Pub Date : 2014-11-01DOI: 10.1192/APT.BP.114.012583
J. Luty
SUMMARY There have been many developments in addiction psychiatry over the past decade. Some of these are political, such as preference for recovery-/abstinence-based programmes. Prohibition is becoming increasingly unrealistic, especially considering the effective legalisation of recreational cannabis in Uruguay and two US states. Legal highs and diversion of prescribed drugs (such as methadone, gabapentinoids, methylphenidate and benzodiazepines) are now a major problem. Furthermore, diversion of opioid drugs that are prescribed for pain is reaching epidemic proportions, causing a significant change in the nature of patients being referred to addiction services.
{"title":"Drug and alcohol addiction: new challenges","authors":"J. Luty","doi":"10.1192/APT.BP.114.012583","DOIUrl":"https://doi.org/10.1192/APT.BP.114.012583","url":null,"abstract":"SUMMARY There have been many developments in addiction psychiatry over the past decade. Some of these are political, such as preference for recovery-/abstinence-based programmes. Prohibition is becoming increasingly unrealistic, especially considering the effective legalisation of recreational cannabis in Uruguay and two US states. Legal highs and diversion of prescribed drugs (such as methadone, gabapentinoids, methylphenidate and benzodiazepines) are now a major problem. Furthermore, diversion of opioid drugs that are prescribed for pain is reaching epidemic proportions, causing a significant change in the nature of patients being referred to addiction services.","PeriodicalId":89879,"journal":{"name":"Advances in psychiatric treatment : the Royal College of Psychiatrists' journal of continuing professional development","volume":"20 1","pages":"413-421"},"PeriodicalIF":0.0,"publicationDate":"2014-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/APT.BP.114.012583","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65779798","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 : 2014-09-01DOI: 10.1192/APT.BP.112.010926
M. Doyle, A. Carballedo
The World Health Organization (WHO) has indicated that 8–12% of couples worldwide experience infertility, and in recent years the number seeking treatment has dramatically increased. The diagnosis and therapy put a heavy psychological and physical burden on most patients, female and male. The incidence of depression in couples presenting for infertility treatment is significantly higher than in comparable fertile couples. Anxiety is significantly higher in infertile couples than in the general population. Professionals have become aware of the importance of providing educational interventions to address patients' fears and concerns, and to better prepare patients for the demands of treatment. Health professionals should follow a patient-centred approach to provide for the specific needs of the couple. Women in general have a positive attitude to seeking psychological help in the form of cognitive-behavioural therapy, couples counselling and infertility counselling. Learning Objectives •Learn about the incidence rates of infertility and its impact on the mental health of the couple. •Know about infertility treatment and its psychological impact. •Learn about the different management strategies that can be helpful in the treatment of mental illness associated with infertility.
{"title":"Infertility and mental health","authors":"M. Doyle, A. Carballedo","doi":"10.1192/APT.BP.112.010926","DOIUrl":"https://doi.org/10.1192/APT.BP.112.010926","url":null,"abstract":"The World Health Organization (WHO) has indicated that 8–12% of couples worldwide experience infertility, and in recent years the number seeking treatment has dramatically increased. The diagnosis and therapy put a heavy psychological and physical burden on most patients, female and male. The incidence of depression in couples presenting for infertility treatment is significantly higher than in comparable fertile couples. Anxiety is significantly higher in infertile couples than in the general population. Professionals have become aware of the importance of providing educational interventions to address patients' fears and concerns, and to better prepare patients for the demands of treatment. Health professionals should follow a patient-centred approach to provide for the specific needs of the couple. Women in general have a positive attitude to seeking psychological help in the form of cognitive-behavioural therapy, couples counselling and infertility counselling.\u0000 Learning Objectives\u0000 •Learn about the incidence rates of infertility and its impact on the mental health of the couple.\u0000 •Know about infertility treatment and its psychological impact.\u0000 •Learn about the different management strategies that can be helpful in the treatment of mental illness associated with infertility.","PeriodicalId":89879,"journal":{"name":"Advances in psychiatric treatment : the Royal College of Psychiatrists' journal of continuing professional development","volume":"20 1","pages":"297-303"},"PeriodicalIF":0.0,"publicationDate":"2014-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/APT.BP.112.010926","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65777389","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 : 2014-09-01DOI: 10.1192/APT.BP.113.011767
J. Richards
Young adults and adolescents who experience a first episode of psychosis are faced with important issues and choices concerning their future mental health. Individual and family psychological treatments and psychosocial supportive measures are now well recognised interventions for this group of individuals. This article considers the complexity surrounding medication management after the initial recovery from psychosis. The discussion focuses particularly on the medical treatments, developmental considerations and roles of psychiatrists in improving outcomes for this group of patients.
{"title":"Medication management following first-episode psychosis in young people: a developmental approach","authors":"J. Richards","doi":"10.1192/APT.BP.113.011767","DOIUrl":"https://doi.org/10.1192/APT.BP.113.011767","url":null,"abstract":"Young adults and adolescents who experience a first episode of psychosis are faced with important issues and choices concerning their future mental health. Individual and family psychological treatments and psychosocial supportive measures are now well recognised interventions for this group of individuals. This article considers the complexity surrounding medication management after the initial recovery from psychosis. The discussion focuses particularly on the medical treatments, developmental considerations and roles of psychiatrists in improving outcomes for this group of patients.","PeriodicalId":89879,"journal":{"name":"Advances in psychiatric treatment : the Royal College of Psychiatrists' journal of continuing professional development","volume":"76 1","pages":"314-322"},"PeriodicalIF":0.0,"publicationDate":"2014-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/APT.BP.113.011767","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65779459","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 : 2014-09-01DOI: 10.1192/S1355514600018800
M. Doyle, A. Carballedo
{"title":"Infertilidad y salud mental [translation of “Infertility and mental health” by Rodolfo Zaratiegui]","authors":"M. Doyle, A. Carballedo","doi":"10.1192/S1355514600018800","DOIUrl":"https://doi.org/10.1192/S1355514600018800","url":null,"abstract":"","PeriodicalId":89879,"journal":{"name":"Advances in psychiatric treatment : the Royal College of Psychiatrists' journal of continuing professional development","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2014-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/S1355514600018800","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66142764","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 : 2014-09-01DOI: 10.1192/APT.BP.113.011569
D. Nicholls, E. Barrett, S. Huline-Dickens
SUMMARY This article reviews the recent changes to the DSM diagnostic classification of feeding and eating disorders with particular reference to children and adolescents. The common clinical presentations of the ‘atypical’ feeding and eating problems of middle childhood and early adolescence are reviewed using clinical case vignettes, and the limited evidence base regarding management is summarised. There are many gaps in the evidence base and this is likely to be an area of rapid development for the field subsequent on the new terminology outlined in DSM-5.
{"title":"Atypical early-onset eating disorders","authors":"D. Nicholls, E. Barrett, S. Huline-Dickens","doi":"10.1192/APT.BP.113.011569","DOIUrl":"https://doi.org/10.1192/APT.BP.113.011569","url":null,"abstract":"SUMMARY This article reviews the recent changes to the DSM diagnostic classification of feeding and eating disorders with particular reference to children and adolescents. The common clinical presentations of the ‘atypical’ feeding and eating problems of middle childhood and early adolescence are reviewed using clinical case vignettes, and the limited evidence base regarding management is summarised. There are many gaps in the evidence base and this is likely to be an area of rapid development for the field subsequent on the new terminology outlined in DSM-5.","PeriodicalId":89879,"journal":{"name":"Advances in psychiatric treatment : the Royal College of Psychiatrists' journal of continuing professional development","volume":"20 1","pages":"330-339"},"PeriodicalIF":0.0,"publicationDate":"2014-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/APT.BP.113.011569","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65778873","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 : 2014-09-01DOI: 10.1192/APT.BP.113.011981
S. Jauhar, E. Marshall, I. Smith
The relationship between alcohol use and cognitive impairment has been notoriously difficult to disentangle. We present what is known about cognitive impairment associated with alcohol use/misuse, covering the spectrum from mild and subtle cognitive change through to severe alcohol-related brain damage, including Wernicke–Korsakoff syndrome. We highlight aids to the diagnosis and management of these conditions, and emphasise the benefits of prompt treatment on outcome. We also review progress in understanding their neurobiology. Suggestions for possible service configuration based on both our clinical practice and national guidelines are given.
{"title":"Alcohol and cognitive impairment","authors":"S. Jauhar, E. Marshall, I. Smith","doi":"10.1192/APT.BP.113.011981","DOIUrl":"https://doi.org/10.1192/APT.BP.113.011981","url":null,"abstract":"The relationship between alcohol use and cognitive impairment has been notoriously difficult to disentangle. We present what is known about cognitive impairment associated with alcohol use/misuse, covering the spectrum from mild and subtle cognitive change through to severe alcohol-related brain damage, including Wernicke–Korsakoff syndrome. We highlight aids to the diagnosis and management of these conditions, and emphasise the benefits of prompt treatment on outcome. We also review progress in understanding their neurobiology. Suggestions for possible service configuration based on both our clinical practice and national guidelines are given.","PeriodicalId":89879,"journal":{"name":"Advances in psychiatric treatment : the Royal College of Psychiatrists' journal of continuing professional development","volume":"20 1","pages":"304-313"},"PeriodicalIF":0.0,"publicationDate":"2014-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/APT.BP.113.011981","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65779734","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 : 2014-09-01DOI: 10.1192/APT.BP.113.011999
H. Gordon, V. Khosla
SUMMARY Mental disorder and criminality are separate entities but some people with a mental disorder commit criminal offences and some criminals have a mental disorder. Before 1800 there was no separate category of mentally disordered offenders (referred to as criminal lunatics until 1948) in UK legislation. The provision of facilities for mentally disordered offenders in Britain and Ireland overlapped with, but was also separate from, provision for the mentally ill generally. The interface between general and forensic psychiatry is an area of tension and of collaboration. To understand how contemporary general and forensic psychiatry interact, it is useful to have an understanding of how factors have evolved over time.
{"title":"The interface between general and forensic psychiatry: a historical perspective","authors":"H. Gordon, V. Khosla","doi":"10.1192/APT.BP.113.011999","DOIUrl":"https://doi.org/10.1192/APT.BP.113.011999","url":null,"abstract":"SUMMARY Mental disorder and criminality are separate entities but some people with a mental disorder commit criminal offences and some criminals have a mental disorder. Before 1800 there was no separate category of mentally disordered offenders (referred to as criminal lunatics until 1948) in UK legislation. The provision of facilities for mentally disordered offenders in Britain and Ireland overlapped with, but was also separate from, provision for the mentally ill generally. The interface between general and forensic psychiatry is an area of tension and of collaboration. To understand how contemporary general and forensic psychiatry interact, it is useful to have an understanding of how factors have evolved over time.","PeriodicalId":89879,"journal":{"name":"Advances in psychiatric treatment : the Royal College of Psychiatrists' journal of continuing professional development","volume":"20 1","pages":"350-358"},"PeriodicalIF":0.0,"publicationDate":"2014-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/APT.BP.113.011999","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65779268","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 : 2014-09-01DOI: 10.1192/APT.BP.113.011957
B. Patel, M. Perera, J. Pendleton, A. Richman, Biswadeep Majumdar
SUMMARY This article presents evidence for the efficacy of psychosocial interventions for people with dementia and their carers. The evidence base is not yet robust enough to clearly suggest which interventions are most suited for which environment. However, from our literature review there appears to be reason to use music therapy, aromatherapy, life story work, animal-assisted therapy and post-diagnosis/carer support work. We focus on both the traditional outcome measures of behavioural and psychological symptoms of dementia (BPSD) and the more difficult to measure, but equally important, person-centred outcomes of non-pharmacological interventions, as their properties are distinctly different from those of pharmacological agents.
{"title":"Psychosocial interventions for dementia: from evidence to practice","authors":"B. Patel, M. Perera, J. Pendleton, A. Richman, Biswadeep Majumdar","doi":"10.1192/APT.BP.113.011957","DOIUrl":"https://doi.org/10.1192/APT.BP.113.011957","url":null,"abstract":"SUMMARY This article presents evidence for the efficacy of psychosocial interventions for people with dementia and their carers. The evidence base is not yet robust enough to clearly suggest which interventions are most suited for which environment. However, from our literature review there appears to be reason to use music therapy, aromatherapy, life story work, animal-assisted therapy and post-diagnosis/carer support work. We focus on both the traditional outcome measures of behavioural and psychological symptoms of dementia (BPSD) and the more difficult to measure, but equally important, person-centred outcomes of non-pharmacological interventions, as their properties are distinctly different from those of pharmacological agents.","PeriodicalId":89879,"journal":{"name":"Advances in psychiatric treatment : the Royal College of Psychiatrists' journal of continuing professional development","volume":"20 1","pages":"340-349"},"PeriodicalIF":0.0,"publicationDate":"2014-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/APT.BP.113.011957","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65779707","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 : 2014-09-01DOI: 10.1192/APT.BP.113.012260
G. Aiello, Sheraz Ahmad
We describe the work of a psychodynamic psychotherapy group for individuals affected by chronic schizophrenia in our community-based rehabilitation and recovery service. Despite presenting with negative symptoms, over time patients made good use of the psychodynamic setting: they attended, expressed emotions, made connections and reflected within the group on their personal experience of mental ill health. We discuss the rationale and indications for psychodynamic psychotherapy for individuals with severe and enduring mental illnesses. We also reflect on the challenges we faced working psychodynamically with psychosis and on the necessary adaptation of the approach to work with chronic psychosis. We present vignettes from group sessions to illustrate themes that we identified in the therapy, making links with the literature. We conclude that the unstructured setting of the psychodynamic group approach can help individuals affected by most severe forms of psychosis to make sense of their experiences and use the space.
{"title":"Community-based psychodynamic group psychotherapy for treatment-resistant schizophrenia","authors":"G. Aiello, Sheraz Ahmad","doi":"10.1192/APT.BP.113.012260","DOIUrl":"https://doi.org/10.1192/APT.BP.113.012260","url":null,"abstract":"We describe the work of a psychodynamic psychotherapy group for individuals affected by chronic schizophrenia in our community-based rehabilitation and recovery service. Despite presenting with negative symptoms, over time patients made good use of the psychodynamic setting: they attended, expressed emotions, made connections and reflected within the group on their personal experience of mental ill health. We discuss the rationale and indications for psychodynamic psychotherapy for individuals with severe and enduring mental illnesses. We also reflect on the challenges we faced working psychodynamically with psychosis and on the necessary adaptation of the approach to work with chronic psychosis. We present vignettes from group sessions to illustrate themes that we identified in the therapy, making links with the literature. We conclude that the unstructured setting of the psychodynamic group approach can help individuals affected by most severe forms of psychosis to make sense of their experiences and use the space.","PeriodicalId":89879,"journal":{"name":"Advances in psychiatric treatment : the Royal College of Psychiatrists' journal of continuing professional development","volume":"20 1","pages":"323-329"},"PeriodicalIF":0.0,"publicationDate":"2014-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/APT.BP.113.012260","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65779521","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 : 2014-09-01DOI: 10.1192/APT.BP.109.007336
V. Khosla, P. Davison, H. Gordon, V. Joseph
SUMMARY With the subspecialisation of psychiatry in the UK, clinicians encounter problems at the interfaces between specialties. These can lead to tension between clinicians, which can be unhelpful to the clinical care of the patient. This article focuses on the interface between general and forensic psychiatry in England and Wales. The pattern of mental health services in England and Wales differs to an extent from those in Scotland, Northern Ireland and in the Republic of Ireland. Consequently, the interface between general and forensic psychiatry is subject to varying influences. Important interface issues include: the definition of a ‘forensic patient’; the remit and organisation of services; resources; clinical responsibility; and care pathways. This article also discusses a general overview of how to improve collaboration between forensic and general adult psychiatric services.
{"title":"The interface between general and forensic psychiatry: the present day","authors":"V. Khosla, P. Davison, H. Gordon, V. Joseph","doi":"10.1192/APT.BP.109.007336","DOIUrl":"https://doi.org/10.1192/APT.BP.109.007336","url":null,"abstract":"SUMMARY With the subspecialisation of psychiatry in the UK, clinicians encounter problems at the interfaces between specialties. These can lead to tension between clinicians, which can be unhelpful to the clinical care of the patient. This article focuses on the interface between general and forensic psychiatry in England and Wales. The pattern of mental health services in England and Wales differs to an extent from those in Scotland, Northern Ireland and in the Republic of Ireland. Consequently, the interface between general and forensic psychiatry is subject to varying influences. Important interface issues include: the definition of a ‘forensic patient’; the remit and organisation of services; resources; clinical responsibility; and care pathways. This article also discusses a general overview of how to improve collaboration between forensic and general adult psychiatric services.","PeriodicalId":89879,"journal":{"name":"Advances in psychiatric treatment : the Royal College of Psychiatrists' journal of continuing professional development","volume":"20 1","pages":"359-365"},"PeriodicalIF":0.0,"publicationDate":"2014-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/APT.BP.109.007336","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65770868","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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