Psychiatric bulletin (2014)最新文献

{"title":"Teaching and learning the mental state exam in an integrated medical school. Part I: Student perceptions.","authors":"Sarah Huline-Dickens,&nbsp;Eithne Heffernan,&nbsp;Paul Bradley,&nbsp;Lee Coombes","doi":"10.1192/pb.bp.113.042655","DOIUrl":"https://doi.org/10.1192/pb.bp.113.042655","url":null,"abstract":"<p><p>Aims and method To investigate medical students' performance at and perceptions of the mental state examination (MSE) at a medical school with a modern integrated curriculum. We undertook an evaluative case study comprising a survey and analysis of performance data. The study is presented in two parts: part 1 discusses the students' perceptions of the MSE and the teaching, learning and practising of it. Results Most students in the study group considered the MSE an important examination in medicine. Other perceptions grouped in themes are presented. Unsurprisingly, most students found psychiatric attachments the most useful part of the course for learning about the MSE. About a half of students had witnessed an MSE being undertaken in clinical practice. Clinical implications Although students appear to recognise the importance of this examination in medicine, the teaching and learning of it possibly needs greater emphasis in the undergraduate curriculum, and teaching and learning opportunities improved throughout the course. </p>","PeriodicalId":90710,"journal":{"name":"Psychiatric bulletin (2014)","volume":"38 5","pages":"236-42"},"PeriodicalIF":0.0,"publicationDate":"2014-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/pb.bp.113.042655","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32721931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges and opportunities in (neuro)psychiatry.","authors":"Ketan D Jethwa","doi":"10.1192/pb.38.5.251a","DOIUrl":"https://doi.org/10.1192/pb.38.5.251a","url":null,"abstract":"It would appear that British psychiatry is retreating to a neurophobic position.[1][1] The disconnect between psychiatry and its medical foundations is further exacerbated by the lack of medical experience in specialties relevant to psychiatry such as neurology, endocrinology and geriatric medicine","PeriodicalId":90710,"journal":{"name":"Psychiatric bulletin (2014)","volume":"38 5","pages":"251-2"},"PeriodicalIF":0.0,"publicationDate":"2014-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/pb.38.5.251a","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32722842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bulletin comment: Smoking, mental ill health and electronic cigarettes.","authors":"","doi":"10.1192/pb.bp.114.048934","DOIUrl":"https://doi.org/10.1192/pb.bp.114.048934","url":null,"abstract":"","PeriodicalId":90710,"journal":{"name":"Psychiatric bulletin (2014)","volume":"38 5","pages":"249"},"PeriodicalIF":0.0,"publicationDate":"2014-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/pb.bp.114.048934","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32721933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How can a young person wait over 90 hours in an emergency department for a bed?","authors":"Gil Myers,&nbsp;Delphine Coyle,&nbsp;Christopher Kowalski,&nbsp;Ramya Srinivasan","doi":"10.1192/pb.38.5.250","DOIUrl":"https://doi.org/10.1192/pb.38.5.250","url":null,"abstract":"We have recently been involved in a difficult case of a young person who remained in a local emergency department bed for over 90 hours while several specialty registrar (StR) doctors spent the majority of their on-call time attempting, and failing, to find an appropriate available bed. Over the course of this time, at least 40 units were contacted, numerous referral letters faxed and the case was handed over 6 times, all while the young person waited in an unsuitable setting that offered little to meet his mental health needs. \u0000 \u0000Although this is an extreme case, it reflects the trend we have observed of difficulty in finding beds, especially out of hours, and the fact that bed finding is becoming a major aspect of our on-call time. As Hillen & Szaniecki demonstrated,1 the majority of referrals are made between the hours of 5 pm and 9 am when daytime services are closed. \u0000 \u0000We have read with interest the findings of NHS England’s Child and Adolescent Mental Health Services (CAMHS) tier 4 report2 published in July 2014, which reported that the number of NHS-funded CAHMS tier 4 beds has increased by just 136 in the past 8 years, compared with a 284 rise between 1999 and 2006. This means that there were 1264 beds available nationally in January 2014. The BBC have declared this a problem of ‘patchy provision’ and, based on their findings, NHS England have identified a need and promised ‘up to 50 new beds around the country with further beds moved according to need’.2 While this goes some way to providing more beds, this is only part of the problem. \u0000 \u0000There is currently no system to find out which beds are available at any given time and no external support to make the bed-finding process efficient. In our experience, weekly published lists are not representative of genuine availability and are quickly obsolete. There is no universal referral form so each referral necessitates new paperwork and often indiscriminate, convoluted processes of speaking to each individual bed manager, night nurses and support staff who do not have the responsibility to admit patients out of hours. A young person with complex problems and behaviours that need careful management is considered too risky for an open ward and so they are refused. Beds alone will not solve this; we need places that can be accessed out of hours with appropriate staffing levels and staff adequately trained to confidently manage the potential risk. \u0000 \u0000Because of these difficulties in admission, we are concerned that a prolonged wait in an emergency department will become more commonplace and that measures such as the Mental Health Act 1983 will be used to compel young people into admissions as their mental health deteriorates while waiting for a bed, and low-secure units become the default due to their ability to tolerate risk. \u0000 \u0000We are surprised that there is no centrally produced daily bulletin of national bed states and no provision to make NHS England accessible out of hours to assist with f","PeriodicalId":90710,"journal":{"name":"Psychiatric bulletin (2014)","volume":"38 5","pages":"250"},"PeriodicalIF":0.0,"publicationDate":"2014-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/pb.38.5.250","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32721934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A new service model for the treatment of severe anorexia nervosa in the community: the Anorexia Nervosa Intensive Treatment Team.","authors":"Calum Munro,&nbsp;Victoria Thomson,&nbsp;Jean Corr,&nbsp;Louise Randell,&nbsp;Jennie E Davies,&nbsp;Claire Gittoes,&nbsp;Vicky Honeyman,&nbsp;Chris P Freeman","doi":"10.1192/pb.bp.113.044818","DOIUrl":"https://doi.org/10.1192/pb.bp.113.044818","url":null,"abstract":"<p><p>Aims and method A community intensive treatment service for severe anorexia nervosa is described. The service is multidisciplinary but driven by a focus on psychological formulation. Psychological and dietetic interventions are grounded in a process of active risk management. Evaluations of safety, cost and acceptability of the service are described. Results Patients are highly satisfied with their care. A relatively low mortality rate for such a high-risk population was observed. In-patient bed use and costs were substantially reduced. Clinical implications There is a case for greater use of intensive community care for patients with severe anorexia nervosa, as it can be acceptable to patients, relatively safe and cost less than admission. </p>","PeriodicalId":90710,"journal":{"name":"Psychiatric bulletin (2014)","volume":"38 5","pages":"220-5"},"PeriodicalIF":0.0,"publicationDate":"2014-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/pb.bp.113.044818","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32721928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The electronic cigarette: a knight in shining armour or a Trojan horse?","authors":"Neil W Schluger","doi":"10.1192/pb.bp.114.048439","DOIUrl":"https://doi.org/10.1192/pb.bp.114.048439","url":null,"abstract":"<p><p>Electronic cigarettes have caused a sharp debate in the public health community, with some promoting them as a means of harm reduction for tobacco users and some taking a strong stand against them because of fear of renormalising smoking behaviour and interrupting tobacco control progress. People with mental health problems smoke at high rates and e-cigarettes seem a potentially attractive method of cessation in this population, and their use should be studied carefully. </p>","PeriodicalId":90710,"journal":{"name":"Psychiatric bulletin (2014)","volume":"38 5","pages":"201-3"},"PeriodicalIF":0.0,"publicationDate":"2014-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/pb.bp.114.048439","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32721924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe and enduring mental health problems within an established substance misuse treatment partnership.","authors":"Kathryn Walsh,&nbsp;Alex Copello","doi":"10.1192/pb.bp.113.045138","DOIUrl":"https://doi.org/10.1192/pb.bp.113.045138","url":null,"abstract":"<p><p>Aims and method The study reports findings of an investigation into the presence of severe and enduring mental health problems within the four statutory and non-statutory teams of an established substance misuse treatment partnership. Results Of a total of 772 clients in the four teams surveyed, 69 (8.9%) were identified as having severe and enduring mental health problems and problem substance use in the past 12 months. Alcohol was the most prevalent substance used by this predominantly male group. Different rates were found across the four teams, with higher numbers in the non-statutory teams. The clients displayed significant levels of self-harm and suicide risk and were responsible for 131 acute service contacts over the past 12 months. Clinical implications Clients with severe and enduring mental health problems engaged with substance misuse services display high levels of complex need. It is important to identify the best and most effective service response to this group. </p>","PeriodicalId":90710,"journal":{"name":"Psychiatric bulletin (2014)","volume":"38 5","pages":"216-9"},"PeriodicalIF":0.0,"publicationDate":"2014-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/pb.bp.113.045138","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32721927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delayed discharge from intellectual disability in-patient units.","authors":"John Devapriam,&nbsp;Satheesh Gangadharan,&nbsp;Judith Pither,&nbsp;Matthew Critchfield","doi":"10.1192/pb.bp.113.044388","DOIUrl":"https://doi.org/10.1192/pb.bp.113.044388","url":null,"abstract":"<p><p>Aims and method We undertook a cross-sectional service evaluation of the reasons and extent of delay in the discharge process in an intellectual disability hospital over a 12-month period. Delays at each stage of the discharge process are also quantified in this study. Results We found that discharge was delayed for 29% of patients during the study period. The majority (78.5%) was due to awaiting completion of assessment of future care needs and waiting for public funding. Clinical implications Commissioners (health and social), provider trusts, regulators and community providers should consider the reasons for delay in the discharge process and adopt a whole systems approach to discharge planning. This is highly relevant in light of recommendations by the Department of Health following the Winterbourne View scandal, which has raised concern about patients staying in intellectual disability in-patient units too long and for the wrong reasons. </p>","PeriodicalId":90710,"journal":{"name":"Psychiatric bulletin (2014)","volume":"38 5","pages":"211-5"},"PeriodicalIF":0.0,"publicationDate":"2014-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/pb.bp.113.044388","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32721926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electronic cigarettes in mental health settings - solving a conundrum?","authors":"Elena Ratschen","doi":"10.1192/pb.bp.114.047431","DOIUrl":"https://doi.org/10.1192/pb.bp.114.047431","url":null,"abstract":"<p><p>Electronic cigarettes (e-cigarettes), have recently been the focus of much attention and debate. This article attempts to highlight their relevance and potential importance for mental health settings, with a focus on in-patient units. To do so, the complexities involved in smoking among people with mental disorder, the debate surrounding e-cigarettes, and their potential to be utilised as a smoking cessation or temporary abstinence aid in the context of smoke-free policies and new National Institute for Health and Care Excellence guidance for smoking cessation in mental health settings, will be discussed and synthesised below. </p>","PeriodicalId":90710,"journal":{"name":"Psychiatric bulletin (2014)","volume":"38 5","pages":"226-9"},"PeriodicalIF":0.0,"publicationDate":"2014-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/pb.bp.114.047431","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32721929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stigma creating stigma: a vicious circle.","authors":"Sokratis Dinos","doi":"10.1192/pb.bp.114.048124","DOIUrl":"https://doi.org/10.1192/pb.bp.114.048124","url":null,"abstract":"<p><p>Despite anti-stigma campaigns in the UK in recent years, the experiences of people with mental health problems indicate that stigma is still a major problem. The stigma of being a member of a socially excluded group, based on socioeconomic, personal or cultural/ethnic characteristics, should be considered alongside the stigma of mental illness. Membership of a stigmatised group (not based on mental illness) is often itself a risk factor for developing mental health problems. This article discusses the experiences of people from Black and minority ethnic and lesbian, gay and bisexual groups to explore how stigma can create more stigma. </p>","PeriodicalId":90710,"journal":{"name":"Psychiatric bulletin (2014)","volume":"38 4","pages":"145-7"},"PeriodicalIF":0.0,"publicationDate":"2014-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/pb.bp.114.048124","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32679952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}