British Psychiatrists Research Articles

DSM-III in the Training of British Psychiatrists: a National Survey

All 223 psychiatric clinical tutors in the UK were surveyed on their use of DSM-III in their postgraduate training programmes. Results indicate that DSM-III is widely used in clinical training to some extent in the majority of schemes (73%) and in the schemes where it is used it is rated as moderately useful by nearly everyone (93%). DSM-III is generally perceived to have positive effects on learning basic elements of psychopathology and in offering a common language for diagnostic discussion. Interestingly only 16% of users felt that DSM-III was so complicated that it impeded rather than facilitated the teaching of diagnosis. Few schemes provide specific teaching courses and case conferences provide the major forum for teaching DSM-III.

Compulsory Psychiatric Treatment in the Community

Several English consultant psychiatrists were asked to identify which patients currently under their care they would recommend for treatment with a community treatment order, if such a provision existed. The psychiatrists were asked to match each such 'nominated' patient for age, sex and diagnosis with one or two control patients, not considered to require compulsory treatment in the community. From specific data collected, it was found that: the two groups did not differ in their 'lifetime' histories of psychiatric admissions, substance misuse, criminal charges or dangerousness; 65-72% of the total sample had a history of serious dangerousness; but in the 12 months before nomination, the 'nominated' patients were significantly less likely than the controls to have complied with psychiatric treatment, and more likely to have defaulted from follow-up. The results indicate that a psychiatrist's decision to recommend a patient for treatment with a community treatment order will depend predominantly on specific criteria related to the patient's recent past.

Are British Psychiatrists Racist?

Out of a sample of 220 British psychiatrists, 139 completed a questionnaire regarding a case vignette of psychotic illness. The sex and 'race' of the vignette were varied and the responses compared. The Afro-Caribbean case was regarded as that of an illness of shorter duration, and requiring less neuroleptics than the white case. Respondents judged the Afro-Caribbean case as potentially more violent and thought criminal proceedings were more appropriate. The female vignette was perceived as less violent, less criminal, and less likely to need neuroleptics. Cannabis psychosis and acute reactive psychosis tended to be diagnosed more often and schizophrenia less often in Afro-Caribbean cases, refuting the claim that psychiatrists tend to overdiagnose schizophrenia in this group. Such 'race thinking' (a form of stereotyping which is distinct from ideological racism) could lead to inappropriate management.

Discrimination on the grounds of diagnosis

The study used the methodology of randomly allocating case vignettes to a sample of British consultant psychiatrists to assess the influence of a past diagnosis of alcohol dependence on present treatment attitudes. The case vignettes either did or did not include the previous diagnosis of alcohol dependence and the sex of the 'case' was also randomized. Psychiatrists receiving the vignette with the diagnosis of alcohol dependence were more likely to rate the patient as difficult, annoying, less in need of admission, uncomplaint, having a poor prognosis and more likely to be discharged from follow-up. There was minimal sex difference. Psychiatrist with a special interest in addictions regarded people with a past diagnosis of alcohol dependence as less difficult to manage than their non-specialist colleagues. The implications for education and treatment are discussed.

The Development of DSM-IV

To the Editor.— We note with interest the recent discussion on the development of DSM-IV and the emphasis placed on correspondence with the terminology of the International Classification of Diseases, Tenth Revision (ICD-10). 1 While it is clearly highly desirable to avoid incongruities in terminology between these two systems, it is likely that a much more important cause of the inexact communication about patients' disorders is the tendency of most clinicians to continue to use the classification system they learned during their initial specialty training. The extent of this problem was first highlighted by the findings of Kendell, 2 who noted, in relation to ICD-9 , that the introduction of a new nomenclature and a companion glossary had no appreciable influence on the diagnoses made by English psychiatrists. Similar results were later reported by Lipkowitz and Idupugnanti 3 in relation to DSM-III . They reviewed the criteria used by a random sample

Psychiatric Admission of Mentally Ill Mothers with their Infants

There is a greatly increased risk of a woman developing a psychiatric illness requiring hospital admission during the early postpartum period. Admission of the mother has usually meant separating her from her infant at a time when bonding and attachment are developing. Nearly 40 years ago English psychiatrists began admitting infants with their mentally ill mothers, and although the theoretical basis for this is sound, there are few systematic studies of the practical problems encountered, or the outcomes. This paper compares a group of 32 psychiatrically ill postpartum women who were admitted to a Canadian general hospital psychiatric unit with their infants to a group of 26 psychiatrically ill postpartum women hospitalized on the same unit who refused admission of their infants. The women admitted with their infants were more likely to be older, living with the infants' father, in a stable residence and job, in hospital for a longer time, and caring for their babies at 2 year follow-up in contrast to the women who were admitted without their infants. The two groups were diagnostically different with joint admission mothers likely to suffer from an affective psychotic illness, while the mothers without infants were more likely to suffer from personality disorder or substance abuse. The effects of mother-infant admission and some of the practical problems encountered are discussed.

The Manchester scheme for training overseas psychiatrists

There was a time when overseas psychiatrists considered themselves fortunate to come to this country to be an assistant in one of the well-known postgraduate departments. If they showed perseverance they could learn enough to obtain an English postgraduate qualification, and they could participate in the training of English psychiatrists. The more entrepreneurial of them could obtain full-time jobs in psychiatry, but otherwise hands on experience of patient care was limited.

Henry Maudsley – psychiatrist, philosopher and entrepreneur

Despite his acknowledged pre-eminence among British psychiatrists of the 19th century, Henry Maudsley (1835-1918) remains a 'shadowy figure', a name known through the Hospital and annual lecture funded by his beneficence. Apart from the homage paid by Sir Aubrey Lewis in 1951, there has been no recent attempt at any biography nor any critical reappraisal of Maudsley's life and work. On the basis of reviewing his role in the Medico-Psychological Association (MPA), his rather pessimistic and degenerationist philosophy, his undoubted wealth and his 'hypercritical nature', it is possible to define an alternative view of his significance and influence.

Canadian qualifications for British psychiatrists

Canadian qualifications for British psychiatrists

Canadian qualifications for British psychiatrists

Canadian qualifications for British psychiatrists

Canadian qualifications for British psychiatrists

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Canadian qualifications for british psychiatrists

Canadian qualifications for british psychiatrists

An English Psychiatrist in Ontario

After 30 years of psychiatry in England I've just had a cold plunge through Canadian psychiatry as a staffman in an Ontario general hospital. Because science is international and a good many British psychiatrists work in Canada I expected clinical practice to be the same: but psychiatry is different on the two sides of the Atlantic. Before my raw, insistent perceptions of these differences fade, as they do so quickly when one adapts to a new life, I will write some of them down. However faulty they form a rough mirror in which we can all examine our own professional faces.

British psychiatrists in Canada

British psychiatrists in Canada

British psychiatrists in Canada

British psychiatrists in Canada

British psychiatrists in Canada

British psychiatrists in Canada

Response of the Irish Division to ‘Planning for the Future’

SummaryIn 1981, the Labour Minister for Health in a coalition government, Mrs Eileen Desmond, set up a study group ‘to examine the main components, both institutional and community, of the psychiatric services; to assess the existing services, to clarify their objectives and to draw up planning guidelines for future development of the service with due regard to cost implications; to carry out such studies and to take part in such consultations as are necessary to assist this examination’. The result appeared in December 1984 in the form of a report The Psychiatric Services: Planning for the Future. The text of the response of the Irish Division of the College, reproduced in full here, was sent to the current Minister for Health, Mr Barry Desmond, (also a Labour Minister in a coalition government) in October 1985. Meanwhile, in February 1986, Mr Desmond caused widespread alarm in political circles by the sudden announcement of the closure of two of the 22 psychiatric hospitals in the Republic without prior provision of alternative community services. British readers will detect a close parallel between this Irish report and the series of DHSS reports exemplified by Better Services for the Mentally Ill (HMSO, 1975). Perhaps the only significant difference between these two reports is that sectorisation (a mental health team headed by a psychiatrist and assigned to a ‘sector’ of 25,000 to 30,000 persons) is advocated rather more firmly in Planning for the Future. It is also worth remembering that the Republic of Ireland, in its population size and urban-rural distribution is comparable to the whole of Yorkshire. Half the population lives in Dublin. Elsewhere, psychiatric services must cope with widely scattered rural populations, with a minority only of working adults. There is a large private sector in Irish medicine and 20% of psychiatric admissions are to one or other of five private psychiatric hospitals. Despite these social differences from the UK, several comparative studies have shown a remarkable similarity in declared attitudes and practice amongst Irish compared with British psychiatrists. Finally, the method of remuneration of Irish family doctors differs from the UK: Irish GP's are paid, not on a capitation basis, but on a ‘fee-per-item-of-service’ basis with a majority of the population availing of this service free: patients tend to move from doctor to doctor and many use private health insurance to opt for private care. Psychiatric referral rates from general practice are low as in Britain.

British psychiatrists in Canada

British psychiatrists in Canada

Consumers' views of DSM-III: attitudes and practices of U.S. psychiatrists and 1984 graduating psychiatric residents.

The authors surveyed U.S. psychiatrists and psychiatric residents graduating in 1984 about their use and views of DSM-III. Although the majority approved of DSM-III generally, 35% of the psychiatrists and 20% of the residents said they would stop using it if it were not required. Residents accepted DSM-III better than did practicing psychiatrists. Many of the respondents doubted the validity of some diagnoses and stated that many of their patients did not satisfy criteria needed for the DSM-III diagnoses in their records. Most respondents did not use all DSM-III axes and did not want new axes. The authors discuss the survey results and their implications for revision of DSM-III.

British psychiatrists in Canada

British psychiatrists in Canada