Advances in Psychiatric Treatment current issue

[Editorials] Deliberate practice and CPD in psychiatry

Bhugra, D. — 2008-04-30

Deliberate practice (the seeking of situations in which one’s skills are challenged and thus improved) is key to the acquisition of clinical expertise. This editorial outlines the philosophy of deliberate practice and potential difficulties in making use of it in psychiatry.

[Editorials] Psychiatry and the arts: new interfaces?

Green, J. — 2008-04-30

I discuss the productive interface between psychiatry and the arts in the 20th century and ask whether such an interface is likely to remain as vibrant into the 21st. I review how new models of mental functioning that have an impact on current psychiatric practice have a wider cultural relevance. This editorial looks forward to a series of articles in future issues of APT which will explore some of these ideas in more detail.

[Articles] Mentalisation and metaphor in poetry and psychotherapy

Holmes, J. — 2008-04-30

People turn to poetry and to psychotherapy when in states of heightened emotion – love, elation, despair, death and loss. Through the analysis of a particular poem this article suggests that there are formal similarities between poetry and psychotherapy that can illuminate the workings of the latter. Perhaps the most overarching of these is mentalisation: the capacity to ‘think about feelings’ or to be ‘mind-minded’. Finding the ‘right words in the right order’ is a task for therapists and their patients as well as for poets, since the appropriate image or metaphor can mirror or evoke feelings in the listener in a way that facilitates empathic attunement. If feelings can be objectified, their power to distress or overwhelm is mitigated. Thus, poetry and psychotherapy are similarly concerned with processes of repair of the human experiential and communicative fabric.

[Articles] Detained - what's my choice? Part 1: Discussion

Roberts, G., Dorkins, E., Wooldridge, J., Hewis, E. — 2008-04-30

Choice, responsibility, recovery and social inclusion are concepts guiding the ‘modernisation’ and redesign of psychiatric services. Each has its advocates and detractors, and at the deep end of mental health/psychiatric practice they all interact. In the context of severe mental health problems choice and social inclusion are often deeply compromised; they are additionally difficult to access when someone is detained and significant aspects of personal responsibility have been temporarily taken over by others. One view is that you cannot recover while others are in control. We disagree and believe that it is possible to work in a recovery-oriented way in all service settings. This series of articles represents a collaborative dialogue between providers and consumers of compulsory psychiatric services and expert commentators. We worked together, reflecting on the literature and our own professional and personal experience to better understand how choice can be worked with as a support for personal recovery even in circumstances of psychiatric detention. We were particularly interested to consider whether and how detention and compulsion could be routes to personal recovery. We offer both the process of our co-working and our specific findings as part of a continuing dialogue on these difficult issues.

[Articles] Continuing the dialogue: INVITED COMMENTARY ON ...DETAINED - WHAT'S MY CHOICE? PART 1

Copeland, M. E., Mead, S. — 2008-04-30

We consider the value of dialogue between healthcare professionals and mental health service users with severe mental illnesses. Discussion with the service user before, during and after a psychiatric crisis should help services to offer choice even to individuals under compulsory detention.

[Articles] 'To God' and 'The Silent One': poems by Ivor Gurney

2008-04-30

[Articles] A values-based perspective on good practice in compulsion: INVITED COMMENTARY ON ... DETAINED - WHAT'S MY CHOICE? PART 1

Fulford, K. W. M., King, M. — 2008-04-30

We outline how the values-based approach adopted in training materials supporting the Mental Health Act 2007 for England and Wales will complement recovery-based practice in compulsory psychiatric detention.

[Articles] Detained - what's my choice? Part 2: Conclusions and recommendations

Dorkins, E., Roberts, G., Wooldridge, J., Hewis, E. — 2008-04-30

We have developed this succession of articles as a series of iterative steps, each seeking to uphold the recovery values of co-working and collaboration, looking for agreement and commonality but valuing equally diverse viewpoints and difference. Our conclusion is that this is the beginning of a creative dialogue on choice as a route to recovery for people who are psychiatrically detained. We commend our method of engaging with the inevitable tensions and dilemmas by: clarifying the story behind difficult interactions, identifying the relevant guiding principles and jointly working to explore from different viewpoints what can be done to promote recovery.

[Articles] Problem psychiatrists?

Margerison, N. — 2008-04-30

This article focuses mainly on issues regarding doctors’ clinical performance (capability) and behaviour (conduct), and is aimed at medical managers who deal them. It covers identifying problems and how to manage them, describes typical underpinning (disciplinary) frameworks and sets out the role of the UK’s National Clinical Assessment Service and other external bodies in more serious cases.

[Articles] How to implement a smoke-free policy

Cormac, I., McNally, L. — 2008-04-30

It takes courage, leadership and planning to successfully implement a smoke-free policy in mental health settings. The content of the policy is crucial in setting parameters for implementation. Management and clinicians should work closely together to develop and coordinate the implementation strategy, ensuring that resources are effectively used and deadlines are met. Key success factors are effective management at both central and local levels, as well as consultation with service users, carers and staff to gain support for the policy and obtain suggestions for improvement. Other important factors are advance planning, recruitment of experienced staff, effective communication and extensive training of staff in smoking cessation support. Local teams should develop appropriate procedures based on the policy. They should work closely with the central management team. The resources developed and obtained by local teams should be shared throughout the organisation and should be tailored to meet the needs of particular services.

[Articles] Review of smoking cessation treatments for people with mental illness

Campion, J., Checinski, K., Nurse, J. — 2008-04-30

This article reviews the current literature regarding treatments for smoking cessation in both the general population and in those with mental health problems. The gold-standard treatment for the general population is pharmacotherapy (nicotine replacement therapy, bupropion or varenicline) coupled with individual or group psychological support. This is also effective in helping people with mental illness to reduce or quit smoking, but care must be taken to avoid adverse medication interactions and to monitor antipsychotic medication in particular as cigarette consumption reduces.

[Articles] Smoking by people with mental illness and benefits of smoke-free mental health services

Campion, J., Checinski, K., Nurse, J., McNeill, A. — 2008-04-30

Smoking is the largest single cause of preventable illness in the UK. Those with mental health problems smoke significantly more and are therefore at greater risk. The new Health Act (2006) will require mental health facilities in England to be completely smoke-free by 1st July 2008. This article reviews the current literature regarding how smoking affects both the physical and mental well-being of people with mental health problems. It also considers the effects of smoke-free policy in mental health settings.

[Articles] Medical history-taking in psychiatry

Phelan, M., Blair, G. — 2008-04-30

A good medical history is an essential starting point in ensuring that the physical health needs of people with severe mental illness are addressed. Psychiatrists have an important role in helping to tackle the general ill health, excess of undiagnosed physical illness and reduced survival rates among their patients. To do this they need to use their medical training, communication skills and regular contact with patients. Assessments should include family history, past and current physical health, medication, lifestyle, healthcare and physical symptoms. Some groups of patients will need more detailed assessments.

[Articles] IQ tests as aids to diagnosis and management in early schizophrenia

Harrison-Read, P. — 2008-04-30

Intellectual and other more specific neurocognitive impairments in schizophrenia are important for understanding the aetiology of the condition and its likely outcome. However, these impairments are not usually considered important for supporting a diagnosis in suspected early schizophrenia. IQ testing is widely available and probably acceptable to most people likely to be experiencing the early stages of psychosis and who might be unable or unwilling to disclose details of their history and mental state or to cooperate with more comprehensive neuropsychological assessment. Although in general IQ tests have only limited diagnostic value in schizophrenia, the finding of a substantial decline in IQ score from the estimated premorbid level may be helpful in supporting a provisional diagnosis of early schizophrenia in cases without organic signs in which the clinical picture is unclear or incomplete. More important, the results of IQ tests may contribute to a better understanding of patients’ impairments and assist clinical management in a number of ways, as illustrated here by three fictional case studies.