Scottish Psychiatrists Research Articles

Scottish psychiatrists' attitudes to electroconvulsive therapy: survey analysis

Aims and methodElectroconvulsive therapy (ECT) prescription rates in Scotland are decreasing. This study aims to look for possible causes, in particular psychiatrists' attitudes. Ninety-one Scottish psychiatrists completed a survey in 2009 relating to demographics, training, current practice, National Institute for Health and Care Excellence (NICE) guidelines and attitudes.ResultsThe mean number of times the psychiatrists had prescribed ECT in the past 2 years was twice. About 43% felt that their prescribing rates had decreased. Reasons for this included more effective medication, public and patient perception, and NICE guidelines. There was a significant correlation between doctors' gender and estimated prescription rates (P= 0.004), however, not with other prescription data. Almost all surveyed psychiatrists (97%) agreed that ECT has a place in current psychiatric practice.Clinical implicationsDespite generally positive attitudes to ECT shown by psychiatrists in this study, prescription rates were low and decreasing. With more effective medication the role of ECT in therapy appears to be changing.

The peculiarities of the Scots? Scottish influences on the development of English psychiatry, 1700–1980

This paper examines the multiple influences Scottish psychiatrists have exercised over the shape of English responses to mental illness during nearly three centuries, beginning with George Cheyne and ending with R.D. Laing. Scotland's distinctive response to mental illness was largely ignored until recently, as though it had simply followed the English path. The neglect has begun to be rectified, but the powerful influence of the Scots on developments south of the border requires more sustained attention than it has received hitherto.

Review of the forensic psychiatry service at Zomba Mental Hospital and a comparison of forensic psychiatry services in Malawi and Scotland

This retrospective case-note study describes the demographic details, offences and diagnostic characteristics of 283 patients admitted to Zomba Mental Hospital, Malawi, after early diversion from the Criminal Justice System between May 1997 and February 2007. Given the historical links between Malawi and Scotland and the ongoing involvement of Scottish psychiatrists in the development of psychiatry in Malawi, a comparison is drawn between the provision of secure psychiatric treatment in these low- and high-income countries. Consistent with Scottish prison mental health team referrals and Scottish high secure psychiatric patients, the Malawian patients were predominantly men, poorly educated and drug misusing, but alcohol was less often a problem. Affective disorders were rarely diagnosed, as is also the case in the equivalent Scottish populations. In Malawi, there appears to be a problem with aftercare because many of the patients had been detained before. The length of detention was very short, other than an exceptional finding for substance misuse--a mental disorder with no Mental Health Act equivalence in the UK. Absconding was the commonest outcome. Malawian patients diverted from the Criminal Justice System are treated on general adult psychiatry wards where few secure measures can be offered. Further, there is little capacity for follow-up, no community compulsion legislation exists and psychiatric expertise is limited to a few disparate sites. However, the service is developing and the data in this study represent a small part of that ongoing programme.

Survey of Scottish psychiatrists' views on neuropsychology training

Aims and MethodA national survey of members of the Scottish division of the Royal College of Psychiatrists to establish the training in neuropsychology they have received, their views on neuropsychology service provision and on potential formal postgraduate neuropsychology training opportunities.ResultsA 54% (n = 288) consultant psychiatrist response rate was achieved. the responses suggest that where specialist neuropsychology services exist, they are not perceived to be sufficient to deal with clinical demand. Consultant psychiatrists indicated that there are limited training opportunities in neuropsychology for psychiatrists, and this seems to be reflected in their limited confidence in interpreting basic recommended neuropsychological assessment tools. There seems to be a definite desire among consultant psychiatrists for postgraduate training opportunities.Clinical ImplicationsScottish psychiatrists desire an increase in formal neuropsychology training opportunities.

Uncertainty among Scottish psychiatrists over NHS continuing care guidance

Aims and MethodTo examine knowledge among Scottish psychiatrists of the 1996 guidance on National Health Service (NHS) responsibility for continuing healthcare, a postal questionnaire was devised and sent to the 132 consultants and specialist registrars in the South-East Scotland Deanery in May 2007.ResultsTwo-thirds of the clinicians (67%, n= 88) responded, 88% of whom had in-patient responsibilities. Only 24% responded positively to an awareness of the current Scottish guidance. There was a strong association between awareness of the guidance and psychiatric speciality, and greater awareness among clinicians with previous experience of a relevant complaint or appeal.Clinical ImplicationsUncertainty about NHS continuing healthcare guidance among practising psychiatrists suggests a need for increased awareness of the issues, with training implications for the new guidance on NHS continuing healthcare in Scotland which became effective in February 2008.

Unilateral and bilateral electroconvulsive therapy: what informs Scottish psychiatrists' choices?

Aims and MethodA postal questionnaire was sent to Scottish consultant psychiatrists asking about their attitudes towards unilateral and bilateral electroconvulsive therapy (ECT), and the difference in effectiveness between the two ECT types that they considered clinically significant.ResultsThe response rate was 61%. of those that responded, 62% were prescribers of ECT and most (79%) favoured bilateral ECT over unilateral ECT. the outcome that they were most concerned with was remission rate: 97% believe that an absolute difference of more than 5% in remission rate would make the difference in effectiveness between the two types of ECT clinically important.Clinical ImplicationsFuture investigators should focus on comparative remission rates of bilateral and unilateral ECT.

Crime and Punishment (Scotland) Act 1997: a survey of sentencers' views concerning the Scottish 'hybrid order'.

The Crime and Punishment (Scotland) Act 1997 introduced the hospital direction (HD), often termed the 'hybrid order' because it allows courts to simultaneously send a mentally disordered offender to hospital and impose a prison sentence, to be completed after hospital discharge. It is the first measure that explicitly allows the imposition of a prison sentence for an offender meeting criteria for detention under the Mental Health (Scotland) Act 1984. A previous survey showed that psychiatrists in Scotland favoured the principle of a hybrid order (Darjee et al., 2000). In this study all Scottish Sheriffs (n = 110) and High Court Judges (n = 26) were surveyed for their views on the HD. Of the 56 respondents 19 felt unable to participate largely due to lack of experience in sentencing mentally disordered offenders. Respondents felt the HD was a useful measure, but, in contrast to Scottish Office guidance, indicated that psychiatrists should recommend it directly if they considered that it was an appropriate disposal. Respondents viewed the HD as primarily an incapacitating measure and most respondents hoped that it would encourage psychiatrists to admit 'psychopaths'; although Scottish psychiatrists do not favour the hospitalisation of offenders with primary personality disorders. It is concluded that in its current form and with current guidance the HD is difficult to use, as there are no criteria to differentiate it from a hospital order (HO) and psychiatrists cannot recommend it. Further, recent legislation that makes public safety the primary concern when deciding on the discharge of restricted patients in Scotland, erodes the utility of the HD as an incapacitating measure. However following the Reports of the Millan and MacLean Committees in Scotland, the role of the HD may be strengthened and clarified.

Cognitive–behavioural therapy: a survey of the training, practice and views of Scottish consultant psychiatrists

Aims and MethodA postal survey of all consultant psychiatrists employed by the NHS in Scotland was performed with the aim of determining the numbers and characteristics of consultant psychiatrists who have received training in cognitive–behavioural therapy (CBT). Additional aims were to ascertain the current practice of CBT, along with general attitudes towards practice and training issues.ResultsNine per cent of consultant psychiatrists had received formal training in CBT. An additional 20% had received informal tuition with supervision of cases. For consultants appointed within the previous five years, 48% had received the recommended amount of supervised experience. In practice, consultants were unable to devote significant amounts of time to formal CBT but were actively using CBT techniques and supported the availability of training opportunities.Clinical ImplicationsThe survey suggests that the current Royal College of Psychiatrists' guidelines do not appear to have been fully implemented for the area surveyed. Further debate is needed to ascertain the exact form that training in CBT should take.

Psychiatrists' attitudes to maintenance drug treatment in depression

Aims and methodThe recurrence rate of major depression can be decreased by the use of maintenance drug treatment. This paper describes a survey of Scottish psychiatrists' attitudes to prescribing maintenance therapy. Questionnaires were sent to all Scottish psychiatrists at consultant and associate specialist grade.ResultsIt is evident that there are major differences in prescribing practices. How patients are managed would appear to depend on to whom they are referred.Clinical implicationsPsychiatrists do not appear to be practising evidence-based medicine in this context. There is perhaps a need for greater consensus on the prevention of recurrence.

The College: an analysis of members' views

Aims and methodIn November 1997 a questionnaire was sent to a large random sample of members, fellows, affiliates and inceptors living in the UK or the Republic of Ireland.ResultsOne thousand four hundred and seventy-six completed questionnaires were available for analysis, a response rate of 63%. The College was complemented for raising standards of education and training in psychiatry and criticised for not trying hard enough, or failing, to influence the policies of the Department of Health. A high proportion of respondents highly valued the British Journal of Psychiatry and Psychiatric Bulletin but few made use of the library. A high percentage of Irish, Welsh and Scottish members, and of members of the five smaller faculties, participated in and expressed their appreciation of the activities of the College.ImplicationsWhatever its other failings the College is not dominated by general psychiatrists and their interests, or by London-based psychiatrists. It is surprisingly successful at involving Scottish, Welsh and Irish psychiatrists, and members of the smaller faculties, in its activities. To some extent, however, the faculties are thriving at the expense of the English divisions.

Psychiatrists' attitudes to physical examination of new out-patients with a major depressive disorder

This survey examined Scottish psychiatrists' attitudes to physical examination and appropriate investigations in the routine assessment of new out-patients with a major depressive disorder. A discrepancy exists between current opinion towards and actual practice of physical examination in the assessment of new out-patients with depression. Numerous obstacles to performing investigations were identified including lack of time, inadequate consulting rooms, lack of equipment and lack of chaperon. The many obstacles identified are considerable but not insurmountable. Missed diagnoses may have adverse consequences for patients as well as medico-legal implications.

Medical audit among Scottish child psychiatrists

Working for Patients (DOH, 1989) has provided considerable impetus to the development of medical audit. The Royal College of Psychiatrists (1989) Preliminary Report on Medical Audit defined and distinguished between clinical audit, peer review and performance indicators, and referred to some of the particular problems affecting the development of audit in psychiatric practice. There are special concerns for child and adolescent psychiatrists developing medical audit programmes because of the wide diversity of child and adolescent practice and the considerable variability of resources in the subspecialty. Nicol (1989) has described the initial concern of the National Child Psychiatry Section's Working Group on audit with the Korner Report (HMSO, 1982) and the proposals on performance indicators outlined by the DHSS in 1987.

Scottish psychiatrists in primary health-care settings. A silent majority.

There has been a growing number of reports of psychiatrists moving out into primary-care settings. We report a survey of consultant psychiatrists to assess the extent of this practice in Scotland. Some time spent in the primary-care setting was reported by 56%, the figures being highest in rural areas. An equal number of non-consultant medical staff were involved. Most schemes were initiated by psychiatrists, over half of whom had had some postgraduate general-practice experience. A similar survey in England and Wales showed that only 19% of consultant psychiatrists spent time in primary-care settings, a smaller proportion of non-consultant staff being involved. The value of working in primary-care settings has yet to be assessed.

The use of the term 'borderline patient' by Scottish psychiatrists: a preliminary survey.

One hundred and sixty Scottish psychiatrists complete a questionnaire eliciting the extent of their use of the term 'borderline patient' and the factors affecting this. The term was used by 27.5 per cent, the majority of whom felt that it ought to be included in current diagnostic classification systems. There was, however, general dissatisfaction with the vagueness of current definitions of the term and a confusing use of numerous diagnostic labels. Use of the term was not related to status, geographical location, or familiarity with American psychiatric literature. The practice of psychodynamically-oriented psychotherapy and extended working contact with psychiatry in North America were found significantly to increase its use.

Opinions on Psychotherapy: An Enquiry

This enquiry was prompted by a discussion on training in psychotherapy which took place at the Troon Conference on the Teaching of Psychiatry (Ingram, 1963). We felt that more precise information was required about what is meant by the term psychotherapy, which methods are in use and what opinions are held by psychotherapists in training. This information could be of value in assessing the workload of psychiatrists and in deciding what training might be given to psychiatrists and medical students. It was therefore decided to seek the opinions of Scottish psychiatrists on some aspects of their current practice in psychotherapy.

THE DIAGNOSIS OF SCHIZOPHRENIA BY SCOTTISH PSYCHIATRISTS.

In Scotland the central collection of forms bearing details of admissions to all psychiatric hospitals was begun in January, 1962. These forms are intended to provide knowledge about the incidence of psychiatric disorders and the result of treatment. The details of this scheme and the nature of the information required were presented at a meeting of the Scottish Division of the Royal Medico-Psychological Association in 1961, and in the discussion which followed the reliability of data which depended on clinical diagnosis was questioned.