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Summary: We argue that editorial independence, through robust practice of publication ethics and research integrity, promotes good science and prevents bad science. We elucidate the concept of research integrity, and then discuss the dimensions of editorial independence. Best practice guidelines exist, but compliance with these guidelines varies. Therefore, we make recommendations for protecting and strengthening editorial independence. [ABSTRACT FROM AUTHOR]

SUMMARY: In legal parlance, a 'witness' must have personal knowledge of the facts that form the basis of their inference or opinion. However, unlike an ordinary or a professional witness, an expert witness can provide opinion evidence, an exception to this doctrine. The evolution of the role of an expert witness or a skilled witness (in Scotland) is outlined in this clinical reflection. [ABSTRACT FROM AUTHOR]

Summary: The non-reporting of negative studies results in a scientific record that is incomplete, one-sided and misleading. The consequences of this range from inappropriate initiation of further studies that might put participants at unnecessary risk to treatment guidelines that may be in error, thus compromising day-to-day clinical practice. [ABSTRACT FROM AUTHOR]

SUMMARY: This editorial introduces the second of two special issues of BJPsych Advances on neurodevelopmental disorders, including intellectual disability, autism spectrum disorder, attention-deficit hyperactivity disorder and epilepsy. Topics discussed in the issue include using technological advances such as apps to manage epilepsy in intellectual disability, person-centred support and integrated care, training, and non-restrictive approaches and appropriate medication for managing self-injurious and challenging behaviour. [ABSTRACT FROM AUTHOR]

SUMMARY: The outgoing Editor in Chief of BJPsych Advances considers the 30-year history of the journal, outlining its development from a slim four-paper issue to an authoritative publication offering blended learning approaches for consultant psychiatrists and also for trainees preparing for their examinations. [ABSTRACT FROM AUTHOR]

SUMMARY: This editorial introduces the first of two special issues of BJPsych Advances on neurodevelopmental disorders, including intellectual disability, autism spectrum disorder, attention-deficit hyperactivity disorder and epilepsy. This issue is intended to offer a clinical tool kit for mental health professionals giving guidance on assessment and management of these disorders and associated conditions, such as behaviours that challenge. [ABSTRACT FROM AUTHOR]

SUMMARY: Peer reviewing is a hugely important part of the scientific process that ensures published articles are of sufficient quality to deserve dissemination to the wider scientific community. Building on a previous article published in this journal, this article addresses topics that potential or practising peer reviewers may find useful. These include what peer reviewing is, why do peer reviews, how to become a reviewer, what to write in a review and where to find more information. It includes a template for writing a review, and lists various websites and guidelines that can help ease the entire process depending on what type of article is being reviewed. Peer reviewing can be enormously rewarding and help clinicians diversify their scope of work while also benefiting the scientific community by contributing to the quality control of published work. [ABSTRACT FROM AUTHOR]

Summary: Poor research integrity is increasingly recognised as a serious problem in science. We outline some evidence for this claim and introduce the Royal College of Psychiatrists (RCPsych) journals' Research Integrity Group, which has been created to address this problem. [ABSTRACT FROM AUTHOR]

SUMMARY: The differentiation of pathological stress responses from responses that are appropriate and adaptive is a challenge with little to guide the clinician. This refreshment considers adjustment disorder and possible approaches to distinguishing those who have the disorder from those who are responding 'normally' to stressful events. [ABSTRACT FROM AUTHOR]

SUMMARY: An article in BJPsych Advances on the topic of dissociative identity disorder gave rise to a number of linked commentaries and a vigorous eLetter debate. This commentary, by the Editor, points out the journal's role as a CPD journal and clarifies its position on the publication of reviews and opinion pieces on controversial topics. [ABSTRACT FROM AUTHOR]

Abstract: Individuals with personality disorders (especially paranoid personality disorder) tend to be reluctant to engage in treatment. This paper aimed to elucidate the role of personality disorder in predicting engagement with psychological treatment for depression. The Outcomes of Depression International Network (ODIN) involves six urban and three rural study sites throughout Europe at which cases of depression were identified through a two-stage community survey. One patient in seven who was offered psychological treatment for depression had a comorbid diagnosis of personality disorder (most commonly paranoid personality disorder). Forty-five percent of patients who were offered psychological treatment for depression did not complete treatment. The odds of completion were higher for patients with a comorbid diagnosis of personality disorder, especially paranoid, anxious or dependent personality disorder. The relatively low number of cases with some specific personality disorders (e.g. schizoid personality disorder) limited the study''s power to reach conclusions about these specific disorders. This study focused on a community-based sample which may lead to apparently lower rates of engagement when compared to studies based on treatment-seeking populations. Episodes of depression in the context of personality disorder may represent a valuable opportunity to engage with patients who might otherwise resist engagement. [Copyright &y& Elsevier]

Background: Very few studies have examined the cross-national prevalence of suicidal ideation in the general population or variables associated with it.Aims: To examine the risk factors for suicidal ideas in the general population.Method: As part of a five-country two stage epidemiological study of depressive disorder (the ODIN study) a random sample of over 12 000 people were screened using the Beck Depression Inventory (BDI). There followed detailed analysis of item 9 of the BDI, which measured the severity of suicidal ideation.Results: Age, marriage, concern by others and severity of depressed mood independently increased or decreased the odds of suicidal ideation overall. An interaction between life events and social supports was identified, although this differed between men and women. Only concern by others and severity of depression were independently associated with serious suicidal ideation. The study does not allow for interpretation of the direction of the association.Conclusions: A number of social, clinical and demographic variables were independently associated with all suicidal ideation and with serious suicidal ideation. Longitudinal studies are required to confirm whether these are risk factors for or the result of suicidal ideation or have some other relationship. [ABSTRACT FROM AUTHOR]

Background: Little is known about patterns of healthcare use by people with depression in Europe.Aims: To examine the use and cost of services by adults with depressive or adjustment disorders in five European countries, and predictive factors.Method: People aged 18-65 years with depressive or adjustment disorders (n=427) in Ireland, Finland, Norway, Spain and the UK provided information on predisposition (demographics, social support), enablement (country, urban/rural, social function) and need (symptom severity, perceived health status) for services. Outcome measures were self-reported use Client Services Receipt Interview and costs of general practice, generic, psychiatric or social services in the past 6 months.Results: Less frequent use was made of generic services in Norway and psychiatric services in the UK. Severity of depression, perceived health status, social functioning and level of social support were significant predictors of use; the number of people able to provide support was positively associated with greater health service use.Conclusions: Individual participant factors provided greater explanatory power than national differences in healthcare delivery. The association between social support and service use suggests that interventions may be needed for those who lack social support. [ABSTRACT FROM AUTHOR]

Background: This paper examines the pattern and frequency of implementation of environmental strategies and the use of psychotropic medication in the management of patients with delirium in an acute hospital setting.Method: The study involved 46 consecutive referrals to a consultation psychiatry service each of whom met ICD-10 criteria for delirium. Patients were subdivided into hyperactive, hypoactive and mixed subtypes of delirium and assessed regarding severity of delirium, the use of psychotropic medication prior to consultation and the implementation of environmental measures in their management.Results: Mean age was 60.1 years. Thirty per cent of patients were of the hyperactive subtype, 24% hypoactive and 46% mixed. Psychotropic medication was given to 56.5% prior to consultation and this is significantly associated with severity of delirium and in particular, with hyperactive delirium subtype. Of eight environmental strategies only four were instituted in over 50% of the patients prior to consultation. The application of these strategies was associated with overall severity of delirium, agitation, mood lability and sleep-wake cycle disturbance. It was not significantly associated with severity of disorientation or with disturbed perception/thinking.Conclusion: Simple environmental strategies such as limiting changes in staff, minimising noise levels and involving relatives in re-orientation are frequently overlooked in the management of patients with delirium. Our study suggests that the implementation of environmental strategies occurs primarily in responses to behavioural challenges rather than to limit the core features of delirium. [ABSTRACT FROM AUTHOR]

Personality disorders have for many years been on the fringe of psychiatry, with considerable doubts expressed about the usefulness, implications and validity of the concept. It is argued here that developments in the past few years have brought personality disorders into the mainstream of psychiatric practice. In particular, the recognition that personality function can be separated usefully from clinical symptoms, and that both mental state and personality can be disordered simultaneously, has led to better assessment and understanding. Advances in the classification, epidemiology, treatment and prognosis of personality disorders show that these conditions are common, extensive in their pathology, and cause much suffering. They cannot be ignored or dismissed as peripheral to psychiatry for they are an essential part of good psychiatric practice. [ABSTRACT FROM AUTHOR]

In a one-year prevalence study of conspicuous psychiatric morbidity in two group general practices, one urban and the other rural, personality disorder was diagnosed in 5.3% by the GP and in 5.6% by the psychiatrist, but this increased to 28% when personality disorder was assessed using a structured interview. The prevalence of personality disorder was higher in the urban practice than in the rural one but there was no consistent association between personality disorder and mental state disorder, with the exception of alcohol abuse and dependence. The high rate of personality disorder found using the interview schedule is likely to be a true finding, and failure to recognise this hidden morbidity is important in both general and psychiatric practice. [ABSTRACT FROM AUTHOR]

The dramatic clinical presentation of parasuicide tends to deflect attention from the repetitive pattern of this behaviour in many patients. In an epidemiological study of annual cohorts of parasuicides for 1972, 1977, and 1982 admitted to the Regional Poisoning Treatment Centre, Edinburgh, it was found that for certain subgroups of the population 'repeaters' were actually commoner than 'first-ever' patients, and a number of risk factors were identified, of which social class was particularly important. The clinical characteristics of patients distinguished by their frequency of repetition were also described, with special attention to the stability of these differentiating features over time. It is suggested that the habitual repeater requires closer study, and that the factors which lead to initiation into a parasuicidal 'career' are not necessarily those which conduce to repetition. [ABSTRACT FROM AUTHOR]

316 psychiatric patients--predominantly out-patients--with a clinical diagnosis of neurosis (International Classification of Disease), were given an interview schedule for assessing personality disorders. Nearly two fifths were rated as having personality disorder, the anankastic type being the most common and sociopathic personality disorder the least. Patients with anxiety, phobic and obsessional neurosis were all significantly more likely to show personality disorder than those with depressive neurosis. Broadly, passive-dependent personalities were linked to anxiety neurosis, anankastic personality disorder to obsessional neurosis, and both anankastic and passive-dependent personalities to phobic neurosis. In a clinical trial of the efficacy of two dosage regimes of phenelzine in 60 patients the presence of personality disorder significantly impaired clinical outcome. The results suggest strongly that the assessment of personality in neurotic disorders is necessary to make an adequate diagnosis and predict the outcome of treatment. [ABSTRACT FROM AUTHOR]

Adjustment disorder has been a recognised disorder for decades but has been the subject of little epidemiological research. Now researchers have identified the prevalence of adjustment disorder in primary care, and found general practitioner recognition very low but with high rates of antidepressant prescribing. Possible reasons for the seemingly low prevalence, recognition rate and inappropriate management include its recognition as a residual category in diagnostic instruments and poor delineation from other disorders or from normal stress responses. These problems could be rectified in ICD-11 and DSM-5 if changes according it full syndromal status, among others, were made. This would have an impact on future research. [ABSTRACT FROM AUTHOR]

The finding that induced abortion is a risk factor for subsequent psychiatric disorder in some women raises important clinical and training issues for psychiatrists. It also highlights the necessity for developing evidence-based interventions for these women. P.C. / Evidence suggesting a modest increase in mental health problems after abortion does not support the prominence of psychiatric issues in the abortion debate, which is primarily moral and ethical not psychiatric or scientific. M.O. et al. [ABSTRACT FROM AUTHOR]

The article offers information on the term adjustment disorder which was then transient situational disturbance. It was entered in the DSM-II nomenclature in 1968 and was recognized in ICD-9 in 1978. With this, its consequence is the danger of exaggerating the need for expensive and sometimes unpredictable mental health interventions in those whose problems are likely to resolve spontaneously. The author mentioned that adjustment disorder has always been controversial and has been described as a waste- basket diagnosis.

A letter to the editor from Patricia Casey and Peter Tyrer is presented to respond to comments on their article on clinical psychiatry.

A response by Norman Kreitman and Patricia Case to a letter to the editor about their article on parasuicide in the December 1988 issue is presented.

Abstract: The influence of severity of personality disorder on outcome of depression is unclear. Four hundred and ten patients with depression in 9 urban and rural communities in Finland, Ireland, Norway, Spain and the United Kingdom, were randomised to individual problem-solving treatment (n =121), group sessions on depression prevention (n =106) or treatment as usual (n =183). Depressive symptoms were recorded at baseline, 6 and 12 months. Personality assessment was performed using the Personality Assessment Schedule and analysed by severity (no personality disorder, personality difficulty, simple personality disorder, complex personality disorder). Complete personality assessments were performed on 301 individuals of whom 49.8% had no personality disorder; 19.3% had personality difficulties; 13.0% had simple personality disorder; and 17.9% had complex personality disorder. Severity of personality disorder was correlated with Beck Depression Inventory (BDI) scores at baseline (Spearman''s r =0.21; p <0.001), 6 months (r =0.14; p =0.02) and 12 months (r =0.21; p =0.001). On multi-variable analysis, BDI at baseline (p <0.001) and type of treatment offered (individual therapy, group therapy, treatment as usual) (p =0.01) were significant independent predictors of BDI at 6 months. BDI at baseline was the sole significant independent predictor of BDI at 12 months (p <0.001). There was no interaction between personality disorder and treatment type for depression. While multi-variable analyses indicate that depressive symptoms at baseline are the strongest predictor of depressive symptoms at 6 and 12 months, the strong correlations between severity of personality disorder and depressive symptoms make it difficult to establish the independent effect of personality disorder on outcome of depression. [Copyright &y& Elsevier]

There is a strong link between childhood adversity and subsequent substance misuse. We describe a case of childhood adversity consisting of physical and sexual abuse, experience of homelessness in childhood and adulthood, intimate partner violence and polysubstance misuse in a 32 year old woman currently attending the methadone maintenance programme in the Drug Treatment Centre Board, Trinity Court, Dublin. The relevant literature to the case is reviewed in relation to the aetiology and symptoms of this complex case.

Objective: To determine the proportion of those that are homeless attending the Mater Misericordiae Hospital's (MUH) psychiatric service, including those presenting to accident and emergency who were homeless, and to compare the homeless group with the non-homeless so as to obtain a profile of this group., Methods: All adults over 16, referred for psychiatric assessment, attending A&E were included, as were those attending outpatient clinics, liaison consultations and inpatients in the psychiatric unit, in the six-month period from January to June 2003. Excluded were those who were under 16, who refused to participate, who did not speak English, those with a diagnosis of personality disorder and organic brain damage. Questionnaires were completed by psychiatric registrars and a community psychiatric nurse, with an ICD-10 diagnosis recorded on each individual, in consultation with the treating consultant psychiatrist., Results: A total of 628 patients were seen in MUH during the study period, and 13.8% were homeless. Of the homeless, 56.3% were seen as emergency referrals in the A&E, 23% were inpatients (including the psychiatric unit and consultations in medical/surgical wards) and 20.7% were seen in the outpatient department. Of all the A&E referrals to psychiatry, 34.8% were homeless. The homeless presented most commonly in suicidal crisis (26.6%) compared with 12.5% in the non-homeless group. Substance-abuse disorders were the primary diagnosis in 42.3% of the homeless group, accounting for 14.2% in the housed sample. Outcome for both groups was similar, with slightly more homeless being referred for psychiatric admission (17.8%), as compared to 12.0% in the nonhomeless group., Conclusions: Mental illness and the need for psychiatric services remain a serious issue for a significant segment of the homeless population. The homeless are overrepresented in our accident and emergency department, with their psychological and medical needs not being met in primary care. An integrated multi-disciplinary treatment approach, including outreach work, that addresses their many needs, appears to hold the greatest promise of success in this population.

Objectives: There have been concerns in the international literature that the manner in which psychiatry and psychiatric patients is portrayed in the print media is negative and sensational. If correct this has serious implications for the stigma and prejudice that our patients will suffer. This study was designed to evaluate the content and tone of articles relating to psychiatry. It was compared with a broadly similar study published in 1995 and will form the base from which to measure changes in psychiatric coverage over time., Method: All the daily broadsheets, one daily tabloid and three Sunday broadsheets were examined for a six month period in 1999 and all articles, letters or headlines incorporating psychiatry-related material were examined. Using specific definitions, articles and headlines were examined for tone and content as well as for the contribution of mental health professionals., Results: Overall 0.65 articles per newspaper per day were found. News items and feature predominated, with forensic issues receiving the greatest attention. The tone of the articles was either neutral or positive and the improvement in the tone of articles in the tabloids was particularly noticeable when compared with an earlier study. This is very different from the findings of international studies. However, the headlines were more sensational in tone than the contents of the articles themselves. Increasingly the opinion of health professionals was sought but contributions from psychiatrists remained low, writing just two articles and constituting 15% of health professionals whose opinions were sought. Nine per cent of items constituted misuse of terms., Conclusions: The Irish print media are not hostile to psychiatry and there has been an improvement in tone and type of article in the past five years. Greater involvement of psychiatrists in the media and particularly more direct engagement with editors is required if there is to be a shift from coverage of forensic matters in favour of informative articles as well as improvement in the headline tone.