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Psychiatrists make important and specific contributions to the care of thosewith mental health problems and high-quality services should enable patientsto benefit optimally from a psychiatrist's distinctive skills. In thisarticle we seek to identify and consider the core expertise of thepsychiatrist.
To establish prevalence of domestic violence among female psychiatric patients, including risk factors, health professional attention and acceptability of routine enquiry. Participants were 70 adult women in an inner-city community mental health team who received questionnaire and case-note review. Main outcome measures were: lifetime/point prevalence of domestic violence; attitudes to routine enquiry; past disclosure and recording in psychiatric records; clinical and demographic risk factors.
Results
Lifetime prevalence was 60% for physical violence from partners, 27% during pregnancy and 40% receiving injuries. Point prevalence was not reported, as an insufficient number of participants were currently in a relationship. As many as 82% regarded routine enquiry as acceptable, but only 24% had ever been questioned. Logistic regression analysis showed prediction by presence of children, previous overdose, and experience of sexual abuse.
Clinical implications
Domestic violence in female psychiatric patients is common but undetected. Enquiry should be routine, but would require staff training.
There has been much uncertainty about the concept of recovery in psychosis. The aim of this paper is to conceptualise recovery, through service users' descriptions of their recovery stories. A qualitative approach (interpretive phenomenological analysis) was used to guide interviews and analysis of data.
Results
Eight service users were interviewed about their recovery from psychosis. Data analysis revealed four superordinate themes: ‘impacts on mental health’, ‘self-change and adaptation’, ‘social redefinition’ and ‘individualised coping mechanisms’.
Clinical implications
Data indicates that multiple dimensions of recovery are all important to individuals when considering their subjective experiences of recovery from psychosis. Recovery can only be conceptualised by the person making the recovery journey and treatment outcome measures must reflect this individuality.
To determine female authorship of original articles and editorials between January 1997 and December 2008 in the British Journal ofPsychiatry and the Psychiatric Bulletin. Editorials from Advances in Psychiatric Treatment and the geographical region of the female first author of original articles were also included in the study.
Results
The gender was determined for 99.2% of the 2324 first authors of original articles and 100% of the 614 editorials. The percentage of original articles by female first authors fluctuated over the study period, ranging from 22.5 to 42.1% (mean 33.6) in the British Journal ofPsychiatry, and from 25.5 to 46.8% (mean 37.6) in thePsychiatric Bulletin. There was a gross underrepresentation of females as first authors of editorials in all three journals. The percentage of female first authors of original articles from low- and middle-income countries ranged from 0.3 to 3.4% in both the British Journal of Psychiatry and thePsychiatric Bulletin.
Clinical implications
There is an increasing trend in female first authorship of original articles. However, females remain underrepresented, especially in editorials, in the British psychiatric journals examined. The representation of female first authors from low- and middle-income countries is disproportionately low. Strategies to address these inequalities should be implemented.
To examine the effect of taking an elective psychiatry and literature course during the first year of medical school on performance in the later mandatory general psychiatry curriculum. Class members were surveyed for baseline characteristics at the time of their admission to medical school. Following completion of their fourth year, average grades in psychiatry were calculated and results compared for those who did and those who did not take the course. Multiple regression analysis was used to assess the effects of baseline characteristics that were significantly different between the groups.
Results
Students who took the course had statistically significant(t = −3.34, P <0.001) higher grades in fourth year psychiatry. They had lower admission interview scores (t = −2.15, P <0.05) and reported less academic stress (t = −9.55,P <0.01) before taking the course.
Clinical implications
Literature is an effective medium through which to teach medical students psychiatry as it can lead to a greater understanding of the topic.
Concerns have been raised that catatonia is underdiagnosed. Prevalence varies (1.3-32%) depending on diagnostic criteria. We used the Modified Rogers Scale to rate catatonic signs in patients consecutively admitted to three psychiatric wards over a 10-month period.
Results
The prevalence of patients demonstrating any catatonic signs was at least 7.9-19.1%. The most common catatonic signs were marked underactivity (not sedated), echolalia/palilalia, marked overactivity (not restlessness) and gegenhalten. In those with catatonic signs, the most common diagnoses were schizophrenia, schizoaffective disorder and dementia.
Clinical implications
Most of the most common catatonic signs in our sample were motor signs. Antipsychotic-induced motor signs reflect interaction between drug and disease. Catatonic signs are not anchored in any one diagnosis and are on a spectrum of severity and quantity. Prevalence of these signs is higher than often presumed.
The patient's experience of the clinician is an increasingly important area in time of ‘consumer choice’ and appraisal of the individual practitioner. Validated, easy-to-use scales are scarce. The aim was to validate a user-friendly, brief scale measuring patient satisfaction (PatSat scale). Over three phases, patients were involved in developing and validating the scale against the Verona satisfaction subscale.
Results
A highly significant correlation was found between the two scales (Spearman's correlation coefficient 0.97, two-tailed P <0.001).
Clinical implications
The PatSat is a new patient satisfaction scale validated in a psychiatric out-patient population. It appeared popular with patients and took less than 1 minute to fill in. The use of validated scales measuring patient satisfaction is a pivotal part of mental health delivery and advancing overall quality of care.
To explore the extent to which 2007 Department of Health guidelines on monitoring of high-dose (⩾100 mg) methadone were followed, the reasons for non-adherence to these and the prevalence of QTc prolongation. We developed a simple tool for collecting data from case notes.
Results
Out of 25 service users, 11 had had an electrocardiogram (ECG) and 7 had evidence of requests sent to general practitioners. After implementation of our recommendations, ten more service users had ECGs within 1 month. All but one ECG was normal. Methadone prescribing in favour of lower doses has been observed. QTc interval prolongation was not common.
Clinical implications
Effective communication between primary and secondary care services is important in identifying cases and arranging ECGs.
To identify the outcomes of patients in the obstetric screening clinic. In 2 years, 180 women were referred by midwives to a clinic run by specialist community perinatal team. ‘Ultra-high risk’ patients were identified. There were four outcome measures predicated on level of care.
Results
Of those referred, 69 women were managed in primary care/generic community mental health teams, 90 by specialist perinatal team and 21 did not attend; 23 women were ultra-high risk. The majority of the ultra-high risk patients required treatment with specialist teams.
Clinical implications
Specialist community perinatal screening clinics are successful at identifying those at high risk of developing mental health problems. Ultra-high risk women needed a higher level of service. High morbidity in women who fail to attend the services demands more assertive follow-up. Cumulative personal and family history is an important risk factor.