British Psychiatrists Research Articles

Comparison of clinical presentation and management of children and adolescents with ARFID between paediatrics and child and adolescent psychiatry: a prospective surveillance study

ObjectiveTo compare the clinical presentations, management and outcomes of avoidant/restrictive food intake disorder (ARFID) across paediatric and child and adolescent (C&A) psychiatric settings.Study designProspective surveillance study.MethodsData were collected during a...

Bernard Hart (1879-1966) and his influence on British psychiatry.

Bernard Hart was among the most eminent 20th-century British psychiatrists. Following medical qualification at University College Hospital, London, he trained in psychiatry, which included two years studying in Paris and Zurich. He was appointed as the first psychiatric consultant at University College Hospital, then spent some time in Liverpool, where he specialized in treating war neurosis. Early in his career, Hart was one of the first to introduce the ideas of Freud and Janet, and the importance of unconscious processes, to the British public. After the First World War, Hart returned to University College Hospital, where he remained until 1947, building up a flourishing department. Hart was appointed to numerous senior offices and directed the psychiatric section of the British Emergency Medical Services in the Second World War. Hart is believed to be the last psychiatrist to certify someone (John Amery) as being of sufficiently sound mind to die for treason.

The impact of psychiatry school on attitudes towards psychiatry in medical students and junior doctors in Pakistan

AimsTo assess the impact of Psychiatry School on the attitudes towards psychiatry in Pakistani medical students (MS) and junior doctors (JD).MethodInspired by the Royal College of Psychiatrists’ ‘Choose Psychiatry’ campaign, an online event by the name of ‘Psychiatry Autumn School Pakistan’ was held on the 1st of November 2020. The event was promoted through social media and medical students and junior doctors from across Pakistan were invited to attend. Moreover, a panel of British and Pakistani psychiatrists belonging to different sub-specialties was invited to deliver talks. The attendees were provided an insight into psychiatry as a viable career option and were introduced to the training pathways, research opportunities, and the various sub-specialties present within the field.Participants were requested to complete the 'Attitudes Towards Psychiatry' (ATP-30) questionnaires before and immediately after the event. Individual scores on the questionnaire can range from 30 to 150 and a high score indicates a positive attitude. Statistical analysis was performed using a paired t-test.Result41 attendees (MS = 30, JD = 11) completed the pre-and post-school survey. The respondents were majorly female (76%) and from public sector universities (76%), with an average age of 23 years. The mean ATP score before the course was 119 (MS = 117, JD = 121) which increased by 9 points to 128 (MS = 126, JD = 131) after the event. When the two samples were compared using a paired t-test, the difference was statistically significant p < 0.005.ConclusionWe conclude that a psychiatry school can positively influence attitudes towards psychiatry in medical students and junior doctors and our findings are consistent with similar studies done in other countries.In Pakistan, unfortunately, only 2–4% of undergraduate students opt for a career in psychiatry owing to insufficient knowledge and awareness about the available treatment modalities and advancement in the field. Hence, such an intervention can greatly enhance recruitment within the profession as it makes psychiatry more accessible and visible as a career choice, generates awareness about the effectiveness and evolution of psychotherapeutic practices, and eradicates misconceptions about the field that prevail among young doctors.This was the first psychiatry school held in Pakistan and the findings of the study as well the feedback received from the participants and the speakers motivate us to continue campaigning for ‘Choose Psychiatry.’

Speech and Music Acoustics, Rhythms of the Brain and their Impact on the Ability to Accept Information

Introduction. A radical tendency in modern approaches to understanding the mechanisms of the brain is the tendency of some scientists to believe that the brain is a receptor capable of capturing thoughts; the nature of the occurrence of the thoughts themselves, however, is not to be clarified. However, speech expressing thoughts is undoubtedly the result of the work of the brain, so studies of the frequency structure of speech can be the basis for considering the material structure of the brain as a kind of “antenna”. In this approach, the problem of noise protection against the background of the undeniable frequency similarity of speech and music appears to us from somewhat different positions. This study raises the question of how essential the overall height of the musical system is to the perception of music (are there musical systems that are harmful or useful, in terms of their effects on the psyche). This question is also relevant to speech perception.Methodology and sources. The main sources in which the work of the brain and the essence of consciousness are considered from the positions indicated above were for us the work of American and British neurophysiologists and psychiatrists (Sam Parnia, Peter Fenwick). These scientists are studying the phenomena that accompany clinical death, and argue that at these moments the brain functions to the greatest extent as a receiving “antenna”. Assuming that any antenna is to be tuned, we are trying to identify possible ways to “tune” the brain. To do this, we propose to study the frequency characteristics of speech (in the simplest case, when singing vowels in a calm state) for their belonging to a particular musical system, as well as the peculiarities of music perception depending on the musical system (on the height of the note “la”). Varying the frequency characteristics of speech in a particular musical system can be considered, in our opinion, the main way to “tune” the brain. The methodology of the method is based on the use of frequency analysis of sound and the basic provisions of the elementary theory of music.Results and discussion. The main conclusion made by Western psychiatrists is the brain is not an organ of thought, consciousness exists independently from outside, the work of consciousness cannot be explained by the functioning of the brain – it requires a hardware check. If the neural network is an “antenna” that captures thoughts, and its “adjustment” at the physical level can be carried out (and is carried out) through sensory systems (including the hearing organ), the study of the frequency structure of speech will answer a number of important questions, including including related and higher brain functions (insight, creativity). Our experiments (Saint Petersburg Electrotechnical University, FIBS, department of EUT) showed that the influence of the “increased” or “lowered” musical-speech system on brain activity is insignificant. The study revealed the equiprobability of the frequency structure of speech. Since our brain lacks some characteristic set of frequencies – elements of a uniformly temperamental system, it is not necessary to talk about the harmful (or any other noise) effect of the “raised” and “lowered” systems due to deviation from the “internal standard”.Conclusion. In response to the assumptions made by Western experts, we proposed a frequency interpretation of the processes occurring in the brain, which, perhaps, will explain in more detail such phenomena as inspiration, discovery, etc., which occur with minimal activity of consciousness. Despite the limited methods of hardware study of factors that influence the activity of the brain and largely determine its higher functions (for example, creativity), the results of the brain's work in relation to music (both in terms of its creation and in terms of our reaction to it) are quite analyzable , which was shown in this study. The “musicality” of speech is extremely vividly represented in its frequency structure and allows one to reveal, to one degree or another, the features of the brain.

Towards Modern Depressive Disorder: Professional Understanding of Depression in Interwar Britain.

This article examines the way in which British psychiatrists defined, categorized, and applied depression in the period between the two World Wars. To analyze the professional understanding and application of the notion, various expert literatures will be analyzed, such as textbooks, medical journals, and medical documents kept in daily practice. Through the analysis, this article suggests that in the interwar decades, the status of depression as a distinct mental disorder was far from established in terms of its definition, terminology, and classification, although the disorder had already become the most prevalent mental illness by the turn of the century. Also, this article argues that the early twentieth century should be recognized as a part of the long evolution through which depression achieves its modernity, beginning in the early twentieth century and ending in the post-war era. Such findings about a specific psychiatric diagnosis can be applied to the explanation of contemporary psychiatry. At least before the Second World War, British psychiatry had not yet entered into its modern phase and was still under the strong influence of the Victorian medical tradition. Thus, this article claims that in order to understand British psychiatry and its characteristics against this historical background, continuity should be stressed rather than modernity.

« J’ai pensé qu’il fallait étudier les aliénés » : l’œuvre de Charles Darwin et la médecine mentale

ObjectivesTo help position the “evolutionist point of view” in psychopathology and psychiatry, given that the history of the influence of Charles Darwin's (1809–1882) theory of evolution in these areas remains unclear and a source of misunderstandings. MethodsWe propose a historical essay on the relationships between Charles Darwin, his work, and psychiatry and psychopathology. The methodology implemented draws on the historiographic rules of verification and contextualization advocated by Henri Ellenberger, and on Sonu Shamdasani's “historical cubism”. ResultsCharles Darwin himself drew much inspiration from the writings of British psychiatrists of his time, and was directly in contact with some of them, such as James Crichton-Browne (1840–1938), with whom he decisively collaborated for his work on the expression of emotions. However, from the middle of nineteenth century to the beginning of First World War, European psychiatry was mainly influenced by the theory of degeneration, and later – to a lesser extent – by the anthropological evolutionism of Herbert Spencer (1820–1903) and the eugenic movement. Some of the founders of modern psychopathology were later influenced by an evolutionary approach, in particular Sigmund Freud (1856–1939) who, together with Sándor Ferenczi (1873–1933), applied to mental disorders hypotheses that were influenced mainly by the psychological Lamarckism of August Pauly (1850–1914) and the recapitulationism of Ernst Heckel (1834–1919). More recently, John Bowlby (1907–1990), through his theory of attachment, became a precursor of neodarwinian psychopathology. DiscussionDespite appearances, the degeneracy theory, Spencerism, and eugenics all differed markedly from Darwin's thinking, particularly with respect to the complex mechanisms of natural selection. Although more sophisticated, the evolutionary approach according to Freud and Ferenczi was based on biological principles that were challenged by scientific discoveries in the interwar period. Bowlby's continuators, and in particular the somewhat tendentious sociobiology, lost sight of the issue of pre-human biological evolution. ConclusionFinally, the path remains open today for a rational Darwinian approach to human emotions and their vicissitudes.

James Patrick Watson MD, FRCP, FRCPsych

![Figure][1] James (Jim) Watson, who died after a stroke on 3 August 2016 aged 80, was among a small band of British psychiatrists who trained in the 1960s and 70s to take psychiatry out of the asylums and establish robust services in general hospital and community settings. They were also

Surviving the Lunacy Act of 1890: English Psychiatrists and Professional Development during the Early Twentieth Century.

In recent decades, historians of English psychiatry have shifted their major concerns away from asylums and psychiatrists in the nineteenth century. This is also seen in the studies of twentieth-century psychiatry where historians have debated the rise of psychology, eugenics and community care. This shift in interest, however, does not indicate that English psychiatrists became passive and unimportant actors in the last century. In fact, they promoted Lunacy Law reform for a less asylum-dependent mode of psychiatry, with a strong emphasis on professional development. This paper illustrates the historical dynamics around the professional development of English psychiatry by employing Andrew Abbott’s concept of professional development. Abbott redefines professional development as arising from both abstraction of professional knowledge and competition regarding professional jurisdiction. A profession, he suggests, develops through continuous re-formation of its occupational structure, mode of practice and political language in competing with other professional and non-professional forces. In early twentieth-century England, psychiatrists promoted professional development by framing political discourse, conducting a daily trade and promoting new legislation to defend their professional jurisdiction. This professional development story began with the Lunacy Act of 1890, which caused a professional crisis in psychiatry and led to inter-professional competition with non-psychiatric medical service providers. To this end, psychiatrists devised a new political rhetoric, ‘early treatment of mental disorder’, in their professional interests and succeeded in enacting the Mental Treatment Act of 1930, which re-instated psychiatrists as masters of English psychiatry.

Le traumatisme psychique au risque de la parole. Le rôle du transfert dans les psychothérapies

Traumatic neuroses are a clinical entity which manifests and develops as a result of psychological trauma. Since their first description by Oppenheim in 1889, they have posed a problem with the specificity of care they required. The answer to that question, that of treatment depended primarily on the concept with which the author had already of psychic trauma. Shell shock considered primarily as a stress disorder, was first described by the British military psychiatrists at the time of the First World War. It was this psychophysiological concept that prevailed in this line of thought which led to the diagnosis of “post-traumatic stress disorder” (PTSD). The proposed treatments aimed to reduce or to eradicate the symptoms by acting directly on them by cognitive-behavioral techniques, hypnosis, “EMDR”, etc. At the same time, another school of thought, initiated by Freud and his students, defended the idea that the psychological trauma resulted from an encounter with the “reality of death”. Freud's successors clarified that the traumatic event took place when the Ego of the subject was completely absorbed by his efforts of repression. (“Fenichel”), that is to say, presented neurosis transference, hysterical or obsessive. This corresponds to what we learned from clinical and psychotherapies which we had brought to patients presenting with a traumatic neurosis. These psychotherapies are not “cure types of psychoanalysis” but they use the concepts of psychoanalysis in particular on the issue of transference. We will use the metaphorical schemas of the psychic apparatus proposed by Freud to try to understand the link between the traumatic image which broke in and what Freud calls “the lost object”. This “lost object” is a myth constituted over the early days of the nursling's life: there would be an object capable to fully satisfy the subject, appearing to show nothing missing. More the structure of the subject is neurotic, that is to say, the more it is dissatisfied with the objects of his desire, stronger the longing for the mythical lost object will be. And it is in this place that comes to lodge the traumatic image purveyor of a paradoxical enjoyment even if it pays a fear of annihilation as infants. In biogenic law, with the acquisition of language, the fear of annihilation and pleasure suffer repression (primal repression). We understand more now that there may be a therapeutic effect on the neurotic structure grace of transference. In transferring, the patient sends a message towards a subject (the therapist) seemingly to know. That is to say, he has the desire to inform the therapist of his thoughts with as little censorship as possible, and in doing so, he informs himself, consciously and unconsciously in its own psychic content conscious and unconscious. The motor of this work is the unconscious guilt resulting from having faced the real of death, which is the subject of an anthropological censure. Oedipal guilt pre-conscious or conscious is induced by the previous primary conviction. At the end of this journey that involves the data of the Oedipus complex, the mythical lost object loses its appeal. The traumatic image will possibly disappear, the traumatic event is no longer something that is repeated but a more memory, the subject feels relieved of the trauma as well as the lost object. Three progress-reports of psychotherapy illustrate the theoretical points.

Adults with attention-deficit hyperactivity disorder – diagnosis or normality?

Attention-deficit hyperactivity disorder in adults evokes extreme responses within British psychiatrists, because its diagnostic validity and pharmacological treatments are heavily contested. We propose a model that accommodates apparently divergent evidence, and provides a clinical framework for clinicians and patients, allowing safe, responsible and ethically balanced clinical practice.

At the crossroads of anthropology and epidemiology: current research in cultural psychiatry in the UK.

Cultural psychiatry research in the UK comprises a broad range of diverse methodologies, academic disciplines, and subject areas. Methodologies range from epidemiological to anthropological/ethnographic to health services research; mixed methods research is becoming increasingly popular, as are public health and health promotional topics. After briefly outlining the history of cultural psychiatry in the UK we will discuss contemporary research. Prominent themes include: the epidemiology of schizophrenia among Africans/Afro-Caribbeans, migration and mental health, racism and mental health, cultural identity, pathways to care, explanatory models of mental illness, cultural competence, and the subjective experiences of healthcare provision among specific ethnic groups such as Bangladeshis and Pakistanis. Another strand of research that is attracting increasing academic attention focuses upon the relationship between religion, spirituality, and mental health, in particular, the phenomenology of religious experience and its mental health ramifications, as well as recent work examining the complex links between theology and psychiatry. The paper ends by appraising the contributions of British cultural psychiatrists to the discipline of cultural psychiatry and suggesting promising areas for future research.

The past, present and future of psychiatric diagnosis

The past, present and future of psychiatric diagnosis

Provision of spiritual and pastoral care facilities in a high-security hospital and their increased use by those of Muslim compared to Christian faith

The relationship between religion and psychiatry remains controversial amongst British psychiatrists. We looked at the provision of spiritual and pastoral care facilities in a high-security hospital and the role of faith chaplains with particular reference to the Muslim minority group. There was a significantly higher uptake of pastoral care services amongst those of Muslim faith compared to Church of England and Roman Catholic Christians. Possible reasons for this are discussed. Resources allocated for the Muslim faith group were limited and heavily dependent on the availability of the Muslim faith chaplain. Our study highlighted the need for clearly defined standards for the provision of spiritual and pastoral care within high-secure psychiatric hospitals, and by implication other NHS psychiatric settings, a re-examination of the role of the faith chaplain in relation to the clinical team, and raised questions about the equitable allocation of resources between various faith groups within the hospital.

Experiences of a junior doctor establishing mental health services in Somaliland

The author of this personal re£ection is a junior doctor from Somaliland, a country that has suiered from civil war. He studied medicine there, and became interested in mental health care.This aspect of heath care is among the most neglected in the horn of Africa. However, with the support of British psychiatrists, the author has established educational training in psychiatry. He has also subsequently initiated mental health services in his hometown of Borama.Within a few years, an inpatient psychiatric unit, an outpatient department and community mental health outreach were also created. Key to his success was intensive cooperation and collaboration with the community, resulting in broad support for mental health programmes. He has also attempted to collaborate with traditional healers, but remains hesitant of their role.

Poster #86 CLINICAL AND SOCIAL CORRELATES OF LATE ONSET FIRST-EPISODE PSYCHOSIS: FINDINGS FROM THE AESOP STUDY

Les délires chroniques survenant tardivement ont été étudiés essentiellement par des psychiatres européens, et se sont vus classés de façon variable tant dans les nosographies européennes qu’internationales. En Allemagne, Manfred Bleuler a défini la schizophrénie tardive, les psychiatres britanniques parlent de paraphrénie tardive et en France ces tableaux cliniques sont classés dans la catégorie des psychoses hallucinatoires chroniques. Les classifications internationales qui ont à une époque individualisé la schizophrénie tardive l’intègrent actuellement dans le groupe des schizophrénies. Pourtant ces formes à début tardif présentent des particularités que nous avons tenté de définir dans ce travail et qui soulèvent la question de facteurs déclenchants, de l’existence d’une prédictivité, voire même orientent vers des notions de diagnostic précoce.Chronic delusion occurring late in life has essentially been studied by European psychiatrists. « Late-onset schizophrenia » was first described and defined by Manfred Bleuler in 1943, as a form of schizophrenia which occurs after the age of 40. Later, British psychiatrists often used the term « Late-onset paraphrenia » interchangeably with « Late-onset schizophrenia » to designate this disorder. However, late-onset paraphrenia is a British concept which includes all delusional disorders starting after age 60. American psychiatrists had little interest in this patient group, so it is only within the DSM III-R that a separate category was created for patients who developed schizophrenia after age 44. There is now no longer a « late-onset » category for schizophrenia within the DSM IV, nor age criterion for the diagnosis of schizophrenia. In the French nosography, schizophrenia is excluded when a non-affective, non-organic psychosis begins after the age of 40. These chronic delusion syndromes fall into a specific French category : « Psychose Hallucinatoire Chronique» (chronic hallucinatory psychosis).Basing themselves on the analysis of many studies, the authors endeavor to define the characteristics of late-onset schizophrenia. The exact prevalence is not known, but is considered lower than 1 %. There is a preponderance of women over men in this form of disease, that could be explained by the relative excess of dopamine type 2 (D2) receptors in young men (compared with young women), and by a protective role played by estrogens until the menopause, among women predisposed to schizophrenia. Studies of families reveal a lower lifetime risk of schizophrenia in first degree relatives of patients with late-onset schizophrenia, than those with an early onset. Most of these patients have been or are married, and had worked for a long time. Generally at the onset of the illness they are isolated and unemployed. Paranoid and schizoid abnormal premorbid personality traits are frequently noted with the diagnosis of late-onset schizophrenia. An association between late-onset schizophrenia and sensory impairment (visual and auditory) is frequently observed and appear to be in link with auditory and visual hallucinations. The analysis of clinical features reveal that the later the schizophrenia breaks out, the more the patient shows delusion and hallucinatory symptoms, which remain limited to his surroundings, whereas in younger patients, delusion has no limit. Moreover, late-onset schizophrenic patients have a lower prevalence of looseness of associations and negative symptoms than those with an earlier onset. The authors note from the few studies on the treatment, that a number of patients responded well to low dose of antipsychotic agents. The use of « atypical » anti-psychotic drugs is recommended, in order to reduce the adverse effects, notably the extrapyramidal symptoms which are frequent in elderly people.Finally, they conclude that patients with late-onset schizophrenia have symptoms very similar to those of patients with early-onset schizophrenia. But, when taking the different forms of schizophrenia-even the late onset ones-into account, raises the question of the role of trigger factors that could guide research on predictive factors and early diagnosis. This may be one explanation for the survival of the French entity « Psychose Hallucinatoire Chonique ».

On Dissidents and Madness: From the Soviet Union of Leonid Brezhnev to the “Soviet Union” of Vladimir Putin

Back to table of contents Previous article Next article Book ReviewsFull AccessOn Dissidents and Madness: From the Soviet Union of Leonid Brezhnev to the “Soviet Union” of Vladimir PutinD. Ray Freebury, M.B., F.R.C.P.C.D. Ray FreeburySearch for more papers by this author, M.B., F.R.C.P.C.Published Online:1 Aug 2011https://doi.org/10.1176/ps.62.8.pss6208_0979AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail On Dissidents and Madness: From the Soviet Union of Leonid Brezhnev to the “Soviet Union” of Vladimir Putinvan VorenRobert; New York, Rodopi Amsterdam, 2009, 312 pages, $96.10 hardcover, $28.50 softcoverThe book On Dissidents and Madness is the personal story of a unique man and a true friend of ethical psychiatry. It is a story of courage, terror, opportunism, ingenuity, honesty, and humanity. It is a story of countries, politics, psychiatric organizations, ruthlessness, apologists, and shame. And although it is also a story of growth and change both personal and societal, it reminds us that resistance to true reform still runs deep in society.A related review is available as an online supplement to this review at ps.psychiatryonline.org.As a teenager in 1977, Canadian-born Dutch author Robert van Voren had been troubled by stories of the mistreatment of Soviet dissidents and began collecting signatures on a petition to send to Moscow. He made frequent, daring undercover trips to the Soviet Union, obtaining firsthand information about the psychiatric mistreatment of political dissidents. When, early in the 1980s a group of British, French, German, and Swiss psychiatrists and activists met in Paris and formed the International Association on Political Use of Psychiatry (IAPUP), van Voren was the only member of the group who had the damning evidence of political misuse of psychiatry.The aim of the group was to have the Soviet All-Union Society of Psychiatrists and Neuropathologists barred from membership in the World Psychiatric Association (WPA). The IAPUP was successful insofar as the All-Union Society resigned rather than face the ignominy of expulsion. Subsequently, the WPA assembly voted for conditions that Soviet psychiatry would have to meet before being readmitted. The assembly, rather than its executive branch, eventually distinguished itself as WPA's decision-making body. As a former chairman of the APA Committee on the International Abuse of Psychiatry, and subsequently as a colleague of van Voren with the Geneva Initiative in Psychiatry (GIP), this reviewer can corroborate the engrossing and often troubling events reported, which included the all-too-leaden responses of the leadership of the WPA.Van Voren was also concerned about the treatment of genuine psychiatric patients in the Soviet Union as well as the devaluation of psychiatrists and the inadequate training they received. After the breakup of the Soviet Union, the GIP (the transformed IAPUP) was able to organize a series of meetings in some of the newly independent states where psychiatrists from various parts of the former Soviet Union met and were exposed to the best of Western psychiatry. After some initial mistrust, it did not take long before a Network of Reformers emerged under the aegis of the GIP.The second part of the book is an account of the successes of the GIP and the Network of Reformers in creating nongovernmental organizations of psychiatrists, nurses, and even public mental health support groups in the countries that achieved independence after the fall of the Soviet Union. In this section of the book we also see how the author transformed from a zealous, sometimes vengeful teenager to an inspired but realistic and worldly-wise reformer. He was very much aided in this transformation by a philosophical Ukrainian Jewish psychiatrist, Semyon Gluzman, who, despite having been a victim of the abuses and having spent several years in the Gulag, did not paint all the abusers alike.Despite the presence of some annoying grammatical errors and spelling mistakes that were missed during the editing of the book, this is a very readable account of a dishonorable episode in the history of psychiatry and the contributions of those who endeavored to restore some honor and humanity to our specialty. It will have wide appeal to those interested in the history of psychiatry and should be required reading for psychiatric residents.The reviewer reports no competing interests.Dr. Freebury is a training and supervising psychoanalyst with the Canadian Psychoanalytic Society, Montreal, Quebec, Canada. FiguresReferencesCited byDetailsCited ByNone Volume 62Issue 8 August 2011Pages 979-979 Metrics PDF download History Published online 1 August 2011 Published in print 1 August 2011

Does the academic performance of psychiatrists influence success in the NHS Clinical Excellence Award Scheme?

ObjectivesGiven the uncertainty about factors that influence receipt of Clinical Excellence Awards (CEA) and recent availability of advanced research metrics, we examined the factors that predict CEA success using a convenience sample of English psychiatrists.DesignObservational study examining region, subspecialty, H-index, M-index, number of publications, years since registration and years in specialty.SettingACCEA Nominal Roll, cross-referenced with data from the GMC's list of registered medical practitioners and Thompson's Web of Science database.ParticipantsA total of 494 psychiatrists including 245 with national levels awards and a random sample with local level awards.Main outcome measuresReceipt of local or national CEA awards in 2008 and 2009.ResultsOf those with national awards, 126 had university contracts and 119 NHS contracts. Across all staff, years since qualification in medicine and H-index were the dominant influences. For local awards we found that years worked in the specialty was the main predictor of a CEA award with a smaller contribution from H-index. For national awards to university staff (academics) years on the medical register and publication rate were significant predictors. For national awards to NHS staff (non-academics) H-index and total cites were predictive, but these were themselves related to age.ConclusionsProgression in CEAs among psychiatrists is strongly influenced by age (years spent in specialty and years on the medical register) with an additional contribution from research productivity. Currently, research impact is crudely assessed in the CEA process. We suggest that CEA committees formally assess the impact of NHS-related research using standardized research metrics which are openly available. We also suggest that supporting organizations and local trusts adhere to the rules mandated by the ACCEA.

British Psychiatrists Rank Own Specialty as Least Respected

British Psychiatrists Rank Own Specialty as Least Respected

A study of British psychiatrists found that the specialty has an image problem in the United Kingdom. What can we do to reduce the stigma against our specialty—here and abroad?

A study of British psychiatrists found that the specialty has an image problem in the United Kingdom. What can we do to reduce the stigma against our specialty—here and abroad?

Psychiatry in Britain, c. 1900

At this period, British psychiatrists practised in a climate of opinion that was deeply pessimistic, influenced by the views of Henry Maudsley and by the accumulation in asylums of incurable patients. The inflexible Lunacy Act of 1890 tended to encourage chronicity. The terminology both of mental illness and of the doctors who dealt with it was uncertain. Management of these disorders was intimately involved with the operation of the Poor Law. Neurology, on the other hand, carried high prestige and advanced clinically; many patients with neurotic disorders came under the care of neurologists. Postgraduate education and training in psychiatry was practically non-existent, as was academic psychiatry, in contrast notably to Germany, though there was a small professional organization.