Pub Date : 2014-01-01DOI: 10.1192/APT.BP.113.011429
Daniel Kinnair, E. Anderson, Henderikus van Diepen, Catherine Poyser
Interprofessional education, learning which brings together different professional groups, helps to prepare practitioners for effective team-based collaborative practice and is now included in all undergraduate training programmes in the health professions. We explore the merits of team-based interprofessional learning, drawing on learning theory and mental health policy. We endorse the use of a practice-based interprofessional education model involving patients in which students experience the complexity of team working and the clinical team gain a more detailed analysis of team processes, which can enhance the quality of patient care. The model has been replicated for undergraduate education in mental healthcare and could easily be used for postgraduate staff. Interprofessional education at postgraduate level could foster the ongoing team-based reflective learning needed to enable mental health services in the UK to adapt to the dramatic changes both in their organisation and in the roles and responsibilities of individual professions.
{"title":"Interprofessional education in mental health services: learning together for better team working","authors":"Daniel Kinnair, E. Anderson, Henderikus van Diepen, Catherine Poyser","doi":"10.1192/APT.BP.113.011429","DOIUrl":"https://doi.org/10.1192/APT.BP.113.011429","url":null,"abstract":"Interprofessional education, learning which brings together different professional groups, helps to prepare practitioners for effective team-based collaborative practice and is now included in all undergraduate training programmes in the health professions. We explore the merits of team-based interprofessional learning, drawing on learning theory and mental health policy. We endorse the use of a practice-based interprofessional education model involving patients in which students experience the complexity of team working and the clinical team gain a more detailed analysis of team processes, which can enhance the quality of patient care. The model has been replicated for undergraduate education in mental healthcare and could easily be used for postgraduate staff. Interprofessional education at postgraduate level could foster the ongoing team-based reflective learning needed to enable mental health services in the UK to adapt to the dramatic changes both in their organisation and in the roles and responsibilities of individual professions.","PeriodicalId":89879,"journal":{"name":"Advances in psychiatric treatment : the Royal College of Psychiatrists' journal of continuing professional development","volume":"20 1","pages":"61-68"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/APT.BP.113.011429","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65778292","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.113.011171
M. Oto, M. Reuber
SUMMARY Psychogenic non-epileptic seizures (PNES) have a significant impact on most patients in terms of distress, disability, loss of income and iatrogenic harm. Three-quarters of patients with PNES are initially misdiagnosed and treated for epilepsy. Misdiagnosis exposes patients to multiple iatrogenic harms and prevents them from accessing psychological treatment. In most cases, the patient’s history (and witness accounts) should alert clinicians to the likely diagnosis of PNES. Since this diagnosis may be resisted by patients and may involve ‘un-diagnosing’ epilepsy, video-electroencephalogram recording of typical seizures is often helpful. The underlying causes of PNES are diverse: a model combining predisposing, precipitating and perpetuating factors is a useful way of conceptualising their aetiology. The initial step of treatment should be to limit iatrogenic harm. There is some evidence for the effectiveness of psychotherapy.
{"title":"Psychogenic non-epileptic seizures: aetiology, diagnosis and management","authors":"M. Oto, M. Reuber","doi":"10.1192/APT.BP.113.011171","DOIUrl":"https://doi.org/10.1192/APT.BP.113.011171","url":null,"abstract":"SUMMARY Psychogenic non-epileptic seizures (PNES) have a significant impact on most patients in terms of distress, disability, loss of income and iatrogenic harm. Three-quarters of patients with PNES are initially misdiagnosed and treated for epilepsy. Misdiagnosis exposes patients to multiple iatrogenic harms and prevents them from accessing psychological treatment. In most cases, the patient’s history (and witness accounts) should alert clinicians to the likely diagnosis of PNES. Since this diagnosis may be resisted by patients and may involve ‘un-diagnosing’ epilepsy, video-electroencephalogram recording of typical seizures is often helpful. The underlying causes of PNES are diverse: a model combining predisposing, precipitating and perpetuating factors is a useful way of conceptualising their aetiology. The initial step of treatment should be to limit iatrogenic harm. There is some evidence for the effectiveness of psychotherapy.","PeriodicalId":89879,"journal":{"name":"Advances in psychiatric treatment : the Royal College of Psychiatrists' journal of continuing professional development","volume":"20 1","pages":"13-22"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/APT.BP.113.011171","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65778519","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.110.008235
R. Hunter
There has been little pharmacological advance in the treatment of schizophrenia since the introduction of chlorpromazine in the 1950s. This may be set to change as recent advances in molecular biology offer the prospect of a better understanding of the pathophysiology of the disorder and allow investigation of the complex interplay of genetic and environmental risk factors. In this review I discuss future approaches to antipsychotic drug development, highlighting the need to better define symptom areas and develop drugs based on an understanding of neurobiological mechanisms. The development of biomarkers has the potential in future to improve differential diagnosis and help predict response to treatment. These developments herald the possibility of a more integrated drug discovery approach and the subsequent provision of more stratified healthcare, and hopefully significant improvements in patient care and improved long-term outcomes.
{"title":"Developing tomorrow’s antipsychotics: the need for a more personalised approach","authors":"R. Hunter","doi":"10.1192/APT.BP.110.008235","DOIUrl":"https://doi.org/10.1192/APT.BP.110.008235","url":null,"abstract":"There has been little pharmacological advance in the treatment of schizophrenia since the introduction of chlorpromazine in the 1950s. This may be set to change as recent advances in molecular biology offer the prospect of a better understanding of the pathophysiology of the disorder and allow investigation of the complex interplay of genetic and environmental risk factors. In this review I discuss future approaches to antipsychotic drug development, highlighting the need to better define symptom areas and develop drugs based on an understanding of neurobiological mechanisms. The development of biomarkers has the potential in future to improve differential diagnosis and help predict response to treatment. These developments herald the possibility of a more integrated drug discovery approach and the subsequent provision of more stratified healthcare, and hopefully significant improvements in patient care and improved long-term outcomes.","PeriodicalId":89879,"journal":{"name":"Advances in psychiatric treatment : the Royal College of Psychiatrists' journal of continuing professional development","volume":"20 1","pages":"3-12"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/APT.BP.110.008235","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65771844","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.112.010330
J. Luty
SUMMARY Psychiatrist Thomas Szasz fought coercion (compulsory detention) and denied that mental illness existed. Although he was regarded as a maverick, his ideas are much more plausible when one discovers that between 1939 and 1941, up to 100 000 mentally ill people, including 5000 children, were killed in Nazi Germany. In the course of the Nazi regime, over 400 000 forced sterilisations took place, mainly of people with mental illnesses. Other countries, including Denmark, Norway, Sweden and Switzerland, had active forced sterilisation programmes and eugenics laws. Similar laws were implemented in the USA, with up to 25 000 forced sterilisations. These atrocities were enabled and facilitated by psychiatrists of the time and are only one example of the dark side of the profession. This article re views some of these aspects of the history of psychiatry, including Germany’s eugenics programme and the former USSR’s detention of dissidents under the guise of psychiatric treatment.
{"title":"Psychiatry and the dark side: eugenics, Nazi and Soviet psychiatry","authors":"J. Luty","doi":"10.1192/APT.BP.112.010330","DOIUrl":"https://doi.org/10.1192/APT.BP.112.010330","url":null,"abstract":"SUMMARY Psychiatrist Thomas Szasz fought coercion (compulsory detention) and denied that mental illness existed. Although he was regarded as a maverick, his ideas are much more plausible when one discovers that between 1939 and 1941, up to 100 000 mentally ill people, including 5000 children, were killed in Nazi Germany. In the course of the Nazi regime, over 400 000 forced sterilisations took place, mainly of people with mental illnesses. Other countries, including Denmark, Norway, Sweden and Switzerland, had active forced sterilisation programmes and eugenics laws. Similar laws were implemented in the USA, with up to 25 000 forced sterilisations. These atrocities were enabled and facilitated by psychiatrists of the time and are only one example of the dark side of the profession. This article re views some of these aspects of the history of psychiatry, including Germany’s eugenics programme and the former USSR’s detention of dissidents under the guise of psychiatric treatment.","PeriodicalId":89879,"journal":{"name":"Advances in psychiatric treatment : the Royal College of Psychiatrists' journal of continuing professional development","volume":"20 1","pages":"52-60"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/APT.BP.112.010330","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65776474","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.112.010652
Glenn Roberts, J. Boardman
Professional practice explicitly focused on supporting the recovery of those it serves is broadly backed by an emerging profile of necessary knowledge, key skills and innovative collaborations, although there is no universally accepted practice ‘model’. This article outlines these components and discusses the associated need for change in the culture of provider organisations along with implementation of wider social and economic policies to support peoples’ recovery and social inclusion. This is a values-led approach supported by persuasive advocacy and international endorsement but still in need of further development, systematic evaluation and confirmatory evidence.
{"title":"Becoming a recovery-oriented practitioner","authors":"Glenn Roberts, J. Boardman","doi":"10.1192/APT.BP.112.010652","DOIUrl":"https://doi.org/10.1192/APT.BP.112.010652","url":null,"abstract":"Professional practice explicitly focused on supporting the recovery of those it serves is broadly backed by an emerging profile of necessary knowledge, key skills and innovative collaborations, although there is no universally accepted practice ‘model’. This article outlines these components and discusses the associated need for change in the culture of provider organisations along with implementation of wider social and economic policies to support peoples’ recovery and social inclusion. This is a values-led approach supported by persuasive advocacy and international endorsement but still in need of further development, systematic evaluation and confirmatory evidence.","PeriodicalId":89879,"journal":{"name":"Advances in psychiatric treatment : the Royal College of Psychiatrists' journal of continuing professional development","volume":"20 1","pages":"37-47"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/APT.BP.112.010652","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65777569","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.113.011395
Liz Leicester, S. Lawrie
SUMMARY We highlight and briefly expand on what we consider some particularly important messages from Claire Bithell’s article, including the importance and influence of public engagement, the rewards of talking to the media and the availability of some helpful resources.
{"title":"How psychiatrists can win friends and influence people: COMMENTARY ON… HOW PSYCHIATRISTS CAN ENGAGE WITH THE MEDIA","authors":"Liz Leicester, S. Lawrie","doi":"10.1192/APT.BP.113.011395","DOIUrl":"https://doi.org/10.1192/APT.BP.113.011395","url":null,"abstract":"SUMMARY We highlight and briefly expand on what we consider some particularly important messages from Claire Bithell’s article, including the importance and influence of public engagement, the rewards of talking to the media and the availability of some helpful resources.","PeriodicalId":89879,"journal":{"name":"Advances in psychiatric treatment : the Royal College of Psychiatrists' journal of continuing professional development","volume":"20 1","pages":"79-80"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/APT.BP.113.011395","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65778747","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.113.011270
Susan Bailey, Richard Williams
We consider key facets of the concept of mental health recovery and how they are reflected in other concepts that run through the emerging focus on public mental healthcare. We widen the scene to portray the niche into which recovery fits and show how it and recent research indicate why psychiatrists should use the social sciences more widely to complement neuroscience.
{"title":"Towards partnerships in mental healthcare: COMMENTARY ON… UNDERSTANDING ‘RECOVERY’ & BECOMING A RECOVERY-ORIENTED PRACTITIONER","authors":"Susan Bailey, Richard Williams","doi":"10.1192/APT.BP.113.011270","DOIUrl":"https://doi.org/10.1192/APT.BP.113.011270","url":null,"abstract":"We consider key facets of the concept of mental health recovery and how they are reflected in other concepts that run through the emerging focus on public mental healthcare. We widen the scene to portray the niche into which recovery fits and show how it and recent research indicate why psychiatrists should use the social sciences more widely to complement neuroscience.","PeriodicalId":89879,"journal":{"name":"Advances in psychiatric treatment : the Royal College of Psychiatrists' journal of continuing professional development","volume":"20 1","pages":"48-51"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65778678","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.110.008664
Liz Boardman, J. Bernal, S. Hollins
Good communication is central to psychiatric consultation. It informs assessment, diagnosis and treatment, and is an important part of empowering people to take more control of their own mental health. But active listening and personally tailored explanations may require additional skills and may need to be practised in the context of ethical and legal frameworks. In this article we consider the additional impairments that occur in people with intellectual disabilities who use psychiatric services and describe practical steps that can be taken by clinicians and service providers to overcome these impairments, to make reasonable adjustments and to ensure that patients obtain maximum benefit from services.
{"title":"Communicating with people with intellectual disabilities: a guide for general psychiatrists","authors":"Liz Boardman, J. Bernal, S. Hollins","doi":"10.1192/APT.BP.110.008664","DOIUrl":"https://doi.org/10.1192/APT.BP.110.008664","url":null,"abstract":"Good communication is central to psychiatric consultation. It informs assessment, diagnosis and treatment, and is an important part of empowering people to take more control of their own mental health. But active listening and personally tailored explanations may require additional skills and may need to be practised in the context of ethical and legal frameworks. In this article we consider the additional impairments that occur in people with intellectual disabilities who use psychiatric services and describe practical steps that can be taken by clinicians and service providers to overcome these impairments, to make reasonable adjustments and to ensure that patients obtain maximum benefit from services.","PeriodicalId":89879,"journal":{"name":"Advances in psychiatric treatment : the Royal College of Psychiatrists' journal of continuing professional development","volume":"20 1","pages":"27-36"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/APT.BP.110.008664","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65772570","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.110.008839
C. Bithell
SUMMARY The media offers opportunities for psychiatrists to communicate with a wide and varied audience, thereby influencing the views of the public and policy makers on mental health issues. There are many different types of media outlet, including daily news media, documentary makers, specialist media, features and comment, and new media. The Science Media Centre is an independent press office that aims to help ensure that the views of scientists, clinicians and researchers are heard in the UK national news media when their area of expertise hits the headlines. In the news media, journalists work to tight time frames and often focus on sensational and controversial topics, presenting challenges for those wanting to engage. For experts to work effectively with the news media it helps to understand more about the way the media works and how to develop necessary skills. Psychiatrists who do work successfully with the media can help ensure that the public receive accurate information about mental health problems, and gain an appreciation of the importance of research in the field and a better understanding of the role of the psychiatrist.
{"title":"How psychiatrists can engage with the media","authors":"C. Bithell","doi":"10.1192/APT.BP.110.008839","DOIUrl":"https://doi.org/10.1192/APT.BP.110.008839","url":null,"abstract":"SUMMARY The media offers opportunities for psychiatrists to communicate with a wide and varied audience, thereby influencing the views of the public and policy makers on mental health issues. There are many different types of media outlet, including daily news media, documentary makers, specialist media, features and comment, and new media. The Science Media Centre is an independent press office that aims to help ensure that the views of scientists, clinicians and researchers are heard in the UK national news media when their area of expertise hits the headlines. In the news media, journalists work to tight time frames and often focus on sensational and controversial topics, presenting challenges for those wanting to engage. For experts to work effectively with the news media it helps to understand more about the way the media works and how to develop necessary skills. Psychiatrists who do work successfully with the media can help ensure that the public receive accurate information about mental health problems, and gain an appreciation of the importance of research in the field and a better understanding of the role of the psychiatrist.","PeriodicalId":89879,"journal":{"name":"Advances in psychiatric treatment : the Royal College of Psychiatrists' journal of continuing professional development","volume":"20 1","pages":"71-78"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/APT.BP.110.008839","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65773349","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/APT.BP.111.009761
D. Osborne, Christopher Williams
Different forms of excessive reassurance-seeking safety behaviours are explored, along with reasons why these unhelpful responses occur across a range of mental health disorders. This short update covers the rationale for reducing and stopping these behaviours and offers interventions to help people understand and overcome the unhelpful impact that excessive reassurance-seeking can have on them and others.
{"title":"Excessive reassurance-seeking","authors":"D. Osborne, Christopher Williams","doi":"10.1192/APT.BP.111.009761","DOIUrl":"https://doi.org/10.1192/APT.BP.111.009761","url":null,"abstract":"Different forms of excessive reassurance-seeking safety behaviours are explored, along with reasons why these unhelpful responses occur across a range of mental health disorders. This short update covers the rationale for reducing and stopping these behaviours and offers interventions to help people understand and overcome the unhelpful impact that excessive reassurance-seeking can have on them and others.","PeriodicalId":89879,"journal":{"name":"Advances in psychiatric treatment : the Royal College of Psychiatrists' journal of continuing professional development","volume":"19 1","pages":"420-421"},"PeriodicalIF":0.0,"publicationDate":"2013-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/APT.BP.111.009761","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65775473","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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