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Objective: This paper aims to discuss the answers to Review Paper Exam for the Malaysian Master of Medicine (Psychiatry) May 2012 theory examination. The paper studied the psychotropic prescription practice in cancer patients using a health care registration database. Methods: One of the papers presented during the journal club presentation was picked-up for evaluation of student's critical appraisal. Results: Model answers were provided at the end of the Critical Review Paper. Conclusion: This review paper evaluates students' understanding and critical thinking on the topic of Psychotropic Drugs in cancer patients. This paper may serve as a guideline to teach students how to critically appraise topic related to psychiatry. [ABSTRACT FROM AUTHOR]

This article presents a speech by Barbara Wootton delivered at the Quarterly Meeting of the Royal College of Psychiatrists in London, England on November 18, 1976. She discusses the contributions of Aubrey Lewis to psychiatry and in particular she examines Lewis' research on health as a social concept in the light of recent developments in psychiatry. She praises Lewis for making a sensible and measurable definition of health and its application in understanding mental illness.

Background: Whereas the most influential journals in psychiatry are English language journals, periodicals published in other languages serve an important purpose for local communities of clinicians and researchers. This study aimed at analyzing the scientific production and the recognition of non-English general psychiatry journals. Methods: In a cohort study, the 2009 volume of ten journals from Brazil (1), German language countries (5), France (2), Italy (1), and Poland (1) was searched for original articles. Patterns of citations to these articles during 2010 and 2011 as documented in Web of Science were analyzed. Results: The journals published 199 original articles (range: 4-46), mostly observational studies. Half of the papers were cited in the following two years. There were 246 citations received, or an average of 1.25 cites per article (range: 0.25-4.04). Many of these citations came from the local community, that is, from the same authors and journals. Citations by other periodicals and other authors accounted for 36% [95%-CI: 30%-42%], citations in English sources for 33% [28%-39%] of all quotations. There was considerable heterogeneity with regard to citations received among the ten journals investigated. Conclusion: Non-English language general psychiatry journals contribute substantially to the body of research. However, recognition, and in particular recognition by the international research community is moderate. [ABSTRACT FROM AUTHOR]

In their recent paper, Natalie Banner and Tim Thornton evaluate seven volumes of the Oxford University Press series "International Perspectives in Philosophy and Psychiatry," an international book series begun in 2003 focusing on the emerging interdisciplinary field at the interface of philosophy and psychiatry. According to Natalie Banner and Tim Thornton, the series represents a clear indication that the interdisciplinary field of philosophy of psychiatry has been flourishing lately. Philosophers and psychiatrists face a "new philosophy of psychiatry". However, the optimism which the "new" philosophy of psychiatry celebrates is precisely the exiling of philosophy from the foundations of psychiatry. The 150 year old belief that psychopathology cannot do without philosophical reflection has virtually disappeared from common psychiatric education and daily clinical practice. Though the discipline of psychiatry is particularly suited to contributions from philosophy, the impact of philosophy on psychiatry nowadays remains limited. With some exceptions, philosophical papers are embedded in a philosophical context inscrutable to ordinary psychiatrists. Much current philosophical work is perceived by psychiatrists as negativistic. I would encourage the field of psychiatry to incorporate once again basic philosophical attitudes which render possible true dialogue with philosophy and enrich both disciplines. The views developed here should not discredit the value and importance of Natalie Banner and Tim Thornton's paper and the excellent series "International Perspectives in Philosophy and Psychiatry." As Jaspers said "Everybody inclined to disregard philosophy will be overwhelmed by philosophy in an unperceived way". [ABSTRACT FROM AUTHOR]

Background: This paper is concerned with the issue of service user involvement in education and training within psychological therapy training within the UK. Aims: In particular this paper reflects on the literature on user involvement to gain a deep understanding of its status in the education and training of psychological therapists. Method: A systematic search of the literature indicates minimal involvement from service users in the education and training of psychological therapists. Results: The possible reasons for this are discussed, along with what service users might want from such involvement, what it might add to psychological therapies training, the models of involvement that might be adopted, how service users may be recruited and how they may be involved in the various stages of the educational process, from commissioning, through delivery, to evaluation of programmes. Conclusion: If service user involvement in psychological therapy training is carefully planned, supported and evaluated, it could improve the trainees' practice, so that it reflected the priorities and wishes of those receiving the service. Nevertheless, it is currently an underdeveloped area within contemporary psychological educational practice. Declaration of interests: None. [ABSTRACT FROM AUTHOR]

The concept of 'whole system' working is fundamental to contemporary policy and consequently to practice and service development within UK mental health services. This paper reports on an exploratory study of the meaning of the 'whole system' to staff working within adult mental health services in North Wales, conducted within a broader practice development project. A focus group was used to collect data from a multiprofessional group drawn from two acute inpatient wards, Community Mental Health Teams (CMHTs) and an assertive outreach team. Thematic analysis generated three themes central to effective whole system working in adult mental health services. Discussion on the efficacy of the whole system gave rise to an understanding that this whole system varies in its effectiveness in responding to people with differing clinical presentations. Furthermore, it appears that under certain circumstances, the whole system may work to shift responsibility in order to manage worker's anxiety more adroitly than, for example, working creatively to respond to people's needs. The paper concludes that whilst by no means exhaustive or complete, these three themes enable critical reflection, discussion and identification of practice development challenges that may facilitate more effective whole system working and better services in North Wales and possibly in other settings. [ABSTRACT FROM AUTHOR]

Since at least 1970, one of the constraints upon compensability for pure mental harm at common law has been that a plaintiff must have suffered not just adverse psychological consequences from negligence but a ‘recognisable psychiatric illness’. In a powerful unanimous decision, the Supreme Court of Canada in Saadati v Moorhead [2017] 1 SCR 543 has controversially removed this requirement. This paper reviews the reasoning in the decision and considers its ramifications, concluding that while it is likely to extend the liability of defendants, this will occur only in a small cross-section of cases where a plaintiff exhibits significant symptomatology of a mental disorder albeit falling short of sufficient for an unequivocal diagnosis within the meaning DSM-5 or ICD-10. It notes that in the post-Ipp reforms in Australia, a ‘recognised psychiatric illness’ has been statutorily enshrined as a prerequisite to recovery by plaintiffs, so statutory law reform would be required to implement the Saadati decision. While it welcomes the contribution of the Saadati approach to reducing the law’s discrimination against mental (as opposed to physical) injuries, it calls for close scrutiny of the actual effects of the Saadati decision. [ABSTRACT FROM AUTHOR]

Films featuring psychiatrists, psychiatry and the mentally ill abound, for better or for worse. The use of cinema in postgradute psychiatry training has been gaining increasing acceptability, but its potential for use in undergraduate psychiatry has received little attention in the literature. This paper reports on the rationale behind, and medical students' responses to a special study module for third year medical students at King's College London, which utilized movies to highlight the significance of the social, cultural and historical context in shaping representations of mental illness, psychiatry, and psychiatrists. Medical students were very receptive to the use of film as an educational tool and able to understand both the benefits and limitations. They found the module enjoyable, and subjectively rated their knowledge of psychiatric topics and the history of psychiatry as significantly improved. The results presented are course feedback from medical students (n = 8) who completed the module. Although our findings provide provisional support for the use of film as an educational tool in undergraduate psychiatry, more systematic research is needed to delineate the potential role of cinema in undergraduate psychiatric education. [ABSTRACT FROM AUTHOR]

Psychopathology is usually recognized as an important clinical and research tool in psychiatric textbooks. However, in the era of operationalized psychiatric diagnosis, therapeutic guidelines and strong neuroscientific impact on the self-understanding of psychiatry, its role became somewhat insecure in recent decades. And it has even been argued that psychopathology will sooner or later be fully replaced by neuroscientific concepts. This paper elucidates the theoretical (and, partly, historical) framework of this debate and argues for a modern understanding of psychopathology. This understanding will, on the one hand, be compatible with neurobiological and social sciences appoaches to mental illness, and, on the other hand, will not abandon psychopathology's demand to be an indispensable foundation of psychiatry. [ABSTRACT FROM AUTHOR]

Convulsive therapy (COT) is a major European contribution to the psychiatric armamentarium and biological psychiatry. COT was introduced in psychiatry by László Meduna, a Hungarian neuropsychiatrist. All subsequent publications about the first patient treated with COT, Zoltán L (ZL), were based on Meduna’s papers and autobiography. After 4 years of catatonic stupor, ZL received camphor-induced COT which resulted in full remission and discharge from the institution. The aim of this paper is to reconstruct ZL’s case history from the original case notes—partly written by Meduna himself—which were recovered from the archives of the National Institute of Psychiatry and Neurology. The case notes show that ZL repeatedly received COT between 1934 and 1937, first with camphor and then with cardiazol induction. After the first course of COT the catatonic stupor was resolved and the psychotic symptoms subsided. However, the remission lasted for only a few months and was followed by a relapse. Despite repeated courses of COT, ZL never became symptom free again, was never discharged and died in the Institute in 1945. This historical case is discussed from both the diagnostic and therapeutic points of view, and an attempt is made to explain the possible reasons for the discrepancies found between Meduna’s account and ZL’s case notes. [ABSTRACT FROM AUTHOR]

The issue of power has become increasingly important within psychiatry, psychotherapy and mental health nursing generally. This paper will suggest that the work of Michel Foucault, the French philosopher and historian, has much to contribute to the discussion about the nature, existence and exercise of power within contemporary mental health care. As well as examining his original and challenging account of power, Foucault's emphasis on the intimate relationship between power and knowledge will be explored within the context of psychiatry and mental health nursing. This is to say that the paper will investigate Foucault's account of how power and knowledge are central to the process by which human beings are‘made subjects’ and therefore how‘psychiatric identities’ are produced. In doing so, it will be suggested that Foucault's work can not only make a valuable contribution to contemporary discussions about power and knowledge, but can also provide a significant critique and reconceptualization of the theoretical foundations and associated diagnostic and therapeutic practices of psychiatry and mental health nursing. [ABSTRACT FROM AUTHOR]

This paper describes a statewide survey assessment of the training needs of governing board members and presents a demographic profile of governing board presidents. Presidents of the 55 governing boards in a consortium of state-funded, community-based mental health agencies were mailed questionnaires. They were asked to respond in terms of board rather than individual priorities. Forty-four questionnaires were returned representing 80% of the sample and 57% of all governing boards in the state. Seventy-one percent of the respondents were male and 55% were executives or managers. Their mean age was 45. Of the 10 needs assessment items, the two highest rated pertained to the financing of centers and knowledge of mental health legislation. Three areas of need emerged from a factor analysis; a board mandate factor, a board organization factor, and a planning and evaluation factor. The perceived training needs of the Chicago Metropolitan Area and Downstate Illinois were similar. The issue of effective citizen involvement vis-à-vis valid representation and appropriate training was discussed. [ABSTRACT FROM AUTHOR]

The Outline for Cultural Formulation (OCF) in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) marked an attempt to apply anthropological concepts within psychiatry. The OCF has been criticized for not providing guidelines to clinicians. The DSM-5 Cultural Issues Subgroup has since converted the OCF into the Cultural Formulation Interview (CFI) for use by any clinician with any patient in any clinical setting. This paper presents perceived barriers to CFI implementation in clinical practice reported by patients ( n = 32) and clinicians ( n = 7) at the New York site within the DSM-5 international field trial. We used an implementation fidelity paradigm to code debriefing interviews after each CFI session through deductive content analysis. The most frequent patient threats were lack of differentiation from other treatments, lack of buy- in, ambiguity of design, over- standardization of the CFI, and severity of illness. The most frequent clinician threats were lack of conceptual relevance between intervention and problem, drift from the format, repetition, severity of patient illness, and lack of clinician buy- in. The Subgroup has revised the CFI based on these barriers for final publication in DSM-5. Our findings expand knowledge on the cultural formulation by reporting the CFI's reception among patients and clinicians. [ABSTRACT FROM AUTHOR]

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This paper deals with clinical situations frequently encountered in military psychiatry. Using three narratives of soldiers assessed at the Israeli Defence Forces (IDF) during a period of marked conflict between Israel and the Palestinian Authority, the author portrays ethical dilemmas generated during assessments for fitness to go to combat. When the focus of the assessment is the soldier's refusal to serve in the army, particularly during periods of increased conflict, the psychiatrist faces a dilemma because of double loyalties, to the army of which he is a part, and to the soldier and his right to live. Based on previous literature and experience, some cases of refusal to serve may be understood going beyond the boundaries imposed by the medical model. The author discusses these issues in the context of Israeli society. In Israel, conscription is universal, and the army is not professional. However, given the lack of social legitimacy in Israel for refusal to serve in the IDF due to conscientious objection, soldiers who are otherwise aware of the ethical dilemmas imposed upon them by the harsh Israeli reality are left with no option other than to get exempted from military duties on psychiatric grounds. The author discusses how social and historical factors contribute to the construction of psychiatric and psychological symptoms. [ABSTRACT FROM AUTHOR]

The thrust of this paper is to argue that Habermasian theory can provide useful insight and understanding to inform participatory research in the area of forensic mental health care. Habermasian theory about communication, participation, and democracy is used to explore retrospectively the relatively free discussions that took place within a user-led research project evaluating forensic mental health care. We (the academics within the research project team) first describe the stages of the research project, outlining how it opened up space for discussion about service users' experiences of the forensic mental health care they had received. Habermas's distinction between 'strategic action' (orientated towards getting things done) and 'communicative action' (interaction orientated towards freely agreeing consensual understanding) is then explored in a re-analysis of users' accounts of the interactions they recalled having with service providers. We then offer an account of interactions between service user researchers presenting their work at academic forums and their audiences of service providers. In particular, we look at the communication that occurred and, again using Habermasian theory, consider the issues that arose about open discussion and similarities and differences between therapy and participatory research. [ABSTRACT FROM AUTHOR]

Current research suggests that the presence of social capital (Putnam, R. D. (1993). The prosperous community: Social capital and public life. American Prospect, 13, 35-42.) in a community setting positively affects physical and psychological health and well-being. Indeed, McKenzie et al. ((2002). Social capital and mental health. British Journal of Psychiatry, 181, 280-283.) highlighted the impact of social context on mental health and noted that social capital may be influential in the incidence and prevalence of mental illness. The authors suggested that studies of the geographies of mental health could also be useful in understanding the relationship between social capital and psychological health and well-being but note that this relationship is likely to be complex. The purpose of this paper is to develop the commentary from McKenzie et al. further and consider the relationship between social capital, psychological health and a society experiencing conflict. Social capital is often described as the glue that holds society together, producing a positive environment for a community to foster and thrive. Little attention has focused on the relationship between social capital and psychological health and well-being when specific communities experience (and/or contribute to) political strife and civil disorder. One would assume that social capital at the horizontal level is minimal in these cases as civil conflict acts as a barrier to its production. This would have a deleterious effect on psychological health and well-being. The issues outlined above are explored in the context of one region of the United Kingdom currently experiencing civil conflict: Northern Ireland. Social capital theory is re-conceptualized in this light. [ABSTRACT FROM AUTHOR]

In two opinion surveys, a total of 130 psychotherapists and psychotherapy students were asked to respond to questions about different aspects of treatment with psychotherapy combined with antidepressant medication. Their answers show that, at psychotherapy units belonging to regional psychiatry, an average of half the patients and at non-regional psychotherapy units nearly a quarter of the patient group were prescribed antidepressant medication. Usually medication is initiated before psychotherapy and more patients terminated than started medication during psychotherapy. The psychotherapists' experience of combined treatment was either positive, negative or mixed, the latter depending on which patients and which psychic problems were being treated. The reported specific effects on the psychotherapeutic work are presented as well as various aspects of how the medication prescription was performed. Regarding opinions of the interaction between psychotherapy and medication, some psychotherapists considered that the treatments were difficult to combine and should be kept separate, whereas the majority of the psychotherapists advocated an integration of the treatments. On the basis of the survey responses, this paper discusses different aspects of how the prescribing of medication during psychotherapy can be understood and carried out. [ABSTRACT FROM AUTHOR]

There has been no comprehensive history of the scope and roles of private psychiatric hospitals in the USA. This paper documents the origins, functions, support, and contributions of private psychiatric hospitals from their beginnings in the eighteenth century through 2003. An interesting feature of nineteenth century psychiatry was the interplay between private and public institutions which reveals a pattern of the public purchase of private beds that is conceptually much like what we have today. From the early twentieth century through 1970, advancements in somatic treatments, new ways of using the hospital milieu, the introduction of antipsychotic medications, the shift from institution-based to noninstitution-based loci of acute and long-term treatment and care, the beginnings of day hospitals and a shortage of psychiatrists and nurses, all impacted upon the private psychiatric hospital. While the private psychiatric hospitals expanded in number and in responsibilities during these decades, at the end of the 1960's their future was a matter of serious debate. A comprehension of the history of the private psychiatric hospital since 1970 is based on an understanding of the impact of for-profit hospital chains, managed care, the privatization of traditionally public services, the requirement for “treatment in the least restrictive alternative,” further erosion of the use of any form of inpatient treatment, and an overall decrease in expenditures for mental health services. The future of the private psychiatric hospital may well be based on its ability both to maintain its traditional, patient-centered approach and to create innovative, effective, efficient, novel systems of care and treatment. [ABSTRACT FROM AUTHOR]

Freud's philosophical anthropology is in fact little more than an amplified psychiatry. For Freud, the human being is in essence a sick animal. In this paper, I discuss the possibility of founding this ‘anthropological turn’ on evolutionary biology. On the one hand, it is shown that Freud's own attempted ‘evolutionary psychiatry’ failed because of his very limited knowledge of Darwinism and his awe for Haeckel and Lamarck. On the other hand, I argue that more recent attempts to reconcile psychoanalysis and evolutionary biology do not always provide a solid biological foundation for the Freudian philosophical project, despite the fact that they are—from a Darwinian point of view—tenable. This is so because, generally speaking, these theories consider psychopathologies either as adaptations or as accidental disorders, and not as inevitable but dysfunctional parts of human nature, like Freud did. [ABSTRACT FROM AUTHOR]

In this paper, we argue that risk assessment should be considered a part of daily clinical psychiatric practice. We discuss the advantages and disadvantages of various risk assessment procedures. In the event that a high risk for violence is present, we advise on strategies for discharging our duty to protect the public. Finally, by way of an illustrative case, we apply theory to practice and discuss the issues of risk management and risk reduction essential to a modern approach to psychiatry. [ABSTRACT FROM AUTHOR]

At an advanced age, serious medical and psychiatric illnesses frequently coalesce. Often, the need for admission to inpatient geriatric psychiatric care arises from coexisting medical problems. While cognitive and behavioral interventions are important, the complexity of physical comorbidities usually becomes the focus of hospitalization and requires intensive medical treatments. This paper describes adaptations made in one metropolitan geriatric psychiatry unit in order to better treat complex patients who experience both medical and psychiatric illness. The need for all members of the interdisciplinary team to expand their practice and the importance of complementary approaches of psychiatry and medicine are emphasized. [ABSTRACT FROM AUTHOR]

There have been a few reports describing the characteristics and outcomes of male offenders with intellectual disability (ID). Therefore, while we are building up a reasonable picture of this client group, there are almost no reports of female offenders with ID. This paper is a preliminary attempt to present information on a small cohort of female offenders. Characteristics of female offenders are presented including information on age, IQ, mental illness, referring agents, crimes committed, problems identified, sexual and physical abuse and outcome. Some comparisons are made with corresponding descriptions of male cohorts in ). The main result is that females constitute 9% of referrals to the service. Other notable results are that: at 61% sexual abuse in the cohort of female offenders is higher than in male cohorts but at 38.5% physical abuse is no higher than in appropriate comparison groups; as with mainstream female offenders identification of mental illness is high at 67%; and total re-offending over 5 years was 22% but, excluding prostitution, was only 16.5%. In some respects, this cohort of female offenders shows similar characteristics to their male counterparts. However, there are higher levels of mental illness, higher levels of sexual abuse and lower levels of re-offending. It is hypothesized that as females constitute such a low percentage of referrals, it suggests that women with ID do not show the same levels of sexually abusive behaviour or aggressive behaviour – the two most frequent reasons for male referral. Therefore, an intervening variable such as mental illness may indeed be a significant factor. Lower re-offending rates may indicate the success of interventions directed at psychological problems and mental illness. [ABSTRACT FROM AUTHOR]

This paper seeks to address whether integrated structures are associated with more integrated forms of service. Northern Ireland has one of the most structurally integrated and comprehensive models of health and personal social services in Europe. Social and health services are jointly administered and this arrangement should, in theory, promote collaborative working and interdisciplinary arrangements. The study employed a cross-sectional survey of consultants in old age psychiatry in England and Northern Ireland. Potential respondents were sourced from the UK Royal College of Psychiatrists membership list and locally collected information. A self-administered postal questionnaire. Along with general service arrangements, the domains measured reflect core policy issues for older people''s services. Under particular scrutiny in this study were the degree of integration of health and social service provision, as well as inter-professional team working. The integrated health and social care services in Northern Ireland do appear to provide more integrated patterns of working, primarily in managerial arrangements and in the location of staff. There was no evidence of the impact of integration on practice in areas such as: assessment, referral and medical screening. The factors found to be associated with greater integration of health and social care in the prediction model fell into three categories: provision of specialist services; provision of outreach activities; and shared policies by which the whole team worked. Health and personal social services in Northern Ireland have a distinct advantage over their counterparts in comparable areas of England. The results indicate that integrated structures in old age psychiatry services are associated more with integrated management systems and less with integrated practice-related activities. Further research is required on the effectiveness and cost effectiveness of integrating services in general. It is important that future intervention studies systematically measure the component parts, nature and extent of integration and their individual and joint contribution to the effectiveness and efficacy of services. Copyright © 2003 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This paper focuses on Günter Ammon's concept of dynamic psychiatry and how its practice can aid and enhance group dynamics. This is illustrated by an account of group dynamic therapeutic work in the Hospital Menterschwaige in Munich, demonstrating how this work has its roots in the theoretical concept of dynamic psychiatry. [ABSTRACT FROM AUTHOR]

The article presents information about report of the speaker-elect of the American Psychiatric Association (APA). The speaker-elect in his speech says "I am honored to have served as speaker-elect of the Assembly, and before addressing current important issues facing us and stating my goals for the coming year, I would like to provide an overview of the structure and function of the Assembly for our members." The speaker-elect further informs that any APA member can propose an action paper for his or her representative to bring forward for consideration by the Assembly.

Why has there been a very rapid elaboration of the category of personality disorder within psychiatric classifications over the last 20 years? Personality disorder is the site of considerable psychiatric controversy. Its classification, diagnosis, and treatment are disputed not only within psychiatry, but also in closely related fields of forensic and psychological work. For severe cases, the Home Secretary in Britain has recently suggested that pre-emptive incarceration is justified, and many psychiatrists feel that personality disorder is not amenable to treatment. This paper seeks to make a contribution to the sociology of psychiatric knowledge, drawing both on recent work on the sociology of science and technology, and on the relationship between psychiatric practice and government in the late 20th century. [ABSTRACT FROM AUTHOR]

Medical dominance is not a transhistorical and invariant property of the medical profession. Rather it is a set of occupational privileges that can be invoked or revoked according to changing alignments of political, economic and cultural power, Using the example of British psychiatry in the context of the health service reforms of the 1980s, it is argued that medical dominance may be fracturing as a result of the policy switch towards community mental health care and the managerial reorganisation of the health services. Knowledge claims and medical procedures that have legitimated the dominant position of psychiatry within the mental health services - a medicoeclectic ideology, a view of doctor superiority over other mental health professionals and the extensive use of physical treatments - are outlined and contrasted with the conflicting ideas and authority structures of community care and health service management. Challenges to medical dominance in mental health, it is contended, are represented by the legislative empowerment of a range of previously subordinated groups of professionals and paraprofessionals. This paper draws primarily upon two sources of data; an ethnography and in-depth interview study of 40 psychiatrists and managers in the Bristol area in 1989-90 and an analysis of the writings of psychiatrists in the professional press. [ABSTRACT FROM AUTHOR]

This paper is concerned with the use of multivariate statistical methods in relation to classification in psychiatry. There are two aspects of classification: the classification of symptoms to form syndromes and of patients into diagnostic groups. Critical papers are reviewed, and proposed severe limitations on the methods answered. The use of multivariate methods has increased objectivity and agreement between investigators, but differences remain, largely on issues in statistical logic, which must be resolved. [ABSTRACT FROM AUTHOR]

The article explores the use of recovery orientation, medication, and shared responsibility in contemporary mental health services in Australia. It highlights the importance of improving the relationships between psychiatrists, other clinicians and consumers as well as the influence of the personal recovery paradigm in mental health. Challenges in clinical practice are mentioned.

The article discusses the application of the proposed doctrine in the specialty of psychiatry. It focuses on the law of mental health malpractice with a concentration on reasonable innovation. Also, it advances a proposed philosophy of reasonable innovation and the application of the doctrine to specific innovations in the history of psychiatry.

Background: The Psychiatric Out-Patient Experiences Questionnaire (POPEQ) is an 11-item core measure of psychiatric out-patients experiences of the perceived outcome of the treatment, the quality of interaction with the clinician, and the quality of information provision. The POPEQ was found to have evidence for reliability and validity following the application of classical test theory but has not previously been assessed by Rasch analysis. Methods: Two national postal surveys of psychiatric outpatients took place in Norway in 2004 and 2007. The performance of the POPEQ, including item functioning and differential item functioning, was assessed by Rasch analysis. Principal component analysis of item residuals was used to assess the presence of subdimensions. Results: 6,677 (43.3%) and 11,085 (35.2%) psychiatric out patients responded to the questionnaire in 2004 and 2007, respectively. All items in the scale were retained after the Rasch analysis. The resulting scale had reasonably good fit to the Rasch model. The items performed the same for the two survey years and there was no differential item functioning relating to patient characteristics. Principal component analysis of the residuals confirmed that the measure to a high degree is unidimensional. However, the data also reflects three potential subscales, each relating to one of the three included aspects of health care. Conclusions: The POPEQ had excellent psychometric properties and Rasch analysis further supported the construct validity of the scale by also identifying the three subdimensions originally included as components in the instrument development. The 11-item instrument is recommended in future research on psychiatric out-patient experiences. Future development may lead to the construction of more precise measures of the three subdomains that the POPEQ is based on. [ABSTRACT FROM AUTHOR]

This paper reviews current research on innovative attempts to improve the dissemination and effectiveness of supported employment. The domains of active investigation include: (1) organization and financing of services, (2) disability policies, (3) program implementation and quality, (4) motivation, (5) job development, (6) illness-related barriers, (7) job supports, (8) career development, and (9) new populations. Work in each of these areas offers the promise of improving services and outcomes in the near future. [ABSTRACT FROM AUTHOR]

This paper assesses the extent to which the Individual Placement and Support (IPS) approach is currently adopted in England. Interviews based on the Supported Employment Fidelity Scale were conducted with staff from five of the leading providers of supported employment. One provider obtained a good IPS adherence score, three a fair score and one a non-adherence score. Constraints influencing providers' capacity to provide an IPS service related to funding, values and organizational policy. The authors discuss the implications of these constraints in relation to the recent commissioning guidance for vocational services in the UK. [ABSTRACT FROM AUTHOR]

Access to community mental health services for adults with a history of trauma is an important area of concern. This paper examines utilization of community services by more than 4,000 individuals in four states who either had an inpatient diagnosis of post-traumatic stress disorder or experienced an inpatient seclusion/restraint. Although both groups are identified with an inpatient stay, the types of trauma are different in important ways. The analysis relies exclusively on administrative data from inpatient and community programs. Findings indicate that individuals who had been restrained or secluded were substantially more likely to access community services than individuals with an inpatient diagnosis of PTSD. Women were substantially more likely than men to access community mental health services, regardless of the type of trauma. There was little variation among states in access to community services for each type of trauma. This research provides an efficient, nonintrusive model to use existing data resources to evaluate access to care, practice patterns, and treatment outcomes for individuals with a history of trauma. [ABSTRACT FROM AUTHOR]

Objective: The aim of this present paper is to highlight some of the issues faced by therapists and sign language interpreters when working with deaf patients. Conclusions: Key issues include linguistic, interpreting and role challenges, and potential threats to the therapeutic alliance. Recommendations are made in relation to preparation strategies and training for sign language interpreters and therapists. [ABSTRACT FROM AUTHOR]

The article presents several applications of aesthetic theory to psychiatry and psychotherapy based on the research conducted by historian John Callender. He presented the involvement of philosophical aesthetic to psychotherapy through a novel which was influenced by his appreciation in art. He has introduced the issue of intersubjectivity in aesthetic which was known as driving into a sudden conclusion without any instinctive thinking. According to Callender, the issue shows more on the emotional content and challenged psychotherapy.

In this article I review the psychotherapy outcomes literature as it pertains to the Dodo hypothesis. This is the proposition that the effects of psychotherapy are due to common factors rather than specific techniques. A variety of sources provide substantial empirical support for the Dodo hypothesis. I conclude that CBT and medication do not appear to be any better than other methodologies for the treatment of psychological distress. I look at some of the criticisms of the Dodo hypothesis. I suggest that the major themes that emerge from the literature as it stands are conclusions that would be immediately obvious to most clinicians. Further, the utility of specific techniques has not been ruled out, due to some serious conceptual flaws in efficacy trials. I suggest that there are a number of ways for family therapists to survive in an evidence-based world. One is to point out to champions of evidence-based practice just how flimsy their claims are. Another would be to advocate for pluralism and to practise and conduct research under the aegis of a contextual philosophy. [ABSTRACT FROM AUTHOR]

Abstract: UK “Psychiatric Survivors”—a variety of activist groups comprising individuals who have been on the “receiving end” of psychiatric treatment—have, since the mid-1980s, mounted a challenge to the psychiatric system. “Survivors” have formulated their own knowledge-base concerning a range of human problems hitherto regarded as the province of “official” psychiatry only. “Official” knowledge stresses scientific classification, professional expertise, and statistical evidence: “Survivor” knowledge, by contrast, emphasises individual experience, the traumas of the life-course, and the personal testimony of the survivor as itself expert data. This paper focuses upon the truth-claims enacted by the “testimony of the survivor” and the relation of “testimony” to political practice. Specifically, I analyse a key text containing the testimonies of female survivors whose behaviour has been officially labelled as “deliberate self-harm”; that is, women who harm themselves, through self-poisoning or self-laceration, and subsequently receive medical/psychiatric treatment. The main focus is upon the political functions of testimony in theory and practice—the ways in which “survivors” challenge the power of psychiatry. [Copyright &y& Elsevier]

The Royal Australian and New Zealand College of Psychiatrists is co-ordinating the development of clinical practice guidelines (CPGs) in psychiatry, funded under the National Mental Health Strategy (Australia) and the New Zealand Health Funding Authority. This paper presents CPGs for schizophrenia and related disorders. Over the past decade schizophrenia has become more treatable than ever before. A new generation of drug therapies, a renaissance of psychological and psychosocial interventions and a first generation of reform within the specialist mental health system have combined to create an evidence-based climate of realistic optimism. Progressive neuroscientific advances hold out the strong possibility of more definitive biological treatments in the near future. However, this improved potential for better outcomes and quality of life for people with schizophrenia has not been translated into reality in Australia. The efficacy-effectiveness gap is wider for schizophrenia than any other serious medical disorder. Therapeutic nihilism, under-resourcing of services and a stalling of the service reform process, poor morale within specialist mental health services, a lack of broad-based recovery and life support programs, and a climate of tenacious stigma and consequent lack of concern for people with schizophrenia are the contributory causes for this failure to effectively treat. These guidelines therefore tackle only one element in the endeavour to reduce the impact of schizophrenia. They distil the current evidence-base and make recommendations based on the best available knowledge.A comprehensive literature review (1990−2003) was conducted, including all Cochrane schizophrenia reviews and all relevant meta-analyses, and a number of recent international clinical practice guidelines were consulted. A series of drafts were refined by the expert committee and enhanced through a bi-national consultation process.This guideline provides evidence-based recommendations for the management of schizophrenia by treatment type and by phase of illness. The essential features of the guidelines are: (i) Early detection and comprehensive treatment of first episode cases is a priority since the psychosocial and possibly the biological impact of illness can be minimized and outcome improved. An optimistic attitude on the part of health professionals is an essential ingredient from the outset and across all phases of illness. (ii) Comprehensive and sustained intervention should be assured during the initial 3−5 years following diagnosis since course of illness is strongly influenced by what occurs in this‘critical period’. Patients should not have to‘prove chronicity’ before they gain consistent access and tenure to specialist mental health services. (iii) Antipsychotic medication is the cornerstone of treatment. These medicines have improved in quality and tolerability, yet should be used cautiously and in a more targeted manner than in the past. The treatment of choice for most patients is now the novel antipsychotic medications because of their superior tolerability and, in particular, the reduced risk of tardive dyskinesia. This is particularly so for the first episode patient where, due to superior tolerability, novel agents are the first, second and third line choice. These novel agents are nevertheless associated with potentially serious medium to long-term side-effects of their own for which patients must be carefully monitored. Conventional antipsychotic medications in low dosage may still have a role in a small proportion of patients, where there has been full remission and good tolerability; however, the indications are shrinking progressively. These principles are now accepted in most developed countries. (vi) Clozapine should be used early in the course, as soon as treatment resistance to at least two antipsychotics has been demonstrated. This usually means incomplete remission of positive symptomatology, but clozapine may also be considered where there are pervasive negative symptoms or significant or persistent suicidal risk is present. (v) Comprehensive psychosocial interventions should be routinely available to all patients and their families, and provided by appropriately trained mental health professionals with time to devote to the task. This includes family interventions, cognitive-behaviour therapy, vocational rehabilitation and other forms of therapy, especially for comorbid conditions, such as substance abuse, depression and anxiety. (vi) The social and cultural environment of people with schizophrenia is an essential arena for intervention. Adequate shelter, financial security, access to meaningful social roles and availability of social support are essential components of recovery and quality of life. (vii) Interventions should be carefully tailored to phase and stage of illness, and to gender and cultural background. (viii) Genuine involvement of consumers and relatives in service development and provision should be standard. (ix) Maintenance of good physical health and prevention and early treatment of serious medical illness has been seriously neglected in the management of schizophrenia, and results in premature death and widespread morbidity. Quality of medical care for people with schizophrenia should be equivalent to the general community standard. (x) General practitioners (GPs)s should always be closely involved in the care of people with schizophrenia. However, this should be truly shared care, and sole care by a GP with minimal or no specialist involvement, while very common, is not regarded as an acceptable standard of care. Optimal treatment of schizophrenia requires a multidisciplinary team approach with a consultant psychiatrist centrally involved. [ABSTRACT FROM AUTHOR]

The article discusses the development of a mental health agency job function inventory. This report describes the development of an Inventory of Job Functions (IJF) which can be used for descriptive analysis of roles and functions within mental health agencies. A pool of 175 job functions was generated from job descriptions and other sources. Duplicate and ambiguous items were eliminated. Eight mental health agency directors were asked to modify or add to the 125 remaining items. The authors independently classified each item into one of eight content categories. The two judgments were compared and ambiguous items were modified. Items that were placed in the same content category by at least three of four different judges who then independently classified them were retained.

The article focuses on the adoption of a historically accurate and psychiatrically important play written by several visiting academics in Australia. It highlights several elements of producing a play which include the name of the theatre company as well as finding lawyers to oversee contracts offered to and developed by the theatre company and hiring a rehearsal space. It also highlights the concept of public relations and public awareness.

This article discusses the quantified multiple diagnostic procedure in psychiatric classification. Gradually, psychiatry has assumed a psychological approach to the understanding and treatment of mental illness. Such an approach places no particular emphasis on the exact nature of the patient's pathological manifestations per se, although, in some cases, symptoms may be useful in deducing the nature of the individual's motives, in evaluating the adequacy of his means for satisfying these motives, and in deciding what approaches are most likely to prove feasible for the acquisition of new behavior patterns.

The article presents information on report of the speaker of the American Psychiatric Association. "I have served the Assembly with the idea that I am only the custodian of your time and your budget, managing the agenda and minding the money. Apart from the larger common objectives of advocating for our patients and our profession, it has also been my particular objective as the Speaker to advocate for the constituents of the Assembly. I have listened carefully to our deliberations and concerns about patients, the profession and its values, its scientific basis, and its governance, have been impressed by the vigor and rigor of these animated debates, which inexorably move us toward a consensus and advance our causes."

The article discusses the significance of spirituality in psychiatric education and training. In tries to answer how the traditional principles of morality, in diverse races and cultures, be accommodated within a system of medical education based on scientific rationality. Specifically, it focuses on psychiatry, where the disconnection appears to be serious.

The article presents the author's views on Donald L. Burnham's work in the field of medicine, particularly in psychiatry. According to the author, Burnham believed that the essence of psychodynamic psychotherapy is to understand the concern of the patient and to speak it clearly and compassionately to the patient. Moreover, republication of Burnham's "Restitutional Functions of Symbol and Myth in Strindberg's Inferno," is noted.

The article focuses on a research which explores the predictors of the length of stay in a psychiatric emergency care centre (PECC) in Australia. It examines demographic and clinical characteristics through file audit in 477 patients who were presented to a PECC within a six-month period. An overview of the results of the study is provided.

From the starting point of narrative ethnography, this article explores a specific kind of service user involvement in psychiatry: staff training activities in which patients and former patients are invited to "tell their stories". A core feature of these stories is that they are based on the narrators' self-perceived experience, and they all have a highly personal character. I call these stories service user narratives, and these are the topic of study in this article. The narratives' disposition, content and functions are explored, as is the role played by the personal aspects of the stories. This article investigates two functions of the service user narrative: the narrative as a means (1) of creating alternative images of mental ill health, and (2) of enabling a critique of psychiatry. The context wherein the stories are told can be understood as containing an inherent power asymmetry, in which the narrators hold a subordinate position relative to the organization and its employees. Hence, the study explores how power structures affect and might be affected by the user narratives. It turns out that while the user narratives work as counter-narratives in some respects, questioning the dominant order, in other ways they maintain the current power balance within psychiatry. The personal features of the user narrative are vital to enabling the delivery of a critique–however, at the same time, the same personal features could also work to help maintain the narrator's inferior position. [ABSTRACT FROM AUTHOR]

Objective: To conceptualize the characteristics or traits of healthy acculturative self in a global and multicultural society. The self needs to be recapitulated in terms of globally adapting and dynamically changing environment. Methods: A meta-analytic method is applied to this study by reviewing research papers, 1990 to 2012, via academic search engines, in the following key words: acculturation and health/self/personality/ identity. Also. the concept of “scientific analogy” (Gentner, 1983, 2003, 2010) is employed. Results: Six conceptual frames of healthy acculturative self are summed up as conceptual templates or modules. [1.] Resilient Self: The resilient self has the capacity to make best use of resource and to cope with emerging stressors and life crises during acculturation. [2.] Globally Adapting Self: The self is able to adapt oneself to globally changing environment. [3.] Holistic and Synchronistic Self: The self is able to comprehend cultural information of the past, in the present mode, as one actively confronts culturally different situations. [4.] Optimistic Self: The self strives to achieve one's goals and is able to overcome depression or life frustration. [5.] Spirituality-oriented Self: The self is open to other religious values or differences as one positively appreciates other religious values as well as tolerates diverse religious systems and world views. [6.] Multicultural Personality-oriented Self: The self is sensitive enough to learn culturally diverse life-styles or values. Conclusion: The conceptual categories of healthy acculturative self are recommended to be used as meta-cognitive maps when mental health professionals and cultural psychiatrists conduct psychiatric assessment and diagnosis. [Copyright &y& Elsevier]

Although Freud had aspirations of a university structure for psychoanalytic education the sociopolitical structure of the Austro-Hungarian empire precluded this, and psychoanalysis developed by default in the central European heartland within a part-time, private-practice educational structure. With its rapid spread in the post-World-War-II United States, and its ready penetration of American academic psychiatry, a counter educational structure arose in some quarters: the department-of-psychiatry-affiliated institute within the medical school. This article outlines beyond these other, more ambitious, academic vistas (the David Shakow model, the Anna Freud model, the Menninger Foundation, Emory University (USA), AP de BA (Argentina)); conceptions even closer to the ideal (idealized) goal of full-time placement within the university, with strong links to medicine, to the behavioral sciences and to the humanities. The putative advantages of such a structure are presented. [ABSTRACT FROM AUTHOR]