Pub Date : 2013-09-01DOI: 10.1192/apt.bp.108.005926
Robin Downie, Jane Macnaughton
A judgement is an assertion made with evidence or good reason in a context of uncertainty. In psychiatry the uncertainty is inherent in the professional context, and the evidence derives from the academic literature and scientific studies as they are applied to a specific patient. The nature of the uncertainty and the factors which should inform professional judgement are explored. Professional judgement is currently facing two serious challenges: an obsession with numbers, which comes from within medicine, and the 'patient choice' agenda, which is politically inspired and comes from outside medicine. This paper strives to defend professional judgement in the clinic against both challenges.
{"title":"In Defence of Professional Judgement.","authors":"Robin Downie, Jane Macnaughton","doi":"10.1192/apt.bp.108.005926","DOIUrl":"10.1192/apt.bp.108.005926","url":null,"abstract":"<p><p>A judgement is an assertion made with evidence or good reason in a context of uncertainty. In psychiatry the uncertainty is inherent in the professional context, and the evidence derives from the academic literature and scientific studies as they are applied to a specific patient. The nature of the uncertainty and the factors which should inform professional judgement are explored. Professional judgement is currently facing two serious challenges: an obsession with numbers, which comes from within medicine, and the 'patient choice' agenda, which is politically inspired and comes from outside medicine. This paper strives to defend professional judgement in the clinic against both challenges.</p>","PeriodicalId":89879,"journal":{"name":"Advances in psychiatric treatment : the Royal College of Psychiatrists' journal of continuing professional development","volume":"15 5","pages":"322-327"},"PeriodicalIF":0.0,"publicationDate":"2013-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3784818/pdf/emss-54179.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31767698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-09-01DOI: 10.1192/APT.BP.111.009407
J. Baird, Ruth Stocks
Risk assessment and management is an integral part of modern clinical practice. In this article we discuss best practice in the assessment and management of risk of harm to others. Unstructured clinical judgement methods have been used for many years, but it is only more recently that actuarial and structured clinical judgement methods have been introduced. These methods are discussed and compared. We describe a process that could be followed by a clinical team and give an illustrative case example. Last, we reflect on aspects of current practice and consider the possible direction of developments in the field.
{"title":"Risk assessment and management: forensic methods, human results","authors":"J. Baird, Ruth Stocks","doi":"10.1192/APT.BP.111.009407","DOIUrl":"https://doi.org/10.1192/APT.BP.111.009407","url":null,"abstract":"Risk assessment and management is an integral part of modern clinical practice. In this article we discuss best practice in the assessment and management of risk of harm to others. Unstructured clinical judgement methods have been used for many years, but it is only more recently that actuarial and structured clinical judgement methods have been introduced. These methods are discussed and compared. We describe a process that could be followed by a clinical team and give an illustrative case example. Last, we reflect on aspects of current practice and consider the possible direction of developments in the field.","PeriodicalId":89879,"journal":{"name":"Advances in psychiatric treatment : the Royal College of Psychiatrists' journal of continuing professional development","volume":"19 1","pages":"358-365"},"PeriodicalIF":0.0,"publicationDate":"2013-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/APT.BP.111.009407","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65774767","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 : 2013-09-01DOI: 10.1192/APT.BP.112.010702
A. Beveridge
This article examines James Boswell’s Life of Samuel Johnson , his celebrated biography of his friend, the great 18th-century literary figure, Samuel Johnson. The book records their many conversations, much of which was concerned with madness and melancholy. This is not surprising as both men experienced recurrent bouts of low spirits. They also lived in an era which has been called ‘The Age of Nerves’. This article will consider how they conceived of ‘nervous disease’ and how they tried to remedy it. It will also look at Johnson’s role as a therapeutic mentor to Boswell.
{"title":"Talking about madness and melancholy: Boswell’s Life of Samuel Johnson","authors":"A. Beveridge","doi":"10.1192/APT.BP.112.010702","DOIUrl":"https://doi.org/10.1192/APT.BP.112.010702","url":null,"abstract":"This article examines James Boswell’s Life of Samuel Johnson , his celebrated biography of his friend, the great 18th-century literary figure, Samuel Johnson. The book records their many conversations, much of which was concerned with madness and melancholy. This is not surprising as both men experienced recurrent bouts of low spirits. They also lived in an era which has been called ‘The Age of Nerves’. This article will consider how they conceived of ‘nervous disease’ and how they tried to remedy it. It will also look at Johnson’s role as a therapeutic mentor to Boswell.","PeriodicalId":89879,"journal":{"name":"Advances in psychiatric treatment : the Royal College of Psychiatrists' journal of continuing professional development","volume":"19 1","pages":"392-398"},"PeriodicalIF":0.0,"publicationDate":"2013-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/APT.BP.112.010702","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65777712","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 : 2013-09-01DOI: 10.1192/APT.BP.112.011098
J. Hughes, Aileen Beatty
This article examines the notion of personhood and shows how it offers a robust conceptual underpinning to person-centred care. We use a fictitious case vignette to clarify the nature of personhood. Mental health professionals need a broad view of personhood, which we feel is best captured by regarding the person as a ‘situated embodied agent’. Using this characterisation, we aim to demonstrate how it can underpin the notion of person-centred care and show the practical implications of this in connection with our fictitious case. The broad view supports a specific approach to people with dementia, but also shows the challenges that face the implementation of good-quality dementia care. Discussion of this case shows both the relevance of philosophy to clinical practice and the ways in which clinical practice can enrich the debates of philosophy.
{"title":"Understanding the person with dementia: a clinicophilosophical case discussion","authors":"J. Hughes, Aileen Beatty","doi":"10.1192/APT.BP.112.011098","DOIUrl":"https://doi.org/10.1192/APT.BP.112.011098","url":null,"abstract":"This article examines the notion of personhood and shows how it offers a robust conceptual underpinning to person-centred care. We use a fictitious case vignette to clarify the nature of personhood. Mental health professionals need a broad view of personhood, which we feel is best captured by regarding the person as a ‘situated embodied agent’. Using this characterisation, we aim to demonstrate how it can underpin the notion of person-centred care and show the practical implications of this in connection with our fictitious case. The broad view supports a specific approach to people with dementia, but also shows the challenges that face the implementation of good-quality dementia care. Discussion of this case shows both the relevance of philosophy to clinical practice and the ways in which clinical practice can enrich the debates of philosophy.","PeriodicalId":89879,"journal":{"name":"Advances in psychiatric treatment : the Royal College of Psychiatrists' journal of continuing professional development","volume":"19 1","pages":"337-343"},"PeriodicalIF":0.0,"publicationDate":"2013-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/APT.BP.112.011098","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65778036","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 : 2013-09-01DOI: 10.1192/APT.BP.112.010439
J. Garland, L. O’Rourke, D. Robertson
Autism spectrum disorders (ASDs) are lifelong conditions. Although not all adults with ASD require psychiatric input, general adult psychiatrists increasingly find themselves responsible for the care of adults with the disorder. This may present a new and unique challenge to them. Here, we summarise the core clinical features of ASD; discuss appropriate diagnostic practice; review the principles of management; and identify key educational, social care and voluntary services for adults with ASD in the UK.
{"title":"Autism spectrum disorder in adults: clinical features and the role of the psychiatrist","authors":"J. Garland, L. O’Rourke, D. Robertson","doi":"10.1192/APT.BP.112.010439","DOIUrl":"https://doi.org/10.1192/APT.BP.112.010439","url":null,"abstract":"Autism spectrum disorders (ASDs) are lifelong conditions. Although not all adults with ASD require psychiatric input, general adult psychiatrists increasingly find themselves responsible for the care of adults with the disorder. This may present a new and unique challenge to them. Here, we summarise the core clinical features of ASD; discuss appropriate diagnostic practice; review the principles of management; and identify key educational, social care and voluntary services for adults with ASD in the UK.","PeriodicalId":89879,"journal":{"name":"Advances in psychiatric treatment : the Royal College of Psychiatrists' journal of continuing professional development","volume":"11 1","pages":"378-391"},"PeriodicalIF":0.0,"publicationDate":"2013-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/APT.BP.112.010439","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65777071","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 : 2013-09-01DOI: 10.1192/APT.BP.112.010850
A. Pitman
The artist Arshile Gorky played a central role in the development of Abstract Expressionism during the 1940s. Born in Armenia, his early figurative works recall a childhood of persecution by Ottoman Turks, a period during which he suffered a number of significant losses. The painting The Artist and His Mother (c. 1926–1936) is based on a photograph showing the 7-year-old Gorky with his mother, 7 years before she starved to death during the Armenian Genocide. This article explores the early experiences that haunt this painting and the difficulties Gorky struggled with during his adult life as an immigrant to the USA – factors that contribute to an understanding of his suicide in 1948.
{"title":"Trauma, bereavement and the creative process: Arshile Gorky's The Artist and His Mother","authors":"A. Pitman","doi":"10.1192/APT.BP.112.010850","DOIUrl":"https://doi.org/10.1192/APT.BP.112.010850","url":null,"abstract":"The artist Arshile Gorky played a central role in the development of Abstract Expressionism during the 1940s. Born in Armenia, his early figurative works recall a childhood of persecution by Ottoman Turks, a period during which he suffered a number of significant losses. The painting The Artist and His Mother (c. 1926–1936) is based on a photograph showing the 7-year-old Gorky with his mother, 7 years before she starved to death during the Armenian Genocide. This article explores the early experiences that haunt this painting and the difficulties Gorky struggled with during his adult life as an immigrant to the USA – factors that contribute to an understanding of his suicide in 1948.","PeriodicalId":89879,"journal":{"name":"Advances in psychiatric treatment : the Royal College of Psychiatrists' journal of continuing professional development","volume":"19 1","pages":"366-369"},"PeriodicalIF":0.0,"publicationDate":"2013-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/APT.BP.112.010850","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65777727","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 : 2013-09-01DOI: 10.1192/APT.BP.112.011064
Stavros Bekas
A genuinely critical and reflective approach to psychiatry can potentiate learning, improve practice and promote personal development. To support this assertion, I attempt to link theory and practice. Following a brief overview of the seminal ideas that permeate the literature on critical thinking, I present three perspectives of reflective practice – those of the psychiatric trainee, the teacher and the practitioner – through examples of reflective exploration of personal experience, under the light of relevant evidence. I conclude with a critique on the limitations of reflective psychiatry.
{"title":"Critical reflection: a sound foundation for learning and practice in psychiatry","authors":"Stavros Bekas","doi":"10.1192/APT.BP.112.011064","DOIUrl":"https://doi.org/10.1192/APT.BP.112.011064","url":null,"abstract":"A genuinely critical and reflective approach to psychiatry can potentiate learning, improve practice and promote personal development. To support this assertion, I attempt to link theory and practice. Following a brief overview of the seminal ideas that permeate the literature on critical thinking, I present three perspectives of reflective practice – those of the psychiatric trainee, the teacher and the practitioner – through examples of reflective exploration of personal experience, under the light of relevant evidence. I conclude with a critique on the limitations of reflective psychiatry.","PeriodicalId":89879,"journal":{"name":"Advances in psychiatric treatment : the Royal College of Psychiatrists' journal of continuing professional development","volume":"19 1","pages":"320-328"},"PeriodicalIF":0.0,"publicationDate":"2013-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/APT.BP.112.011064","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65777849","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 : 2013-09-01DOI: 10.1192/APT.BP.111.009480
A. Ingrassia
The use of portfolios has rapidly expanded in recent years and is now relevant to a number of different aspects of professional practice in medicine in general and psychiatry in particular, including training, appraisal and revalidation as well as continuing professional development. In this article I will examine the background of important changes and new trends in medical education on which the increasing use of portfolios is based, their potential value as learning and assessment tools, and some of the challenges and dilemmas associated with their use.
{"title":"Portfolio-based learning in medical education","authors":"A. Ingrassia","doi":"10.1192/APT.BP.111.009480","DOIUrl":"https://doi.org/10.1192/APT.BP.111.009480","url":null,"abstract":"The use of portfolios has rapidly expanded in recent years and is now relevant to a number of different aspects of professional practice in medicine in general and psychiatry in particular, including training, appraisal and revalidation as well as continuing professional development. In this article I will examine the background of important changes and new trends in medical education on which the increasing use of portfolios is based, their potential value as learning and assessment tools, and some of the challenges and dilemmas associated with their use.","PeriodicalId":89879,"journal":{"name":"Advances in psychiatric treatment : the Royal College of Psychiatrists' journal of continuing professional development","volume":"19 1","pages":"329-336"},"PeriodicalIF":0.0,"publicationDate":"2013-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/APT.BP.111.009480","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65775298","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 : 2013-09-01DOI: 10.1192/APT.BP.112.010710
E. Wong, R. Krishnadas, J. Cavanagh
There has been a surge in interest in the boundaries of psychiatry, both as a specialty in its own right and as a branch of medicine separate from neurology. Our article expands on this, giving examples of how recent developments in neuroimmunology can be beneficial for psychiatry, using multiple sclerosis (MS) as an example. We also provide a summary of literature on novel research in the treatment of depression using anti-inflammatory agents. Finally, we suggest approaches to the identification and management of major depressive disorder in patients with MS or other physical illnesses, and how this translates to general psychiatric practice.
{"title":"The interface between neurology and psychiatry: the case of multiple sclerosis","authors":"E. Wong, R. Krishnadas, J. Cavanagh","doi":"10.1192/APT.BP.112.010710","DOIUrl":"https://doi.org/10.1192/APT.BP.112.010710","url":null,"abstract":"There has been a surge in interest in the boundaries of psychiatry, both as a specialty in its own right and as a branch of medicine separate from neurology. Our article expands on this, giving examples of how recent developments in neuroimmunology can be beneficial for psychiatry, using multiple sclerosis (MS) as an example. We also provide a summary of literature on novel research in the treatment of depression using anti-inflammatory agents. Finally, we suggest approaches to the identification and management of major depressive disorder in patients with MS or other physical illnesses, and how this translates to general psychiatric practice.","PeriodicalId":89879,"journal":{"name":"Advances in psychiatric treatment : the Royal College of Psychiatrists' journal of continuing professional development","volume":"1 1","pages":"370-377"},"PeriodicalIF":0.0,"publicationDate":"2013-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/APT.BP.112.010710","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65777319","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 : 2013-07-01DOI: 10.1192/APT.BP.110.008763
A. Cole-King, G. Green, L. Gask, K. Hines, S. Platt
The death of a patient by suicide can severely affect mental health professionals, particularly if it occurs despite major efforts to intervene. Notwithstanding the difficulties faced by clinicians, suicide prevention remains of paramount importance in order to help save lives. This article seeks to promote a pragmatic and compassionate biopsychosocial response using evidence-based interventions to reduce suicide. It introduces practical strategies that psychiatrists can use in everyday clinical practice, in particular the paradigm shift of suicide mitigation to help prevent suicide. We believe that every encounter with a suicidal person is an opportunity to intervene to reduce their distress and, potentially, to save a life. We believe that it is no longer acceptable for clinicians to state that if patients wish to kill themselves they can do so, in the absence of any attempt at a compassionate intervention.
{"title":"Suicide mitigation: a compassionate approach to suicide prevention","authors":"A. Cole-King, G. Green, L. Gask, K. Hines, S. Platt","doi":"10.1192/APT.BP.110.008763","DOIUrl":"https://doi.org/10.1192/APT.BP.110.008763","url":null,"abstract":"The death of a patient by suicide can severely affect mental health professionals, particularly if it occurs despite major efforts to intervene. Notwithstanding the difficulties faced by clinicians, suicide prevention remains of paramount importance in order to help save lives. This article seeks to promote a pragmatic and compassionate biopsychosocial response using evidence-based interventions to reduce suicide. It introduces practical strategies that psychiatrists can use in everyday clinical practice, in particular the paradigm shift of suicide mitigation to help prevent suicide. We believe that every encounter with a suicidal person is an opportunity to intervene to reduce their distress and, potentially, to save a life. We believe that it is no longer acceptable for clinicians to state that if patients wish to kill themselves they can do so, in the absence of any attempt at a compassionate intervention.","PeriodicalId":89879,"journal":{"name":"Advances in psychiatric treatment : the Royal College of Psychiatrists' journal of continuing professional development","volume":"24 1","pages":"276-283"},"PeriodicalIF":0.0,"publicationDate":"2013-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/APT.BP.110.008763","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65772645","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号