Psychiatric bulletin (2014)最新文献

Aims and method For many trainees, an obstacle into psychiatry is the challenge of an imprecise job design and uncertainty about the psychiatrist's job design across many complex, often ad hoc care situations involving multiple professions and organisations. The UK's National Health Service (NHS) has introduced inductions for trainee psychiatrists geared towards improving that. Are the induction programmes effective? This article presents an analysis of the outcomes (n = 1115) of inductions about the care programme approach, dual diagnosis, carer support, mental health risk assessment, psychological therapy and suicide risk assessment. Results Univariate analyses of variance revealed a consistent interaction of care programme approach, dual diagnosis, carer support and psychological therapy inductions. Psychiatrists who attend all four inductions have the best perceptions about their job design, strongest teamwork approach, and highest motivation. Clinical implications The NHS and hospitals outside the UK should note these results when prioritising inductions for trainee psychiatrists.

Morale among psychiatrists continues to be seriously challenged in the face of recruitment difficulties, unfilled posts, diagnostic controversies, service reconfigurations and public criticism of psychiatric care, in addition to other difficulties. In this article, we argue that the positivist paradigm that continues to dominate British psychiatry has led to an undervaluing of subjectivity and of the role of emotions within psychiatric training and practice. Reintegrating the subjective perspective and promoting emotional awareness and reflection may go some way towards restoring faith in the psychiatric specialty.

Aims and method To determine rates of parent-reported child awareness of parental depression, examine characteristics of parents, children and families according to child awareness, and explore whether child awareness is associated with child psychopathology. Data were available from 271 families participating in the Early Prediction of Adolescent Depression (EPAD) study, a longitudinal study of offspring of parents with recurrent depression. Results Seventy-three per cent of participating children were perceived as being aware of their parent's depression. Older children, and children of parents who experienced more severe depression, were more likely to be aware. Awareness was not associated with child psychopathology. Clinical implications Considering children in the context of parental depression is important. Child awareness may influence their access to early intervention and prevention programmes. Further research is needed to understand the impact of awareness on the child.

Audit is an important tool for quality improvement. The collection of data on clinical performance against evidence-based and clinically relevant standards, which are considered by clinicians to be realistic in routine practice, can usefully prompt reflective practice and the implementation of change. Evidence of participation in clinical audit is required to achieve intended learning outcomes for trainees in psychiatry and revalidation for those who are members of the Royal College of Psychiatrists. This article addresses some of the practical steps involved in conducting an audit project, and, to illustrate key points, draws on lessons learnt from a national, audit-based, quality improvement programme of lithium prescribing and monitoring conducted through the Prescribing Observatory for Mental Health.