Pub Date : 2014-03-01DOI: 10.1192/APT.BP.113.011205
Jessica Yakeley, A. Williams
Antisocial personality disorder is a complex condition carrying high rates of comorbidity and mortality for individuals as well as harmful consequences for their families and society. Despite the publication of National Institute for Health and Care Excellence (NICE) guidelines for the disorder, the evidence base and provision of effective treatments remain inadequate, and the belief that the condition is untreatable remains widespread among psychiatrists and other professionals. This article highlights current diagnostic controversies and summarises the evidence for conceptualising antisocial personality disorder as a disorder of attachment. Informed by this developmental perspective, we provide a framework for the management and treatment of adults with antisocial personality disorder, highlighting the importance of creating a safe setting and recommending adaptations of therapeutic technique to facilitate the engagement of this ‘treatment-rejecting’ patient population. We conclude with an outline of the current government policy on the treatment of high-risk offenders with personality disorder.Know the current diagnostic criteria and epidemiology of antisocial personality disorder.Evaluate the evidence that antisocial personality disorder can be conceptualised as a disorder of attachment, and use a developmental framework to inform treatment interventions.Gain an understanding of psychological approaches to antisocial personality disorder.
{"title":"Antisocial personality disorder: new directions","authors":"Jessica Yakeley, A. Williams","doi":"10.1192/APT.BP.113.011205","DOIUrl":"https://doi.org/10.1192/APT.BP.113.011205","url":null,"abstract":"Antisocial personality disorder is a complex condition carrying high rates of comorbidity and mortality for individuals as well as harmful consequences for their families and society. Despite the publication of National Institute for Health and Care Excellence (NICE) guidelines for the disorder, the evidence base and provision of effective treatments remain inadequate, and the belief that the condition is untreatable remains widespread among psychiatrists and other professionals. This article highlights current diagnostic controversies and summarises the evidence for conceptualising antisocial personality disorder as a disorder of attachment. Informed by this developmental perspective, we provide a framework for the management and treatment of adults with antisocial personality disorder, highlighting the importance of creating a safe setting and recommending adaptations of therapeutic technique to facilitate the engagement of this ‘treatment-rejecting’ patient population. We conclude with an outline of the current government policy on the treatment of high-risk offenders with personality disorder.Know the current diagnostic criteria and epidemiology of antisocial personality disorder.Evaluate the evidence that antisocial personality disorder can be conceptualised as a disorder of attachment, and use a developmental framework to inform treatment interventions.Gain an understanding of psychological approaches to antisocial personality disorder.","PeriodicalId":89879,"journal":{"name":"Advances in psychiatric treatment : the Royal College of Psychiatrists' journal of continuing professional development","volume":"20 1","pages":"132-143"},"PeriodicalIF":0.0,"publicationDate":"2014-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/APT.BP.113.011205","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65778670","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 : 2014-03-01DOI: 10.1192/S1355514600018782
Cyrus S. H. Ho, M. Zhang, A. Mak, R. Ho
{"title":"精神科中的代谢综合征：认识与处理的进展 [translation of “Metabolic syndrome in psychiatry: advances in understanding and management” by John Ying]","authors":"Cyrus S. H. Ho, M. Zhang, A. Mak, R. Ho","doi":"10.1192/S1355514600018782","DOIUrl":"https://doi.org/10.1192/S1355514600018782","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":"2014-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66142704","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 : 2014-03-01DOI: 10.1192/APT.BP.112.010314
C. Bennett, R. Jones, Danny J. Smith
Depression is missed more often in adolescents than in adults, partly because they present with symptoms different from those in adults and because many do not seek help. Early detection or the delay of onset can have a significant effect on a young person’s development and social functioning. We briefly discuss diagnosis and screening instruments before presenting the wide range of educational and psychological preventive approaches developed for adolescent depression. Many of the latter are based on the cognitive–behavioural or interpersonal therapy models. We consider how clinicians might use the current evidence base to identify and prevent depression in adolescents, and outline the principles of management of the disorder.
{"title":"Prevention strategies for adolescent depression","authors":"C. Bennett, R. Jones, Danny J. Smith","doi":"10.1192/APT.BP.112.010314","DOIUrl":"https://doi.org/10.1192/APT.BP.112.010314","url":null,"abstract":"Depression is missed more often in adolescents than in adults, partly because they present with symptoms different from those in adults and because many do not seek help. Early detection or the delay of onset can have a significant effect on a young person’s development and social functioning. We briefly discuss diagnosis and screening instruments before presenting the wide range of educational and psychological preventive approaches developed for adolescent depression. Many of the latter are based on the cognitive–behavioural or interpersonal therapy models. We consider how clinicians might use the current evidence base to identify and prevent depression in adolescents, and outline the principles of management of the disorder.","PeriodicalId":89879,"journal":{"name":"Advances in psychiatric treatment : the Royal College of Psychiatrists' journal of continuing professional development","volume":"20 1","pages":"116-124"},"PeriodicalIF":0.0,"publicationDate":"2014-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/APT.BP.112.010314","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65776720","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 : 2014-03-01DOI: 10.1192/APT.BP.113.011593
J. Mari
This brief article describes the main health indicators of Brazil and gives an overview of psychiatric care. It points out the primary pitfalls of the mental healthcare system and presents some suggestions for the future of mental health in the country.
{"title":"Mental healthcare in Brazil: modest advances and major challenges","authors":"J. Mari","doi":"10.1192/APT.BP.113.011593","DOIUrl":"https://doi.org/10.1192/APT.BP.113.011593","url":null,"abstract":"This brief article describes the main health indicators of Brazil and gives an overview of psychiatric care. It points out the primary pitfalls of the mental healthcare system and presents some suggestions for the future of mental health in the country.","PeriodicalId":89879,"journal":{"name":"Advances in psychiatric treatment : the Royal College of Psychiatrists' journal of continuing professional development","volume":"20 1","pages":"113-115"},"PeriodicalIF":0.0,"publicationDate":"2014-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/APT.BP.113.011593","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65779152","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 : 2014-03-01DOI: 10.1192/APT.BP.112.010538
F. Akerele
Issues relating to the consent of individuals under 18 years of age in England and Wales are covered by the Family Law Reform Act 1969, the Children Act 1989, the Mental Health Act 1983 (to some extent) and case law. Legislation on the consent of minors to hospital admission and treatment is complicated and contradictory, leaving clinicians unsure when to rely on the consent of the minor or that of someone with parental responsibility. This article reviews the concept of the zone of parental control (ZPC), introduced in England in 2008. It argues that this concept is too vague and subjective to provide any clear guidance on who can give consent for a minor’s admission and treatment.
{"title":"Adolescent decision-making and the zone of parental control: a missed opportunity for legislative change","authors":"F. Akerele","doi":"10.1192/APT.BP.112.010538","DOIUrl":"https://doi.org/10.1192/APT.BP.112.010538","url":null,"abstract":"Issues relating to the consent of individuals under 18 years of age in England and Wales are covered by the Family Law Reform Act 1969, the Children Act 1989, the Mental Health Act 1983 (to some extent) and case law. Legislation on the consent of minors to hospital admission and treatment is complicated and contradictory, leaving clinicians unsure when to rely on the consent of the minor or that of someone with parental responsibility. This article reviews the concept of the zone of parental control (ZPC), introduced in England in 2008. It argues that this concept is too vague and subjective to provide any clear guidance on who can give consent for a minor’s admission and treatment.","PeriodicalId":89879,"journal":{"name":"Advances in psychiatric treatment : the Royal College of Psychiatrists' journal of continuing professional development","volume":"20 1","pages":"144-150"},"PeriodicalIF":0.0,"publicationDate":"2014-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/APT.BP.112.010538","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65777222","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 : 2014-03-01DOI: 10.1192/APT.BP.113.011643
A. Vallance
SUMMARY This commentary offers further arguments relating to the ambiguities inherent in the new concept of the zone of parental control (ZPC) as defined by the revised Mental Health Act Code of Practice, but argues that a directive approach needs to be balanced with flexibility. The conflicting rights of child, parent and State are also discussed. Whereas medico-legal discourse tends to base itself on previous legislative frameworks, it is argued that an evidence-based approach may also be valuable in order to ascertain and incorporate young people’s views on the matter.
{"title":"Seeking clarity in the twilight zone: COMMENTARY ON… ADOLESCENT DECISION-MAKING AND THE ZONE OF PARENTAL CONTROL","authors":"A. Vallance","doi":"10.1192/APT.BP.113.011643","DOIUrl":"https://doi.org/10.1192/APT.BP.113.011643","url":null,"abstract":"SUMMARY This commentary offers further arguments relating to the ambiguities inherent in the new concept of the zone of parental control (ZPC) as defined by the revised Mental Health Act Code of Practice, but argues that a directive approach needs to be balanced with flexibility. The conflicting rights of child, parent and State are also discussed. Whereas medico-legal discourse tends to base itself on previous legislative frameworks, it is argued that an evidence-based approach may also be valuable in order to ascertain and incorporate young people’s views on the matter.","PeriodicalId":89879,"journal":{"name":"Advances in psychiatric treatment : the Royal College of Psychiatrists' journal of continuing professional development","volume":"20 1","pages":"151-152"},"PeriodicalIF":0.0,"publicationDate":"2014-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/APT.BP.113.011643","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65778828","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 : 2014-03-01DOI: 10.1192/APT.BP.113.011619
Cyrus S. H. Ho, M. Zhang, A. Mak, R. Ho
SUMMARY Metabolic syndrome comprises a number of cardiovascular risk factors that increase morbidity and mortality. The increase in incidence of the syndrome among psychiatric patients has been unanimously demonstrated in recent studies and it has become one of the greatest challenges in psychiatric practice. Besides the use of psychotropic drugs, factors such as genetic polymorphisms, inflammation, endocrinopathies and unhealthy lifestyle contribute to the association between metabolic syndrome and a number of psychiatric disorders. In this article, we review the current diagnostic criteria for metabolic syndrome and propose clinically useful guidelines for psychiatrists to identify and monitor patients who may have the syndrome. We also outline the relationship between metabolic syndrome and individual psychiatric disorders, and discuss advances in pharmacological treatment for the syndrome, such as metformin.
{"title":"Metabolic syndrome in psychiatry: advances in understanding and management","authors":"Cyrus S. H. Ho, M. Zhang, A. Mak, R. Ho","doi":"10.1192/APT.BP.113.011619","DOIUrl":"https://doi.org/10.1192/APT.BP.113.011619","url":null,"abstract":"SUMMARY Metabolic syndrome comprises a number of cardiovascular risk factors that increase morbidity and mortality. The increase in incidence of the syndrome among psychiatric patients has been unanimously demonstrated in recent studies and it has become one of the greatest challenges in psychiatric practice. Besides the use of psychotropic drugs, factors such as genetic polymorphisms, inflammation, endocrinopathies and unhealthy lifestyle contribute to the association between metabolic syndrome and a number of psychiatric disorders. In this article, we review the current diagnostic criteria for metabolic syndrome and propose clinically useful guidelines for psychiatrists to identify and monitor patients who may have the syndrome. We also outline the relationship between metabolic syndrome and individual psychiatric disorders, and discuss advances in pharmacological treatment for the syndrome, such as metformin.","PeriodicalId":89879,"journal":{"name":"Advances in psychiatric treatment : the Royal College of Psychiatrists' journal of continuing professional development","volume":"20 1","pages":"101-112"},"PeriodicalIF":0.0,"publicationDate":"2014-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/APT.BP.113.011619","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65779191","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 : 2014-03-01DOI: 10.1192/APT.BP.113.011304
H. Rickards, S. Jacob, B. Lennox, T. Nicholson
Autoimmune encephalitides can present with altered mental states, particularly psychosis and delirium. Psychiatrists need to be particularly vigilant in cases of first-episode psychosis and to look out for other, sometimes subtle, features of encephalitis. Encephalitis related to N -methyl-D-aspartate (NMDA) receptor autoantibodies is the most common autoimmune cause of isolated psychosis, the second being related to voltage-gated potassium channel (VGKC)-complex antibodies. Psychiatrists should note ‘red flag’ signs of seizures, autonomic instability, movement disorders and sensitivity to antipsychotic medication (including neuroleptic malignant syndrome). They should also be aware that, in some cases, encephalitis is a non-metastatic manifestation of malignancy. Treatment primarily involves suppression of immunity and is often successful if delivered early. There is accumulating evidence that isolated psychiatric syndromes can be caused by autoimmunity and this could potentially signal a significant change in the approach to disorders such as schizophrenia. Psychiatrists and neurologists need to work together to diagnose, manage and understand this group of conditions.
自身免疫性脑炎可表现为精神状态改变，特别是精神病和谵妄。精神科医生需要对首发精神病病例特别警惕，并注意脑炎的其他(有时是微妙的)特征。与N -甲基- d -天冬氨酸(NMDA)受体自身抗体相关的脑炎是孤立性精神病最常见的自身免疫性原因，其次是与电压门控钾通道(VGKC)复合物抗体相关。精神科医生应该注意癫痫发作、自主神经不稳定、运动障碍和对抗精神病药物(包括抗精神病药恶性综合征)敏感的“危险信号”。他们还应该意识到，在某些情况下，脑炎是恶性肿瘤的非转移性表现。治疗主要包括抑制免疫，如果及早提供，通常是成功的。越来越多的证据表明，孤立的精神综合征可能是由自身免疫引起的，这可能标志着治疗精神分裂症等疾病的方法发生了重大变化。精神科医生和神经科医生需要共同努力来诊断、管理和理解这组疾病。
{"title":"Autoimmune encephalitis: a potentially treatable cause of mental disorder","authors":"H. Rickards, S. Jacob, B. Lennox, T. Nicholson","doi":"10.1192/APT.BP.113.011304","DOIUrl":"https://doi.org/10.1192/APT.BP.113.011304","url":null,"abstract":"Autoimmune encephalitides can present with altered mental states, particularly psychosis and delirium. Psychiatrists need to be particularly vigilant in cases of first-episode psychosis and to look out for other, sometimes subtle, features of encephalitis. Encephalitis related to N -methyl-D-aspartate (NMDA) receptor autoantibodies is the most common autoimmune cause of isolated psychosis, the second being related to voltage-gated potassium channel (VGKC)-complex antibodies. Psychiatrists should note ‘red flag’ signs of seizures, autonomic instability, movement disorders and sensitivity to antipsychotic medication (including neuroleptic malignant syndrome). They should also be aware that, in some cases, encephalitis is a non-metastatic manifestation of malignancy. Treatment primarily involves suppression of immunity and is often successful if delivered early. There is accumulating evidence that isolated psychiatric syndromes can be caused by autoimmunity and this could potentially signal a significant change in the approach to disorders such as schizophrenia. Psychiatrists and neurologists need to work together to diagnose, manage and understand this group of conditions.","PeriodicalId":89879,"journal":{"name":"Advances in psychiatric treatment : the Royal College of Psychiatrists' journal of continuing professional development","volume":"37 1","pages":"92-100"},"PeriodicalIF":0.0,"publicationDate":"2014-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/APT.BP.113.011304","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65778724","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 : 2014-03-01DOI: 10.1192/APT.BP.113.011403
B. Mann, Elizabeth Matias, J. Allen
Although there is an increasing focus on recovery within mental health services, there has been limited exploration of the applicability of these principles within forensic services. The authors draw on their experiences within forensic rehabilitation services to discuss the potential obstacles to secure recovery, exploring the systemic and risk management aspects of such a setting as well as considering attachment theory within this context. Some proposals based on clinical experience are given on how such obstacles are faced and tackled.
{"title":"Recovery in forensic services: facing the challenge","authors":"B. Mann, Elizabeth Matias, J. Allen","doi":"10.1192/APT.BP.113.011403","DOIUrl":"https://doi.org/10.1192/APT.BP.113.011403","url":null,"abstract":"Although there is an increasing focus on recovery within mental health services, there has been limited exploration of the applicability of these principles within forensic services. The authors draw on their experiences within forensic rehabilitation services to discuss the potential obstacles to secure recovery, exploring the systemic and risk management aspects of such a setting as well as considering attachment theory within this context. Some proposals based on clinical experience are given on how such obstacles are faced and tackled.","PeriodicalId":89879,"journal":{"name":"Advances in psychiatric treatment : the Royal College of Psychiatrists' journal of continuing professional development","volume":"20 1","pages":"125-131"},"PeriodicalIF":0.0,"publicationDate":"2014-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/APT.BP.113.011403","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65778753","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 : 2014-01-01DOI: 10.1192/APT.BP.112.010801
M. Woodbury-Smith
In medical practice it is crucial that symptom descriptions are as precise and objective as possible, which psychiatry attempts to achieve through its psychopathological lexicon. The term ‘autism spectrum disorder’ has now entered psychiatric nosology, but the symptom definitions on which it is based are not robust, potentially making reliable and valid diagnoses a problem. This is further compounded by the spectral nature of the disorder and its lack of clear diagnostic boundaries. To overcome this, there is a need for a psychopathological lexicon of ‘social cognition’ and a classification system that splits rather than lumps disorders with core difficulties in social interaction.
{"title":"Changing diagnostic practices: autism spectrum disorder","authors":"M. Woodbury-Smith","doi":"10.1192/APT.BP.112.010801","DOIUrl":"https://doi.org/10.1192/APT.BP.112.010801","url":null,"abstract":"In medical practice it is crucial that symptom descriptions are as precise and objective as possible, which psychiatry attempts to achieve through its psychopathological lexicon. The term ‘autism spectrum disorder’ has now entered psychiatric nosology, but the symptom definitions on which it is based are not robust, potentially making reliable and valid diagnoses a problem. This is further compounded by the spectral nature of the disorder and its lack of clear diagnostic boundaries. To overcome this, there is a need for a psychopathological lexicon of ‘social cognition’ and a classification system that splits rather than lumps disorders with core difficulties in social interaction.","PeriodicalId":89879,"journal":{"name":"Advances in psychiatric treatment : the Royal College of Psychiatrists' journal of continuing professional development","volume":"20 1","pages":"23-26"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/APT.BP.112.010801","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65777716","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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