The Psychiatrist current issue

Antipsychotic polypharmacy - confusion reigns [Editorials]

Taylor, D. — Fri, 29 Jan 2010 15:01:19 PST

Polypharmacy is usually employed where single drugs are considered insufficiently effective. Some polypharmacy is rational and evidence based, some neither. Antipsychotic polypharmacy remains stubbornly widespread despite condemnation of the practice by numerous bodies. The practice could not be said to be evidence based. Its persistence probably stems from a well-meaning desire to improve response and from confusion about the mechanism of action of antipsychotics. In particular, the concept that more antipsychotic(s) must always be, or might be, ‘better’ is virtually groundless. Nonetheless, some specific antipsychotic polypharmacy regimens have shown particular benefits on adverse effect profiles. Targeted, evidence-based polypharmacy may be the way forward.

Polypharmacy and high-dose antipsychotic regimes in the community [Original papers]

Tungaraza, T. E., Gupta, S., Jones, J., Poole, R., Slegg, G. — Fri, 29 Jan 2010 15:01:19 PST

Aims and method To determine the pattern of psychotropic prescribing in a group of people with psychosis who were living in the community under community mental health team (CMHT) care. Case-note entries over the previous 12 months were examined.

Results Only a third of individuals were on one psychotropic medication. Atypical antipsychotics were prescribed to 80.6%. Polypharmacy was common. A third of people were taking three or more psychotropic drugs and 13.7% were on high-dose regimes, mostly involving two atypical antipsychotics.

Clinical implications The use of atypicals has not eliminated polypharmacy or high-dose antipsychotic regimes. Clinicians need to be aware of this long-standing problem.

Characteristics of people with severe mental illness who obtain employment [Original papers]

Butler, G., Howard, L., Choi, S., Thornicroft, G. — Fri, 29 Jan 2010 15:01:19 PST

Aims and method We explored sociodemographic and clinical factors associated with obtaining employment for people with severe mental illness. Standardised validated interviews and questionnaires were administered to participants who had been recruited into a randomised controlled trial of supported employment.

Results Older age and diagnosis of schizophrenia were found to be independent predictors of unemployment in the previous year. Other factors of unemployment such as ethnicity and educational level were not associated with obtaining employment.

Clinical implications Older people and those with a diagnosis of schizophrenia may need additional targeted help in obtaining employment if they are to be helped to meet their vocational aims. Further research is needed to determine how this can be done most effectively.

Controlled comparison of two crisis resolution and home treatment teams [Original papers]

Fri, 29 Jan 2010 15:01:19 PST

Aims and method To compare an existing crisis resolution service with a new crisis resolution team (CRT) in Wales. The impact of the new team was measured by changes in bed days and admissions. A random sample of patients from each service was assessed for service satisfaction, social functioning and quality of life after first presentation.

Results The total number of bed days was reduced following the introduction of the new CRT (27.3%). The frequency and duration of compulsory admissions increased by 31% in the CRT between the first and second years and by 7% in the control service, offset by a greater reduction in informal admissions in the CRT (23.5%) compared with the control group (13.3%); overall bed usage was unchanged. Service satisfaction, social functioning and quality of life showed no important differences between the services.

Clinical implications Crisis resolution teams may reduce informal admissions in the short term but at the cost of more compulsory admissions later.

Electroconvulsive therapy: medical students' attitudes and knowledge [Original papers]

Kinnair, D., Dawson, S., Perera, R. — Fri, 29 Jan 2010 15:01:19 PST

Aims and method With increasing numbers of students and falling numbers of individuals receiving electroconvulsive therapy (ECT) it has been difficult to timetable all students to witness ECT, and it has been suggested that this experience may be dispensed with. However, we wondered how the experience of witnessing ECT might enhance students’ knowledge and, just as importantly, challenge negative perceptions of ECT. We surveyed students’ attitudes and knowledge at the beginning and the end of their 8-week attachment in psychiatry.

Results There appears to be a clear benefit in terms of knowledge and positive attitudinal change for students who both witness ECT and receive a lecture on the subject.

Clinical implications Direct observation of ECT can challenge and affect attitudes in ways a lecture may not. Any changes to the provision of ECT teaching for medical students, including replacing witnessing ECT, needs to be carefully developed and assessed.

Antipsychotic polypharmacy: review of mechanisms, mortality and management [Review Article]

Langan, J., Shajahan, P. — Fri, 29 Jan 2010 15:01:19 PST

Antipsychotic polypharmacy is an increasingly encountered clinical scenario. This review considers the reasons behind antipsychotic polypharmacy and the patterns of its use. We also consider the evidence of effectiveness of combined therapy v. monotherapy and the rationale behind the potentially beneficial combinations that are used. The potential dangers of antipsychotic polypharmacy are also discussed and the limited research regarding switching from polypharmacy to monotherapy is reviewed. Some provisional recommendations regarding antipsychotic polypharmacy are proposed.

Religion, spirituality and mental health [Special articles]

Dein, S., Cook, C. C. H., Powell, A., Eagger, S. — Fri, 29 Jan 2010 15:01:19 PST

Research demonstrates important associations between religiosity and well-being; spirituality and religious faith are important coping mechanisms for managing stressful life events. Despite this, there is a religiosity gap between mental health clinicians and their patients. The former are less likely to be religious, and recent correspondence in the Psychiatric Bulletin suggests that some at least do not consider it appropriate to encourage discussion of any spiritual or religious concerns with patients. However, it is difficult to see how failure to discuss such matters can be consistent with the objective of gaining a full understanding of the patient’s condition and their self-understanding, or attracting their full and active engagement with services.

A clinical librarian pilot project in psychiatry [Education & training]

Gorring, H., Turner, E., Day, E., Vassilas, C. A., Aynsley, M. — Fri, 29 Jan 2010 15:01:19 PST

Aims and method A 4-month pilot was conducted to assess whether the clinical librarian model, which has been successfully used within acute hospitals, would work in a mental health setting. A librarian attended weekly clinical team meetings in two community mental health teams to help generate clinical questions. A summary of the evidence on each topic was then presented the following week. An evaluation of the pilot was carried out using a questionnaire survey, focus groups and interviews.

Results Results suggest that the project had produced a positive impact within the teams and begun the process of embedding evidence-based information within clinical practice.

Clinical implications With some adaptations, the clinical librarian model can be an effective method of implementing evidence-based practice and addressing continuing professional development needs within mental health clinical teams.

Preparing for practice: a higher education perspective. Commentary on... A clinical librarian pilot project in psychiatry [Education & training]

Spoor, P., Neilly, L. — Fri, 29 Jan 2010 15:01:19 PST

Research suggests that contact time between clinical team and clinical librarian can have a direct and positive impact on patient care through encouraging a more rigorous approach to information retrieval and appraisal of the evidence base. This commentary focuses on the findings of a specific clinical librarian pilot project in a mental health trust. It discusses how clinicians could be better supported to develop improved information literacy skills through initiatives in higher education and what impact this might have on the model of clinical librarianship proposed by the project.

The real cost of waiting in a prison for a hospital psychiatric bed [Correspondence]

Thakkar, P. B., Kini, R., Brown, P. — Fri, 29 Jan 2010 15:01:19 PST

First things first [Correspondence]

Mushtaq, S. A., Muthuveeran, R. M. — Fri, 29 Jan 2010 15:01:19 PST

Are psychiatrists natural leaders? [Correspondence]

Agrawal, V. — Fri, 29 Jan 2010 15:01:19 PST

Doctor's ethnicity also matters [Correspondence]

Solari, C. A., El-Khoury, J. — Fri, 29 Jan 2010 15:01:19 PST

WPBA or CASC/OSCE: where is it going wrong? [Correspondence]

Sikdar, S. — Fri, 29 Jan 2010 15:01:19 PST

We all have thought processing difficulties from time to time... it's just the way we react that differs [Correspondence]

Metseagharun, T. — Fri, 29 Jan 2010 15:01:19 PST

Screening tests for dementia [Correspondence]

Ganesan, B. — Fri, 29 Jan 2010 15:01:19 PST

CORRECTIONS [Corrections]

Fri, 29 Jan 2010 15:01:19 PST

Dr Ruth Seifert [Obituaries]

Turner, T. — Fri, 29 Jan 2010 15:01:19 PST

Professor Frederick Hope Stone, OBE [Obituaries]

Stone, D., James, D., Morton, H. — Fri, 29 Jan 2010 15:01:19 PST

Adam [Reviews]

Conn, R. — Fri, 29 Jan 2010 15:01:19 PST

Understanding Repeated Self-Injury: A Multidisciplinary Approach [Reviews]

Lloyd, K. — Fri, 29 Jan 2010 15:01:19 PST

Cognitive Behavioral Therapy for Anxiety Disorders - Mastering Clinical Challenges [Reviews]

Ruths, F. A. — Fri, 29 Jan 2010 15:01:19 PST

Children with Mental Disorder and the Law: A Guide to Law and Practice [Reviews]

Khan, A., Jasper, A. — Fri, 29 Jan 2010 15:01:20 PST

Developing Mental Health Services for Children and Adolescents with Learning Disabilities: A Toolkit for Clinicians [Reviews]

Stewart, H. — Fri, 29 Jan 2010 15:01:20 PST

Professor Sir David Goldberg [E-interview]

Fannon, D. — Fri, 29 Jan 2010 15:01:20 PST