Psychiatric bulletin (2014)最新文献

{"title":"Unheard voices: outcomes of tertiary care for treatment-refractory psychosis.","authors":"S Neil Sarkar,&nbsp;Derek K Tracy,&nbsp;Maria-Jesus Mateos Fernandez,&nbsp;Natasza Nalesnik,&nbsp;Gurbinder Dhillon,&nbsp;Juliana Onwumere,&nbsp;Anne-Marye Prins,&nbsp;Karen Schepman,&nbsp;Tracy Collier,&nbsp;Thomas P White,&nbsp;Anita Patel,&nbsp;Fiona Gaughran,&nbsp;Sukhwinder S Shergill","doi":"10.1192/pb.bp.112.042598","DOIUrl":"https://doi.org/10.1192/pb.bp.112.042598","url":null,"abstract":"<p><p>Aims and method In up to a quarter of patients, schizophrenia is resistant to standard treatments. We undertook a naturalistic study of 153 patients treated in the tertiary referral in-patient unit of the National Psychosis Service based at the Maudsley Hospital in London. A retrospective analysis of symptoms on admission and discharge was undertaken using the OPCRIT tool, along with preliminary economic modelling of potential costs related to changes in accommodation. Results In-patient treatment demonstrated statistically significant improvements in all symptom categories in patients already identified as having schizophrenia refractory to standard secondary care. The preliminary cost analysis showed net savings to referring authorities due to changes from pre- to post-discharge accommodation. Clinical implications Despite the enormous clinical, personal and societal burden of refractory psychotic illnesses, there is insufficient information on the outcomes of specialised tertiary-level care. Our pilot data support its utility in all domains measured. </p>","PeriodicalId":90710,"journal":{"name":"Psychiatric bulletin (2014)","volume":"38 2","pages":"71-4"},"PeriodicalIF":0.0,"publicationDate":"2014-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/pb.bp.112.042598","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32681061","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":"Partha banerjea.","authors":"Sabina Dosani","doi":"10.1192/pb.bp.114.046979","DOIUrl":"https://doi.org/10.1192/pb.bp.114.046979","url":null,"abstract":"Dr Partha Banerjea is a consultant adolescent psychiatrist, running a high-risk, high-impact adolescent service at the Maudsley Hospital in South London. He is lead clinician for Southwark Child and Adolescent Mental Health Service, and visiting lecturer at the London School of Economics and Political Science. He has a keen interest in how to train future psychiatrists and interdisciplinary ideas such as the interface between psychiatry and the arts. He studied as an undergraduate at the University of Birmingham, then undertook postgraduate studies in New Zealand before returning to the Maudsley and St George's to complete his training. What is your idea of a perfect mental health service? Free at point of access, mindful of differential engagement patterns (race, ethnicity and class all play a part here), flexible, resourced financially with treatments that work, backed by research in the real world that utilises cross-disciplinary ideas as a way of embedding implementation, creative, and free from both central government whimsy and sanctimonious therapists making no difference in the lives of the people they respectfully serve and see. Which psychiatrist, living or dead, do you most admire? Easily it would be Professor David Goldberg, who ran the adolescent service in Wandsworth while I was training. He is a psychiatrist who demonstrated immense generosity of spirit combined with a polymath's ability to effortlessly synthesise academic data not only from psychiatry and numerous psychological therapies, but also from anthropology, sociology and politics, and he brought it alive often in the room with a patient, to their benefit. To this day it is unlikely ever to be surpassed. What do you consider to be your greatest achievements? Teaching systemic theory through the films of Kurosawa, seeing the excitement in a trainee when a new idea sparks like a rewind in a dancehall, talking Miles Davies with colleagues and adolescents alike. What has been your most controversial idea? That class may be a greater factor in alignments of perception than race and that if services wanted creativity they need to tolerate uncertainty and discomfort. What frustrates you most about working in psychiatry? Government ministers introducing policy in stark contrast to available evidence, while simultaneously forgetting that they are here to serve the people. They forget that politics is showbiz for ugly people, and since most political careers end in failure, the price for their particular hubris should not be paid for by the everyman on the street. …","PeriodicalId":90710,"journal":{"name":"Psychiatric bulletin (2014)","volume":"38 2","pages":"96"},"PeriodicalIF":0.0,"publicationDate":"2014-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/pb.bp.114.046979","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32681075","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":"Play: Experimental Methodologies in Developmental and Therapeutic Settings.","authors":"S. Dosani","doi":"10.1192/PB.BP.113.045088","DOIUrl":"https://doi.org/10.1192/PB.BP.113.045088","url":null,"abstract":"Play matters. Not just to beleaguered parents who are glad of a break while their offspring are self-entertaining, but to children, to those who work with them and to those who study them. \u0000 \u0000Because play matters, I have been putting off writing this review until I found something positive to say. I have found something favourable, but rather like the book itself, you have to read a lot else to discover it. \u0000 \u0000My first gripe with this book is the subtitle: ‘Experimental Methodologies in Developmental and Therapeutic Settings’. Readers of this journal know an experiment is a study of cause and effect. It differs from non-experimental methods in that it involves the deliberate manipulation of one variable, while trying to keep all other variables constant. There are no experimental methodologies described in this book. These are many anecdotes, case studies and reports of interventions that, by their nature, do not include standardised interventions or measures which would allow them to be easily repeated. A more accurate subtitle would be ‘Global clinical experience and qualitative participative methods’. \u0000 \u0000My second quibble is with this book’s use of the term ‘play’. Throughout the text, play means so many disparate things, which are sometimes used as synonyms when they ought not to be. ‘Play’ encompasses working with creative arts, using child-friendly assessment tools, exploring displacement using puppets, observing children with dolls, engaging them with games and using drama as an educational tool in a school campaign to combat sexism. To add confusion, some definitions of play are offered at the beginning of the book and then not referred to again. \u0000 \u0000This book could have been a rich, intercultural discourse from places as diverse as Kolkata, Mumbai, Egypt, Barbados, Tanzania and Montenegro. If this multi-author text had been skillfully edited, it probably would have been. Instead, lengthy, meandering paragraphs and sudden lurches between conceptual models, history and accounts of projects are hard to read. Imagine arriving at an art gallery where paintings are strewn haphazard over the floor, rather than hung. \u0000 \u0000The gem? Chapter 5 on story stems as assessment tools. Narrative story stems are an evidence-based assessment of attachment of children, using storytelling assisted by doll play. It is has been validated by a number of research studies and can be used with preschool children and those in their early school years. \u0000 \u0000The rest of the book often reads more like a set of assembly instructions: ‘it is critical to enter [children’s] inner world and identify the key connect points’. Play might be a lot of things, but it shouldn’t be such hard work.","PeriodicalId":90710,"journal":{"name":"Psychiatric bulletin (2014)","volume":"38 1","pages":"95-95"},"PeriodicalIF":0.0,"publicationDate":"2014-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66555723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality assurance in mental health clustering for PbR or the 'national tariff' - a slave with many masters.","authors":"Rahul Bhattacharya","doi":"10.1192/pb.38.2.86a","DOIUrl":"https://doi.org/10.1192/pb.38.2.86a","url":null,"abstract":"I believe the quality assurance of the clustering process (using the Mental Health Clustering Tool (MHCT) incorporating the Health of the Nation Outcome Scales (HoNOS)) is a complex field. Bekas & Michev1 have approached it from the MHCT ‘red rule’ perspective and the ICD-10 coding perspective. What the results show is that to comply with one you might potentially be in breach of the other. We face this in clinical practice; for example, bipolar affective disorder is considered to be a ‘psychotic’ condition, although as clinicians we all know there are times when patients with bipolar affective disorder are not psychotic. On such occasions, if you rate them on the MHCT they might score ‘0’ and then if you cluster them in a psychotic cluster you breach the ‘red rule’ and if you do not, you breach the ICD-10 coding expectations. \u0000 \u0000There would be another layer of complexity added when all the ‘care packages’ are agreed between the commissioners and providers. I am sure there would be interest to ensure that the care provided or offered reflects the package agreed. The elusive ‘gold standard’ that the authors allude to, if developed, cannot be one-dimensional. It needs to clarify, when there are conflicting standards, that the clinician has to adhere to the one which takes priority and therefore in my opinion should be hierarchical. In fact, the authors of the MHCT might consider dropping the ‘red rules’ which might have outlived their usefulness when there are agreed care packages in place. Until then the MHCT and the clustering process remain imperfect tools that clinicians have to navigate to communicate with the commissioners.","PeriodicalId":90710,"journal":{"name":"Psychiatric bulletin (2014)","volume":"38 2","pages":"86"},"PeriodicalIF":0.0,"publicationDate":"2014-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/pb.38.2.86a","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32681064","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":"Socioeconomic status and prescribing for schizophrenia: analysis of 3200 cases from the Glasgow Psychosis Clinical Information System (PsyCIS).","authors":"Daniel J Martin,&nbsp;John Park,&nbsp;Julie Langan,&nbsp;Moira Connolly,&nbsp;Daniel J Smith,&nbsp;Mark Taylor","doi":"10.1192/pb.bp.112.042143","DOIUrl":"https://doi.org/10.1192/pb.bp.112.042143","url":null,"abstract":"<p><p>Aims and method To investigate whether socioeconomic status influenced rates of depot medication prescribing, polypharmacy (more than two psychotropic medications), newer (second-generation) antipsychotic prescribing and clozapine therapy. Postcodes, Scottish Index of Multiple Deprivation (SIMD) categories and current medication status were ascertained. Patients in the most deprived SIMD groups (8-10 combined) were compared with those in the most affluent SIMD groups (1-3 combined). Results Overall, 3200 patients with ICD-10 schizophrenia were identified. No clear relationship between socioeconomic status and any of the four prescribing areas was identified, although rates of depot medication use in deprived areas were slightly higher. Clinical implications Contrary to our hypothesis, there was no evidence that patients with schizophrenia within NHS Greater Glasgow and Clyde who live in more deprived communities had different prescribing experiences from patients living in more affluent areas. </p>","PeriodicalId":90710,"journal":{"name":"Psychiatric bulletin (2014)","volume":"38 2","pages":"54-7"},"PeriodicalIF":0.0,"publicationDate":"2014-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/pb.bp.112.042143","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32680596","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":"Mental health screening in police custody - acceptability among detainees.","authors":"Abdul Raoof, Babatunde Adeeko","doi":"10.1192/pb.38.2.89a","DOIUrl":"10.1192/pb.38.2.89a","url":null,"abstract":"","PeriodicalId":90710,"journal":{"name":"Psychiatric bulletin (2014)","volume":"38 2","pages":"89-90"},"PeriodicalIF":0.0,"publicationDate":"2014-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4115396/pdf/pbrcpsych_38_2_019.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32681073","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":"Profile: Dr Bourne's identity - credit where credit's due.","authors":"Jonathan Pimm","doi":"10.1192/pb.bp.113.046060","DOIUrl":"10.1192/pb.bp.113.046060","url":null,"abstract":"","PeriodicalId":90710,"journal":{"name":"Psychiatric bulletin (2014)","volume":"38 2","pages":"83-5"},"PeriodicalIF":0.0,"publicationDate":"2014-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4115399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32681063","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":"Workplace-based assessments need trainer consistency.","authors":"Yasmine A Nasr","doi":"10.1192/pb.38.2.87b","DOIUrl":"https://doi.org/10.1192/pb.38.2.87b","url":null,"abstract":"Despite their many criticisms, I am in favour of workplace-based assessments (WPBAs). They do, in theory, assess a range of important skills and do this outside of stressful examination conditions, thereby allowing trainees to perform to their greatest ability. The Assessment of Clinical Expertise (ACE) in particular covers many of the same skills assessed in the long case but avoids the snapshot examination the latter was often criticised for. The ACE overcomes this by assessing patients across multiple specialties with varying patient groups and attempts to minimise examiner bias by requiring completion from a number of different trainers. It also supersedes the long case by allowing full observation of the patient encounter and so in addition to assessing diagnostic and management skills, provides a more reliable means of assessment of communication skills and the ability of the trainee to develop a rapport with their patient. \u0000 \u0000As a trainee, however, I can clearly see that WPBAs are not without their problems. The main concern for myself and many trainees alike is not with their format or the skills they assess, but rather the rating and feedback. There is lack of consistency among trainers in completing these forms with no standards of reference to work to and so there is great subjectivity in their completion. Perhaps the introduction of external assessors who have received further training could be a step forward in overcoming such inconsistencies.","PeriodicalId":90710,"journal":{"name":"Psychiatric bulletin (2014)","volume":"38 2","pages":"87"},"PeriodicalIF":0.0,"publicationDate":"2014-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/pb.38.2.87b","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32681067","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":"Confidence in the face of risk: the Risk Assessment and Management Self-Efficacy Study (RAMSES).","authors":"Jaime Delgadillo,&nbsp;Omar Moreea,&nbsp;Hannah Outhwaite-Luke,&nbsp;Toby Dace,&nbsp;Brenda Nicholls,&nbsp;Georgina Ramseyer,&nbsp;Veronica Dale","doi":"10.1192/pb.bp.112.040394","DOIUrl":"https://doi.org/10.1192/pb.bp.112.040394","url":null,"abstract":"<p><p>Aims and method To evaluate a comprehensive risk management programme. A Risk Assessment and Management Self-Efficacy Scale (RAMSES) was used to evaluate the impact of a clinical guideline and training course. Fifty-three psychological therapists were randomly allocated to training v. waiting list in a controlled, delayed-intervention design. Differences in mean self-efficacy scores between groups were examined using analysis of covariance (ANCOVA). Results The RAMSES measure had adequate factor structure, internal consistency and construct validity. When adjusting for baseline scores and cluster design, the group exposed to training had a higher mean self-efficacy score than controls. Mean differences between groups were not significant after the control group received training, nor at 6 months' follow-up. Clinical implications Exposure to training and clinical guidelines can improve self-efficacy in risk assessment and management. An important advance put forward by this study is the specification of areas of competence in risk assessment and management, which can be measured using a psychometrically sound tool. </p>","PeriodicalId":90710,"journal":{"name":"Psychiatric bulletin (2014)","volume":"38 2","pages":"58-65"},"PeriodicalIF":0.0,"publicationDate":"2014-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/pb.bp.112.040394","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32681059","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 2014.","authors":"John Elliott","doi":"10.1192/pb.38.2.87a","DOIUrl":"https://doi.org/10.1192/pb.38.2.87a","url":null,"abstract":"","PeriodicalId":90710,"journal":{"name":"Psychiatric bulletin (2014)","volume":"38 2","pages":"87"},"PeriodicalIF":0.0,"publicationDate":"2014-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/pb.38.2.87a","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32681068","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}