bluuebunny/crossref_metadata_2025_split huggingface dataset:
Service innovations: a service for the homeless with mental illness in Aberdeen
Authors: Wood Angie , Sclare Paul , Love John 
Published: September 2002

Aims and MethodTo evaluate the first 3 years of a newly developed service for the homeless mentally ill in Aberdeen. All 86 referrals to the service between 1996 and 1999 were reviewed.ResultsThe majority of referrals came from social care staff and self-referrals.Half were diagnosed as having severe and enduring mental illness and of these one-quarter (11 cases) were engaged in long-term psychiatric care. A total of 744 in-patient days were required, only one admission was a compulsory detention.Clinical ImplicationsIt has proven possible to identify and engage with a number of homeless individuals who have untreated serious mental illness by setting up a small dedicated service that has close links with an established adult mental health team and which establishes close working relationships with colleagues in social care settings.
Use of a prescribing protocol in routine clinical practice: experience following the introduction of donepezil
Authors: Jari Jaiker , Prettyman Richard 
Published: September 2002

Aims and MethodFollowing the introduction of donepezil into clinical practice a protocol for prescribing it was developed in Leicestershire. A prospective clinical audit was undertaken to monitor compliance with the protocol, which also provided an opportunity to evaluate the outcome of therapy in routine clinical practice.ResultsOverall there was close adherence to the protocol by the clinicians and clinical factors, as well as organisational and resource-related factors, were important in determining who received treatment. The principal outcome measures (Mini-Mental State Examination, Barthel ADL Index and Clinical Dementia Rating Scale) did not demonstrate any significant treatment effect.Clinical ImplicationsThis study demonstrates the feasibility and acceptability of using a protocol-based approach to manage the introduction of new drug treatments in psychiatry.
‘Sadly confused’: the detection of depression and dementia on medical wards
Authors: Rao Rahul 
Published: September 2002

Aims and MethodDementia and depression are common psychiatric diagnoses in older people, and are common reasons for referral to liaison psychiatry services. The present study examined the accuracy of physicians' diagnoses for both disorders in consecutive referrals to a liaison old age psychiatry service.ResultsPositive predictive values for depression and dementia were high, but levels of treatment of depression and documentation of past psychiatric history were both poor. Alcohol misuse and stroke accounted for the commonest accompanying disorders.Clinical ImplicationsThe findings have implications for the encouragement of physicians to treat depression when this is suspected. Educational programmes for this purpose may be useful, incorporating an exploration of attitudes and knowledge of physicians towards depression in older people.
Precursors of compliance with lithium treatment in affective disorders
Authors: Macleod Mairi S. , Sharp Donald M. 
Published: September 2002

Aims and MethodObjective and subjective lithium compliance was investigated in 30 out-patients attending at an affective disorders clinic. Possible precursors of compliance levels were investigated; namely lithium knowledge and attitudes, patient satisfaction and dosage of lithium administered.ResultsAll patients were defined as currently compliant. Patients with a previous history of non-compliance were exclusively diagnosed with manic depression. Patient satisfaction, lithium knowledge and attitudes were not good predictors of lithium compliance.Clinical ImplicationsCompliance with lithium can remain excellent in the presence of moderate lithium knowledge and poor attitudes. Poor attitude towards lithium worsens with years on medication, despite high levels of compliance. Clinicians should be aware that larger prescribed dosages of lithium may be associated with poorer compliance.
Using the internet as a source of self-help for people who self-harm
Authors: Prasad Vibhore , Owens David 
Published: September 2002

Aims and MethodTo describe the information and help available on the internet for people who self-harm. We searched the internet using a meta-search engine. We visited sites and followed up links with e-mails and letters. We also searched bibliographic databases, seeking published material about the internet and self-harm.ResultsThe support that we found largely took the form of information about suicide, self-injury and psychological issues. Less often, sites offered e-mail support and online discussions. We found little information about self-poisoning, and most about self-injury. There is little published research about self-harm and the internet.Clinical ImplicationsThe unregulated sites of the internet contain much material about self-injury. Although it is not possible at present to weigh up risks and benefits, many individuals and organisations plainly regard internet information about self-harm as a valuable service.
The use of the Royal College of Psychiatrists' trainee's log book: a cross-sectional survey of trainees and trainers
Authors: Cornwall Peter L. , Doubtfire Ali 
Published: September 2002

Aims and MethodThe use of the Royal College of Psychiatrists' trainee's log book was evaluated by a cross-sectional survey of psychiatric trainees and their consultant trainers.ResultsOne-quarter of trainees had not received a log book. There was a lack of mutual commitment to using the log book, with fewer than 45% of trainees believing their trainers were committed to its use. There had been little use of the log book beyond the setting of educational objectives. However, concern that trainees would be against using the log book for formative assessment was not observed.Clinical ImplicationsMore work needs to be done by the College to promote the use of the log book to both trainees and trainers.
Improving the assessment of risk of violence: a clinical audit of case note documentation
Authors: Campbell Michael , Chaplin Robert 
Published: September 2002

Aims and MethodsTo improve the rate of documentation of risk in new referrals to a community mental health team. A retrospective audit of 46 case notes was followed by a training session on risk of violence. The following 50 case notes were studied for changes in risk assessment.ResultsPrior to the study there were very low rates of documentation of risk of violence. Significant improvements were made in 45% of the items in the history and mental state although not in the formulation of a risk assessment statement.Clinical ImplicationsIt is possible to improve the risk of violence documentation with no extra time, resources or paperwork and with true multi-disciplinary involvement.
Questionnaire survey of automobile driving among users of a substance misuse service
Authors: Bradbeer Tim , Ormsby Jim , Fleming Philip 
Published: September 2002

Aims and MethodUsers of a substance misuse service were asked to complete a questionnaire, detailing information about driving habits as well as attitudes about substance use and driving.ResultsOf 120 subjects, 94 had ever driven, with only 36 currently driving. Fifty-six subjects had been charged with a driving offence but only 18 stated that they had been involved in an accident while intoxicated. The majority would not use drugs before driving and remain within a safe level of alcohol use. Most subjects stated that they were not informed of current legal issues concerning driving and substance use.Clinical ImplicationsUsers of a substance misuse service were reasonably responsible in their driving habits, however, it is still important for clinical staff working in such services to make their patients aware of the danger of driving under the influence of substances.
How many patients self-medicate with St John's wort?
Authors: Redvers A. , Laugharne R. , Kanagaratnam G. , Srinivasan G. 
Published: September 2002

Aims and MethodSt John's wort is popularly taken as a herbal remedy, but it interacts with prescribed drugs. The aim of this survey was to estimate the prevalence of patients self-medicating with St John's wort. All new referrals to a community mental health team over 5 months were asked about any use of St John's wort.ResultsFifteen patients, of 101, had taken St John's wort at some time and of those seven were currently taking it. Patients who used St John's wort tended to be younger and female. Only nine of the 15 patients took it for depressive symptoms and none had received medical advice. One patient was taking an interacting medication.Clinical ImplicationsA significant number of patients are taking St John's wort. In order to prevent drug interactions, doctors should ask all patients whether they use it, especially young women who may be on the contraceptive pill. Patients need better education about its risks and benefits and it should be taken with medical advice.
Eating disorders in Scotland: starved of resources?
Authors: Lemouchoux Camille , Millar Harry , Naji Simon 
Published: September 2002

Aims and MethodTo describe eating disorder services in Scotland. Fifty-two services completed a postal questionnaire.ResultsSix of the mainland health board areas, with a total population of 1.5 million, were not covered by any (self-defined) ‘specialist’ service. Although most services had access to in-patient facilities, we identified only one designated bed in Scotland for eating disorder patients, and this in a non-specialist service. In many other ways, services did not meet published recommendations for the provision of eating disorders services.Clinical ImplicationsIt is suggested that a national strategy should be formulated, and a model of service provision is proposed.
Severe mental illness and airports – the scope of the problem
Authors: Wieshmann U. C. , Anjoyeb M. , Lucas B. B. 
Published: September 2002

Aims and MethodMental illness may cause specific problems in the environment of an international airport. The aim of our study was to assess frequency, presentation and safety implications of mental disorders requiring formal admission at an international airport. We performed a retrospective study over 4 years including patients who were detained by the police and admitted.ResultsThe frequency of admissions was one per million passengers, the frequency of incidents raising safety concerns was four per 10 million passengers. An in-flight disturbance occurred in 1.4 per 10 million arriving passengers. Most common were schizophrenia or schizotypal disorder (46.8%) and mania (22.6%). Twenty per cent of patients presented with wandering.Clinical ImplicationsEmergency admissions and incidents causing safety concerns were rare. Airport wandering was a frequent presenting sign that should be recognised.
Managing dangerous people with severe personality disorder: a survey of forensic psychiatrists' opinions
Authors: Haddock A. , Snowden P. , Dolan M. , Parker J. , Rees H. 
Published: September 2002

Aims and MethodTo canvass the opinions of psychiatrists working in forensic settings on the recent proposals relating to dangerous people with severe personality disorder (DSPD). Psychiatrists from secure settings were invited to a series of meetings. A questionnaire was circulated and the discussions recorded.ResultsOpinion remains divided over diagnosis, treatability and assessment of risk in personality disorders. The medicalisation of DSPD to allow indeterminate detention in unconvicted cases is unacceptable to the majority (75%). There is no consensus on the Government proposals relating to DSPD. Only a minority (20%) of psychiatrists would work in a new specialist service, which has significant implications for service development.Clinical ImplicationsThe involvement of psychiatrists in preventative detention solely for public protection requires greater discussion.
Attention-deficit hyperactivity disorder and the use of methylphenidate
Authors: Ball Claire 
Published: September 2002

Aims and MethodGeneral practitioners (GPs) were surveyed on their experience of and attitudes towards attention-deficit hyperactivity disorder (ADHD) treatment using methylphenidate, and asked about prescribing practice.ResultsMost GPs have experience of children with ADHD and the use of methylphenidate. The majority felt that it was a drug that should be initiated by a specialist who should continue to provide clinical monitoring, but that primary care could provide ongoing prescribing and physical monitoring. There was a lack of training in this area, with most GPs requesting further training both on ADHD and its management.Clinical ImplicationsADHD is a topical issue both in the health service and with the public. This survey suggests that GPs may be willing to play a role in the management of ADHD once the child has seen a specialist, but that child and adolescent mental health services need to consider how training will be provided.
Home or away: which patients are suitable for a psychiatric home treatment service?
Authors: Harrison Judy , Alam Nooreen , Marshall John 
Published: September 2002

Aims and MethodHome treatment offers an alternative to in-patient care, but little has been written about the practicalities of running such a service. Using routine information sources, details of referral and outcome are presented for patients assessed by a home treatment service over 6 months.ResultsForty-eight per cent of referrals were not accepted, mainly because of lack of cooperation, risk to self or others or the illness not being acute enough. Referrals from junior doctors and accident & emergency were least likely to be accepted. Seventy-two per cent of patients accepted suffered from schizophrenia, bipolar affective disorder or depression with psychosis, similar to the diagnoses for in-patients. Twenty per cent of patients accepted had to be transferred to in-patient care later.Clinical ImplicationsStaffing levels need to take account of time spent assessing patients. Junior doctors need training in how to use home treatment services appropriately and a wider range of options are needed to manage patients in crisis out of hours. It is possible to target patients with severe mental illness in a home treatment setting, but a significant number will need transfer to inpatient care.
Psychotherapy training and the Calman reforms
Authors: Logan Katharine E. , Muzaffar Nabila 
Published: September 2002

Aims and MethodThere have been major changes in the duration and the requirements of higher specialist training in psychotherapy in the UK. A postal survey was sent to all higher specialist trainees in psychotherapy to study their attitudes to, and experience of, these changes.ResultsEighty-nine per cent of trainees responded. The majority of trainees expressed concern about the reduction in length of training. There were gaps in provision of some essential training modalities. A substantial group of trainees did not have protected research time.Clinical ImplicationsPsychotherapy trainees believe the changes in training sacrifice depth for breadth. This highlights the ongoing debate about the future of psychotherapy within the NHS.
Conspiracy of silence? Telling patients with schizophrenia their diagnosis
Authors: Clafferty Robert A. , McCabe Elaine , Brown Keith W. 
Published: September 2002

Aims and MethodWe undertook a postal questionnaire survey of all consultant psychiatrists working in Scotland to examine whether psychiatrists themselves may contribute to the misunderstandings surrounding schizophrenia by avoiding discussion of the diagnosis with their patients.ResultsTwo-hundred and forty-six (76%) responded. Ninety-five per cent thought the consultant psychiatrist was the most appropriate person to tell a patient their diagnosis of schizophrenia, although only 59% reported doing so in the first established episode of schizophrenia, rising to 89% for recurrent schizophrenia. Fifteen per cent would not use the term ‘schizophrenia’ and a variety of confusing terminology was reported. Over 95% reported telling patients they had mood disorders or anxiety, under 50% that they had dementia or personality disorders.Clinical ImplicationGreater openness by psychiatrists about the diagnosis of schizophrenia may be an essential first step in reducing stigma.
On being in a young offender institution: what boys on remand told a child psychiatrist
Authors: Dimond C. , Misch P. , Goldberg D. 
Published: September 2002

Aim and MethodTo describe the reported experiences of 15- and 16-year-old boys on remand in a young offender institution (YOI) as told to a child psychiatrist. Nineteen remanded adolescents were interviewed using the Kiddie-Schedule for Affective Disorders and Schizophrenia as part of a study. During the warm-up conversation prior to this semi-structured interview, the boys were given the opportunity to talk about their experiences of being in a YOI.ResultsThe boys described experiences of institutionalisation, including the deprivation of incarceration and the intimidation of a ‘macho-culture’, which on occasions verged on the abusive. Their responses are described.Clinical ImplicationsAn emotionally deprived prison environment that lacks appropriate care for children is likely to contribute to the very high levels of mental disorder known to exist in this population. A major reform of conditions for young prisoners has commenced since this study was conducted. The prison service and society as a whole must, however, ensure that the planned improved living conditions for children in prison are reached. Child psychiatry has a very important contribution to make by providing mental health care within prison institutions in order to engage young prisoners with mental health problems and their families.
Postal survey of psychiatrists' knowledge and attitudes towards driving and mental illness
Authors: Wise M. E. Jan , Watson James P. 
Published: September 2002

Aims and MethodWe assessed psychiatrists' knowledge and attitudes towards the Driver and Vehicle Licensing Agency (DVLA) regulations concerning mental illness. A postal survey of all consultant and trainee psychiatrists (228) on the South Thames (East) regional psychiatry rotation was carried out.ResultsFor category 1 (private car and motorcycles) licenses, 40.0% of psychiatrists could correctly advise patients with a bipolar affective disorder; this figure was 0% for schizophreniform disorders. For category 2 (heavy goods vehicles) licenses the corresponding figures were 13.2% and 11.8%, respectively.For alcohol misuse, alcohol dependency and alcohol related disorders, the scores were 26.0%, 29.1% and 19.7%.Clinical ImplicationsPsychiatrists fail to know or apply existing DVLA regulations, for a number of reasons. Failure to inform patients of the restrictions and to record this may result in medico-legal liability for practitioners.
A national survey of old age psychiatry services in Wales
Authors: Napier Alison 
Published: September 2002

Aims and MethodA postal questionnaire was circulated to all consultants in old age psychiatry in Wales, examining provision of services with reference to the indicative service levels defined by the Royal College of Psychiatrists and Royal College of Physicians.ResultsThe response rate was 100%. Levels of staffing and resources overall fell well below recommendations and varied widely between services. The average population over 65 served by a whole time consultant was 22 995; more than twice that recommended. No association was found between morale or how well population needs were perceived as being met, and the size of the population served.Clinical ImplicationsConsiderable investment in staff and other resources is needed for the recommendations made by the royal Colleges concerning service levels and, by implication, service quality to be met.
The impact of suicide on community mental health teams: findings and recommendations
Authors: Linke Stuart , Wojciak Jenny , Day Samantha 
Published: September 2002

Aims and MethodThe study investigated the personal impact of patient suicides on the members of community mental health teams and the sources of support utilised for coping with adverse effects.ResultsForty-four questionnaires were returned. Eighty-six per cent of staff reported having had at least one patient suicide, with an average of 4.2 suicides. The majority of staff reported that patient suicides had significant adverse effects on their personal and professional lives. Some of the effects were long-lasting (greater than 1 month). Staff found that peer support, reviews, dedicated staff meetings and support from senior colleagues were of most value.Clinical ImplicationsStaff require skilled and dedicated support following a patient suicide in order to minimise its detrimental effects on personal, professional and team functioning.
Impact of patient suicide on psychiatric trainees
Authors: Yousaf Farida , Hawthorne Malcolm , Sedgwick Philip 
Published: September 2002

Aims and MethodA survey of 89 psychiatric trainees in a regional rotational training scheme was carried out to investigate the impact immediately after a patient's suicide and at the time of the study. Main outcome measures used were the Impact of Events Scale and a rating scale of the impact on personal and professional life.ResultsTwenty-three trainees out of 53 who returned questionnaires reported at least one suicide. Initial reactions included shock, self-blame, guilt, grief and fear of negligence. Impact on personal and professional life was moderately severe. Over half of the trainees were ‘clinically stressed’ in the immediate aftermath, with no statistically significant reduction overtime.Clinical ImplicationsThe impact of a patient suicide can be profound. It can be experienced as a stressful event but can also lead to positive changes in clinical practice. Greater availability of training and support as well as further research in this area are recommended.
Gatekeeping access to community mental health teams
Authors: McEvoy P. , Colgan S. , Richards D. 
Published: September 2002

Aims and MethodA retrospective survey to explore how consultant psychiatrists, senior house officers and community psychiatric nurses prioritised referrals to four sectorised community mental health teams.ResultsReferral outcomes appeared to be comparable for patients with psychoses, sub-threshold mental health problems and personality disorders. However, differences in the outcomes were apparent for patients with a primary diagnosis of drug/alcohol misuse, as well as for patients with affective disorders and neuroses.Clinical ImplicationsIt may be necessary to establish clearer, consistent boundaries in order to consolidate services for patients with severe mental health problems.
A survey of amphetamine prescribing by drug services in the East and West Midlands
Authors: Moselhy H. F. , Georgiou G. , Kahn A. , Day E. 
Published: September 2002

Aims and MethodThis study aimed to assess the current level of amphetamine prescribing for adults in drug services in the West and East Midlands. A questionnaire was developed to investigate prescribing habits and attitudes, and was addressed to the senior member of staff in each drug service within the West and East Midlands area.ResultsA total of 41 services were identified, and 29 questionnaires were returned (a 71% response rate). Of the services that replied, 20 (69%) prescribed amphetamines, with 132 (12%) patients identified as amphetamine misusers currently receiving a prescription. However, 26 (90%) services felt that substitute prescribing did have a role in a comprehensive service for this group.Clinical ImplicationsAlthough amphetamine prescribing has been shown to reduce both criminal and injecting behaviour, only two-thirds of the local services prescribe such drugs, with a small percentage of amphetamine users receiving a prescription. There is a need for a national consensus about substitute prescribing of amphetamines and increased flexibility within drug services when managing the problem.