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BJPsych Bulletin

Gayathri Venkatesan, Scott Weich, Orla McBride, Liz Twigg, Helen Parsons, Jan Scott, Kamaldeep Bhui, Patrick Keown
Aims and methodTo compare rates of admission for different types of severe mental illness between ethnic groups, and to test the hypothesis that larger and more clustered ethnic groups will have lower admission rates. This was a descriptive study of routinely collected data from the National Health Service in England. RESULTS: There was an eightfold difference in admission rates between ethnic groups for schizophreniform and mania admissions, and a fivefold variation in depression admissions...
May 11, 2018: BJPsych Bulletin
Peter Tyrer
SummaryBob Spitzer died in December 2015 but is not likely to be forgotten quickly. His Herculean task in reforming psychiatric diagnosis, mainly by the development of the third edition of the Diagnostic and Statistical Manual of Mental Disorders in 1980, has been acknowledged by many, but it remains unfinished. To complete the process, we need more than good diagnostic reliability, we need better veracity.Declaration of interestNone.
May 7, 2018: BJPsych Bulletin
Norman Poole
SummaryThe incoming editor Dr Norman Poole sets out a vision for his tenure at the helm of the BJPsych Bulletin. There will be redoubled focus on training and educational articles and an engagement with the cultural and social ramifications of this most vital of specialisms.Declaration of interestDr Poole is editor of the BJPsych Bulletin.
May 7, 2018: BJPsych Bulletin
Dipen Patel, Manjunath Minajagi
Aims and methodVitamin D deficiency is increasing in the general population, and is linked with physical and mental illness. However, evidence on its prevalence in people with mental illness is limited. This study investigated vitamin D deficiency in 104 adult patients admitted to a psychiatric hospital in the UK. RESULTS: Forty-nine per cent were vitamin D deficient (serum 25(OH)D 50 nmol/L). There were no statistically significant differences in mean serum vitamin D between different subgroups of mental illness...
May 2, 2018: BJPsych Bulletin
Clare Gerada
This article focuses on doctors and suicide. It provides real examples to illustrate why doctors die by their own hand. These reasons are replicated in the general population, but also include a host of additional risk factors related to being a doctor. In each case, information about the doctor is in the public domain or, as in one case, consent from the next of kin has been obtained for a detail not in the public domain. The author is a doctors' doctor, heading up a confidential health service for doctors with mental illness or addiction, the National Health Service Practitioner Health Programme...
May 1, 2018: BJPsych Bulletin
Noel Collins, Laurie Corna
Aims and methodTo understand general practitioner (GP) reticence to refer older patients to a local Improving Access to Psychological Therapies (IAPT) service providing mostly cognitive-behavioural therapy (CBT)-based interventions. Semi-structured, hour-long interviews were conducted with eight GPs and then analysed by modified grounded theory and thematic analysis. RESULTS: GP views regarding the treatability of older adults with CBT influenced their willingness to refer to a CBT-based IAPT service...
April 29, 2018: BJPsych Bulletin
Susham Gupta, Elvan U Akyuz, Toby Baldwin, David Curtis
Aims and methodCommunity treatment orders (CTOs) have been in used in England and Wales since November 2008; however, their effectiveness has been debated widely, as has the question of which methodology is appropriate to investigate them. This paper uses national data to explore the use of CTOs in England. RESULTS: About 5500 patients are subject to CTOs at any one time. Each year, ~4500 patients are made subject to a CTO each year and ~2500 are fully discharged, usually by the responsible clinician; fewer than half of CTO patients are recalled, and two-thirds of recalls end in revocation...
April 23, 2018: BJPsych Bulletin
H J Welstead, J Patrick, T C Russ, G Cooney, C M Mulvenna, C Maclean, A Polnay
Aims and methodCaring for patients with personality disorder is one of the biggest challenges in psychiatric work. We investigated whether mentalisation-based treatment skills (MBT-S) teaching improves clinicians' understanding of mentalising and attitudes towards personality disorder. Self-report questionnaires (Knowledge and Application of MBT (KAMQ) and Attitudes to Personality Disorder (APDQ)) were completed at baseline and after a 2-day MBT-S workshop. RESULTS: Ninety-two healthcare professionals completed questionnaires before and after training...
April 23, 2018: BJPsych Bulletin
Andrea Brown, Richard Jenkinson, Julia Coakes, Annette Cockfield, Tish O'Brien, Louise Hall
Aims and methodA cognitive-behavioural therapy in-patient treatment model for adults with severe anorexia nervosa was developed and evaluated, and outcomes were compared with the previous treatment model and other published outcomes from similar settings. RESULTS: This study showed the Pathways to Recovery outcomes were positive in terms of improvements in body mass index and psychopathology.Clinical implicationsAdults with anorexia nervosa can achieve good outcomes despite longer illness duration and comorbidities...
June 2018: BJPsych Bulletin
Simon Dein
This paper argues for the inclusion of religion and spirituality in psychiatric care. After discussing the antagonism of psychiatrists and psychologists to religion, I present a critical overview of studies examining the relationships between spirituality, religion and diverse aspects of mental health: depression, suicide, anxiety, delinquency, drug abuse and schizophrenia. The need to assesses the impact of religion in different faith groups is discussed. Measures of religious coping, both positive and negative, may provide a more accurate portrayal as to how individuals deploy religion in their lives than global measures such as belief and attendance...
June 2018: BJPsych Bulletin
Else Guthrie, Mathew Harrison, Richard Brown, Rajdeep Sandhu, Peter Trigwell, Seri Abraham, Shazada Nawaz, Peter Kelsall, Rachel Thomasson
Aims and methodTo develop and pilot a clinician-rated outcome scale to evaluate symptomatic outcomes in liaison psychiatry services. Three hundred and sixty patient contacts with 207 separate individuals were rated using six subscales (mood, psychosis, cognition, substance misuse, mind-body problems and behavioural disturbance) plus two additional items (side-effects of medication and capacity to consent for medical treatment). Each item was rated on a five-point scale from 0 to 5 (nil, mild, moderate, severe and very severe)...
June 2018: BJPsych Bulletin
David Veale
In 2012, the coalition government introduced the legal right for National Health Service (NHS) patients in England to choose their mental healthcare provider for out-patient treatment. This was a significant step towards parity of care between mental and physical ill health, and NHS Improvement and NHS England have provided sensible guidance on its implementation. However, several factors prevent the system from working as it was intended: lack of awareness of the principle of patient choice for out-patient treatment; complacency from some trusts and commissioners; mental health trusts operating outside the e-referrals system; misuse of care pathways; lack of direct access by many general practitioners for out-of-area referrals; and delays in authorisation for funding...
April 2018: BJPsych Bulletin
Stephen Noblett, Jane Beenstock, James Noblett, Joanne Ireland, Sarah Ormiston
Aims and method The increased rates of smoking in people with mental illness is well documented, and establishing smoke-free mental health environments has been emphasised over recent years. This article examines the financial costs of implementing smoke free guidance and assesses the cost associated with patients who were prescribed clozapine and who committed to stopping smoking cigarettes for the duration of the study period. RESULTS: Patients (38) who were prescribed clozapine were included in the study...
April 2018: BJPsych Bulletin
Henry Bladon
This paper looks at the relationship between fiction and psychiatry. Specifically, the idea of psychiatrists as fiction writers is explored, and reference is made to various fictional texts to illustrate the problems of stigma and negative imagery. These two main areas of focus are highlighted as ones that the practice of writing fiction might address, and some potential pitfalls are discussed. The paper suggests how psychiatrists might ameliorate the present problems by incorporating their unique clinical skills and knowledge into fictional narratives...
April 2018: BJPsych Bulletin
Mohammed A Rashed, Rachel Bingham, Norman A Poole, Abdi Sanati, Werdie van Staden
This paper presents a debate in which the authors participated at the World Psychiatric Association conference in Cape Town, South Africa in November 2016. Professor van Staden acted as chair and here, as at the debate, provides a rationale for debating a topic that many of those involved in mental health believe to be decided. The discussion that ensued demonstrated, however, that while the arguments have moved on they have not ceased. Who won? Well that depends how you look at it. A few in the audience shifted position towards the motion but the majority remained opposed...
April 2018: BJPsych Bulletin
Mick James, Jon Painter, Bill Buckingham, Malcolm W Stewart
Aims and method The Health of the Nation Outcome Scales (HoNOS) and its older adults' version (HoNOS 65+) have been used widely for 20 years, but their glossaries have not been revised to reflect clinicians' experiences or changes in service delivery. The Royal College of Psychiatrists convened an international advisory board, with UK, Australian and New Zealand expertise, to identify desirable amendments. The aim was to improve rater experience by removing ambiguity and inconsistency in the glossary rather than more radical revision...
April 2018: BJPsych Bulletin
Peter Tyrer
The diagnosis of generalised anxiety disorder is a distraction of no value. It is highly unreliable, co-occurring with many other disorders of firmer diagnostic status, and has intrinsic connections to personality dysfunction. It is argued that classification would be heartily relieved to rid itself of this unnecessary appendage and for the symptom of anxiety to remain as a descriptive term only. Declaration of interest None.
April 2018: BJPsych Bulletin
Daniel Racey
In this article I argue that fictional accounts of mental illness should be unethically unobliged. I suggest that art is not generated with conscious ethical intent and provide evidence that art proceeding from an ethical agenda is more likely to be poor art. I also consider ways in which a writer-doctor might need to compromise what they articulate to maintain a professional ethical integrity. Declaration of interest None.
April 2018: BJPsych Bulletin
Helen M Stallman, Jeneva L Ohan
Help-seeking is important for patients with suicidal ideation. Currently, a risk management paradigm is used with patients who express suicidality; however, this may limit support and increase stigma, reducing future help-seeking. Coping planning is proposed as a paradigm shift that overcomes these problems by focusing on patient needs and strengths. Declaration of interest None.
April 2018: BJPsych Bulletin
Katie Lambert, Simon Chu, Chris Duffy, Victoria Hartley, Alison Baker, Jane L Ireland
Aims and method We explored the prevalence and use of constant supportive observations (CSO) in high, medium and low secure in-patient services in a single National Health Service (NHS) mental health trust. From clinical records, we extracted data on the length of time of CSO, the reason for the initiation of CSO and associated adverse incidents for all individuals who were placed on CSO between July 2013 and June 2014. RESULTS: A small number of individuals accounted for a disproportionately large proportion of CSO hours in each setting...
April 2018: BJPsych Bulletin
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