Michael Fitzgerald thinks that ‘All future psychiatrists should be neuropsychiatrists’[1][1] - and, what’s more, should only concern themselves with diagnosis and prescribing, leaving psychological treatments to non-psychiatrists. I disagree. Don’t get me wrong, I enjoy ‘hunt the lesion
{"title":"Psychiatrists as neurologists . . . or biologists","authors":"P. Timms","doi":"10.1192/PB.37.12.403C","DOIUrl":"https://doi.org/10.1192/PB.37.12.403C","url":null,"abstract":"Michael Fitzgerald thinks that ‘All future psychiatrists should be neuropsychiatrists’[1][1] - and, what’s more, should only concern themselves with diagnosis and prescribing, leaving psychological treatments to non-psychiatrists. I disagree. Don’t get me wrong, I enjoy ‘hunt the lesion","PeriodicalId":89639,"journal":{"name":"The psychiatrist","volume":"74 1","pages":"403-404"},"PeriodicalIF":0.0,"publicationDate":"2013-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83785183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fitzgerald[1][1] suggests that psychiatrists should not directly provide psychological therapies. There are a number of reasons why some of them should. First, specialist experience in delivering psychological therapies may strengthen the skill of a psychiatrist in choosing when and how to use
{"title":"Some psychiatrists should continue to directly provide psychological therapies","authors":"Mohsin Khan","doi":"10.1192/PB.37.12.404","DOIUrl":"https://doi.org/10.1192/PB.37.12.404","url":null,"abstract":"Fitzgerald[1][1] suggests that psychiatrists should not directly provide psychological therapies. There are a number of reasons why some of them should.\u0000\u0000First, specialist experience in delivering psychological therapies may strengthen the skill of a psychiatrist in choosing when and how to use","PeriodicalId":89639,"journal":{"name":"The psychiatrist","volume":"1 1","pages":"404-404"},"PeriodicalIF":0.0,"publicationDate":"2013-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87281179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-11-01DOI: 10.1192/PB.BP.112.041780
Stavros Bekas, Orlin Michev
Aims and method To validate care cluster allocation for payment by results (PbR) in mental health and to evaluate clustering and auditing methodologies. We applied exclusion criteria to the patient population of a mental health trust. An automated validation compared cluster with expected ICD-10 codes or scores on the Health of the Nation Outcome Scales (HoNOS) and Mental Health Clustering Tool (MHCT). Six hundred ‘mismatched’ cases were reviewed in depth to better understand the reasons why these cases appeared misclustered. Results There was a significant mismatch between ICD-10 codes, HoNOS and MHCT scores and allocated care cluster, with differences between services and localities. Some clusters appeared to be more accurately allocated. The ‘deep dive’ analysis indicated that most mismatches occurred because psychosis was allocated to a non-psychotic cluster and vice versa , but also as a result of inherent weaknesses of the MHCT. Clinical implications High levels of inappropriate care cluster allocation highlight the need to improve practice. Weaknesses in the MHCT and ICD-10 coding mean that the final arbiter should be clinical judgement. Auditing will, by necessity, have a significant margin of error.
{"title":"Payment by results: validating care cluster allocation in the real world","authors":"Stavros Bekas, Orlin Michev","doi":"10.1192/PB.BP.112.041780","DOIUrl":"https://doi.org/10.1192/PB.BP.112.041780","url":null,"abstract":"Aims and method To validate care cluster allocation for payment by results (PbR) in mental health and to evaluate clustering and auditing methodologies. We applied exclusion criteria to the patient population of a mental health trust. An automated validation compared cluster with expected ICD-10 codes or scores on the Health of the Nation Outcome Scales (HoNOS) and Mental Health Clustering Tool (MHCT). Six hundred ‘mismatched’ cases were reviewed in depth to better understand the reasons why these cases appeared misclustered.\u0000\u0000Results There was a significant mismatch between ICD-10 codes, HoNOS and MHCT scores and allocated care cluster, with differences between services and localities. Some clusters appeared to be more accurately allocated. The ‘deep dive’ analysis indicated that most mismatches occurred because psychosis was allocated to a non-psychotic cluster and vice versa , but also as a result of inherent weaknesses of the MHCT.\u0000\u0000Clinical implications High levels of inappropriate care cluster allocation highlight the need to improve practice. Weaknesses in the MHCT and ICD-10 coding mean that the final arbiter should be clinical judgement. Auditing will, by necessity, have a significant margin of error.","PeriodicalId":89639,"journal":{"name":"The psychiatrist","volume":"78 1","pages":"349-355"},"PeriodicalIF":0.0,"publicationDate":"2013-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83857784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-11-01DOI: 10.1192/PB.BP.113.044461
Sabina Dosai
![Figure][1] Dr Gareth Owen studied philosophy and physics before starting medicine at the Royal Free and University College Medical School, qualifying in 1999. He subsequently trained in general medicine and clinical neuroscience at Addenbrooke’s Hospital, Cambridge, before starting
{"title":"Dr Gareth Owen","authors":"Sabina Dosai","doi":"10.1192/PB.BP.113.044461","DOIUrl":"https://doi.org/10.1192/PB.BP.113.044461","url":null,"abstract":"![Figure][1] \u0000\u0000Dr Gareth Owen studied philosophy and physics before starting medicine at the Royal Free and University College Medical School, qualifying in 1999. He subsequently trained in general medicine and clinical neuroscience at Addenbrooke’s Hospital, Cambridge, before starting","PeriodicalId":89639,"journal":{"name":"The psychiatrist","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83778409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-11-01DOI: 10.1192/PB.BP.113.043513
Sharon Beattie, C. Lister, Julie Khan, P. Cornwall
Aims and method Summer schools are advocated as part of the national recruitment initiative despite little evidence of their impact. This study evaluates the effectiveness of a 3-day non-clinical initiative. Change in attitudes and career intention were measured by administering a questionnaire, which included the 30-item Attitudes Toward Psychiatry (ATP-30) survey, at the start and end of the event. Results Mean ATP-30 scores increased from 119 to 128, which represented a highly statistically significant change ( t = 5.40, d.f. = 18, P <0.001). A positive shift in intention to pursue psychiatry as a career was demonstrated. Clinical implications These results suggest well-planned summer schools can have a significant impact on students’ attitudes. Despite high initial ATP-30 scores a positive shift in attitudes and career intentions was still seen. Further evaluation of the longitudinal impact is needed. Events such as this are important and likely produce a cumulative effect alongside other recruitment strategies.
尽管鲜有证据表明暑期学校的影响，但它作为国家招聘计划的一部分被提倡。本研究评估了为期3天的非临床活动的有效性。在活动开始和结束时，通过管理一份问卷来测量态度和职业意向的变化，其中包括30项对精神病学的态度(ATP-30)调查。结果ATP-30平均评分由119分上升至128分，差异有高度统计学意义(t = 5.40, df = 18, P <0.001)。将精神病学作为职业的意向发生了积极的转变。这些结果表明，计划良好的暑期学校可以对学生的态度产生重大影响。尽管最初的ATP-30得分很高，但态度和职业意向的积极转变仍然可见。需要进一步评价纵向影响。这类活动很重要，可能会与其他招聘策略一起产生累积效应。
{"title":"Effectiveness of a summer school in influencing medical students' attitudes towards psychiatry","authors":"Sharon Beattie, C. Lister, Julie Khan, P. Cornwall","doi":"10.1192/PB.BP.113.043513","DOIUrl":"https://doi.org/10.1192/PB.BP.113.043513","url":null,"abstract":"Aims and method Summer schools are advocated as part of the national recruitment initiative despite little evidence of their impact. This study evaluates the effectiveness of a 3-day non-clinical initiative. Change in attitudes and career intention were measured by administering a questionnaire, which included the 30-item Attitudes Toward Psychiatry (ATP-30) survey, at the start and end of the event.\u0000\u0000Results Mean ATP-30 scores increased from 119 to 128, which represented a highly statistically significant change ( t = 5.40, d.f. = 18, P <0.001). A positive shift in intention to pursue psychiatry as a career was demonstrated.\u0000\u0000Clinical implications These results suggest well-planned summer schools can have a significant impact on students’ attitudes. Despite high initial ATP-30 scores a positive shift in attitudes and career intentions was still seen. Further evaluation of the longitudinal impact is needed. Events such as this are important and likely produce a cumulative effect alongside other recruitment strategies.","PeriodicalId":89639,"journal":{"name":"The psychiatrist","volume":"63 1","pages":"367-371"},"PeriodicalIF":0.0,"publicationDate":"2013-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76046609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
I thank Dr Lawton-Smith for his comments on our paper on community treatment orders (CTOs).[1][1],[2][2] I find it necessary, however, to emphasise that we never implied that all psychiatrists like the new CTOs. In fact, we merely pointed out that they have been used much more than the Department of
{"title":"Diverse response from psychiatrists to CTOs","authors":"P. Lepping","doi":"10.1192/PB.37.11.372B","DOIUrl":"https://doi.org/10.1192/PB.37.11.372B","url":null,"abstract":"I thank Dr Lawton-Smith for his comments on our paper on community treatment orders (CTOs).[1][1],[2][2] I find it necessary, however, to emphasise that we never implied that all psychiatrists like the new CTOs. In fact, we merely pointed out that they have been used much more than the Department of","PeriodicalId":89639,"journal":{"name":"The psychiatrist","volume":"48 1","pages":"372-372"},"PeriodicalIF":0.0,"publicationDate":"2013-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90511571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-11-01DOI: 10.1192/PB.BP.111.036194
Neil Jeyasingam
Phenomenology provides the foundations on which the functions of modern psychiatry stand. It also provides a common language for the assessment of patients, and for the education of the next generation of psychiatrists. However, phenomenology is not anchored in independent clinicopathological correlates, and therefore it is vulnerable to subtle alterations over time. This article briefly discusses some concepts regarding phenomenology and attempts to comment on the various definitions available under the common descriptor termed ‘flight of ideas’. It is asserted that without appropriate monitoring and teaching of these basic descriptors and recognising the value of historical observations, serious inconsistencies will continue to arise in clinical theory and practice, which may prove difficult to rectify.
{"title":"Flight of ideas - death of a definition: a discussion on phenomenology","authors":"Neil Jeyasingam","doi":"10.1192/PB.BP.111.036194","DOIUrl":"https://doi.org/10.1192/PB.BP.111.036194","url":null,"abstract":"Phenomenology provides the foundations on which the functions of modern psychiatry stand. It also provides a common language for the assessment of patients, and for the education of the next generation of psychiatrists. However, phenomenology is not anchored in independent clinicopathological correlates, and therefore it is vulnerable to subtle alterations over time. This article briefly discusses some concepts regarding phenomenology and attempts to comment on the various definitions available under the common descriptor termed ‘flight of ideas’. It is asserted that without appropriate monitoring and teaching of these basic descriptors and recognising the value of historical observations, serious inconsistencies will continue to arise in clinical theory and practice, which may prove difficult to rectify.","PeriodicalId":89639,"journal":{"name":"The psychiatrist","volume":"208 1","pages":"359-362"},"PeriodicalIF":0.0,"publicationDate":"2013-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73773659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-11-01DOI: 10.1192/PB.BP.113.045427
N. Hall
![Figure][1] Zaida Hall, who died recently at the age of 87, became the first female consultant psychiatrist in the University of Southampton in 1971. Together with her colleague and friend, Pamela Ashurst, she built up the Psychotherapy Department, housed initially in a portakabin. It
{"title":"Dr Zaïda Hall DM, FRCP, FRCPsych Formerly Consultant in Psychiatry and Psychotherapy, Southampton University and Royal South Hants Hospital","authors":"N. Hall","doi":"10.1192/PB.BP.113.045427","DOIUrl":"https://doi.org/10.1192/PB.BP.113.045427","url":null,"abstract":"![Figure][1] \u0000\u0000Zaida Hall, who died recently at the age of 87, became the first female consultant psychiatrist in the University of Southampton in 1971. Together with her colleague and friend, Pamela Ashurst, she built up the Psychotherapy Department, housed initially in a portakabin. It","PeriodicalId":89639,"journal":{"name":"The psychiatrist","volume":"18 1","pages":"374-374"},"PeriodicalIF":0.0,"publicationDate":"2013-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78744232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-11-01DOI: 10.1192/PB.BP.113.044537
A. Rosen, H. Killaspy, C. Harvey
The growth of specialism in a field can be considered a healthy response to emerging evidence, technology and skills, yet it risks creating unhelpful barriers to collaborative working and fragmented patient pathways. Mental health services in England have experienced this tension in recent years through the national implementation of local specialist community teams that aim to reduce the need for in-patient admission through a focus on crisis resolution, early intervention and assertive community treatment (ACT). In response to the results of studies assessing its effectiveness, there has been disinvestment in ACT. This risks marginalising people with severe and complex mental health problems by depriving them and their families of the intensive support they need for successful community living, as well as discouraging researchers from undertaking further high-quality studies that can inform the intelligent evolution of the ACT model within different contexts.
{"title":"Specialisation and marginalisation: how the assertive community treatment debate affects individuals with complex mental health needs","authors":"A. Rosen, H. Killaspy, C. Harvey","doi":"10.1192/PB.BP.113.044537","DOIUrl":"https://doi.org/10.1192/PB.BP.113.044537","url":null,"abstract":"The growth of specialism in a field can be considered a healthy response to emerging evidence, technology and skills, yet it risks creating unhelpful barriers to collaborative working and fragmented patient pathways. Mental health services in England have experienced this tension in recent years through the national implementation of local specialist community teams that aim to reduce the need for in-patient admission through a focus on crisis resolution, early intervention and assertive community treatment (ACT). In response to the results of studies assessing its effectiveness, there has been disinvestment in ACT. This risks marginalising people with severe and complex mental health problems by depriving them and their families of the intensive support they need for successful community living, as well as discouraging researchers from undertaking further high-quality studies that can inform the intelligent evolution of the ACT model within different contexts.","PeriodicalId":89639,"journal":{"name":"The psychiatrist","volume":"50 1","pages":"345-348"},"PeriodicalIF":0.0,"publicationDate":"2013-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88951893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-11-01DOI: 10.1192/PB.BP.113.043059
J. Bland
Introduction to Systemic and Family Therapy: A User’s Guide By John Hills Palgrave Macmillan, 2012, £23.99, pb, 216 pp. ISBN: 9780230224445 This book, written by a humane, philosophical and highly experienced clinician, is in a ‘Basic Texts in Counselling and Psychotherapy’ series, billed
{"title":"Introduction to Systemic and Family Therapy: A User’s Guide","authors":"J. Bland","doi":"10.1192/PB.BP.113.043059","DOIUrl":"https://doi.org/10.1192/PB.BP.113.043059","url":null,"abstract":"Introduction to Systemic and Family Therapy: A User’s Guide By John Hills Palgrave Macmillan, 2012, £23.99, pb, 216 pp. ISBN: 9780230224445 \u0000\u0000This book, written by a humane, philosophical and highly experienced clinician, is in a ‘Basic Texts in Counselling and Psychotherapy’ series, billed","PeriodicalId":89639,"journal":{"name":"The psychiatrist","volume":"1 1","pages":"375-375"},"PeriodicalIF":0.0,"publicationDate":"2013-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78796873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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