SUMMARY This editorial introduces the second of two special issues of BJPsych Advances on neurodevelopmental disorders, including intellectual disability, autism spectrum disorder, attention-deficit hyperactivity disorder and epilepsy. Topics discussed in the issue include using technological advances such as apps to manage epilepsy in intellectual disability, person-centred support and integrated care, training, and non-restrictive approaches and appropriate medication for managing self-injurious and challenging behaviour.
{"title":"Neurodevelopmental disorders including intellectual disability: a clinical toolkit for mental health professionals (part 2)","authors":"A. Biswas, P. Casey","doi":"10.1192/bja.2023.40","DOIUrl":"https://doi.org/10.1192/bja.2023.40","url":null,"abstract":"SUMMARY This editorial introduces the second of two special issues of BJPsych Advances on neurodevelopmental disorders, including intellectual disability, autism spectrum disorder, attention-deficit hyperactivity disorder and epilepsy. Topics discussed in the issue include using technological advances such as apps to manage epilepsy in intellectual disability, person-centred support and integrated care, training, and non-restrictive approaches and appropriate medication for managing self-injurious and challenging behaviour.","PeriodicalId":9336,"journal":{"name":"BJPsych Advances","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80369814","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}
Alexis Quinn, Alicia M Wood, Keri-Michèle Lodge, S. Hollins
SUMMARY Despite numerous UK government policies aimed at reducing the number of autistic people and people with an intellectual disability in mental health hospitals, little progress has been made, with many experiencing lengthy stays that offer little therapeutic benefit. Once admitted, people are at risk of restrictive interventions and significantly delayed discharge, resulting in trauma. This article draws on the cases of four people to illustrate the limitations of current mental health system approaches to the challenges experienced by autistic people and people with an intellectual disability. The importance of relational working and listening to people is explored, and we demonstrate how this can facilitate the provision of bespoke housing and care packages to enable a successful return to life in the community. Finally, we offer recommendations on the changes urgently needed to ensure that autistic people and people with an intellectual disability can live ordinary lives in their own homes, with timely and effective support from mental health services when needed, just like everyone else.
{"title":"Listening to the experts: person-centred approaches to supporting autistic people and people with an intellectual disability in the mental health system","authors":"Alexis Quinn, Alicia M Wood, Keri-Michèle Lodge, S. Hollins","doi":"10.1192/bja.2023.31","DOIUrl":"https://doi.org/10.1192/bja.2023.31","url":null,"abstract":"SUMMARY Despite numerous UK government policies aimed at reducing the number of autistic people and people with an intellectual disability in mental health hospitals, little progress has been made, with many experiencing lengthy stays that offer little therapeutic benefit. Once admitted, people are at risk of restrictive interventions and significantly delayed discharge, resulting in trauma. This article draws on the cases of four people to illustrate the limitations of current mental health system approaches to the challenges experienced by autistic people and people with an intellectual disability. The importance of relational working and listening to people is explored, and we demonstrate how this can facilitate the provision of bespoke housing and care packages to enable a successful return to life in the community. Finally, we offer recommendations on the changes urgently needed to ensure that autistic people and people with an intellectual disability can live ordinary lives in their own homes, with timely and effective support from mental health services when needed, just like everyone else.","PeriodicalId":9336,"journal":{"name":"BJPsych Advances","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84326086","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}
Mark Mayall, B. McDermott, R. Sadhu, Yvonne Teoh, Margot Bosanquet, Sunaina Nundeekasen
Multiaxial classification system development (organising important and relevant clinical factors under multiple headings or ‘axes’) has a long history stretching back to the 1940s. The World Health Organization supported the development of a multiaxial system of classification for children from the 1960s and in the 1990s produced a comprehensive multiaxial system which could be used with ICD-10. Using the multiaxial approach provides for an atheoretical framework that can integrate factors from within the child and the environmental influences on the child. This article presents a variety of ways in which the ICD-10 multiaxial framework can be extended from its classic usage to provide clinicians with valuable tools to assist in a biopsychosocial clinical assessment. Using the multiaxial system in an extended format allows a more comprehensive diagnosis and planning of treatments and is helpful in the training and teaching of juniors. It is also useful in evaluating responses to medication when it is combined with a chronological analysis and can provide other useful ways of integrating information relevant to understanding clinical cases.
{"title":"Practical aspects of multiaxial classification: a clinically useful biopsychosocial framework for child and adolescent psychiatry","authors":"Mark Mayall, B. McDermott, R. Sadhu, Yvonne Teoh, Margot Bosanquet, Sunaina Nundeekasen","doi":"10.1192/bja.2023.39","DOIUrl":"https://doi.org/10.1192/bja.2023.39","url":null,"abstract":"\u0000 Multiaxial classification system development (organising important and relevant clinical factors under multiple headings or ‘axes’) has a long history stretching back to the 1940s. The World Health Organization supported the development of a multiaxial system of classification for children from the 1960s and in the 1990s produced a comprehensive multiaxial system which could be used with ICD-10. Using the multiaxial approach provides for an atheoretical framework that can integrate factors from within the child and the environmental influences on the child. This article presents a variety of ways in which the ICD-10 multiaxial framework can be extended from its classic usage to provide clinicians with valuable tools to assist in a biopsychosocial clinical assessment. Using the multiaxial system in an extended format allows a more comprehensive diagnosis and planning of treatments and is helpful in the training and teaching of juniors. It is also useful in evaluating responses to medication when it is combined with a chronological analysis and can provide other useful ways of integrating information relevant to understanding clinical cases.","PeriodicalId":9336,"journal":{"name":"BJPsych Advances","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91176617","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}
Patients view their negative emotions as troublesome and they expect psychiatrists to deal with them, often wanting them taken away. We present a neuropsychoanalytical understanding of the essential biological function of emotion and how it influences behaviour. Through a vignette, we demonstrate how this understanding can contribute to the psychiatrist's management of the clinical encounter, in particular regarding the patient's expectations about their emotions and the pressures placed on the clinician.
{"title":"Managing the clinical encounter with patients with personality disorder in a general psychiatry setting: key contributions from neuropsychoanalysis","authors":"Tennyson Lee, M. Solms","doi":"10.1192/bja.2023.43","DOIUrl":"https://doi.org/10.1192/bja.2023.43","url":null,"abstract":"\u0000 Patients view their negative emotions as troublesome and they expect psychiatrists to deal with them, often wanting them taken away. We present a neuropsychoanalytical understanding of the essential biological function of emotion and how it influences behaviour. Through a vignette, we demonstrate how this understanding can contribute to the psychiatrist's management of the clinical encounter, in particular regarding the patient's expectations about their emotions and the pressures placed on the clinician.","PeriodicalId":9336,"journal":{"name":"BJPsych Advances","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80291743","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}
The COVID-19 pandemic significantly increased the challenges faced by families affected by dementia, leading to an immediate increase in both the number of calls received by Dementia UK's Admiral Nurse Dementia Helpline and the levels of distress and complexity of the calls. Consequently, Admiral nurses experienced feelings of helplessness, echoed in the experiences of other health professionals. One of the approaches that enabled Admiral nurses to cope during this time was ‘hope’, and this article explores the use of hope-based approaches as tools for working therapeutically with families during the pandemic. Although written from the perspective of Admiral nurses, the approaches described are transferable to others working across health and social care. The article provides an overview of one of the main models of hope in the healthcare literature, Snyder's hope model, and explores the literature on hope more widely. Fictitious case vignettes, drawn from clinical practice during the pandemic, are used to illustrate how hope-based approaches can be applied to practice.
{"title":"Hope: a tool for working with families affected by dementia during the COVID-19 pandemic","authors":"Amy Pepper, Zena Aldridge, K. Harrison Dening","doi":"10.1192/bja.2023.38","DOIUrl":"https://doi.org/10.1192/bja.2023.38","url":null,"abstract":"\u0000 The COVID-19 pandemic significantly increased the challenges faced by families affected by dementia, leading to an immediate increase in both the number of calls received by Dementia UK's Admiral Nurse Dementia Helpline and the levels of distress and complexity of the calls. Consequently, Admiral nurses experienced feelings of helplessness, echoed in the experiences of other health professionals. One of the approaches that enabled Admiral nurses to cope during this time was ‘hope’, and this article explores the use of hope-based approaches as tools for working therapeutically with families during the pandemic. Although written from the perspective of Admiral nurses, the approaches described are transferable to others working across health and social care. The article provides an overview of one of the main models of hope in the healthcare literature, Snyder's hope model, and explores the literature on hope more widely. Fictitious case vignettes, drawn from clinical practice during the pandemic, are used to illustrate how hope-based approaches can be applied to practice.","PeriodicalId":9336,"journal":{"name":"BJPsych Advances","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74794222","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}
Eye movement desensitisation and reprocessing (EMDR) is a psychological therapy that addresses trauma, stress and emotional distress. It has been successfully used in the management of various psychiatric disorders. This article shows that it may also be safely used to manage the psychological distress arising from a variety of physical health conditions and in so doing, reduce the illness burden from conditions such as various cancers, traumatic childbirth, tokophobia, pre-eclampsia, myocardial infarction, haemodialysis in end-stage renal disease, and acute postoperative pain. It can be a stand-alone treatment for hyperemesis gravidarum and tinnitus. The article examines the rationale and evidence for its use in these conditions and suggests areas where more research is needed. Adding EMDR therapy to the range of available interventions in general hospitals has the potential to improve the health and well-being of patients in these settings.
{"title":"Eye movement desensitisation and reprocessing: part 3 – applications in physical health conditions","authors":"I. Udo, Tori-Rose Javinsky, C. McDaniel","doi":"10.1192/bja.2023.32","DOIUrl":"https://doi.org/10.1192/bja.2023.32","url":null,"abstract":"\u0000 Eye movement desensitisation and reprocessing (EMDR) is a psychological therapy that addresses trauma, stress and emotional distress. It has been successfully used in the management of various psychiatric disorders. This article shows that it may also be safely used to manage the psychological distress arising from a variety of physical health conditions and in so doing, reduce the illness burden from conditions such as various cancers, traumatic childbirth, tokophobia, pre-eclampsia, myocardial infarction, haemodialysis in end-stage renal disease, and acute postoperative pain. It can be a stand-alone treatment for hyperemesis gravidarum and tinnitus. The article examines the rationale and evidence for its use in these conditions and suggests areas where more research is needed. Adding EMDR therapy to the range of available interventions in general hospitals has the potential to improve the health and well-being of patients in these settings.","PeriodicalId":9336,"journal":{"name":"BJPsych Advances","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82012540","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}
The COVID-19 pandemic has rapidly accelerated the use of online and remote mental healthcare provision. The immediate need to transform services has not allowed for thorough examination of the literature supporting remote delivery of psychiatric care. In this article we review the history of telepsychiatry, the rationale for continuing to offer services remotely and the limitations of psychiatry without in-person care. Focusing on randomised controlled trials we find that evidence for the efficacy of remotely delivered psychiatric care compared with in-person treatment is of low quality and limited scope but does not demonstrate clear superiority of one care delivery method over the other.
{"title":"Telepsychiatry: what clinicians need to know about digital mental healthcare.","authors":"Thomas J Brunt, Oliver Gale-Grant","doi":"10.1192/bja.2022.42","DOIUrl":"10.1192/bja.2022.42","url":null,"abstract":"<p><p>The COVID-19 pandemic has rapidly accelerated the use of online and remote mental healthcare provision. The immediate need to transform services has not allowed for thorough examination of the literature supporting remote delivery of psychiatric care. In this article we review the history of telepsychiatry, the rationale for continuing to offer services remotely and the limitations of psychiatry without in-person care. Focusing on randomised controlled trials we find that evidence for the efficacy of remotely delivered psychiatric care compared with in-person treatment is of low quality and limited scope but does not demonstrate clear superiority of one care delivery method over the other.</p>","PeriodicalId":9336,"journal":{"name":"BJPsych Advances","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10374879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9901460","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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