Psychiatric bulletin (2014)最新文献

{"title":"OCTET Study: flawed by type 2 error.","authors":"Andy J Owen, Deepak Mirok, Loopinder Sood","doi":"10.1192/pb.38.4.196b","DOIUrl":"https://doi.org/10.1192/pb.38.4.196b","url":null,"abstract":"The OCTET study overcame many legal and ethical difficulties in setting up a randomised controlled trial (RCT) of community treatment orders (CTOs).1 We welcome the acknowledgment of some of the limitations of the trial, but are surprised that claims are still being made that the study demonstrates that CTOs do not achieve their principle purpose of reducing relapse and readmission.2 \u0000 \u0000Imagine a hypothetical RCT comparing medication with placebo. The trial would be powered based on estimated effect size and its duration would be based on expected time for response. If, in this scenario, 25% of those in the placebo arm had inadvertently been given the active drug, and if the duration of the study had been only a third of that planned, it would be inconceivable that the investigators would claim a negative result proved the drug ineffective. Yet this is analogous to what has taken place with OCTET. \u0000 \u0000In OCTET, median length of compulsion in the community was 183 days in the CTO group v. 8 days in the Section 17 group. Although this seems to indicate that it was a trial of people who were largely either subject to long periods of community compulsion (CTO group) or only a few days of compulsion (Section 17 group), a more detailed examination brings this into question. Almost 25% of the Section 17 group were still subject to compulsion by the end of the study, and the mean length of compulsion in this group was 46 days. In the CTO group, only 50% were subject to compulsion by the end of the study, with a mean length under compulsion of 170 days. This has two main implications. \u0000 \u0000First, the difference in mean length of compulsion between the CTO group and the Section 17 group was only 125 days, or a little over 4 months. It is questionable whether this is sufficient time for any benefits of CTOs to become apparent, and presumably the initial intention had been to compare 12 months in each arm. \u0000 \u0000Second, in effect, a quarter of the control group were receiving the same type of intervention as the CTO group throughout the course of the study. Any possible benefit in the CTO group would have been offset by the same effects in a large number of control subjects, leading to a large reduction in the power of the study and to type 2 error. The sensitivity analysis does nothing to address this loss of power. We contend that given these problems, in conjunction with the broader issues of recruitment and selection,3 it is not possible to claim that OCTET demonstrates CTOs to be ineffective.","PeriodicalId":90710,"journal":{"name":"Psychiatric bulletin (2014)","volume":"38 4","pages":"196-7"},"PeriodicalIF":0.0,"publicationDate":"2014-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/pb.38.4.196b","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32680927","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":"Outcomes of care programme approach, dual diagnosis, carer support and psychological therapy inductions.","authors":"Caroline Kamau","doi":"10.1192/pb.bp.113.045526","DOIUrl":"https://doi.org/10.1192/pb.bp.113.045526","url":null,"abstract":"<p><p>Aims and method For many trainees, an obstacle into psychiatry is the challenge of an imprecise job design and uncertainty about the psychiatrist's job design across many complex, often ad hoc care situations involving multiple professions and organisations. The UK's National Health Service (NHS) has introduced inductions for trainee psychiatrists geared towards improving that. Are the induction programmes effective? This article presents an analysis of the outcomes (n = 1115) of inductions about the care programme approach, dual diagnosis, carer support, mental health risk assessment, psychological therapy and suicide risk assessment. Results Univariate analyses of variance revealed a consistent interaction of care programme approach, dual diagnosis, carer support and psychological therapy inductions. Psychiatrists who attend all four inductions have the best perceptions about their job design, strongest teamwork approach, and highest motivation. Clinical implications The NHS and hospitals outside the UK should note these results when prioritising inductions for trainee psychiatrists. </p>","PeriodicalId":90710,"journal":{"name":"Psychiatric bulletin (2014)","volume":"38 4","pages":"172-4"},"PeriodicalIF":0.0,"publicationDate":"2014-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/pb.bp.113.045526","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32680913","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":"Author response.","authors":"Ashimesh Roychowdhury,&nbsp;Gwen Adshead","doi":"10.1192/pb.38.4.196a","DOIUrl":"https://doi.org/10.1192/pb.38.4.196a","url":null,"abstract":"","PeriodicalId":90710,"journal":{"name":"Psychiatric bulletin (2014)","volume":"38 4","pages":"196"},"PeriodicalIF":0.0,"publicationDate":"2014-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/pb.38.4.196a","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32680926","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":"Personal experience: Diagnosis and dilemmas - what happens when we diagnose patients with the label 'schizophrenia'.","authors":"Mark Ellerby","doi":"10.1192/pb.bp.113.046631","DOIUrl":"https://doi.org/10.1192/pb.bp.113.046631","url":null,"abstract":"","PeriodicalId":90710,"journal":{"name":"Psychiatric bulletin (2014)","volume":"38 4","pages":"182-4"},"PeriodicalIF":0.0,"publicationDate":"2014-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/pb.bp.113.046631","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32680917","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 model for managing violence in acute adult admission wards.","authors":"Reuven M Magnes","doi":"10.1192/pb.38.3.137","DOIUrl":"https://doi.org/10.1192/pb.38.3.137","url":null,"abstract":"A retrospective survey of contemporaneous electronic case records in a male psychiatric intensive care unit (PICU) in central London was carried out for 2012. The notes were scrutinised for records of serious violence where there was threat to life or limb that resulted in patients being given rapid","PeriodicalId":90710,"journal":{"name":"Psychiatric bulletin (2014)","volume":"38 3","pages":"137"},"PeriodicalIF":0.0,"publicationDate":"2014-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/pb.38.3.137","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32679945","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":"Psychiatry, subjectivity and emotion - deepening the medical model.","authors":"Jessica Yakeley,&nbsp;Rob Hale,&nbsp;James Johnston,&nbsp;Gabriel Kirtchuk,&nbsp;Peter Shoenberg","doi":"10.1192/pb.bp.113.045260","DOIUrl":"https://doi.org/10.1192/pb.bp.113.045260","url":null,"abstract":"<p><p>Morale among psychiatrists continues to be seriously challenged in the face of recruitment difficulties, unfilled posts, diagnostic controversies, service reconfigurations and public criticism of psychiatric care, in addition to other difficulties. In this article, we argue that the positivist paradigm that continues to dominate British psychiatry has led to an undervaluing of subjectivity and of the role of emotions within psychiatric training and practice. Reintegrating the subjective perspective and promoting emotional awareness and reflection may go some way towards restoring faith in the psychiatric specialty. </p>","PeriodicalId":90710,"journal":{"name":"Psychiatric bulletin (2014)","volume":"38 3","pages":"97-101"},"PeriodicalIF":0.0,"publicationDate":"2014-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/pb.bp.113.045260","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32681076","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":"Reported child awareness of parental depression.","authors":"Olga Eyre,&nbsp;Rhys Bevan Jones,&nbsp;Becky Mars,&nbsp;Gemma Hammerton,&nbsp;Ruth Sellers,&nbsp;Robert Potter,&nbsp;Ajay Thapar,&nbsp;Frances Rice,&nbsp;Stephan Collishaw,&nbsp;Anita Thapar","doi":"10.1192/pb.bp.113.044198","DOIUrl":"https://doi.org/10.1192/pb.bp.113.044198","url":null,"abstract":"<p><p>Aims and method To determine rates of parent-reported child awareness of parental depression, examine characteristics of parents, children and families according to child awareness, and explore whether child awareness is associated with child psychopathology. Data were available from 271 families participating in the Early Prediction of Adolescent Depression (EPAD) study, a longitudinal study of offspring of parents with recurrent depression. Results Seventy-three per cent of participating children were perceived as being aware of their parent's depression. Older children, and children of parents who experienced more severe depression, were more likely to be aware. Awareness was not associated with child psychopathology. Clinical implications Considering children in the context of parental depression is important. Child awareness may influence their access to early intervention and prevention programmes. Further research is needed to understand the impact of awareness on the child. </p>","PeriodicalId":90710,"journal":{"name":"Psychiatric bulletin (2014)","volume":"38 3","pages":"122-7"},"PeriodicalIF":0.0,"publicationDate":"2014-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/pb.bp.113.044198","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32679941","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":"Undertaking clinical audit, with reference to a Prescribing Observatory for Mental Health audit of lithium monitoring.","authors":"Carol Paton,&nbsp;Thomas R E Barnes","doi":"10.1192/pb.bp.113.043752","DOIUrl":"https://doi.org/10.1192/pb.bp.113.043752","url":null,"abstract":"<p><p>Audit is an important tool for quality improvement. The collection of data on clinical performance against evidence-based and clinically relevant standards, which are considered by clinicians to be realistic in routine practice, can usefully prompt reflective practice and the implementation of change. Evidence of participation in clinical audit is required to achieve intended learning outcomes for trainees in psychiatry and revalidation for those who are members of the Royal College of Psychiatrists. This article addresses some of the practical steps involved in conducting an audit project, and, to illustrate key points, draws on lessons learnt from a national, audit-based, quality improvement programme of lithium prescribing and monitoring conducted through the Prescribing Observatory for Mental Health. </p>","PeriodicalId":90710,"journal":{"name":"Psychiatric bulletin (2014)","volume":"38 3","pages":"128-31"},"PeriodicalIF":0.0,"publicationDate":"2014-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/pb.bp.113.043752","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32679942","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":"Psychiatry for medical students: need for a more holistic approach to teaching?","authors":"Kristina Rodney,&nbsp;Laura Wilkinson","doi":"10.1192/pb.38.3.138a","DOIUrl":"https://doi.org/10.1192/pb.38.3.138a","url":null,"abstract":"We are two medical students who wish to offer a perspective on undergraduate education and psychiatry.\u0000\u0000During our student placement, we attended the old age psychiatry module at the Northern Deanery MRCPsych programme focusing on dementia and ethics. This was aimed at trainees and not specifically","PeriodicalId":90710,"journal":{"name":"Psychiatric bulletin (2014)","volume":"38 3","pages":"138-9"},"PeriodicalIF":0.0,"publicationDate":"2014-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/pb.38.3.138a","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32679947","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":"Options in managing alternatives to hyoscine in clozapine-induced hypersalivation: a survey of secure services consultants.","authors":"Yasir Kasmi","doi":"10.1192/pb.38.3.140","DOIUrl":"https://doi.org/10.1192/pb.38.3.140","url":null,"abstract":"Clozapine-induced hypersalivation is socially embarrassing and potentially life threatening. It can lead to poor medication adherence, which is of concern for patients in secure settings. \u0000 \u0000Hyoscine hydrobromide is widely used as a first-line treatment, despite little available evidence.1 Alternatives are limited, but 19 different agents are listed in the Maudsley Prescribing Guidelines,1 including antipsychotics, anti-depressants and other drugs with antimuscarinic properties. There are few meaningful trials. Within the north-west of England, obtaining hyoscine has been difficult at times due to supply shortages and so alternatives have been sought. \u0000 \u0000Partnerships in Care have over 50 consultant psychiatrists nationwide caring for over 1000 in-patients, mostly within secure conditions, with a fair proportion prescribed clozapine. To examine prescribing alternatives to hyoscine, all consultants with clinical responsibilities were contacted regarding their prescribing practices and experiences. Responses were sent back in the form of a patient non-identifiable response via email. \u0000 \u0000Just under 50% of consultants replied (n=23). In the absence of hyoscine hydrobromide, there was overall little confidence in alternatives, but clinicians tended to advocate one or two. Atropine, either sublingually or via eye drops was relatively popular and the 8 clinicians that supported its use had some confidence in it. Four clinicians each supported the use of amitriptyline, pirenzepine and trihexyphenidyl. All the medication recommendations received were in the latest Maudsley Prescribing Guidelines in Psychiatry, except for procyclidine. Most options consisted of drugs with antimuscarinic properties such as pirenzepine and trihexyphenidyl. Dose reduction of clozapine was recommended by 1 consultant. The author and another two consultants have had some success with glycopyrrolate syrup, but this is a very expensive option. \u0000 \u0000Clozapine-induced hypersalivation is a condition potentially difficult to manage. The wide range of options and lack of evidence does not support clinicians in their attempts to continue treatment. In circumstances where patients do not respond to hyoscine, the most popular choice was sublingual atropine. National guidance and further trials are required. The shortage of hyoscine raises legal and ethical questions for patients subject to certification by second-opinion doctors and whether clinicians are likely to request further certification for alternative classes of drugs for hypersalivation.","PeriodicalId":90710,"journal":{"name":"Psychiatric bulletin (2014)","volume":"38 3","pages":"140"},"PeriodicalIF":0.0,"publicationDate":"2014-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/pb.38.3.140","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32679950","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}