Subscribe: Advances in Psychiatric Treatment recent issues
http://apt.rcpsych.org/rss/recent.xml
Added By: Feedage Forager Feedage Grade B rated
Language: English
Tags:
articles  childhood trauma  clinical  commentary  evidence  faith  mental capacity  mental  psychiatric  psychosis  review  sexual  treatment 
Rate this Feed
Rate this feedRate this feedRate this feedRate this feedRate this feed
Rate this feed 1 starRate this feed 2 starRate this feed 3 starRate this feed 4 starRate this feed 5 star

Comments (0)

Feed Details and Statistics Feed Statistics
Preview: Advances in Psychiatric Treatment recent issues

BJPscyh Advances recent issues



BJPscyh Advances RSS feed -- recent issues



 



New from CPD Online [CPD Online]

2017-11-01T00:05:16-07:00







Pharmacological interventions for sex offenders: a poor evidence base to guide practice: COMMENTARY ON... COCHRANE CORNER [Round the corner]

2017-11-01T00:05:16-07:00

Although a significant proportion of prisoners and patients in secure hospitals are sex offenders and victim surveys reveal a high level of hidden sexual victimisation, the authors of this Cochrane review found only very limited support for pharmacological intervention with sex offenders. Given the nature and extent of the problem of sexual offending and the promise shown by new drugs, there is a need for clinical scientists, lawyers and ethicists to rise to the challenge of ascertaining the effectiveness and safety of drugs which are being used to treat sex offenders, some involuntarily, without the evidence base to justify confidence as to their effectiveness and safety.




Mental capacity: different models and their controversies [Articles]

2017-11-01T00:05:16-07:00

Modern legislation in the UK addressing the issue of decision-making ability uses tests of mental capacity based on the individual’s ability to understand relevant information given to them. Alternative models of mental capacity do exist, but are largely considered defunct. This article reviews these alternative models and considers their importance. Far from being irrelevant to modern views on mental capacity, these models have already been incorporated into legislation such as the Mental Capacity Act 2005. A better understanding of these models can improve clinicians’ understanding of mental capacity in general. Modern controversies such as the impact of the United Nations Convention on the Rights of Persons with Disabilities (CRPD) are discussed and ways in which our understanding of mental capacity may have to change in the future are addressed.




Diversion from custody: an update [Articles]

2017-11-01T00:05:16-07:00

Liaison and diversion services are concerned with ensuring that individuals with mental health problems and related vulnerabilities who come into contact with the criminal justice system receive appropriate support and treatment. In the past 15 years there have been significant changes in policy, legislation and the broader landscape in community, custodial and hospital settings which have shaped these services. The Bradley Report, published in 2009, represents an important landmark in this field. Bradley made 82 recommendations, from interventions to improve identification of mental illness and vulnerable individuals at risk of offending to effecting speedier transfers of mentally disordered prisoners to hospital. Some progress has been made in achieving these recommendations, and further investment is promised, but at present only half of England is covered by liaison and diversion services.




After Pool: good practice guidelines for expert psychiatric witnesses [Articles]

2017-11-01T00:05:16-07:00

Acting as an expert psychiatric witness can be rewarding, but there are potential costs and pitfalls, such that the role should be undertaken only in an informed manner. With reference to the recent disciplinary cases of Dr Richard Pool and Dr Waney Squier, and a judgment of the Supreme Court, advice is offered to potential expert psychiatric witnesses. Suggestions are made as to training, the negotiation of instructions, the citation of published literature, the construction of expert opinion and how to ensure compliance with the ethical duties of the expert witness.




Working beyond your job plan [Clinical reflection]

2017-11-01T00:05:16-07:00

A job plan is part of a modern contract, informing employee and employer what they are paid to do. It is not a mandatory, inflexible tablet of stone, but frequently National Health Service (NHS) clinicians find themselves working, to their detriment, in excess of what they have agreed to do, by bridging the gap between resources and demand. So what do we do when we are persistently going above and beyond and there is no more left to give: how can we fix the system, and who really gets left behind?




Bullying victimisation and psychosis: the interdependence and independence of risk trajectories [Articles]

2017-11-01T00:05:16-07:00

A number of studies have noted an association between being the victim of bullying and psychotic symptoms. We offer an overview of the topic, focusing especially on a developmental perspective. We highlight the results of the latest studies on psychosis across the continuum and its relationship with bullying. Then we summarise the three main explanatory models investigated: developmental, biological and cognitive. We recommend that bullying in psychosis requires careful study of the developmental trajectories involved, and that research should now focus on how personal, social and biological factors interact.




Trinucleotide repeat disorders: an interesting interface between psychiatry and medicine [Refreshment]

2017-11-01T00:05:16-07:00

The discovery of conditions resulting from the expansion of unstable trinucleotide repeats, with their neuropsychiatric presentations crossing the boundaries of different specialties, provides ample opportunity for research and liaison work between medical and psychiatric subspecialties. Clinicians’ awareness of the presentations and genetic basis of these conditions improves management strategies and the quality of life of patients and their carers.




How evolutionary thinking can help us to understand ADHD [Articles]

2017-11-01T00:05:16-07:00

We argue that current debates about attention-deficit hyperactivity disorder (ADHD) can be considered afresh using an evolutionary lens. We show how the symptoms of ADHD can often be considered adaptive to their specific environment. We suggest that, from an evolutionary point of view, ADHD symptoms might be understood to result from an ‘evolutionary mismatch’, in which current environmental demands do not fit with what evolution has prepared us to cope with. For example, in our ancestral environment of evolutionary adaptedness (EEA), children were not expected to sit still and concentrate on academic tasks for many hours a day. Understanding ADHD in terms of such a ‘mismatch’ raises significant issues regarding the management of childhood ADHD, including ethical ones. An approach based on the concept of mismatch could provide an alternative to current debates on whether ADHD results from nature or nurture and whether it is under- or over-diagnosed. It would allow clinicians and policy makers to take both the child and the environment into account and consider what might be desirable and feasible, both in society and for specific children, to lessen the mismatch.




The role of faith in mental healthcare: philosophy, psychology and practice [Articles]

2017-11-01T00:05:16-07:00

It is time to improve clinical approaches to faith in mental healthcare, particularly in psychotherapy. Understood as a psychological trait, faith has potentially great personal salience and introduces socially desirable biases into human reasoning. Therapies may have faith-informed components, either explicitly, or (as with some forms of mindfulness) implicitly, which may modify the patient’s faith as well as producing symptomatic change. In this narrative review, the ethics of faith’s inclusion in therapy is briefly appraised. The psychology of faith is discussed, and a model of the influence of the practitioner’s faith on therapeutic choice is presented. Finally, faith-informed approaches to practice, including their impact on therapeutic effectiveness, are considered and recommendations made for their optimal implementation.




Integrating religious faith into patient care: COMMENTARY ON... THE ROLE OF FAITH IN MENTAL HEALTHCARE [Commentary]

2017-11-01T00:05:16-07:00

We examine Foreman’s assertion that assessing, addressing and utilising a patient’s faith is warranted. After a brief background, we examine when faith-integrated therapy is indicated, the need for training, an example of such a therapy, and what to do when the faith of the therapist conflicts with that of the patient. Also emphasised is the need for a clear definition of terms.




The Fish Can Sing by Halldor Laxness: holding fast against vanity and illusion [Mindreading]

2017-11-01T00:05:16-07:00

In his early novels, the Icelandic Nobel laureate Halldór Laxness portrayed troubled individuals beset by familial, societal and economic challenges within an unpredictable and often unforgiving landscape; his later work addressed humanistic concerns regarding a well-lived life and the harmony of individual and environment. His 1957 novel The Fish Can Sing lies at the cusp of these preoccupations. Laxness contrasts the economic privations experienced by hard-pressed Icelanders with the ostentatious displays of their Danish colonial overloads; he also portrays individuals afflicted by psychosis, alcohol use disorders and medically unexplained physical symptoms, and delineates the path towards a ‘celebrity’ suicide. The novel warns against self-deceptive vanity and community-endorsed illusions, and celebrates the persistent benefits of nurturing relationships, all within a lyric contemplation of individual adaptive resilience and quotidian domestic pleasures.




New from CPD Online [CPD Online]

2017-09-01T00:09:00-07:00




Controversy over exercise therapy for chronic fatigue syndrome: continuing the debate [Round the corner]

2017-09-01T00:09:00-07:00

EDITOR’S SUMMARY

In a recent Round the Corner, Mitchell commented on a Cochrane Review of exercise therapy for chronic fatigue syndrome (CFS). One of the trials included in that review, and discussed by Mitchell, was the PACE trial. In this month’s Round the Corner we are publishing a response we received from authors of the PACE trial (Chalder, White & Sharpe), together with Mitchell’s reply. Ed.




Clinical staging models: from general medicine to mental disorders [Articles]

2017-09-01T00:09:00-07:00

Revisions of international classification systems for mental disorders have focused on improving the reliability of diagnostic criteria. However, the uncertain validity of the current diagnostic categories means that they do not always fulfil their key purposes, namely to guide treatment and predict outcomes. This is especially true when traditional diagnostic approaches are applied to adolescents and young adults with emerging illnesses. A clinical staging model, similar to those used in general medicine, could improve diagnosis in psychiatry and aid treatment decision-making, especially if applied to individuals aged about 15–25 years, which is the peak age range for the onset of severe mental disorders. Staging models may offer a new framework for the development of interventions with high benefit and low risk, and for research into neurobiological and psychosocial risk factors. However, this approach is not without controversy: some experts oppose its introduction, some argue that it represents a transdiagnostic model, and some suggest it is only viable if disorder-specific models are used.




Why sex is important: background for helping patients with their sexual lives [Articles]

2017-09-01T00:09:00-07:00

Therapy for sexual problems is not solely based on findings from scientific studies; much of it has to do with intuitive knowledge that comes from personal and clinical experience. The author suggests that an ideal way to begin education about helping with patients’ sexual identity, sexual function and relational concerns is to consider why sex is important. Answering this question illuminates the subtle roles sexual behaviour play in our lives. These roles are explained by providing clinically based responses to twelve questions: How are adults nurtured in sexual relationships? How is psychological intimacy created? What is learnt over time through sex? What accounts for the pleasures of sex? Why is sex important? Why is sexual experience unstable? What is a couple’s sexual equilibrium? What is sensuality? Is a life of sexual pleasure possible? What is sexual health? What are the sources of distress about sex? How do these concepts facilitate therapy?




Does childhood trauma play a role in the aetiology of psychosis? A review of recent evidence [Articles]

2017-09-01T00:09:00-07:00

There has been a resurgence of interest in the role of childhood trauma in the aetiology of psychosis. In this review, recent findings on the association between childhood trauma and a continuum of psychotic symptoms are presented. Evidence of the association between specific childhood trauma subtypes and psychotic symptoms is examined, with a brief discussion of some current hypotheses about the potential mechanisms underlying the associations that have been found. Some practice implications of these findings are also highlighted.




Not a one-way street: COMMENTARY ON... DOES CHILDHOOD TRAUMA PLAY A ROLE IN THE AETIOLOGY OF PSYCHOSIS? [Commentary]

2017-09-01T00:09:00-07:00

Coughlan & Cannon have provided an extremely useful review, highlighting the evidence for the association between childhood trauma and psychosis. This is relevant to those working with individuals with psychosis across all age ranges. This commentary discusses further some of the points raised, the complexity of the association and developmental aspects.




Schizophrenia is not a kind of PTSD: COMMENTARY ON... DOES CHILDHOOD TRAUMA PLAY A ROLE IN THE AETIOLOGY OF PSYCHOSIS? [Commentary]

2017-09-01T00:09:00-07:00

Coughlan & Cannon’s article provides a helpful review of the current state of evidence regarding the connection between childhood trauma and psychotic-like symptoms. This commentary focuses on the clinical implications by noting that much of the data comes from studies in non-patient populations and to some extent depends on the underlying assumption of the continuum model of psychosis. I reconsider the presented data focusing purely on clinical diagnoses of psychosis, and consider the implications of the association between trauma and psychosis by looking at the evidence base for specific trauma-focused therapies in psychosis.




Thought disorder [Refreshment]

2017-09-01T00:09:00-07:00

We review thought disorder in psychopathology, including how one can assess it clinically, useful psychometric measures and its clinical importance. In the final section we discuss how recent studies in neuropsychology and neuroimaging have helped understand the mechanisms of abnormal speech and languages in psychotic illnesses.




Functional near-infrared spectroscopy in psychiatry [Articles]

2017-09-01T00:09:00-07:00

Functional near-infrared spectroscopy (fNIRS) has been used in healthcare and medical research for the past two decades. In particular, the use of fNIRS in academic and clinical psychiatry has increased rapidly owing to its advantages over other neuroimaging modalities. fNIRS is a tool that can potentially supplement clinical interviews and mental state examinations to establish a psychiatric diagnosis and monitor treatment progress. This article provides a review of the theoretical background of fNIRS, key principles of its applications in psychiatry and its limitations, and shares a vision of its future applicability in psychiatric research and clinical practice.




Disordered eating in older people: some causes and treatments [Articles]

2017-09-01T00:09:00-07:00

This overview considers causes of disordered eating, including eating disorders, in older people. Eating disorders are becoming more common in older adults and research has shown a related mortality of 21%. The wide range of medical and pharmacological causes of weight loss in older people means that eating disorders may go undetected, occurring insidiously and surreptitiously.




Therapeutic communities and planned environments for serious offenders in English prisons [Articles]

2017-09-01T00:09:00-07:00

Several English prisons contain democratic therapeutic communities (TCs) for personality disordered offenders, and addiction TCs for serious substance misusers. This article describes how these are organised and comments on how they are specifically tailored and accredited for use in custodial settings. It also describes ‘psychologically informed planned environments’ (PIPEs), offender pathways for those with personality disorders and psychopathy which provide additional support for psychological treatment. It ends by explaining how ‘enabling environments’ are assessed, since these are now becoming widely adopted in prisons to reverse toxic environments – which affect staff, the prison and the outside world as well as the individual prisoner – and to counter negative learning found in custodial institutions.




Danger in deep water or just ripples in the pool: has the Pool judgment changed the law on expert evidence? [Articles]

2017-09-01T00:09:00-07:00

The professional regulatory cases of the psychiatrist Dr Richard Pool and the neuropathologist Dr Waney Squier have given rise to concerns among expert psychiatric witnesses, and indeed medical experts in general. Here we restate the law on expert evidence with particular reference to the judgment of the Supreme Court in the case of Kennedy v Cordia. We emphasise that Pool does not change the law regarding ‘what is expertise’; in particular, the case does not establish restrictive, status-based tests governing the admissibility of expert evidence such as according to whether an expert psychiatric witness has undergone higher training, is on the specialist register as a specialist in a particular field or is a consultant. Rather, expertise continues to be legally defined in terms of a combination of qualification, knowledge and experience. Crucially, the test of medical expertise in legal proceedings is a legal test and not one determined within a medical paradigm.




New from CPD Online [CPD Online]

2017-07-03T00:08:02-07:00







Does the evidence support parent-infant psychotherapy?: COMMENTARY ON... COCHRANE CORNER [Round the corner]

2017-07-03T00:08:02-07:00

Parent–infant psychotherapy (PIP) is a psychoanalytic intervention that aims to improve parental and infant mental health. There is uncertainty about the clinical effectiveness of this intervention, particularly in comparison with other interventions. Based on a limited number of trials, this month’s Cochrane Corner review aimed to summarise the best evidence available. Although the review found some tentative support for PIP in relation to attachment outcomes, overall the evidence was of low quality and PIP was not found to be more effective than treatment as usual or other interventions. This commentary contextualises and summarises the findings, and considers their implications for researchers and clinicians.




Community treatment orders: are they useful? [Articles]

2017-07-03T00:08:02-07:00

In the wake of the deinstitutionalisation of mental health services, community treatment orders (CTOs) have been introduced in around 75 jurisdictions worldwide. They make it a legal requirement for patients to adhere to treatment plans outside of hospital. To date, about 60 CTO outcome studies have been conducted. All studies with a methodology strong enough to infer causality conclude that CTOs do not have the intended effect of preventing relapse and reducing hospital admissions. Despite this, CTOs are still debated, possibly reflecting different attitudes to the role of evidence-based practice in community psychiatry. There are clinical, ethical, legal, economic and professional reasons why the current use of CTOs should be reconsidered.




Ethical dilemmas in psychiatry: when teams disagree [Articles]

2017-07-03T00:08:02-07:00

Many ethical dilemmas in medicine are associated with highly unusual clinical situations and are an almost daily challenge for mental health teams. We describe the ethical issues that arose in relation to a significant difference of opinion between team members about using nasogastric clozapine in the treatment of a severely ill patient. We discuss how conflicting emotions and perspectives within teams acquire ethical significance and how negotiation and reflection are essential for good-quality ethical reasoning to take place.




Compassion-focused therapy with children and adolescents [Articles]

2017-07-03T00:08:02-07:00

Compassion-focused therapy (CFT) is embedded in an evolutionary, functional analysis of psychopathology, with a focus on affiliative, caring and compassion processes. CFT has been applied in a number of adult settings, but its clinical applications in child and adolescent psychopathology and psychotherapy have not been systematically explored. This article describes the applications of CFT in paediatric populations. Specifically, the following developmental considerations are discussed: the unique importance of parent–child and attachment relationships for the development of self-compassion, being open to compassion from others and being compassionate to others; the potential effect of compassion training on the maturing brain (affective regulation systems); and the therapeutic targeting of shame and self-criticism to alleviate psychological distress and enhance the effectiveness of cognitive–behavioural interventions.




Managing aggression in epilepsy [Articles]

2017-07-03T00:08:02-07:00

Behavioural changes associated with epilepsy can be challenging for patients and clinicians. Evidence suggests an association between aggression and epilepsy that involves various neurophysiological and neurochemical disturbances. Anti-epileptics have variable effects on behaviour and cognition that need consideration. Early detection and careful consideration of history, symptomatology and possible common comorbid psychiatric disorders is essential. Appropriate investigations should be considered to aid diagnosis, including electroencephalogram (EEG), video EEG telemetry and brain imaging. Optimising treatment of epilepsy, treatment of psychiatric comorbidities and behavioural management can have a major positive effect on patients’ recovery and well-being.




HIV infection and its psychiatric manifestations: a clinical overview [Articles]

2017-07-03T00:08:02-07:00

Highly active antiretroviral therapy (HAART) has led to a reduction in HIV-related morbidity and mortality, and the life expectancy of HIV-positive individuals has improved significantly. It is therefore becoming more likely that clinicians will encounter patients with psychiatric manifestations of the disease. This review summarises the evidence on prevalence, manifestations and treatment of psychiatric conditions in HIV-positive adults. The most prevalent psychiatric illness in this population is depression (35.6%), followed by substance misuse, anxiety, psychosis, adjustment disorder and bipolar affective disorder. Neurocognitive impairment is also common, ranging in severity from asymptomatic (the most frequent) to dementia (the least frequent). Effective treatment of both HIV and psychiatric manifestations is essential to maximising life expectancy and quality of life.




Management of antipsychotic-induced hyperprolactinaemia [Articles]

2017-07-03T00:08:02-07:00

Hyperprolactinaemia is a common endocrine disorder that can be associated with significant morbidity. Antipsychotic medications are frequently linked to hyperprolactinaemia. This disorder usually presents as menstrual problems in women and sexual problems in men, which affect the patients’ quality of life and adherence to antipsychotic treatment. In the past, treatment for hyperprolactinaemia was recommended only for symptomatic patients. However, it has become clear that persistent asymptomatic hyperprolactinaemia can be associated with long-term physical morbidities such as osteoporosis and possibly breast cancer. Hence, it is imperative that hyperprolactinaemia is managed even if asymptomatic when initially detected. This article discusses the various management options, such as reducing the dose of antipsychotic medication, switching to a prolactin-sparing antipsychotic and adding aripiprazole to the treatment regimen.