Pub Date : 2014-08-01DOI: 10.1192/pb.bp.114.048546
Professor Dinesh Bhugra made bold attempts to move psychiatry forward when President of the Royal College of Psychiatrists. In May 2012, Julia Bland went to pick his brains as he prepares to take up the post as head of the World Psychiatric Association (WPA). It is a sign of how things have changed
{"title":"Bulletin comment: Openness, transparency and candour.","authors":"","doi":"10.1192/pb.bp.114.048546","DOIUrl":"https://doi.org/10.1192/pb.bp.114.048546","url":null,"abstract":"Professor Dinesh Bhugra made bold attempts to move psychiatry forward when President of the Royal College of Psychiatrists. In May 2012, Julia Bland went to pick his brains as he prepares to take up the post as head of the World Psychiatric Association (WPA).\u0000\u0000It is a sign of how things have changed","PeriodicalId":90710,"journal":{"name":"Psychiatric bulletin (2014)","volume":"38 4","pages":"180"},"PeriodicalIF":0.0,"publicationDate":"2014-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/pb.bp.114.048546","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32680915","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 : 2014-08-01DOI: 10.1192/pb.bp.113.044016
Aashish Tagore
{"title":"Personal experience: Coming out - the psychotic psychiatrist - an account of the stigmatising experience of psychiatric illness.","authors":"Aashish Tagore","doi":"10.1192/pb.bp.113.044016","DOIUrl":"https://doi.org/10.1192/pb.bp.113.044016","url":null,"abstract":"","PeriodicalId":90710,"journal":{"name":"Psychiatric bulletin (2014)","volume":"38 4","pages":"185-8"},"PeriodicalIF":0.0,"publicationDate":"2014-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/pb.bp.113.044016","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32680918","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}
I have been asked to comment on the editorial in this edition of the Psychiatric Bulletin.† Beyond politics, beyond factions. Just try a little intelligent kindness - after all this is about putting patients first. To put patients first, professionals themselves have to be valued and supported.
{"title":"President's response to editorial by John Cox & Alison Gray.","authors":"Sue Bailey","doi":"10.1192/pb.38.4.195","DOIUrl":"https://doi.org/10.1192/pb.38.4.195","url":null,"abstract":"I have been asked to comment on the editorial in this edition of the Psychiatric Bulletin.† \u0000 \u0000Beyond politics, beyond factions. Just try a little intelligent kindness - after all this is about putting patients first. To put patients first, professionals themselves have to be valued and supported.","PeriodicalId":90710,"journal":{"name":"Psychiatric bulletin (2014)","volume":"38 4","pages":"195"},"PeriodicalIF":0.0,"publicationDate":"2014-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/pb.38.4.195","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32680922","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 : 2014-08-01DOI: 10.1192/pb.bp.114.047514
John Cox, Alison Gray
The College has recently published an occasional paper in response to the Francis inquiry into the care at Mid Staffordshire NHS Foundation Trust. We consider that it overlooks one key question implicit in the inquiry's recommendations: 'Is the business model of care fit for purpose?' We question whether the business model in its present form is appropriate for the delivery of healthcare. We suggest there is a need for greater conceptual clarity with regard to the nature of compassionate care and the meaning of person-centred medicine. We recommend that a broader moral and ethical framework is considered not only for psychiatry, but for all healthcare provision which would transcend specialty and Royal College boundaries.
{"title":"The College reply to Francis misses the big question: a commentary on OP92.","authors":"John Cox, Alison Gray","doi":"10.1192/pb.bp.114.047514","DOIUrl":"https://doi.org/10.1192/pb.bp.114.047514","url":null,"abstract":"<p><p>The College has recently published an occasional paper in response to the Francis inquiry into the care at Mid Staffordshire NHS Foundation Trust. We consider that it overlooks one key question implicit in the inquiry's recommendations: 'Is the business model of care fit for purpose?' We question whether the business model in its present form is appropriate for the delivery of healthcare. We suggest there is a need for greater conceptual clarity with regard to the nature of compassionate care and the meaning of person-centred medicine. We recommend that a broader moral and ethical framework is considered not only for psychiatry, but for all healthcare provision which would transcend specialty and Royal College boundaries. </p>","PeriodicalId":90710,"journal":{"name":"Psychiatric bulletin (2014)","volume":"38 4","pages":"152-3"},"PeriodicalIF":0.0,"publicationDate":"2014-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/pb.bp.114.047514","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32679954","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 : 2014-08-01DOI: 10.1192/pb.bp.113.044024
Aashish Tagore
In a previous article, I wrote a personal account of the stigmatising impact of an acute stress-induced psychotic episode in the context of being suspended from work following a false allegation. Here, I attempt to describe the psychological hurdles I’ve had to face in my recovery back to ‘full functioning’. The psychotic episode took its toll on me. After the acute phase, I was constantly encouraged by both my treating psychiatrist and my care coordinator to take as much time as I could resting and recuperating. This made complete sense at face value: after all, the last thing any of us wanted was for me to feel unduly stressed and to experience a relapse. Despite this, my natural urge was to get back to work post haste. This is a strange trait that most of my medical colleagues will be able to relate to - for some reason we have an inherent sense of duty to our vocation, even if it is at the expense of our own health. .... Language: en
{"title":"Personal experience: Hopes and fears - the road to recovery after psychotic illness.","authors":"Aashish Tagore","doi":"10.1192/pb.bp.113.044024","DOIUrl":"https://doi.org/10.1192/pb.bp.113.044024","url":null,"abstract":"In a previous article, I wrote a personal account of the stigmatising impact of an acute stress-induced psychotic episode in the context of being suspended from work following a false allegation. Here, I attempt to describe the psychological hurdles I’ve had to face in my recovery back to ‘full functioning’. The psychotic episode took its toll on me. After the acute phase, I was constantly encouraged by both my treating psychiatrist and my care coordinator to take as much time as I could resting and recuperating. This made complete sense at face value: after all, the last thing any of us wanted was for me to feel unduly stressed and to experience a relapse. Despite this, my natural urge was to get back to work post haste. This is a strange trait that most of my medical colleagues will be able to relate to - for some reason we have an inherent sense of duty to our vocation, even if it is at the expense of our own health. .... Language: en","PeriodicalId":90710,"journal":{"name":"Psychiatric bulletin (2014)","volume":"38 4","pages":"189-90"},"PeriodicalIF":0.0,"publicationDate":"2014-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/pb.bp.113.044024","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32680919","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}
Based on the findings of the OCTET study,[1][1] Burns & Molodynski reject observations of consultants who reported directly observable benefits from community treatment orders (CTOs). They argue that it is not possible to ‘see with one’s own eyes’ a probabilistic outcome that takes months to
{"title":"The OCTET trial, community treatment orders and evidence-based practice.","authors":"Feras A Mustafa","doi":"10.1192/pb.38.4.197","DOIUrl":"https://doi.org/10.1192/pb.38.4.197","url":null,"abstract":"Based on the findings of the OCTET study,[1][1] Burns & Molodynski reject observations of consultants who reported directly observable benefits from community treatment orders (CTOs). They argue that it is not possible to ‘see with one’s own eyes’ a probabilistic outcome that takes months to","PeriodicalId":90710,"journal":{"name":"Psychiatric bulletin (2014)","volume":"38 4","pages":"197"},"PeriodicalIF":0.0,"publicationDate":"2014-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/pb.38.4.197","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32680928","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 : 2014-08-01DOI: 10.1192/pb.bp.113.045179
Lorna Howe, Anna Tickle, Ian Brown
Aims and method To explore service users' experiences of receiving a diagnosis of schizophrenia and the stigma associated with the diagnostic label. Seven participants were interviewed about their perceptions of these experiences. Interviews were analysed using interpretative phenomenological analysis. Results Five superordinate themes resulted from the analysis: (1) avoidance of the diagnosis of schizophrenia; (2) stigma and diagnostic labels; (3) lack of understanding of schizophrenia; (4) managing stigma to maintain normality; (5) being 'schizophrenic'. These, together with their subthemes, highlighted avoidance of the term schizophrenia by participants and use of alternative terms by professionals, which limited opportunities for understanding the label and challenging associated stigma. Participants strived to maintain normality despite potential stigma. Clinical implications There is a need to address the process of giving a diagnosis as a phenomenon of consequence within its own terms. Implications relate to how professionals deliver and discuss the diagnosis of schizophrenia.
{"title":"'Schizophrenia is a dirty word': service users' experiences of receiving a diagnosis of schizophrenia.","authors":"Lorna Howe, Anna Tickle, Ian Brown","doi":"10.1192/pb.bp.113.045179","DOIUrl":"https://doi.org/10.1192/pb.bp.113.045179","url":null,"abstract":"<p><p>Aims and method To explore service users' experiences of receiving a diagnosis of schizophrenia and the stigma associated with the diagnostic label. Seven participants were interviewed about their perceptions of these experiences. Interviews were analysed using interpretative phenomenological analysis. Results Five superordinate themes resulted from the analysis: (1) avoidance of the diagnosis of schizophrenia; (2) stigma and diagnostic labels; (3) lack of understanding of schizophrenia; (4) managing stigma to maintain normality; (5) being 'schizophrenic'. These, together with their subthemes, highlighted avoidance of the term schizophrenia by participants and use of alternative terms by professionals, which limited opportunities for understanding the label and challenging associated stigma. Participants strived to maintain normality despite potential stigma. Clinical implications There is a need to address the process of giving a diagnosis as a phenomenon of consequence within its own terms. Implications relate to how professionals deliver and discuss the diagnosis of schizophrenia. </p>","PeriodicalId":90710,"journal":{"name":"Psychiatric bulletin (2014)","volume":"38 4","pages":"154-8"},"PeriodicalIF":0.0,"publicationDate":"2014-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/pb.bp.113.045179","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32680910","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}
I need to congratulate Roychowdhury & Adshead[1][1] on a thought-provoking critique. Their arguments struck a chord in exposing the flaws in risk assessment tools and their unjust application in preventative detention; however, I was disappointed that they did not go further. All of these tools,
{"title":"Overselling risk assessment.","authors":"Trevor D Broughton","doi":"10.1192/pb.38.4.195a","DOIUrl":"https://doi.org/10.1192/pb.38.4.195a","url":null,"abstract":"I need to congratulate Roychowdhury & Adshead[1][1] on a thought-provoking critique. Their arguments struck a chord in exposing the flaws in risk assessment tools and their unjust application in preventative detention; however, I was disappointed that they did not go further. All of these tools,","PeriodicalId":90710,"journal":{"name":"Psychiatric bulletin (2014)","volume":"38 4","pages":"195"},"PeriodicalIF":0.0,"publicationDate":"2014-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/pb.38.4.195a","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32680923","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}
Anyone working in an insulin unit in the 1950s would not recognise Dr Pimm’s account of the results of their treatment,1 or details of what it involved. The patients received daily and increasing doses of insulin, rising to many hundreds of units, for a 6-week period. The depth of the resulting hypoglycaemic coma was determined by the patient demonstrating a Babinski response over a period of 15 min. They were then revived by ingesting glucose. I worked in the insulin unit at Newcastle General Hospital from 1956 to 1959, when I was senior registrar to Sir Martin Roth. Insulin treatment was reserved for people experiencing their first attack of schizophrenia, and from memory I would say half made a complete remission and another 25% improved. Nobody thought that we were effecting a cure, but remissions lasted about 2 years. One woman relapsed 9 years after her treatment. Of course there were dangers, but in those days the alternative was incarceration in a locked ward in a Victorian asylum, with little hope of rehabilitation or discharge. Martin Roth was an intellectual giant, but also a man who was perspicacious and compassionate, and who would not have contemplated using such a treatment if he did not think it effective. The depth of the coma seemed to me to be critical in terms of remission. A few patients did not regain consciousness when given glucose, but usually ‘came out of it’ after some hours, although there was the occasional death. Very occasionally, a patient who was clearly psychotic who had an ‘irreversible coma’ on recovery was greatly mentally improved. These days, people find this difficult to believe, but I witnessed it on one occasion. I find it inconceivable that a multitude of psychiatrists, working in Europe and North America over 25 years, would not have noticed that the treatment they were giving was having no effect, when it clearly was, if only for a limited period. The real question was not whether insulin worked but how did insulin work. I have no wish to minimise the success of Dr Bourne’s crusade, but what made insulin units redundant was the realisation that the new antipsychotic drugs actually worked, and at last, we had an effective, cheap and long-lasting method of managing a seemingly incurable disease. This was generally accepted by 1960.
{"title":"Insulin coma therapy.","authors":"Alan Gibson","doi":"10.1192/pb.38.4.198","DOIUrl":"https://doi.org/10.1192/pb.38.4.198","url":null,"abstract":"Anyone working in an insulin unit in the 1950s would not recognise Dr Pimm’s account of the results of their treatment,1 or details of what it involved. The patients received daily and increasing doses of insulin, rising to many hundreds of units, for a 6-week period. The depth of the resulting hypoglycaemic coma was determined by the patient demonstrating a Babinski response over a period of 15 min. They were then revived by ingesting glucose. \u0000 \u0000I worked in the insulin unit at Newcastle General Hospital from 1956 to 1959, when I was senior registrar to Sir Martin Roth. Insulin treatment was reserved for people experiencing their first attack of schizophrenia, and from memory I would say half made a complete remission and another 25% improved. Nobody thought that we were effecting a cure, but remissions lasted about 2 years. One woman relapsed 9 years after her treatment. Of course there were dangers, but in those days the alternative was incarceration in a locked ward in a Victorian asylum, with little hope of rehabilitation or discharge. \u0000 \u0000Martin Roth was an intellectual giant, but also a man who was perspicacious and compassionate, and who would not have contemplated using such a treatment if he did not think it effective. The depth of the coma seemed to me to be critical in terms of remission. A few patients did not regain consciousness when given glucose, but usually ‘came out of it’ after some hours, although there was the occasional death. Very occasionally, a patient who was clearly psychotic who had an ‘irreversible coma’ on recovery was greatly mentally improved. These days, people find this difficult to believe, but I witnessed it on one occasion. I find it inconceivable that a multitude of psychiatrists, working in Europe and North America over 25 years, would not have noticed that the treatment they were giving was having no effect, when it clearly was, if only for a limited period. The real question was not whether insulin worked but how did insulin work. \u0000 \u0000I have no wish to minimise the success of Dr Bourne’s crusade, but what made insulin units redundant was the realisation that the new antipsychotic drugs actually worked, and at last, we had an effective, cheap and long-lasting method of managing a seemingly incurable disease. This was generally accepted by 1960.","PeriodicalId":90710,"journal":{"name":"Psychiatric bulletin (2014)","volume":"38 4","pages":"198"},"PeriodicalIF":0.0,"publicationDate":"2014-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/pb.38.4.198","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32680930","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}
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