bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of comorbid personality disorder on violence in psychosis
Authors: Moran Paul , Walsh Elizabeth , Tyrer Peter , Burns Tom , Creed Francis , Fahy Tom 
Published: February 2003

BackgroundThe impact of comorbid personality disorder on the occurrence of violence in psychosis has not been fully explored.AimsTo examine the association between comorbid personality disorder and violence in community-dwelling patients with psychosis.MethodA total of 670 patients with established psychotic illness were screened for comorbid personality disorder. Physical assault was measured from multiple data sources over the subsequent 2 years. Logistic regression was used to assess whether the presence of comorbid personality disorder predicted violence in the sample.ResultsA total of 186 patients (28%) were rated as having a comorbid personality disorder. Patients with comorbid personality disorder were significantly more likely to behave violently over the 2-year period of the trial (adjusted odds ratio = 1.71, 95% CI 1.05–2.79).ConclusionsComorbid personality disorder is independently associated with an increased risk of violent behaviour in psychosis.
Dialectical behaviour therapy for women with borderline personality disorder
Authors: Verheul Roel , Van Den Bosch Louise M. C. , Koeter Maarten W. J. , De Ridder Maria A. J. , Stijnen Theo , Van Den Brink Wim 
Published: February 2003

BackgroundDialectical behaviour therapy (DBT) is widely considered to be a promising treatment for borderline personality disorder (BPD). However, the evidence for its efficacy published thus far should be regarded as preliminary.AimsTo compare the effectiveness of DBT with treatment as usual for patients with BPD and to examine the impact of baseline severity on effectiveness.MethodFifty-eight women with BPD were randomly assigned to either 12 months of DBT or usual treatment in a randomised controlled study. Participants were recruited through clinical referrals from both addiction treatment and psychiatric services. Outcome measures included treatment retention and the course of suicidal, self-mutilating and self-damaging impulsive behaviours.ResultsDialectical behaviour therapy resulted in better retention rates and greater reductions of self-mutilating and self-damaging impulsive behaviours compared with usual treatment, especially among those with a history of frequent self-mutilation.ConclusionsDialectical behaviour therapy is superior to usual treatment in reducing high-risk behaviours in patients with BPD.
Mood stabilisers plus risperidone or placebo in the treatment of acute mania
Authors: Yatham Laksami N. , Grossman Fred , Augustyns Ilse , Vieta Eduard , Ravindran Arun 
Published: February 2003

BackgroundFew double-blind trials have examined the efficacy of a combination of a mood stabiliser and an atypical antipsychotic in acute mania.AimsTo determine the efficacy of risperidone in combination with a mood stabiliser in acute mania.MethodPatients taking a mood stabiliser were randomised to 3 weeks' treatment with risperidone (n=75) or placebo (n=76).ResultsYoung Mania Rating Scale (YMRS) scores improved rapidly with significantly greater reductions at week 1 in the risperidone group compared with the placebo group. At end-point YMRS scores decreased by 14.5 and 10.3 points in the risperidone and placebo groups, respectively. Significant improvements v. placebo (P < 0.05) were noted in the risperidone group on several other clinically meaningful measures. Additionally, a post hoc analysis excluding carbamazepine-treated patients (plasma concentrations of risperidone active moiety were 40% lower in this group) revealed significantly greater reductions (P=0.047) in YMRS scores in the risperidone group than in the placebo group. Incidence of adverse events was similar in both groups.ConclusionsRisperidone is superior to placebo when used in combination with lithium or divalproex in acute mania.
Status of bipolar disorder research
Authors: Clement Sarah , Singh Swaran P. , Burns Tom 
Published: February 2003

BackgroundBibliometric research has used publication or funding databases to compare the amount of research activity on different illnesses. Only one study has examined bipolar disorder and schizophrenia in this way, and it was restricted to one database.AimsThe primary aim is to compare levels of research activity in bipolar disorder and schizophrenia. Secondary aims are to examine how research activity on the disorders varies over time and across scientific fields.MethodThe numbers of publications, projects, journals and funding awards on bipolar disorder and schizophrenia were extracted from nine computer databases to compare research activity on the two conditions.ResultsRatios (bipolar disorder: schizophrenia) ranged from 1:1.3 for the number of research funding awards to 1:7.6 for the number of clinical trials.ConclusionsThere is a relative dearth of research activity on bipolar disorder compared with schizophrenia.
Hospital doctors' management of psychological problems – Mayou & Smith revisited
Authors: Morgan John F. , Killoughery Maura 
Published: February 2003

BackgroundIn 1986 the British Journal of Psychiatry published a study of physicians' and surgeons' management of psychological problems, later cited as evidence of barriers limiting liaison psychiatry.AimsTo repeat the study after 16 years of liaison psychiatry.MethodAnonymous, confidential questionnaires were distributed to doctors at St George's Hospital, London, replicating the original study.ResultsMost of the 225 respondents believed that psychological factors could influence physical prognosis and should be routinely assessed, with greater sense of responsibility for overdoses and dying patients. Most respondents found emotional assessment impractical. Although 78% wanted more psychiatric input, referrals were avoided because of ‘stigmatisation’. Men were more likely than women to hold pejorative views, but outcomes no longer varied with seniority or speciality.ConclusionsCompared with 1986, hospital doctors appear more aware of the psychological needs of patients.
Flashbacks and post-traumatic stress disorder: the genesis of a 20th-century diagnosis
Authors: Jones Edgar , Vermaas Robert Hodgins , Mccartney Helen , Beech Charlotte , Palmer Ian , Hyams Kenneth , Wessely Simon 
Published: February 2003

BackgroundIt has been argued that post-traumatic stress disorder (PTSD) is a timeless condition, which existed before it was codified in modern diagnostic classifications but was described by different names such as ‘railway spine’ and ‘shellshock’. Others have suggested that PTSD is a novel presentation that has resulted from a modern interaction between trauma and culture.AimsTo test whether one core symptom of PTSD, the flashback, has altered in prevalence over time in soldiers subjected to the intense stress of combat.MethodRandom selections were made of UK servicemen who had fought in wars from 1854 onwards and who had been awarded war pensions for post-combat disorders. These were studied to evaluate the incidence of flashbacks in defined, at-risk populations.ResultsThe incidence of flash backs was significantly greater in the most recent cohort, veterans of the 1991 Persian Gulf War; flashbacks were conspicuous by their absence in ex-servicemen from the Boer War and the First and Second World Wars.ConclusionsAlthough this study raises questions about changing interpretations of post-traumatic illness, it supports the hypothesis that some of the characteristics of PTSD are culture-bound. Earlier conflicts showed a greater emphasis on somatic symptoms.
Influence of cohort effects on patterns of suicide in England and Wales, 1950–1999
Authors: Gunnell David , Middleton Nicos , Whitley Elise , Dorling Daniel , Frankel Stephen 
Published: February 2003

BackgroundAge- and gender-specific suicide rates in England and Wales have changed considerably since 1950.AimsTo assess whether cohort effects underlie some of these changes.MethodGraphical displays to assess age–period–cohort effects on suicide for the period 1950–1999.ResultsSuccessive male birth cohorts born after 1940 carried with them, as they aged, a greater risk of suicide than their predecessors although this effect diminished for the 1975 and 1980 birth cohorts. There was less clear evidence of any increased risk of suicide in post-war female birth cohorts.ConclusionsSucceeding generations of males born in the post-war years have experienced increasing rates of suicide at all ages, an observation in keeping with patterns seen in other countries. If these trends continue into middle- and old-age they will lead to a great increase in overall male suicide rates.
In relative danger? The outcome of patients discharged by their nearest relative from sections 2 and 3 of the Mental Health Act
Authors: Shaw Philip , Hotopf Matthew , Davies Anthony 
Published: February 2003

Aims and MethodAmong the proposed changes in the current review of mental health legislation in England and Wales is the abolition of the right of the nearest relative to discharge patients from assessment and treatment orders (Sections 2 and 3 of the Mental Health Act 1983). We aimed to determine the clinical outcome of patients whose nearest relative applies for discharge. A retrospective case–control cohort study in a south London NHS Trust of 51 patients successfully discharged by their nearest relative and 33 patients whose nearest-relative applications were blocked by the treating psychiatrist on the grounds of ‘dangerousness'.ResultsPatients discharged from section by their nearest relative did not differ significantly from controls in all the measures of clinical outcome examined.Clinical ImplicationsThis study suggests that discharges by the nearest relative against psychiatric advice are not associated with a poor clinical outcome.
Workload implications of the proposed new Mental Health Act – an audit
Authors: Whyte Sean , Meux Clive 
Published: February 2003

Aims and MethodTo estimate specific time and resource implications for professionals, if proposed changes to the Mental Health Act 1983 (England & Wales) in the Government's white paper were to be implemented unchanged. An audit of time spent on current procedures was extrapolated.ResultsThe amount of time required to comply with the Act will rise substantially (by 27% overall). Social workers and independent doctors will spend 30% and 207% more time respectively, complying with the Act, but psychiatrists providing clinical care to forensic patients should be largely unaffected.Clinical ImplicationsIf the Government presses ahead with its plans for mental health law reform as currently proposed, extra resources will be required to provide additional social work and independent medical time – or other services for patients will suffer.
Comparison of the assessment by doctors and nurses of deliberate self-harm
Authors: Weston Sian Nerys 
Published: February 2003

Aims and MethodTo compare the assessment by community psychiatric nurses and junior psychiatric doctors of individuals following deliberate self-harm (DSH) and, in particular, to elicit differences in referral practices and perceptions of mental illness. The health professionals involved completed questionnaires after carrying out DSH assessment.ResultsThere was a significant difference in referral patterns between doctors and nurses after DSH assessment. Doctors were significantly more likely to refer individuals for psychiatric follow-up which involved direct contact with other doctors (51 of 72 (71%) compared with 60 of 175 (34%)). Doctors were also significantly more likely than nurses to perceive individuals as having a mental illness (57 of 72 (79%) compared with 86 of 175 (49%)).Clinical ImplicationsFurther research is warranted to establish the precise reasons for these differences, and to determine whether the widespread introduction of nurse-led services is an effective and efficient use of resources.
Recruitment, retention, satisfaction and stress in child and adolescent psychiatrists
Authors: Littlewood S. , Case P. , Gater R. , Lindsey C. 
Published: February 2003

Aims and MethodA postal survey was sent to all consultant child and adolescent psychiatrists in the UK and Eire examining recruitment, retention, job satisfaction and job stress.ResultsA response was received from 333 (60%) child and adolescent psychiatrists. Sixty-one per cent indicated their service was inadequately resourced and 89% reported that their service failed to meet the College's minimum staffing requirements. Safe access to in-patient beds was not available to 71%. One hundred and thirty vacant posts were identified. Rates of psychological distress and burnout were high. Adequate services and the presence of a close, supportive colleague were associated with higher rates of satisfaction and lower rates of psychological distress and emotional exhaustion.Clinical ImplicationsA multi-faceted approach is suggested and recommendations are described under the headings of self-management, training, recruitment and commissioning.
Consultant responsibilities in child and adolescent mental health services teams: a systems dilemma
Authors: Reder Peter 
Published: February 2003

Aims and MethodsA number of relevant professional bodies were invited to state their views on the responsibilities of consultant child psychiatrists within multi-disciplinary teams in order to ascertain whether there was any consensus on the issue.ResultsLittle consensus or clarity emerged, save for agreement on child psychiatrists' expertise with medical matters. Only medical organisations believed in a notion of the consultant holding ultimate responsibility, although definition of this remained elusive.Clinical ImplicationsConsultants may need to seek clarity about their clinical and legal responsibilities from their employing Trust. However, there are many other dimensions to responsibility which have relevance for the training of child psychiatrists.
Developing, delivering and evaluating interprofessional clinical risk training in mental health services
Authors: Doyle M. , Earnshaw P. , Galloway A. 
Published: February 2003

Aims and MethodThe need for training to prepare mental health professionals to assess and manage risks is now well established. This paper reports on the development, delivery and evaluation of interprofessional clinical risk training in Salford and Manchester since 1998. A training-needs analysis was carried out, followed by post-training evaluation and an impact-monitoring questionnaire.ResultsThe training was very well received by participants, with over 90% of them meeting the objectives and 100% of respondents reporting that the training had a positive impact on their clinical practice more than 12 months afterwards.Clinical ImplicationsThe evaluation of the training demonstrates that a properly planned and delivered 2-day clinical risk assessment course can have a positive impact on the practice of clinicians in mental health services. However, this should be seen only as an introductory course, as more advanced risk training is required. This is currently being delivered and planned.
Website discussion forums: Results of an Australian project to promote telecommunication in dermatology
Authors: Chen Keng , See Adrian , Shumack Stephen 
Published: February 2003

summary Discussion forums on the Internet allow doctors to discuss issues of interest in a rapid, convenient and educational manner. In March 2002, the department of dermatology at the St George Hospital in Sydney launched a national Website with an online discussion forum for dermatologists. Features of the Website forum include the ability to moderate the discussion boards, a choice of public or private discussions and receipt of automatic email notifications. Over three months, three dermatologists posted a total of 13 messages on three different topics. The low rate of participation by dermatologists may have been due to lack of time or familiarity with the technology. Increased promotion to and education of dermatologists who are most likely to use the discussion forum may improve utilization of this means of communication.
Sustainability-the Holy Grail of telehealth?
Authors: Cradduck T D 
Published: February 2003

summary The sustainability of a telehealth programme is one measure of its success. However, the term ‘sustainable telehealth’ has almost become an oxymoron. Many telehealth programmes are initiated in good faith and are based upon well founded principles. Unfortunately, the initial funding cycle is rarely long enough to enable the programme to reach maturity and become integrated into the health-care system. Telehealth does not critically depend on technology; change management is much more important and it takes time for personnel to adopt new modes of practice. In addition, a telehealth programme needs a threshold number of installations before it can be deemed fully operational. In many cases an evaluation carried out at the conclusion of the pilot phase will fail to recognize the initial goals. As a consequence, the criteria used to justify further financial support are often at odds with the original goals and aspirations of the project initiators, and this leads to dissatisfaction by all parties concerned.
Lessons learned from the Hospital Without Walls project
Authors: Dadd Michael , Doyle Briony , Wilson Laurie , Gunaratnam Marcus 
Published: February 2003

summary The Hospital Without Walls is an ongoing ambitious project in home telecare that incorporates research into physiological monitoring, low-power radio communication, database storage of physiological data and methods of viewing clinically relevant information from large quantities of stored data. The system records vital signs from patients in their homes using a body-mounted, two-way radio system and a base station located in the home, which transmits data records to a central recording facility every day or in response to predefined emergency events. The prototype system has successfully undergone preliminary clinical trials, with a particular clinical emphasis on monitoring activity using three-axis accelerometers. Our experience with the trial suggests that there are significant differences in the technical design required for a long-term, home monitoring system and one where monitoring takes place in an environment staffed by health professionals.
Videoconferencing in facilities providing care for elderly people
Authors: Guilfoyle Clare , Wootton Richard , Hassall Stacey , Offer Jan , Warren Margo , Smith Debbie , Eddie Michelle 
Published: February 2003

summary Two studies were conducted to test the feasibility of delivering care by videoconferencing to facilities providing care for elderly people. Both used equipment connected by ISDN lines at 384 kbit/s. During the first study, no consultations, care plans or assessments were conducted. During the second study, 120 assessments were conducted in just over two weeks, both face to face and by videoconference. Why was one project so successful and the other not? The reasons related to ownership, planning, participants and location. A comparison of the two projects highlights some of the considerations necessary to ensure the success of any telehealth project.
The evolution of a successful telemedicine mental health service
Authors: Hailey David , Bulger Tim , Stayberg Sharlene , Urness Douglas 
Published: February 2003

summary Development of telemedicine mental health services in Alberta evolved via a pilot project, the delivery of routine services to a small group of centres and subsequent expansion to a province-wide programme. Success of the service was linked to support for telehealth by the provincial government and consultation between the Alberta Mental Health Board (AMHB) and local stakeholders. Assessments by the AMHB have shown that telepsychiatry is acceptable and sustainable at a realistic cost. However, there are few measures of clinical effectiveness available and none of cost-effectiveness. A detailed economic evaluation of the telemedicine mental health network would now be a major task. The expansion of telemedicine mental health services has increased the expectations of health-care decision makers. In addition, the complexity of the network has increased and new initiatives, such as the use of telepsychology, have been introduced. Management of this successful telehealth programme continues to be time consuming and challenging.
Integrated regional services: Are working process changes desirable and achievable?
Authors: Harno Kari , Grönhagen-Riska Carola , Pohjonen Hanna , Kinnunen Jaakko , Kekomäki Martti 
Published: February 2003

summary In the hospital district of Helsinki and Uusimaa, 32 municipalities with one or more health centres provide primary care to their residents. Legal and organizational barriers between primary care and hospital care impede the continuity of patient care. Integrating primary and secondary care with the aid of information technology may facilitate a virtual electronic patient record, in which the viewing of images and other patient data is possible regardless of the organization that produced them. For example, in one trial, diabetic patients sent their home blood glucose measurements by modem to their health centre. Preliminary observations suggest that they could increase their glucose testing largely because they were able to transmit the results to the database and receive teleconsultations. Also, a picture archiving and communication system (PACS) has been in operation in two clinics of the Helsinki University Central Hospital for over two years and seven hospitals had become filmless by the end of 2001. A regional PACS is planned to be completed by the year 2004.
Using the Australian and New Zealand Telehealth Committee framework to evaluate telehealth: Identifying conceptual gaps
Authors: Hughes Emma , King Chris , Kitt Sharon 
Published: February 2003

summary Telehealth is strongly supported in policy rhetoric as being economically significant to Australia, but evaluation standards have been insufficiently developed to ensure that this is the case. The use of one such evaluation standard, the Australian and New Zealand Telehealth Committee (ANZTC) framework, for telehealth evaluation in Australia makes good sense. However, that framework emphasizes economic and technical considerations at the expense of social contexts. Furthermore, there must be questions about the utility of a framework which, it appears, has been used to evaluate only a single telehealth project in Australia. The combination of the economic rationalism of health-care policy and the technological determinism of a tool model of information and communication technologies (ICTs) can result in evaluations that fail to match the complexities of the intersection of health-care and ICTs. Using the ANZTC framework while at the same time focusing on explaining, rather than just describing, the links between interventions and outcomes seems a reasonable compromise. This involves understanding complex socio-technical networks and relationships, and requires investigators to engage with the gulf between private opinions, public statements and actual behaviour.