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BJPsych Bulletin

Abirami Kirubarajan, Stephen Puntis, Devon Perfect, Marc Tarbit, Mary Buckman, Andrew Molodynski
Aims and methodStreet triage services are increasingly common and part of standard responses to mental health crises in the community, but little is understood about them. We conducted a national survey of mental health trusts to gather detailed information regarding street triage services alongside a survey of Thames Valley police officers to ascertain their views and experiences. RESULTS: Triage services are available in most areas of the country and are growing in scope. There is wide variation in levels of funding and modes of operation, including hours covered...
September 17, 2018: BJPsych Bulletin
Mick James, Bill Buckingham, Gary Cheung, Roderick McKay, Jon Painter, Malcom W Stewart
Aims and methodThe Health of the Nation Outcome Scales for Elderly People (HoNOS65+) has been used widely for 20 years, but has not been updated to reflect contemporary clinical practice. The Royal College of Psychiatrists convened an advisory board, with expertise from the UK, Australia and New Zealand, to propose amendments. The aim was to improve rater experience when using the HoNOS65+ glossary by removing ambiguity and inconsistency, rather than a more radical revision. RESULTS: Views and experience from the countries involved were used to produce a series of amendments intended to improve intra- and interrater reliability and improve validity...
September 17, 2018: BJPsych Bulletin
Peter Tyrer
The Care Programme Approach was a valiant attempt to improve the aftercare of people with severe mental illness after discharge from hospital. It was introduced as a response to a scandal, not an advance in knowledge, and has always suffered by being a reaction to events rather than a trailblazer for the future. It may have dragged the worst of care upwards, but at the expense of creating a bureaucratic monstrosity that has hindered good practice by excessive attention to risk, and vastly increased paperwork with intangible benefit...
September 12, 2018: BJPsych Bulletin
Tayyeb A Tahir, Adam Watkins, Philip Slack, Phil Chick, William Lee, Andrea Gray
Aims and methodRecent funding from Welsh Government for mental health has helped to develop liaison psychiatry services in Wales. Systematic data collection was undertaken to map the liaison psychiatry services in Wales in collaboration with the Royal College of Psychiatrists in Wales and Public Health Wales 1000 Lives Improvement. A questionnaire was designed and circulated to all the health boards in Wales to gather information to map liaison psychiatry services in Wales. Up-to-date information was confirmed in January 2018, via email...
September 7, 2018: BJPsych Bulletin
Rudi Coetzer
SummaryCurrent neuroscience suggests that although short-term memory difficulties frequently occur immediately after electroconvulsive therapy (ECT), longer-term problems are less common. However, gaps in our knowledge remain regarding longer-term cognitive problems after ECT, including memory function. Some of these relate to the complexities surrounding cognitive testing and interpretation of test results. An important question in clinical decision-making is why, despite current evidence suggesting long-term memory problems are less frequent, some patients still report subjective memory difficulties...
August 30, 2018: BJPsych Bulletin
David Gilbert
People affected by health conditions bring insights and wisdom to transform healthcare - 'jewels from the caves of suffering'. Yet traditional patient and public engagement relies on (child-parent) feedback or (adolescent-parent) 'representative' approaches that fail to value this expertise and buffers patients' influence. This editorial outlines the emergence of 'patient leadership' and work in the Sussex Musculoskeletal Partnership, its patient director (the first such role in the National Health Service) and a group of patient/carer partners, who are becoming equal partners in decision-making helping to reframe problems, generate insight, shift dynamics and change practice within improvement and governance work...
August 29, 2018: BJPsych Bulletin
Deirdre Mulryan, Anna McIntyre, Colm McDonald, Sabina Feeney, Brian Hallahan
Aims and methodWe aimed to evaluate clinical note documentation of valproate prescribing and establish the level of knowledge among women of child-bearing potential regarding valproate-associated adverse effects, including teratogenesis, in a regional Irish mental health service. RESULTS: Of the 42 women prescribed sodium valproate, 21.4% (n = 9) had some documentation in relation to associated risks and 33.3% (n = 14) described an awareness of these risks from consultation with their treating mental health team...
August 15, 2018: BJPsych Bulletin
Hannah Chu Han Huang, Mark Taylor, Alasdair Carmichael
Aims and methodWe examined whether intensive home treatment (IHTT) was beneficial for acute schizophrenia, using the Clinical Global Impression (CGI) scale as a measure of severity and change, between 2011-2015. Demographic and clinical details were collected. RESULTS: 309 cases were referred to IHTT, comprising 245 separate individuals. This represented all severe acute psychotic episodes in Edinburgh during the study period. Three quarters of individuals had an improvement in CGI following IHTT and were safely managed at home...
August 6, 2018: BJPsych Bulletin
Martin Clarke, Sudheer Lankappa, Mark Burnett, Najat Khalifa, Charlotte Beer
Aims and methodAs part of a larger clinical trial concerning the use of transcranial magnetic stimulation (TMS) for treatment-resistant depression, the current study aimed to examine referral emails to describe the clinical characteristics of people who self-refer and explore the reasons for self-referral for TMS treatment. We used content analysis to explore these characteristics and thematic analysis to explore the reasons for self-referral. RESULTS: Of the 98 referrals, 57 (58%) were for women...
July 30, 2018: BJPsych Bulletin
Akira Fukutomi, Frances Connan, Anthony P Winston, Pia Ghosh
Aims and methodThis service evaluation was conducted to find out: (1) if mixed gender accommodation in eating disorder units is perceived to be helpful or unhelpful for recovery, and (2) if men were being discriminated against by the implementation of the 2010 Department of Health (DoH) guidelines on the elimination of mixed gender wards. All 32 in-patient units accredited on the Quality Network for Eating Disorders were contacted via a survey. RESULTS: We received 38 responses from professionals from 26 units and 53 responses from patients (46 female, 7 male) from 7 units...
July 26, 2018: BJPsych Bulletin
Richard Laugharne, Matthew Thompson, Alind Srivastava, Simon Marlow, Rohit Shankar
Mental health services in the UK National Health Service have evolved to include primary-care generalist, secondary-care generalist and secondary-care specialist services. We argue that there continues to be an important role for the secondary-care generalists as they minimise interfaces, can live with diagnostic uncertainty and support continuity of care. The lack of commissioning and clinical boundaries in secondary-care generalist services can undermine their feasibility, leading to difficulties recruiting and retaining staff...
July 17, 2018: BJPsych Bulletin
Alexander Galloway, Billy Boland, Gareth Williams
SummaryPoverty is strongly associated with mental illness. Access to state benefits can be a lifeline for people with mental health problems in times of hardship and can assist them on their journey of recovery. However, benefit application processes can discriminate against those with mental illness and can result in individuals unjustly missing out on support. Clinical evidence from mental health professionals can ameliorate these challenges and ensure that people get access to financial help.Declaration of interestDr Billy Boland is on the advisory board of the Money and Mental Health Policy Institute...
July 6, 2018: BJPsych Bulletin
Ann Collins, Antonio Muñoz-Solomando
Aims and methodThis article examines mental health disorders as individuals transition from adolescence to adulthood. Data were collected from clinical records of patients who had transitioned from child and adolescent mental health services to adult mental health services in a region in South Wales. Demographics and clinical diagnoses under both services were recorded. Patterns between adolescent and adult disorders as well as comorbidities were investigated using Pearson's χ2-test and Fisher's exact test...
June 21, 2018: BJPsych Bulletin
Peter Tyrer
SummaryDisturbances of personality are recorded very poorly in official statistics, but there are signs that this is changing. For many years, personality disorder has been either regarded as a secondary diagnosis that can be forgotten in the presence of another mental disorder, or avoided as the diagnosis gives the impression of untreatability or stigma. What is now abundantly clear is that under-diagnosis of personality disorder represents a disservice to patients and practitioners. It prevents a proper understanding of the longitudinal course of psychiatric disorder and an appreciation of some of the positive aspects of abnormal personality that can be used in treatment...
August 2018: BJPsych Bulletin
Philip Graham
Lowering the legal age of sexual consent would decriminalise a large number of 'underage' young people engaging in sexual intercourse. The arguments against such a change in the law are summarised and shown to lack validity.Declaration of interestNone.
August 2018: BJPsych Bulletin
A Hossain, M Malkov, T Lee, K Bhui
Aims and methodThere is limited evidence on ethnic differences in personality disorder prevalence rates. We compared rates of people with personality disorder admitted to hospital in East London from 2007 to 2013. RESULTS: Of all people admitted to hospital, 9.7% had a personality disorder diagnosis. The admission rate for personality disorder has increased each year. Compared with White subjects, personality disorder was significantly less prevalent among Black and other minority ethnic (BME) groups...
August 2018: BJPsych Bulletin
Caroline Guest, Stephen Crockett, Patrick Little, Anish Patel
Aims and methodThe clinical utility of the multidimensional Framework for Routine Outcome Measurement in Liaison Psychiatry (FROM-LP) has not previously been examined. We sought to establish whether referral accuracy and ability to achieve the reason(s) for referral to our liaison service improved after incorporating the Identify and Rate the Aim of the Contact (IRAC) scale of this tool into our referral process. We carried out a retrospective analysis of electronic case notes of all appropriate referrals to the team before and after this adaption...
August 2018: BJPsych Bulletin
Brynmor Lloyd-Evans, Danielle Lamb, Joseph Barnby, Michelle Eskinazi, Amelia Turner, Sonia Johnson
Aims and methodA national survey investigated the implementation of mental health crisis resolution teams (CRTs) in England. CRTs were mapped and team managers completed an online survey. RESULTS: Ninety-five per cent of mapped CRTs (n = 233) completed the survey. Few CRTs adhered fully to national policy guidelines. CRT implementation and local acute care system contexts varied substantially. Access to CRTs for working-age adults appears to have improved, compared with a similar survey in 2012, despite no evidence of higher staffing levels...
August 2018: BJPsych Bulletin
Felix Clay, Sophie Allan, Serena Lai, Siona Laverty, Grace Jagger, Cate Treise, Jesus Perez
Aims and methodFollowing the introduction of new standards for early intervention in psychosis (EIP) in England, EIP services are accepting referrals for people aged 35-65. The Cambridgeshire and Peterborough EIP service (CAMEO) aimed to explore the immediate implications for the service, especially with regards to referral numbers and sources. Data were collected from April 2016 to June 2017. RESULTS: Referrals for over-35s represented 25.7% of all new referrals. Fifty per cent of referrals for over-35s were accepted onto caseload (40...
August 2018: 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...
August 2018: BJPsych Bulletin
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