The most important things I have learnt in my career as a psychiatrist [Education & training]
This paper is something of a patchwork, incorporating many issues that have intrigued me during 34 years of research. I have included the importance of maintaining a solid base in clinical work, alongside research activities, and being alert to the possibility of a somatic condition contributing to psychiatric symptoms. I stress the value of careful observation of patients, their response to treatments and reasons for dropping out. In addition, I have included 14 more lessons, learned from my experience of research, which I hope will be of use to those readers who aspire to become researchers. (Source: Psychiatric Bulletin)
Source: Psychiatric Bulletin - January 31, 2017 Category: Psychiatry Authors: Leff, J. Tags: Education & amp; training Source Type: research
Training in quality improvement for the next generation of psychiatrists [Education & training]
We describe a pilot project to engage in QI trainees across a National Health Service trust and a school of psychiatry. After the first year of this programme over half of psychiatry trainees in the school (58% of core trainees and 47% of advanced trainees) are participating in 28 individual QI projects and QI project methodology is to become embedded in the core psychiatry training course. Specialty doctors, consultants, foundation doctors, general practitioner trainees, medical students and the wider multidisciplinary team have all become engaged alongside trainees, working with patients and their families to identify pr...
Source: Psychiatric Bulletin - January 31, 2017 Category: Psychiatry Authors: Ewins, E., Macpherson, R., van der Linden, G., Arnott, S. Tags: Education & amp; training Source Type: research
Adherence to medication in the community: audit cycle of interventions to improve the assessment of adherence [Current Practice]
Aims and method To investigate whether medication adherence is monitored during follow-up in out-patient reviews. A retrospective audit was carried out with a sample of 50 follow-up patients with a diagnosis of schizophrenia or schizoaffective disorder. Following this, interventions were made prior to the re-audit (including text messaging clinicians and prompt sheets in the out-patient department to encourage adherence discussions).
Results There was an improvement on all the standards set for this audit following the interventions. More doctors had discussed medication adherence (62% second cycle v. 50% first cycle) with...
Source: Psychiatric Bulletin - January 31, 2017 Category: Psychiatry Authors: Farooq, S., Choudry, A. Tags: Current Practice Source Type: research
Perceptual distortions and deceptions: what computers can teach us [Special articles]
The nature of perception has fascinated philosophers for centuries, and has more recently been the focus of research in psychology and neuroscience. Many psychiatric disorders are characterised by perceptual abnormalities, ranging from sensory distortions to illusions and hallucinations. The distinction between normal and abnormal perception is, however, hard to articulate. In this article we argue that the distinction between normal perception and abnormal perception is best seen as a quantitative one, resting on the degree to which the observer's prior expectations influence perceptual inference. We illustrate this point...
Source: Psychiatric Bulletin - January 31, 2017 Category: Psychiatry Authors: Nour, M. M., Nour, J. M. Tags: Special articles Source Type: research
Mental capacity and borderline personality disorder [Special articles]
The use of the Mental Capacity Act 2005 in assessing decision-making capacity in patients with borderline personality disorder (BPD) is inconsistent. We believe this may stem from persisting confusion regarding the nosological status of personality disorder and also a failure to recognise the fact that emotional dysregulation and characteristic psychodynamic abnormalities may cause substantial difficulties in using and weighing information. Clearer consensus on these issues is required in order to provide consistent patient care and reduce uncertainty for clinicians in what are often emergency and high-stakes clinical scen...
Source: Psychiatric Bulletin - January 31, 2017 Category: Psychiatry Authors: Ayre, K., Owen, G. S., Moran, P. Tags: Special articles Source Type: research
'Doc, can I fly to Australia? A case report and review of delirium following long-haul flight [Special articles]
This article suggests that more thought should be given to the title question. (Source: Psychiatric Bulletin)
Source: Psychiatric Bulletin - January 31, 2017 Category: Psychiatry Authors: McCabe, T. Tags: Special articles Source Type: research
Juvenile delinquency, welfare, justice and therapeutic interventions: a global perspective [Review Article]
This review considers juvenile delinquency and justice from an international perspective. Youth crime is a growing concern. Many young offenders are also victims with complex needs, leading to a public health approach that requires a balance of welfare and justice models. However, around the world there are variable and inadequate legal frameworks and a lack of a specialist workforce. The UK and other high-income countries worldwide have established forensic child and adolescent psychiatry, a multifaceted discipline incorporating legal, psychiatric and developmental fields. Its adoption of an evidence-based therapeutic int...
Source: Psychiatric Bulletin - January 31, 2017 Category: Psychiatry Authors: Young, S., Greer, B., Church, R. Tags: Review Article Source Type: research
Pokorny's complaint: the insoluble problem of the overwhelming number of false positives generated by suicide risk assessment [Original papers]
Alex Pokorny's 1983 prospective study of suicide found that 96.3% of high-risk predictions were false positives, and that more than half of the suicides occurred in the low-risk group and were hence false negatives. All subsequent prospective studies, including the recent US Army Study To Assess Risk and Resilience in Servicemembers (STARRS), have reported similar results. We argue that since risk assessment cannot be a practical basis for interventions aimed at reducing suicide, the alternative is for mental health services to carefully consider what amounts to an adequate standard of care, and to adopt the universal prec...
Source: Psychiatric Bulletin - January 31, 2017 Category: Psychiatry Authors: Nielssen, O., Wallace, D., Large, M. Tags: Original papers Source Type: research
Personality disorder: still the patients psychiatrists dislike? [Original papers]
Aims and method In 1988, Lewis and Appleby demonstrated that psychiatrists hold negative attitudes towards patients with personality disorder. We assessed the attitudes of psychiatry trainees towards patients with borderline personality disorder and depression, expecting an improvement. 166 trainees were block randomised to receive one of four case vignettes that varied by diagnosis and ethnic group. We used Lewis and Appleby's original questionnaire and the Attitudes to Personality Disorder Questionnaire (APDQ).
Results We received 76 responses. Lewis and Appleby's questionnaire showed more negative attitudes towards pers...
Source: Psychiatric Bulletin - January 31, 2017 Category: Psychiatry Authors: Chartonas, D., Kyratsous, M., Dracass, S., Lee, T., Bhui, K. Tags: Original papers Source Type: research
Capacity in vacuo: an audit of decision-making capacity assessments in a liaison psychiatry service [Original papers]
Aims and method We aimed to audit the documentation of decision-making capacity (DMC) assessments by our liaison psychiatry service against the legal criteria set out in the Mental Capacity Act 2005. We audited 3 months split over a 2-year period occurring before, during and after an educational intervention to staff.
Results There were 21 assessments of DMC in month 1 (6.9% of all referrals), 27 (9.7%) in month 16, and 24 (6.6%) in month 21. Only during the intervention (month 16) did any meet our gold-standard (n = 2). Severity of consequences of the decision (odds ratio (OR) 24.4) and not agreeing to the intervention (O...
Source: Psychiatric Bulletin - January 31, 2017 Category: Psychiatry Authors: Spencer, B. W. J., Wilson, G., Okon-Rocha, E., Owen, G. S., Wilson Jones, C. Tags: Original papers Source Type: research
Plans, hopes and ideas for mental health [Editorials]
Mental health and the failings of the mental health services are in the spotlight as never before. Nowhere is this more apparent than in the often dire situation with regard to child and adolescent mental health. At the same time, there is a renewed interest in the scope for prevention of mental illness and distress, and in population approaches to mental well-being. It may come as a surprise to some that others have given such serious consideration to strategic approaches to public mental health as long ago as the 1950s. It appears that such consideration was squeezed out by the dominant concerns of serious and enduring m...
Source: Psychiatric Bulletin - January 31, 2017 Category: Psychiatry Authors: Ashton, J. R. Tags: Editorials Source Type: research
The access and waiting-time standard for first-episode psychosis: an opportunity for identification and treatment of psychosis risk states? [Editorials]
Expansion of early intervention services to identify and clinically manage at-risk mental state for psychosis has been recently commissioned by NHS England. Although this is a welcome development for preventive psychiatry, further clarity is required on thresholds for definition of such risk states and their ability to predict subsequent outcomes. Intervention studies for these risk states have demonstrated that a variety of interventions, including those with fewer adverse effects than antipsychotic medication, may potentially be effective but they should be interpreted with caution. (Source: Psychiatric Bulletin)
Source: Psychiatric Bulletin - January 31, 2017 Category: Psychiatry Authors: Whale, R., Thompson, A., Fraser, R. Tags: Editorials Source Type: research
Attachment Theory in Adult Mental Health: A Guide to Clinical Practice [Reviews]
(Source: Psychiatric Bulletin)
Source: Psychiatric Bulletin - November 30, 2016 Category: Psychiatry Authors: Patrick, J. Tags: Reviews Source Type: research
Enabling Recovery: The Principles and Practice of Rehabilitation Psychiatry (2nd edn) [Reviews]
(Source: Psychiatric Bulletin)
Source: Psychiatric Bulletin - November 30, 2016 Category: Psychiatry Authors: Mountain, D. Tags: Reviews Source Type: research
Suicide: A Modern Obsession [Reviews]
(Source: Psychiatric Bulletin)
Source: Psychiatric Bulletin - November 30, 2016 Category: Psychiatry Authors: Davies, T. Tags: Reviews Source Type: research
