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BJPsych Bulletin

George Szmukler
SummaryNight-time confinement, currently imposed as a blanket restriction on all patients on wards in UK high secure hospitals, constitutes an arbitrary restriction of liberty, not being based on any therapeutic purpose for those so restricted, nor serving a need for the protection of others. Its imposition constitutes a form of 'degrading' treatment as well as an unjustified restriction of 'residual' liberty. Persons who are vulnerable, especially those who are involuntarily detained as in this case, are particularly at risk of suffering human rights abuses...
October 30, 2018: BJPsych Bulletin
Huw Green
SummaryPsychotic phenomena include a far wider range of experiences than is captured by the brief descriptions offered in contemporary diagnostic guides. Given the richness of historical clinical phenomenology, what can account for the recent ascendancy of relatively impoverished descriptions of psychosis? One possible explanation is provided by Hacking's notion of dynamic nominalism, where human categories change over time in tandem with those who they classify. But although dynamic nominalism makes sense of changes in behaviour, it fails to account for change at the level of subjective experience...
October 17, 2018: BJPsych Bulletin
Andrew Moore
SummaryThe Five Year Forward View for Mental Health (FYFVMH) was a welcome development in the emerging 'Parity of Esteem' agenda, but focused mainly on a select few specialist services; much more limited attention was given to 'core' general adult and older age mental health services, such as community mental health teams, crisis teams and in-patient units. This relative policy vacuum, when combined with prolonged financial pressures and limited informatics, has left core services vulnerable and struggling to meet growing demands, with little sense of hope, in contrast to some of the newer, 'shiny' specialist services growing around them...
October 8, 2018: BJPsych Bulletin
Saeed Farooq, Abid Choudry, Dan Cohen, Farooq Naeem, Muhammad Ayub
Aims and methodTo systematically review the literature on barriers to the use of clozapine and identify any interventions for optimizing clozapine use in treatment-resistant schizophrenia. Journal databases were searched from 1972 to March 2018. The following search terms were used: treatment-resistant schizophrenia, clozapine, barriers, use, prescription rates, implementation, clozaril and prescribing practices. Following a review of the literature, 15 papers were included in the review. RESULTS: The major barriers that were identified included mandatory blood testing, fear of serious side-effects and lack of adherence by the patients, difficulty in identifying suitable patients, service fragmentation, and inadequate training in or exposure to using clozapine...
September 28, 2018: BJPsych Bulletin
John Tully, Alessandra Cappai, John Lally, Maria Fotiadou
Aims and methodWe aimed to examine clinical and risk outcomes at follow-up, and reoffending and readmission rates, for a sample of 50 admissions to a female medium secure unit (MSU). Demographic, clinical risk assessment (HCR-20 and HoNOS-Secure) and quality of life data were collected using validated measures for all admissions to a female MSU ward in London, UK, between April 2008 and November 2014. RESULTS: All clinical and risk assessment scale scores had improved at follow-up. Quality of life compared favourably to community samples and was good for physical, social and environmental factors and acceptable for psychological health...
September 27, 2018: BJPsych Bulletin
Alex T Ford, Helena Herrera
SummaryThe influence of pharmaceuticals on the environment is an increasing concern among environmental toxicologists. It is known that their growing use is leading to detectable levels in wastewater, conceivably causing harm to aquatic ecosystems. Psychotropic medication is one such group of substances, particularly affecting high-income countries. While these drugs have a clear place in therapy, there is debate around the risk/benefit ratio in patients with mild mental health problems. Therefore, it is necessary to evaluate the wider implications as risks could extend beyond the individual to non-target organisms, particularly those in rivers and estuaries...
September 25, 2018: BJPsych Bulletin
Katherine Johnson, Billy Boland
SummarySafeguarding adults is everybody's business, and it is now standard practice for clinicians to undertake safeguarding training as part of their mandatory training in the UK. Nevertheless, safeguarding work is complex and can involve significant dilemmas for professionals. The Care Act 2014 has introduced a number of differences in the way safeguarding is approached, emphasising the overall well-being and choice of the patient rather than merely focusing on their safety. This paper sets out to illustrate evolving safeguarding demand and practice, and aid clinicians in protecting people at risk by describing how they can approach challenging presentations...
September 24, 2018: BJPsych Bulletin
Sarah Maxwell, Obianuju Ugochukwu, Tim Clarke, Brioney Gee, Emmet Clarke, Hope Westgate, Jonathan Wilson, Belinda R Lennox, Ian M Goodyer
Aims and methodThe Norfolk Youth Service was created in 2012 in response to calls to redesign mental health services to better meet the needs of young people. The new service model transcends traditional boundaries by creating a single, 'youth friendly' service for young people aged 14-25 years. The aim of this study was to investigate the effect of the transition to this new model on patterns of referral, acceptance and service use. We analysed routinely collected data on young people aged 14-25 years referred for secondary mental healthcare in Norfolk before and after implementation of the youth mental health service...
September 21, 2018: BJPsych Bulletin
Alex Till, James Selwood, Edward Silva
Aims and methodAn 'assertive approach' to clozapine, where nasogastric administration is approved, is assessed through a case-load analysis to provide the first systematic description of its use and outcomes worldwide. RESULTS: Five of the most extremely ill patients with treatment-resistant schizophrenia were established and/or maintained on clozapine, resulting in improvements to their mental state; incidents were reduced, segregation was terminated and progression to less restrictive environments was achieved...
September 18, 2018: 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
Daniel M Bennett, Andrew C Bailey, Alasdair D Forrest
No abstract text is available yet for this article.
October 2018: BJPsych Bulletin
Avneet Sharma
No abstract text is available yet for this article.
October 2018: BJPsych Bulletin
T A Buick, D Hamilton, G Weatherdon, C I O'Shea, G McAlpine
Background: Psychiatric in-patients are often transferred to an emergency department for care of minor wounds, incurring significant distress to the patient and cost to the service. Aims: To improve superficial wound management in psychiatric in-patients and reduce transfers to the emergency department. Method: Thirty-four trainees attended two peer-led suturing and wound management teaching sessions, and a suturing kit box was compiled and stored at the Royal Edinburgh Hospital...
October 2018: BJPsych Bulletin
Norman Poole
SummaryThe editor thanks the outgoing Correspondence Editor Greg Shields and welcomes Dr William Badenhorst as his successor. He reflects upon his own inadequacy as a letter writer in the hope it encourages others to be better.Declaration of interestNone.
October 2018: BJPsych Bulletin
Sam Horne, Katherine Hay, Stuart Watson, Kirstie N Anderson
Aims and methodSleep disturbance is common on in-patient psychiatry wards. This study explored subjective and objective patterns of sleep disturbance and contributory environmental factors. Participants were recruited from mental health acute admission wards and had a range of subjective and objective assessments of sleep. Light intensity and noise levels were measured to characterise potential environmental causes for poor sleep. RESULTS: We recruited 20 patients; 15% were high risk for obstructive sleep apnoea...
October 2018: BJPsych Bulletin
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