John M. Eagles

Wake-up call for British psychiatry.

The recent drive within the UK National Health Service to improve psychosocial care for people with mental illness is both understandable and welcome: evidence-based psychological and social interventions are extremely important in managing psychiatric illness. Nevertheless, the accompanying downgrading of medical aspects of care has resulted in services that often are better suited to offering non-specific psychosocial support, rather than thorough, broad-based diagnostic assessment leading to specific treatments to optimise well-being and functioning. In part, these changes have been politically driven, but they could not have occurred without the collusion, or at least the acquiescence, of psychiatrists. This creeping devaluation of medicine disadvantages patients and is very damaging to both the standing and the understanding of psychiatry in the minds of the public, fellow professionals and the medical students who will be responsible for the specialtys future. On the 200th birthday of psychiatry, it is fitting to reconsider the specialtys core values and renew efforts to use psychiatric skills for the maximum benefit of patients.

Obstetric complications in DSM -III schizophrenics and their siblings

Blind to the adult diagnosis, the birth records of 27 patients fulfilling DSM-III criteria for schizophrenia and those of their healthy siblings were examined. A significant excess of obstetric complications was seen in the schizophrenic subjects.

The relationship between mood and daily hours of sunlight in rapid cycling bipolar illness

In this report, cases were described in whom travelling south induced hypomania, and it is perhaps surprising, therefore, that cases of rapid cycling bipolar disorder have not been reported in response to fluctuations in hours of daily sunlight

Selective effects of ECT on hypothalamic—pituitary activity

The hypothesis that ECT produces selective effects on hypothalamic-pituitary activity was investigated by determining the effect of ECT on pituitary hormone release in nine depressed patients. After ECT there were massive and rapid increases in the plasma concentrations of nicotine- and oestrogen-stimulated neurophysin (NSN and ESN), prolactin (PRL) and adrenocorticotropin (ACTH), smaller increases in plasma luteinizing hormone (LH) and cortisol, a significant decrease in plasma growth hormone (GH) concentration but no change in plasma thyrotropin (TSH). There was significant attenuation of PRL responses with repeated ECT. The hormonal responses to ECT cannot simply be attributed to stress, since a similar pattern of increases in plasma hormone concentrations did not occur in psychologically normal patients in whom plasma hormone concentrations were measured during induction of anaesthesia and abdominal incision for cholecystectomy. Analysis of these hormonal responses in terms of the knowledge available on the neurotransmitter control of pituitary hormone release suggests that some of these hormonal responses to ECT may be mediated by the activation of serotonergic neurones, while others are probably due to direct stimulation of the neuroendocrine neurones themselves.

Attitudes of men and women medical students to psychiatry

The attitudes of men and women medical students to psychiatry were compared using an attitude scale, before they began their psychiatry training. Major differences between the sexes were obtained, with the women students consistently displaying more positive attitudes to many aspects of psychiatry. The implications in terms of teaching and recruitment are considered.

Psychometric properties of the BASIS-24© (Behaviour and Symptom Identification Scale–Revised) Mental Health Outcome Measure

Objective. Outcome measurement in mental health services is an area of considerable clinical interest and policy priority. This study sought to assess the Behaviour and Symptom Identification Scale-24 (BASIS-24©), a brief, patient self-reported measure of psychopathology and functioning, in a UK sample, including establishing population norms for comparative purposes. Methods. Participants were 588 adults recruited from psychiatric inpatient, outpatient and primary care settings; and 630 adults randomly sampled from primary care lists who completed the BASIS-24©, and the Brief Symptom Inventory (BSI) at two time points. Results. BASIS-24© demonstrated adequate reliability (coefficient α values for combined clinical sample across subscales ranged from 0.75 to 0.91), validity and responsiveness to change (effect size for change of the BASIS-24© was 0.56 compared with 0.48 for BSI Global Severity Index). Population norms were established for the general population and adult in-patients (at in-take). The scale proved straightforward to complete across clinical settings. Variable rates of questionnaire distribution across clinical settings highlighted the ongoing challenge of incorporating outcome measures in clinical settings. Conclusion. BASIS-24© is a brief, easily administered, self-complete measure of mental well-being and functioning that adequately meets the requirements of reliability, validity and responsiveness to change required of an outcome measure.

A comparison of real patients, simulated patients and videotaped interview in teaching medical students about alcohol misuse

Doctors perform poorly in identifying and in treating patients with alcohol misuse problems and this has been linked to inadequate undergraduate education. We compared three methods of teaching among Aberdeen medical students. In groups of eight or nine students, teaching was conducted with a simulated patient, with real patients or with a videotaped interview. The teachers were five consultant psychiatrists. At the end of each teaching session, students completed a measure of knowledge (multiple-choice questions), two measures of attitudes towards alcohol misusers and a questionnaire tailored to assessment of the teaching session. From the class of 176 students, 156 (89%) participated in the study. Two-way analyses of variance identified a significant difference between teaching methods; students rated the simulated patient sessions as more helpful in acquiring interview skills (F = 11.71, df 2, p < 0.001). We have since expanded our use of simulated patients in the undergraduate teaching programme.

Lithium monitoring before and after the distribution of clinical practice guidelines

Objective: To determine whether distribution of clinical practice guidelines improves lithium monitoring and whether standards of monitoring differed between patients in psychiatric contact and those seen only in primary care.

Seasonal affective disorder among psychiatric nurses in Aberdeen

The Seasonal Pattern Assessment Questionnaire was posted to psychiatric nurses in Aberdeen, and 443 (73% of eligible subjects) responded. The rate of Seasonal Affective Disorder (SAD) was 2.9% and for subsyndromal SAD (S-SAD) was 9.5%. When rates were age and sex adjusted to the Aberdeen population aged 15 to 64, this yielded a prevalence of 1.9% for SAD and 7.2% for S-SAD. As in other studies, there was a preponderance of young female sufferers, but being married appeared to be protective. Comparisons with epidemiological studies elsewhere lead to the conclusion that population rates of winter depression relate to a combination of genetic susceptibility/selection, latitude of residence and geographical mobility.

Core undergraduate psychiatry: what do non-specialists need to know?

Objective  The purpose of this study is to define the most relevant topics for inclusion in an undergraduate psychiatric curriculum by asking non‐psychiatrists what knowledge, skills and attitudes related to psychiatry they need in their day‐to‐day practice.