BJPsych Bulletin最新文献

Aims and method: Non-attendance at out-patient appointments of adult attention-deficit hyperactivity disorder (ADHD) services incurs significant costs and contributes to lost service provision and unmet clinical needs. This cross-sectional study of clinical contacts, between 1 July 2022 and 30 June 2023 in a specialist adult ADHD service, aimed to identify factors, including type of consultation, associated with non-attendance.

Results: Of 3673 organised clinic appointments, 2815 (77%) were attended: 2314 (82%) by telephone and 501 (18%) as in-person appointments; non-attendance rates were 17 and 42%, respectively. Patient characteristics associated with improved attendance included: female gender, age >30 years and presence of other psychiatric diagnoses.

Clinical implications: This study will assist adult ADHD service providers to maximise patient attendance. The role of telephone (or virtual) clinics must be considered. Enhanced appointment reminders and improving access to services targeting at-risk groups could also improve attendance rates.

Aims and method: Neuropsychiatry training in the UK currently lacks a formal scheme or qualification, and its demand and availability have not been systematically explored. We conducted the largest UK-wide survey of psychiatry trainees to examine their experiences in neuropsychiatry training.

Results: In total, 185 trainees from all UK training regions completed the survey. Although 43.6% expressed interest in a neuropsychiatry career, only 10% felt they would gain sufficient experience by the end of training. Insufficient access to clinical rotations was the most common barrier, with significantly better access in London compared with other regions. Most respondents were in favour of additional neurology training (83%) and a formal accreditation in neuropsychiatry (90%).

Clinical implications: Strong trainee interest in neuropsychiatry contrasts with the limited training opportunities currently available nationally. Our survey highlights the need for increased neuropsychiatry training opportunities, development of a formalised training programme and a clinical accreditation pathway for neuropsychiatry in the UK.

At-Risk Mental State (ARMS) services aim to prevent the onset of first-episode psychosis (FEP) in those with specific clinical or genetic risk markers. In England, ARMS services are currently expanding, but the accessibility of this preventative approach remains questionable, especially for a subgroup of FEP patients and those from specific ethnic minority communities. This commentary outlines the key debates about why a complimentary approach to psychosis prevention is necessary, and gives details for an innovative public health strategy, drawing on existing research and health prevention theory.

In this article, we reflect on factors which may tempt psychiatrists to move from working in the UK to Australia. A comparison between the UK and Australian healthcare systems is presented. Following this, G.W. offers personal reflections on his transition between working in the UK and Australia, including an experience of being a patient, the benefits of working and training in the respective countries, and personal sacrifices which must be considered. We conclude that individual clinicians must weigh up the positives and negatives of the system which they want to work within, with the best option for each person being specifically individual to them.

Drama therapy is a popular form of management in mental illness, as it reaches out beyond many other therapies. Few studies have examined both the advantages and disadvantages of this medium. This qualitative study examines both, and finds gains and hazards.

Clozapine remains the gold standard intervention for treatment-resistant schizophrenia; however, it remains underused, especially for some minority groups. A significant impediment is concern about propensity to neutropenia. The aim of this article is to provide an update on current knowledge relating to: the pattern and incidence of severe blood dyscrasias; the effectiveness of current monitoring regimes in reducing harm; the mechanisms of and the distinctions between clozapine-induced neutropenia and agranulocytosis; benign ethnic neutropenia; and changes to the monitoring thresholds in the USA and other international variations. These all have implications for the practical use of clozapine; specifically, how barriers to initiating, maintaining and restarting clozapine can be understood and in many cases overcome, especially for patients from minority groups, potentially with simpler approaches than the use of lithium or G-CSF.

Probability-based estimates of the future suicide of psychiatric patients are of little assistance in clinical practice. This article proposes strategic management of the interaction between the clinician and the patient in the assessment of potentially suicidal patients, using principles derived from game theory, to achieve a therapeutic outcome that minimises the likelihood of suicide. Further developments in the applications of large language models could allow us to quantify the basis for clinical decisions in individual patients. Documenting the basis of those decisions would help to demonstrate an adequate standard of care in every interaction.