Psychiatry Work Research Articles

Donna Marie Norris, MD: Improving Landscapes for Children and Families in Forensic Psychiatry

A major part of forensic psychiatry's work is focused on framing stories about individuals who find their lives, for one reason or another, suddenly linked to the legal system. How did the story's subject come to terms with the choice offered by the poet Robert Frost in his early 20th-century poem

Engaging patients as teachers of clinical interview skills

AIMS AND METHOD To engage patients as teachers of psychiatrists in training and non-consultant career grades, for the purpose of enhancing doctors’ understanding of the patient point of view and of the complexity of the doctor-patient relationship. Patients have been engaged as teachers in a recurrent cycle of ‘Basic Interview Skills’ workshops and the views of the doctors about this initiative have been elicited through a brief anonymous and confidential questionnaire. RESULTS Thirty-six psychiatric senior house officers (SHOs), general practitioners, Vocational Training Scheme SHOs in psychiatry, and staff grade and trust doctors in psychiatry have participated in four cycles of workshops. Five patients have engaged in the workshops as teachers, alongside the clinical tutor. Questionnaire feedback indicated some specific criticisms of a number of participants and dissatisfaction by a small minority of doctors, but the overall evaluation of the experience was positive. CLINICAL IMPLICATIONS Engagement of patients as teachers of psychiatrists in training and other new doctors in mental health services is desirable, feasible and welcomed by most doctors. With due attention to the legitimate sensitivities of participants, the practice of engaging patients as teachers of doctors working in psychiatry could be generalised in training schemes and services across the country.

Everyday resistance in psychiatry through harbouring strategies

The purpose of this article is to study emotion management by focusing on emotion labour in relation to organisational resistance in psychiatry. Drawing on focus group interviews and individual interviews with 11 therapists in psychiatry, and on theories of emotion management and harbouring work (i.e. managing emotion work and renewing energy in a team), we argue that individual workers in psychiatry have to create strategies on their own. The main findings show that emotions are harboured alone and resistance strategies created in solitude can be characterised as everyday resistance and organisational misbehaviour, performed in deep backstage spaces such as the bathroom.

Organizational model of ensuring safety and quality of treatment of aggressive psychiatric patients in mental health nursing in Slovenia

Introduction: The paper presents the organizational measures for managing violence in psychiatric settings and the study that introduces the preliminary success rate of the proposed model. 
 Methods: For the purpose of this study a non-experimental sampling method was employed using a structured questionnaire as a data collection instrument. The sample covered the personnel most frequently exposed to violence namely, the nursing staff in closed and/or intensive psychiatric units in 5 Slovenian psychiatric hospitals, 3 psychiatric homes and 2 special education, and work and care centres. The data were statistically analysed with the SPSS v20 software package, with p < 0.05 indicating statistical significance. 
 Results: The practical part of the functional training was conducted between 2010 and 2013 in specific psychiatric hospitals and wards. In a study carried out in 2013, preliminary results indicating the success rate of the proposed model were obtained. 
 Discussion and conclusions: Health care workers in psychiatry are responsible for providing safe and high quality treatment even in cases of aggressive outbursts, but they lack the necessary functional knowledge to cope with aggression in the workplace. The paper presents an organizational model for ensuring the safety of the patients and the quality of their treatment in case of an aggressive outburst, along with the presentation of the required functional training.

Psychiatry in Russia

SummaryRussian psychiatry has dramatic history, and till now is at a transitional stage of development. It is facing the problems not only common in world psychiatry, but also specific for the Eastern Europe, in particular for Russia. Starting from the beginning of 1990s considerable changes have occurred in psychiatry, especially after 1992 when “The law on psychiatric care and guarantees of citizens rights in its provision was adopted”. It became the ideological and legislative basis for reforms. However there are the definite obstacles for structural reforms in psychiatry. They are as follows: unfavourable technical conditions in many psychiatric clinics, hypercentralization of psychiatric services, shortage of clinical psychologists and social workers in psychiatry, some difficulties in cooperation between psychiatric and general medical institutions. Economic difficulties of the transition period of Russia’s social development prevent overcoming these problem. They are being actively discussed and part of them is being gradually solved, e.g. organization of team work in mental health services, increasing number of specialists on social work, involvement of NGO’s in psychosocial rehabilitation.

History and current condition of Russian psychiatry

Russian psychiatry has a dramatic history, and until now has been at a transitional stage of development. It is facing problems not only common in world psychiatry, but also specific to eastern Europe, in particular Russia. Starting from the beginning of the 1990s, considerable changes have occurred in psychiatry, especially after 1992 when the law on psychiatric care and guarantees of citizens’ rights in its provision was adopted. It became the ideological and legislative basis for reforms. However, there are definite obstacles to structural reforms in psychiatry. They are unfavourable technical conditions in many psychiatric clinics, hypercentralization of psychiatric services, shortage of clinical psychologists and social workers in psychiatry, some difficulties in cooperation between psychiatric and general medical institutions. Economic difficulties in the transition period of Russia's social development prevent the overcoming of these problems. They are being actively discussed and some of them are being gradually solved, e.g. the organization of team work in mental health services, the increasing number of specialists on social work, and the involvement of non-government organizations in psychosocial rehabilitation.

Violence against care workers in psychiatry: Is prosecution justified?

The number of (severe) violent incidents against staff caused by psychiatric inpatients is high. Victims often do not report these incidents to the police, because of various reasons. But if they do report these incidents, the judicial authorities are often reluctant in prosecuting and convicting these patients. The central question in this article is ‘in which cases is it appropriate to prosecute assaultive psychiatric patients?’ In order to identify the influential factors in the decision in respectively reporting, prosecuting and convicting psychiatric patients who assault staff, a literature review has been performed. On the basis of this literature it is advised to report and investigate a case when the incident resulted in severe injury, the incident is a sexual offence, or when a patient repetitively causes violent incidents. Moreover, it appears that, although large amount of studies has been published on violence in psychiatry, the prosecution of violent psychiatric patients has hardly received any attention in the international literature. Empirical studies on this subject are suggested, in order to develop a uniform policy, which is embraced by all parties involved.

Through education to social inclusion: the anti-stigma program implemented by community psychiatry workers and users in Krakow

Through education to social inclusion: the anti-stigma program implemented by community psychiatry workers and users in Krakow

Knowledge about childhood autism and opinion among healthcare workers on availability of facilities and law caring for the needs and rights of children with childhood autism and other developmental disorders in Nigeria

BackgroundIn designing programs to raise the community level of awareness about childhood autism in sub-Saharan Africa, it is logical to use the primary healthcare workers as contact point for education of the general public. Tertiary healthcare workers could play the role of trainers on childhood autism at primary healthcare level. Assessing their baseline knowledge about childhood autism to detect areas of knowledge gap is an essential ingredient in starting off such programs that would be aimed at early diagnosis and interventions. Knowledge of the healthcare workers on availability of facilities and law that would promote the required interventions is also important. This study assessed the baseline knowledge about childhood autism and opinion among Nigerian healthcare workers on availability of facilities and law caring for the needs and rights of children with childhood autism and other developmental disorders.MethodA total of one hundred and thirty four (134) consented healthcare workers working in tertiary healthcare facilities located in south east and south-south regions of Nigeria were interviewed with Socio-demographic, Knowledge about Childhood Autism among Health Workers (KCAHW) and Opinion on availability of Facilities and Law caring for the needs and rights of children with Childhood Autism and other developmental disorders (OFLCA) questionnaires.ResultsThe total mean score of participated healthcare workers on KCAHW questionnaire was 12.35 ± 4.40 out of a total score of 19 possible. Knowledge gap was found to be higher in domain 3 (symptoms of obsessive and repetitive pattern of behavior), followed by domains 1 (symptoms of impairments in social interaction), 4 (type of disorder autism is and associated co-morbidity) and 2 (symptoms of communication impairments) of KCAHW respectively among the healthcare workers. Knowledge about childhood autism (KCA) as measured by scores on KCAHW questionnaire was significantly associated with age group distribution of the healthcare workers, with those age group of fourth decades and above more likely to have higher mean score (p = 0.004) and previous experience of managing children with autism spectrum disorders (ASD) (p = 0.000). KCA showed near significant association with area of specialty, with those healthcare workers in psychiatry compared to pediatrics having higher mean score (p = 0.071) and also with years of working experience of the healthcare workers (p = 0.056). More than half of the healthcare workers subscribed to the opinion that facilities and law caring for the needs and rights of children with childhood autism and other developmental disorders are lacking in Nigeria.ConclusionThe correlates of KCA may help in selection of those tertiary healthcare workers that would best fit the role of trainers. It is important to update the knowledge gaps of those healthcare workers who scored low in different domains of KCAHW questionnaire. It is imperative for policy makers in Nigeria to advocate and implement multidisciplinary healthcare service system that would ensure early diagnosis and interventions. Nationally representative baseline epidemiological data that would guide policy and planning are also desirable.

Book Essays and Reviews

Fashioned as it is in the image of its creator, the intricacy and complexity and of the human psyche is staggering in scope for those of us who seek to understand and repair its maladies. Over the years, this has led workers in psychiatry and psychology to generate an enormous number of theories to explain psychopathological processes, and an equally large number of therapeutic methods designed to repair the damage. Such a wide variety of approaches has led to confusion and conflict, often resulting in a polarization of opinions that has hampered scientific progress. Given the daunting nature of the task, it has become apparent over the years that the most useful innovations in theory and therapeutic technique come from those that systematically integrate past findings with new data and fresh ways of organizing previous findings. Lorna Smith Benjamin’s book on Interpersonal Reconstructive Therapy (IRT) successfully adheres to this integrative model. For this reason, her book should prove highly useful for students, clinicians, and researchers from all sectors of the field of psychotherapy, from behaviorists to psychoanalysts. As implied by the subtitle to Dr. Benjamin’s book, the underlying theories and techniques that she presents are designed to promote recovery in patients who are not responding well to standard psychotherapeutic treatment. However, her work has a far broader application, and should be useful in helping clinicians to stay more focused on the therapeutic task and to achieve a better understanding of the often mysterious repetitive patterns of pathologic behavior manifested by our patients, even those who seem to be getting better with standard treatments. Dr. Benjamin’s IRT approach to understanding and treating psychopathology is based on her Developmental Learning and Loving theory (DLL). J. Bowlby’s (1969) studies on attachment show how early life rePsychiatry 67(2) Summer 2004 208

Community care reforms: health and housing.

Roland Barnes and Martin Collison have uncovered some misunderstandings between housing and health workers in psychiatry. Here, they suggest some ways in which collaboration could be initiated or improved

Somatic and Psychiatric Aspects of Childhood Allergies.

This monograph presents many points of view concerning the pathogenesis of allergic disorders in children, summarizes evidence for the importance of emotional as well as immunologic factors, and cites the thoughts of leading workers in psychiatry and allergy who have a special interest in children. It contains common sense ideas and suggestions of value in the management of children who have allergic disorders. Expressed divergences of opinion, however, underscore the complexity of the mechanisms which are operative in allergy, and indicate a need for refinements in methods of diagnosis and in the objective assessment of therapy. A minor criticism is that although advances in descriptive and theoretical aspects of allergy are stressed, there is little space devoted to current research in basic immunology as it relates to allergy, and not enough is said about the vast area of ignorance which remains. The great need for fresh investigative approaches and for

A Study of Irrational Judgments

T HERE is an important difference of opinion among social scientists concerning whether human behavior is rational or irrational. Traditionally, economic theory has been based on an assumption that behavior is rational, in a specific sense to be defined shortly, whereas most psychological and sociological theory insists that behavior is, at least largely, irrational. Some of the more advanced workers in psychiatry and anthropology have been discovering that much of what superficially appears to be irrational, in terms of what the outside observer considers to be the interests of the subject or the information available to him, is really rational when certain premises of thought-often repressed or at least hidden-are taken into consideration. These newer discoveries pose for research the question of whether human behavior is ever irrational in terms of the value judgments held by the individual or the group and the information available to them. This question remains a crucial one for the economic theory of choice, and its resolution will strongly influence the future direction of economic theory, as well as the relationship of economics to the other social sciences. Some writers in econometrics have claimed that most of the empirical assumptions of the older economists can now be abandoned but that the assumption of is still crucial and must be so, or economics can be nothing more than a descriptive science of the sort envisioned by the institutionalists. By rationality they usually mean in effect transitivity,2 or an internally coherent choice pattern such that if an individual chooses A in preference to B, and B in preference to C, then he will choose A in preference to C.3 The relationship need not logically be that of preference, although it always is in economics. Edwards cites the extensive economic literature in which it is demonstrated that transitivity of preferences (for commodity bundles) is a necessity for conventional economic theory. The psychological assumption behind

Psychiatry: A Social Institution in Process

T HIS paper will report upon uses of social institutional analysis in study of psychiatry. It will aim at indicating how well suited social process analysis is to understanding of professional development. The background of this paper is a study of extra-mural psychiatry done for Russell Sage Foundation several years ago. This study aimed at a sociological analysis of developing profession. And it sought to indicate where, in changing tasks and contexts of psychiatry's work, social science knowledge might profitably be mediated to it or collaborative research established. Extra-mural psychiatry is name generally given to those aspects of psychiatry which are practiced outside of state hospitals in which American psychiatry was born. The first order of business for study was to determine how and why psychiatry had emerged from its exclusively state hospital concerns to confront community in many new roles and with many new functions. It was also necessary to study matrices in which it was now operating. The contingent problems of such expansion were of primary sociological interest. The problem of ordering seeming chaos of this rapidly changing and widely sprawling field presented itself. Criteria for determining relevant data and delimiting scope of inquiry were urgently needed. Material on social institutions seemed best fitted to meet this need. The relevant framework was established by borrowing from a variety of widely separated sources. The eclectic scheme which resulted formed a model which seemed well suited for study of problems peculiar to changing aspects of psychiatry. These problems were indicated in first brief contacts with field. An immediate impression was formed that a condition of great flux prevailed. Changes appeared to be many and rapid and seemed to be proceeding at different rates in different aspects of psychiatry. Problems of reorganizing profession figured large in literature. The effects of rapid changes made during World War II were being assayed. New associations were active. Controversies with ancillary professions flared along margins of psychiatry. Considerable concern with position of psychiatry within medical profession was shown. There appeared to be in present position of extra-mural psychiatry a laboratory of processes involved in establishment and maintenance of a profession. This was problem complex at which study, in terms of social institutional analysis, was directed. The main terms of analysis of eclectic framework are briefly noted as follows. For Cooley, a social institution was a mature, specialized, and comparatively rigid part of social structure.' In these terms study of institutions is study of formally established aspects of group behavior. Malinowski added other dimensions to concept. He viewed social institutions as problemsolving organs of human society. Culture is an instrumental reality which has come into existence to satisfy needs of man. And institutions, organized systems of human activities are the real component units of cultures which have a considerable degree of permanence, universality and independence.2 He added that there is not a simple correlation of need and function. One need does not receive one satisfaction in one institution. But institutions show a pronounced amalgamation of functions..... Still further sophistication was contributed by Radcliffe-Brown. He emphasized human internal organization of social institutions and their integration with environing society. For him function of an institution was the part it plays in total system of social integration of which it is a part. And by social integration he meant

Histopathological changes in the brain in schizophrenia; a critical review.

I. INTRODUCTION INVESTIGATIONS into a possibly characteristic histopathology of the brain in schizophrenia and other so-called functional psychoses can be considered to have begun with the pioneer researches of Alzheimer and other German workers shortly before the close of the 19th century. In the five ensuing decades some of the ablest workers in psychiatry and neuropathology have concerned themselves with this important problem. In this paper it is my purpose to describe and scrutinize the reports concerning the histopathology of schizophrenia, to examine these reports in terms of their experimental and statistical validity, and to emphasize those findings which best stand the test of such scrutiny. It is perhaps unnecessary to remark that while this undertaking is approached with humility, it is not permissible to allow one's respect for the names of pioneer workers to dull the edge of critical evaluation of their work and their interpretations. With this in

Effects of ACTH in patients with mental disease.

THE POSSIBLE occurrence of disordered function of the adrenal cortex in patients with mental disease has interested workers in psychiatry for many years. Although no precise formulation of the nature or significance of changes in function of the adrenal cortex in such diseases has been or can be made, recent increases in knowledge of the function of that gland and of the action of steroid hormones have resulted in the accumulation of data bearing on this problem. Severe hypoglycemia, convulsions induced by drugs or by electric shock, and fever cause changes in blood eosinophil and lymphocyte counts and in the urinary excretion of uric acid in patients with mental diseases, including schizophrenia, showing that the adrenal cortex responds to severe stress. 1 In addition, the milder stress of the effect

The Pshchoanalytic Study of the Child, Vol. II

A group of leading psychoanalysts representing psychiatry, psychology, social work and education have contributed to this second volume in the study of the child. The book deals with a variety of aspects of the child's life and includes essays on personality development, healthy and deviant behavior, learning and reading disabilities, neurotic symptom formation, problems of psychoses in children and the history of child psychiatry. Although written particularly for workers in psychiatry and related fields, the papers contain a wealth of material which should be of value to the pediatrician. Unfortunately, a busy practitioner will not have the time nor the patience to study intently the material presented here.

On the Causation of Mental Symptoms: An Inquiry into the Psychiatric Application of Hughlings Jackson's Views on the Causation of Nervous Symptoms, with Particular Reference to Their Application to Delirium and Schizophrenia

When one compares the present state of psychiatric research with that of neurological research, one finds, in the former, an astonishing confusion of contradictory viewpoints. This confusion would, I believe, be resolved if research workers in psychiatry embodied in their creed certain of the principles which Hughlings Jackson unceasingly laboured to establish.

The Presidential Address delivered at the Fifty-ninth Annual Meeting of the Medico-Psychological Association, held in London on the 26th July, 1900

First let me thank you very heartily for the high honour you have done me by electing me to the Presidential chair. When one looks over the names that have preceded me, from the time of Conolly downwards, one finds that it has been occupied by men of high talent, well known as workers in psychiatry, not only in this country, but abroad. To emulate them will be my endeavour, and I shall certainly do everything in my power to uphold the dignity and welfare of this Association.