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BJPsych Bulletin

Carol Brayne, Sarah Kelly
SummaryThe Prime Minister's challenge on dementia called for improved dementia diagnosis rates, based on assumptions of benefit to individuals and those who care for them. Subsequent policies have led to increased target drives for clinical practice to achieve early diagnosis of dementia through intense case identification. However, the current evidence base and treatment options do not support screening for dementia, and there is little empirical evidence that such intensive case identification and early diagnosis for dementia is justified without a better understanding of the benefits, costs and potential harms to individuals and services...
January 4, 2019: BJPsych Bulletin
Claire Hilton
Historical evidence can be useful to inform debate about current dilemmas in health service policy. However, concepts of historical analysis may be problematic for doctors, for whom a model of 'history' is often based on clinical history-taking: a clinical history aims to explain the present, whereas a historical analysis aims to elucidate the past. This article discusses and illustrates these concepts, and highlights potential pitfalls of poor historical methodology. It also provides pointers about researching the history of psychiatry in the UK and how to contribute historical evidence to health service policy debates today...
December 27, 2018: BJPsych Bulletin
Baroness Molly Meacher
SummaryHumans have always used mind-altering drugs. However, in 1961 the United Nations approved the Single Convention, under which the production, sale or possession of a number of drugs, including heroin, cocaine, ecstasy and cannabis, became illegal. The prohibitionist regime was then introduced by most countries around the world and has substantially remained in place ever since. Some countries, particularly those in Latin America, have never criminalised the use of cannabis. A small number of countries have introduced more liberal policies...
December 20, 2018: BJPsych Bulletin
Karine Macritchie, Tim Mantingh, Diego Hidalgo-Mazzei, Sarah Bourne, Emma Borthwick, Allan H Young
Aims and methodThe OPTIMA mood disorders service is a newly established specialist programme for people with bipolar disorder requiring frequent admissions. This audit compared data on hospital admissions and home treatment team (HTT) spells in patients before entry to and after discharge from the core programme. We included patients admitted between April 2015 and March 2017 who were subsequently discharged. Basic demographic data and numbers of admissions and HTT spells three years before and after discharge were collected and analysed...
November 28, 2018: BJPsych Bulletin
Alec Thomas, Ian Evans, Gaynor Jones
Aims and methodTo describe the functions of the Aneurin Bevan University Health Board Risk Reference Panel and characterise the typical referrals presented and outcomes from the panel. A structured thematic analysis was performed on verbatim transcripts of 48 panel sessions. RESULTS: The 79 codes identified were grouped into 16 subthemes. Four principal themes were identified: two characterising cases brought to the panel (childhood risk factors and current presenting difficulties) and two describing advice given (risk management and wider organisational issues)...
November 26, 2018: BJPsych Bulletin
Charles H Earnshaw, Lucy Shaw, Deepu Thomas, Owen Haeney
Aims and methodAdmissions of patients to secure forensic hospitals are often lengthy. Previous research has examined factors associated with prolonged admission, but studies analysing admission data at a single medium secure unit (MSU) over a prolonged time period are lacking. We compared admission data for all patients admitted to a MSU in England during the years 1985, 1995, 2005 and 2012. RESULTS: The median length of admission increased from 167 days in 1985 to 580 days in 2012, though not in the intervening cohorts...
November 19, 2018: BJPsych Bulletin
Chiara Lombardo, Mónica Santos, Tine Van Bortel, Robert Croos, Ella Arensman, Manaan Kar Ray
Aims and methodThe aim of the study is to improve patient safety by identifying factors influencing gatekeeping decisions by crisis resolution and home treatment teams. A theoretical sampling method was used to recruit clinicians. Semi-structured interviews to elicit various aspects of clinical decision-making were carried out. The transcripts were thematically analysed using a grounded theory approach. RESULTS: Patient needs (safety and treatment) was the primary driver behind decisions. The research also revealed that information gathered was processed using heuristics...
November 19, 2018: 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
Lindsay Thomson
SummaryNight-time confinement is the practice of routinely locking patients in their rooms at night unless there is a contrary clinical indication. It is used in high-secure psychiatric hospitals. This article argues in favour of this practice on the basis of realistic medicine, an individual human rights based approach, the principles of mental health legislation in Scotland and England and cost effectiveness. This is not an academic debate. There is a real danger that those advocating against night-time confinement, if successful, will at best make little difference to the lives of our patients as they sleep, and at worst may hugely impoverish their lives because of reduced daytime activities...
February 2019: BJPsych Bulletin
Ed Silva, Andrew Shepherd
SummaryNight-time confinement, locking patients in their bedrooms overnight, is practiced within high-secure hospitals in the UK. This article provides context, sets out the history and reviews the ethical and pragmatic issues at stake. Thought is given to the future, where we appear to be moving toward a different approach.Declaration of interestE.S. is a consultant forensic psychiatrist at Ashworth Hospital. All his patients are confined at night. He represents the Royal College of Psychiatrists Forensic Faculty at the National Oversight Group, which is the strategic advisory body providing assurance to NHS England regarding the commissioning and provision of high-secure services...
February 2019: 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
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
Neil Armstrong
SummaryThis paper considers a witness seminar in which healthcare professionals discussed working on an acute admissions ward run along therapeutic community lines from the 1960s to the 1980s. Participants remarked that older styles of working are 'unimaginable' today. This paper discusses why. Literature from the humanities and social sciences suggest healthcare is reactive, reflecting wider cultural changes, including a preference for a more bureaucratic, standardised, explicit style of reasoning and a high valuation of personal autonomy...
October 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...
October 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...
October 2018: BJPsych Bulletin
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