A questionnaire was sent to all 24 deans.ResultsTwenty-one schools responded, 15 (71%) provided forensic psychiatry teaching. Thirteen organised one or more lectures and 13 organised visits to forensic psychiatric settings, predominantly high security hospitals, but these were usually only available to a proportion of the students in each year. Clinical placements, seminars or workshops and tutorials or supervisions were each arranged in about half of the schools. Only four schools offered special study modules (SSMs).Clinical ImplicationsForensic psychiatry teaching would benefit from further development, with additional use being made of medium secure hospital units and prisons for the purposes of clinical placements and visits. More SSMs should be organised.
A survey of psychiatrists' views of the use of the Children Act and the Mental Health Act in children and adolescents with mental health problems
Authors: Mears Alex , Worrall Adrian 
Published: September 2002

Aims and MethodTo identify psychiatrists' concerns relating to the use of legislation in children and young people with mental health problems. Four hundred and eighty members of the child and adolescent faculty of the Royal College of Psychiatrists were asked to list their main concerns.ResultsTwo hundred and fifty-eight members responded. The four most reported themes were: choosing between the Mental Health Act and the Children Act; general issues around consent to treatment; issues with social services departments; and the stigma associated with using the Mental Health Act.Clinical ImplicationsThe range of themes identified from this survey have served to focus the evaluation of the use of the Children Act and the Mental Health Act in Children and Adolescents in Psychiatric Settings (CAMHA-CAPS), and informed the design of subsequent data collection tools. The project report has now been submitted to the Department of Health for consideration.
Learning styles of psychiatrists and other specialists
Authors: Airey Nicholas , Marriott James , Rodd June 
Published: September 2002

Aims and MethodTo describe how the Learning Styles Inventory was used to assess the preferred learning styles of a group of senior and specialist registrars from different specialities attending a management course.ResultsOf the 272 doctors studied, the learning styles of psychiatrists (n=42) emerged as significantly different to the group as a whole, favouring reflective observation and concrete experience rather than active experimentation or abstract conceptualisation.Clinical ImplicationsKnowledge of learning styles can help improve interactions with other specialities that adopt different learning strategies, and assist with the individual psychiatrist's lifelong learning. To engage the interest of medical students, psychiatrists may need to consider different teaching approaches in line with the prevalent learning style.
Towards successful implementation of continuing professional development – a survey of psychiatrists' attitudes
Authors: Davies Mark , Ford Mike 
Published: September 2002

Aims and MethodThis survey aims to aid implementation of continuing professional development (CPD) by determining the acceptability of current proposals and predict problem areas. All non-training grade psychiatrists working in the area of a single deanery were asked about their attitude to CPD and, in particular, focusing on the peer group method.ResultsOf the 115 respondents, 98% said they agreed with some form of CPD. Just under half of respondents thought peer groups were appropriate for CPD planning, with four being the most popular size, and 3 months the preferred frequency of meeting. Problems identified with the peer group structure included individual, speciality-based and organisation-related issues. Regarding sharing of CPD information, 40% of respondents thought the College should receive updates of individual progress, while the medical director was cited in over half. Finally, loss of educational supervisor status was felt to be the most appropriate penalty for failure to adhere to the CPD process.Clinical ImplicationsThese results indicate that although there is general agreement to some form of CPD, peer groups are not universally accepted as the best design.
The changing climate for women patients in medium secure psychiatric units
Authors: Hassell Yonette , Bartlett Annie 
Published: September 2002

Aims and MethodWe conducted a telephone survey of medium secure units in England and Wales to determine the distribution of women patients.ResultsThe survey identified 1836 medium secure beds, housing 342 women patients. Women in the NHS were housed primarily in mixed-gender units (170 women, 94%). Most NHS beds in single-gender units were for men (56 beds), whereas most private sector beds in single-gender units were for women (79 beds).Clinical ImplicationsIncreased awareness of the often inappropriateness of services for women in mixed-gender units has led to units deciding not to admit women patients and, inadvertently, more single-gender beds for men in NHS units than for women. The NHS units have to rely on private sector units to provide beds in single-gender units for women, perhaps at the expense of effective continuity of care.
The use of ginkgo biloba in the treatment of dementia
Authors: Maidment Ian 
Published: September 2002

Aims and MethodTo assess and update the available data on use of ginkgo to treat dementia. A Medline search as conducted for the period January 1985 to October 2000. The search included other aspects of the usage of ginkgo, such as side-effects, mechanism of action and drug interactions.ResultsMost of the trials using ginkgo were to treat cerebral insufficiency. Only five trials could be identified that used ginkgo to treat dementia. There are no trials comparing ginkgo to cholinesterase inhibitors such as donepezil.Clinical ImplicationsGinkgo is generally well-tolerated and appears to ease the symptoms of dementia. Although it has been suggested that the effect is comparable to donepezil, confirmation from controlled studies is required.
Anticonvulsant monitoring in psychiatric practice
Authors: Nelson Debbie , Gray Douglas 
Published: September 2002

Aims and MethodA Medline literature search revealed a large number of articles on anticonvulsant monitoring. More relevant articles were selected with the aim of summarising current best practice in this area.ResultsMost articles were written to address monitoring in epilepsy and not psychiatric illness. Serum ranges should only be regarded as guidelines. Some patients may show toxic signs at therapeutic serum levels while others may show tolerance and require higher levels.Clinical ImplicationsAppropriate monitoring of serum levels improves efficacy and enhances safety. Clinician ignorance may lead to inappropriate or inaccurate sampling with resultant adverse consequences for the patient.
Teaching psychiatric trainees ‘compliance therapy’
Authors: Surguladze S. , Timms P. , David A. S. 
Published: September 2002

Aims and MethodTraining workshops were organised to teach junior psychiatrists ‘compliance therapy’. A questionnaire was administered to 19 trainees before and after participation in the workshop. Data from 54 non-participating psychiatrists from the same NHS trust were also obtained for comparison.ResultsThose receiving training were similar to the comparison group except for having less confidence in dealing with non-compliant patients. After training, participants showed a broader awareness of the potential causes and costs of non-compliance and an increased confidence empathising with patients. Beliefs concerning management did not change significantly.Clinical ImplicationsA brief training programme is capable of changing trainee psychiatrists' attitudes towards patient non-compliance in the desired direction.
Access to a child mental health service
Authors: Lamb Graeme , Anfield Anita , Sheeran Anne 
Published: September 2002

Aims and MethodThis was a retrospective case note analysis of all referrals to an inner-London child and family consultation service aiming to examine any changes in patterns of referral and attendance of Bangladeshi and indigenous families over the previous 10-year period.ResultsBangladeshi referrals increased over the period but remained under-represented compared to indigenous families. They were less likely to attend an initial appointment, but once engaged with the service dropout rates were unaffected by ethnicity.Clinical ImplicationsImproved communication between the department, families and referrers may help to increase understanding of the function of the department and lead to more equitable uptake of services in the future.
Two weeks in the life of a community mental health team: a survey of case-mix and clinical activity in the north-west of Sheffield
Authors: Hunter Michael D. , Jadresic Danitza , Blaine Anne , Clancy Louise , Leyshon Noelle , McDonald Eileen , Sanderson Ian , Whiffin Moira , Spearing Graham 
Published: September 2002

Aims and MethodThe aim of the study was to determine whether diagnostic case-mix influenced the distribution of clinical activity within the community mental health team (CMHT). Information concerning every patient involved with the CMHT and every episode of clinical activity was collected over a 2-week period.ResultsData were obtained concerning 417 patients and 1744 corresponding episodes of clinical activity. Diagnostic case-mix significantly differed between the professions. The duration of episodes of clinical activity varied significantly according to the type of patients involved and whether or not direct face to face contact occurred.Clinical ImplicationsDiagnostic case-mix, in addition to absolute numbers, should be considered when estimating the actual work generated by the different professions' case-loads. Patients with psychosis may place an increased time burden upon CMHT members.
Survey of the use of abreaction by consultant psychiatrists
Authors: Wilson Simon 
Published: September 2002

Aims and MethodTo find out current practice in the use of abreaction by consultant psychiatrists a survey was conducted, by postal questionnaire, of all consultant psychiatrists working with adult patients in the Yorkshire area.ResultsOut of 170 consultants, 133 (78%) returned the questionnaire; 64 consultants (48%) had used abreaction at some point in their career and 20 (15%) had done so in the past 5 years. The median number of times abreaction had been used in the previous 5 years was two and only seven consultants (5%) had supervised a trainee in using abreaction.Clinical ImplicationsAbreaction is used rarely and only by a minority of consultants. Few consultants have supervised trainees in the use of abreaction. Future psychiatrists are unlikely to be skilled in the use of abreaction and its use will decline.
Time to abandon the subjective–objective divide?
Authors: Beveridge Allan 
Published: September 2002

“We don't see things as they are, we see things as we are” (Anaïs Nin, 1969)In the mental state examination, a standard method of describing the clinical encounter is to contrast the patient's supposedly ‘subjective’ account with the doctor's ‘objective’ description. In this model, the doctor is granted a privileged position: the clinician's perspective is taken to be superior to that of the patient. The doctor's objective approach is considered neutral, scientific and representing the truth of the matter. In contrast, the patient's subjective report is regarded as unreliable, distorted and potentially false. The lowly status of the subjective perspective is further emphasised by the frequent use of the accompanying prefix, merely.
Competency and use of the Mental Health Act – a matrix to aid decision-making
Authors: Tan Jacinta , Elphick Martin 
Published: September 2002

Aims and MethodCompetence in patients with mental illness is an issue of growing importance. We present a matrix that provides a new tool to separate the elements involved.ResultsThis matrix is compatible with, and makes explicit, the Richardson Committee's suggestions concerning the incorporation of a test of capacity in Mental Health Act assessments.Clinical ImplicationsWe suggest that use of this matrix may offer practical help to clinicians in arriving at a clear understanding of each clinical situation and guide good practice in the use of the Mental Health Act, particularly in problematic cases.
A follow-up study of the use of a patient-held record in mental health
Authors: Stafford A. , Laugharne R. , Gannon K. 
Published: September 2002

Aims and MethodPatient-held records have been introduced in mental health over the past 2 decades. This follow-up study aimed to evaluate one pilot project 5 years after the records were introduced. All patients initially interviewed 4 years previously were approached and asked about their use and opinion of the record.ResultsOf the 19 people interviewed, 12 were still using the record and had a positive opinion of its usefulness. Of all community mental health team contacts, 72% were recorded in the patient-held notes.Clinical ImplicationsPatient-held records are sustainable in a naturalistic clinical setting over the period of 5 years.
A community survey establishing the prevalence rate of autistic disorder in adults with learning disability
Authors: Morgan C. N. , Roy M. , Nasr A. , Chance P. , Hand M. , Mlele T. , Roy A. 
Published: September 2002

AIMS AND METHODMost studies into autistic disorder have concentrated on children. This study aims to establish a prevalence rate of autistic disorders in an adult population with learning disabilities. Adults accessing learning disability services were diagnosed as having an autistic disorder by a two-stage process. The first stage was screening using the Pervasive Developmental Disorder – Mental Retardation Scale and then those identified by screening were diagnosed clinically.RESULTSAn overall population rate of 7.7/10 000 for autistic disorder was obtained, which is a prevalence rate of 30% in those with learning disability. The prevalence rate was higher in intensive service settings.CLINICAL IMPLICATIONSSpecific funding and interventions need to be targeted for the treatment of autistic disorders.
Psychiatric training revisited – better, worse or the same?
Authors: Herzberg Joe , Paice Elisabeth 
Published: September 2002

AIMS AND METHODTo evaluate psychiatric training in one deanery following a programme of site visits, interviews with trainers and trainees, reports, and recommendations. To assess the findings in the context of NHS training requirements. Information was collected by semi-structured interviews and questionnaire surveys.RESULTSForty-three sites were visited, training is generally of a high standard and most trainees are satisfied with their posts. There are significant problems in delivering sufficient community experience to general practice trainees and deficits in availability of multi-professional training programmes.CLINICAL IMPLICATIONSCollege tutors should work to ensure that trainees have access to shared learning occasions with non-medical health professionals to meet the NHS training agenda.
Almost an electronic patient record and almost free
Authors: Searle G. , Rynkowski T. , Sephton A. , Pickford D. , O'Neill G. 
Published: September 2002

AIMS & METHODThis paper describes a project to make all the patient letters held on secretaries' computers available 24-hours a day to improve patient care and risk management. Following a system audit a solution using existing resources was constructed.RESULTSThe implementation of a uniform coherent patient letter naming and filing convention (the CLinically Useful Enquiry System) allowing rapid access to letters to support effective care without massive cost or disruption.CLINICAL IMPLICATIONSThis process can be quickly, simply and cheaply replicated in any organisation with a network supporting e-mail and has the additional benefit of making transition to a future paperless system fast and economical.
Co-prescribing of atypical and typical antipsychotics – prescribing sequence and documented outcome
Authors: Taylor D. , Mir S. , Mace S. , Whiskey E. 
Published: September 2002

AIMS AND METHODTo evaluate patterns of antipsychotic co-prescription and to establish documented outcome, we reviewed 1441 in-patient and community prescriptions written in a large mental health trust. For patients co-prescribed regular atypical and typical antipsychotics for longer than 6 weeks, medication histories were taken and case notes examined to determine sequence of prescribing, documented outcome and reasons for co-prescription.RESULTSFifty-three patients had been co-prescribed aytpical and typical antipsychotics for more than 6 weeks. In 62% of cases the atypical drug had been prescribed first and a typical drug added later. The most frequently documented reason for co-prescription was that symptoms persisted when prescribed a single antipsychotic. Clinical outcome was documented for 64% of patients: 45% of the total number treated showed some improvement, with seven of 53 patients noted to have shown improvements in psychotic symptoms.CLINICAL IMPLICATIONSCo-prescription of aytpical and typical antipsychotics often occurs as a consequence of poor outcome with single drug treatment. In this study there was minimal evidence to suggest that co-prescription improved outcome to an important extent. There remains little support for co-prescription of antipsychotics but considerable evidence to suggest that such practice worsens adverse effect burden. Co-prescription of atypical and typical antipsychotics should be avoided in all but very exceptional circumstances.
Use of atypical antipsychotics by consultant psychiatrists working in forensic settings
Authors: Paton Carol , Garcia Jose A. , Brooke Deborah 
Published: September 2002

AIMS AND METHODAtypical antipsychotics have less neurological side-effects than the older drugs but are only available as oral preparations. This may limit their use in forensic patients. We sent a postal questionnaire to all consultant psychiatrists working in forensic settings in the UK to determine their views.RESULTSThe response rate was 60%. Respondents tended to overestimate the benefits and underestimate the side-effects of the atypical antipsychotics. The majority often prescribed atypical antipsychotics and depots together. Psychoeducation and serum level monitoring were used to optimise/monitor compliance by 50%.CLINICAL IMPLICATIONSUsing atypical antipsychotics as monotherapy is problematic in forensic settings. The extent of polypharmacy means that patients may experience the side-effects of both typical and atypical antipsychotics. More could be done to facilitate and monitor compliance.
The stigmatisation of psychiatric illness: the attitudes of medical students and doctors in a London teaching hospital
Authors: Mukherjee Raja , Fialho Antonio , Wijetunge Aruna , Checinski Ken , Surgenor Tammy 
Published: September 2002

AIMS AND METHODTo study the attitudes and opinions of doctors and medical students with regard to psychiatric illness a questionnaire was sent to all medical students (832) and all doctors of all grades (441) at a London teaching hospital.RESULTSA total of 520 questionnaires were returned. More than 50% felt that people with schizophrenia and drug and alcohol addiction were dangerous and unpredictable. It was felt by the majority that people were not to blame for their conditions and there were low negative responses towards lack of treatability for a majority of conditions.CLINICAL IMPLICATIONSThere were more optimistic views with regard to treatment than the general population. There appeared to be a lessening in stigma as experience increased. This would suggest that early improved education and exposure in the future may lead to a greater decline in stigmatised attitudes.
What services are available for the treatment of transsexuals in Great Britain?
Authors: Murjan S. , Shepherd M. , Ferguson B. G. 
Published: September 2002

AIMS AND METHODWe conducted a questionnaire survey of all 120 health authorities and boards responsible for the commissioning of services for the assessment and treatment of transsexual people in England, Scotland and Wales, in order to identify the nature of the input offered and assess conformity to current international standards of care.RESULTSEighty-two per cent of the commissioning authorities responded and confirmed that most health authorities/boards provide a full service for the treatment of transsexuals, although this would be delivered at a local level in only 20% of cases. However, 11 commissioning authorities gave confused and inaccurate responses and three other health authorities appear to hold views on the commissioning of these specialist services that are not in keeping with the current legal situation and a recent High Court ruling, which establishes the right of transsexual people to NHS assessment and treatment.CLINICAL IMPLICATIONSThere are discrepancies in prioritisation and provision of clinical services for this group that are not standard across Great Britain.