Columns Correspondence the columns c orre sp ondence Acute hospital care Sir: We have read with interest the editorial by Dratcu ( Psychiatric Bulletin, February 2002, 26, 81^82). In developing countries such as ours mental health has come into national focus, with policy makers and health administrators recognising the importance of improving mental health services following the publication of the World Health Report (World Health Organization, 2001). This document places much emphasis on care in the community and deinstitutionalisation. In Sri Lanka an international conference on mental health and psychiatry, organised by ‘Sahanaya’ (National Council for Mental Health) in April 2002 addressed the issues and challenges in community mental health care. Many international participants with experience in community care, especially from the UK and USA, cautioned the proponents of community care from rushing into such a model with scarce resources. They raised the practical implications of closing down large mental hospitals overnight, such as homelessness, social deprivation and even patients ending up in prisons. They reiterated the importance of recognising the role of acute hospital care and ensuring adequate provision of hospital beds and services for those with mental illness. In Sri Lanka, with a population of more than 18 million people, there are but less than 2000 beds for psychiatric patients, with more than 1500 beds being confined to two mental hospitals. This, by any standards, is far below expectation. Most patients in the developing world, however, are traditionally managed in the community by family and friends. It is the severely ill, who are not stable enough to live and survive in the community, that remain in the mental hospitals. Experience shows that the readmission of these patients on discharge is also high. This is by no means an attempt to downplay the role of community care in the developing world. On the contrary, care in the community should be promoted, even championed, but not for the sake of aping models implemented in the developed world that may not be relevant to our setting. Community care will have to be seen in its context and developed accordingly. The hazards of discharging patients with mental illness without sufficient care facilities, such as increased rates of suicide, have been addressed before (Morgan, 1992). It would be pertinent to strike a balance between community care and deinstitutionalisation so that individual patients and their carers are not sacrificed on the altar of ill-planned but wellmeaning programmes. MORGAN, H. G. (1992) Suicide prevention. Hazards on the fast lane to community care. British Journal of Psychiatry, 160,149^153. WORLD HEALTH ORGANIZATION (2001). Mental Health: New Understanding, New Hope.World Health Report1020^3311. Geneva:WHO. K. A. L. A. Kuruppuarachchi Senior Lecturer in Psychiatry, S. S. Williams Lecturer, Department of Psychiatry, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka Police case disposal: an introduction for psychiatrists Sir: Bayney and Ikkos ( Psychiatric Bulletin, May 2002, 26, 182^185) provide a helpful outline of the elements of the police decision-making process with respect to referrals of those with mental disorder. However, they make two important omissions. The first, and most significant, is the implication that the decision to prosecute is a police one. It should be emphasised that while the investigation of crime is undoubtedly a core police role, the decision to prosecute lies with the Crown Prosecution Service (CPS) and not with the police force. It is the role of the police to charge an individual if they feel it appropriate and to then refer the case to the CPS for consideration. Second, the role of the CPS at the preand post-charge stages is not included. The Code for Crown Prosecutors (Crown Prosecution Service, 2000) notes that both before referring a case and during the prosecution, the police have a key liaison role. This role involves both discussing cases in which a decision to make a formal CPS referral has not yet been made, and in providing further information to the CPS as a prosecution proceeds. The police and the CPS, although independent of each other, are 315 fundamentally linked, and the omission of the CPS impairs a full appreciation of the process under scrutiny. CROWN PROSECUTION SERVICE (2000) The Code for Crown Prosecutors. London: Crown Prosecution Service. Adrian R. Brown Specialist Registrar in Forensic Psychiatry,Wathwood Hospital, Gypsy Green Lane, Wath-Upon-Dearne, Rotherham, SouthYorkshire S63 7TQ Clinically useful electronic patient record Sir: We were delighted to see the report by Searle et al ( Psychiatric Bulletin, April 2002, 26, 145^148). We too have had tremendous success with an almost identical system developed in collaboration between the IT department and clinicians (Hunt, 2002). We now have discharge summaries, patient letters and Care Programme Approach reviews available networked across three London boroughs, and multiple sites. Like many others, we found that the patient-based IT systems on offer could not cope with storing and retrieving the complex clinical information that we all need when managing patients. However, using the network that was built to enable communication across the trust, we can now access detailed clinical information 24hours a day when needed, and have gone a long way to ironing out the information problem caused by community teams being based away from in-patient units. The system has been quick and simple to implement and well-received by staff. The key difference with our project is that each patient has only one file, with multiple pages of separate letters within it. We suspect that this makes retrieval and searching somewhat easier. Interested people are welcome to contact us by e-mail in the first instance. HUNT, J. (2002) The M: drive project. British Journal of Healthcare Computing and Information Management, 19, 20^22. AdrianTreloar Consultant Psychiatrist (e-mail: [email protected]), Julie Hunt Head of IM&T (e-mail: Julie.Hunt@ oxleas.nhs.uk) Columns The College columns Co-prescribing of atypical and typical antipsychotics: true rate much higher Sir: Taylor et al ( Psychiatric Bulletin, May 2002, 26, 170^172) rightly point out that co-prescribing may lead to poorer tolerability and increased frequency of anticholinergic effects. Particular attention was not, however, drawn to the possible cardiac side-effects of co-prescribing, especially in the light of recent evidence of antipsychotics causing QT prolongation and subsequent risk of arrhythmias and possible sudden death (Appleby et al, 2000). I was also struck by the low rate of coprescribing, 53 out of 1441 prescriptions (4%). In my experience co-prescribing of typicals and atypicals is far more common, especially when ‘as-required’ medication is taken into account. Not including ‘asrequired’ medication in the study must result in a significant underestimate of the true rate of co-prescribing. In a recent local audit of antipsychotic prescribing in a group of 160 rehabilitation patients in Norwich, 63 (39%) were prescribed atypical antipsychotics. Of these 32 (50.8%) were also prescribed a typical antipsychotic, 15 (23.8%) regularly and 17 (27.0%) on an as-required basis. Further research is needed and justification of using a typical and atypical antipsychotic needs to be clear. In a minority of patients, co-prescribing may lead to better symptom control, but, as pointed out, it may be at the expense of increased side-effects. APPLEBY, L.,THOMAS, S., FERRIER, N., et al (2000) Sudden unexplained death in psychiatric in-patients. British Journal of Psychiatry, 176, 405^406. would aid our cause, would be most welcome. Rebecca Horne Specialist Registrar, Julian Hospital, Bowthorpe Road, Norwich NR2 3TD Shiela Mackenzie Sector Manager, Jeff Clarke Consultant Psychiatrist, Selby and York Primary CareTrust, Bootham Park Hospital, Bootham, YorkYO30 7BY Nurse uniforms Sir: Like Professor Kohen and her colleagues in Lancashire ( Psychiatric Bulletin, April 2002, 26, 156), we felt that there may be much to be gained by nursing staff going back to wearing uniforms in our community units for the elderly, where most in-patients have severe dementia. We undertook a study in three units looking at levels of behaviour disturbance before and after the introduction of uniforms in two of the units, with the third unit as a control. The study involved small numbers and is yet to be published, but we too found a decrease in behaviour disturbance in our patient group. This was particularly apparent when patients were receiving assistance with personal care, a time when disturbed behaviour can be a frequent occurrence. The uniforms were universally liked and staff issued with them for the trial all still insist on wearing them, even though the study period ended some time ago. Unlike our colleagues in Lancashire, however, we have not yet been able to reintroduce uniforms across the service, as we would like. We now have to begin the process of persuading the management of the merits of funding uniforms for all the elderly in-patient areas. Any other recent contributions to the evidence base, which Depot injections in the community Sir: In his letter on mirror-image studies ( Psychiatric Bulletin, April 2002, 26, 155), Professor Hugh Freeman draws attention to the early days of giving depot injections in the community, and says, quite rightly, that this practice coincided with the birth of community psychiatric nursing. Although he mentions the early 1970s as the date of this type of service being given, we, at Herrison Hospital, Dorchester, and St Ann’s Hospital, Poole, started nurses giving depot injections in the patients’ homes in 1967. We did not actually know that we were starting a community nursing service, the plan being for ward nurses to have 1 day off the ward a week to give injections to patients that they had nursed in hospital, in the hope that familiarity between nurse and patient would ensure compliance. It was only when an administrator noticed that two nurses had visited two patients in the same street on the same day that it was decreed that a full-time community nurse should be designated. It might amuse our present-day nursing colleagues that the lady appointed had a case-load of 100 patients. Alan Gibson Retired Consultant Psychiatrist the c olle ge Election results President The results of the recent election of President are as follows: n of ballot papers distributed 8901 n of ballot papers returned 3315 n of invalid ballot papers 7 n of valid ballot papers counted 3308 First stage Jeremy Holmes Anton Obholzer Mike Shooter 1387 436 1485 Election of Sub-Dean The results of the recent election of Registrar are as follows: n of ballot papers distributed 9092 n of ballot papers returned 2283 n of invalid ballot papers 4 n of valid ballot papers counted 2279 Council will be electing a Sub-Dean at its meeting on 24 October 2002. The successful applicant will be the responsible College officer for issues relating to the Specialist Register award of Certificates of Completion of Specialist Training (CCSTs) and take a lead within the College on flexible training. The new Sub-Dean will be expected to be at the College for a minimum of half a day each week, in addition to attending relevant Committees that will include Council (which meets four times a year), the Specialist Training Committee (five times a year) and the Education Committee (three times a year). Any College Member who would like to be considered for this post should write to the Dean, C/o The Royal College of Psychiatrists, Department of Postgraduate Educational Services, 17 Belgrave Square, London SW1X 8PG, for further details. If more than one nomination is received, then an election will be held among Council Members. First stage Andrew Fairbairn Hubert Lacey Richard Williams 880 742 657 Second stage Second stage Jeremy Holmes Anton Obholzer Mike Shooter (non-transferable Registrar 1599 ^ 1633 76) Dr Mike Shooter was therefore elected as President to take office from 27 June 2002. Andrew Fairbairn Hubert Lacey Richard Williams (non-transferable 1183 979 ^ 117) DrAndrew Fairbairn was therefore elected as Registrar to take office from 27 June 2002. 316 Columns Obituaries obituarie s columns Sydney Brandon Formerly Professor of Psychiatry, University of Leicester Sydney Brandon was appointed the Foundation Professor of Psychiatry at the University of Leicester in 1975. As such he was one of the last of that generation of pioneering professors of psychiatry in undergraduate schools that had bloomed in the preceding decade or two. He was also one of the smaller group of professors who had the opportunity of contributing to the creation of a new medical school. From the beginning in Leicester he was a notable wheeler and dealer for the university, for the school and for his subject. His leadership of the then innovative ‘Man in society’ course ensured that the psychosocial perspective on health and disease was emphasised from the start of each student’s career. His cajoling and corralling shaped up local psychiatric services in time to receive the first students in their clinical clerkship. No one could ignore Sydney and anyone who sought to cast psychiatry in a Cinderalla role had to reckon with him. His enthusiasm and energy were infectious. A quarter of the first cohort of Leicester undergraduates opted for a career in psychiatry. At least one is now a professor. A proud Geordie, Sydney started his medical career in Newcastle. Before medicine he had lied about his age to get into the RAF at the end of the war and briefly toyed with a career in aeronautical engineering. Years later he took a great delight in the high honorary rank that came with his role as psychiatric advisor to the RAF. He worked in paediatrics and research in child development before settling into a career in psychiatry. Time in the USA and Manchester led up to his appointment to Leicester. His achievements were many as a researcher and scholar. His work was wide ranging but was always practical and rooted in clinical work. The Leicester trial of electroconvulsive therapy was a notable achievement, not only academically but also as an exercise in persuasion and inspiration. All his consultant colleagues in Leicester agreed to allow all of their eligible and consenting patients to enter the study. But then, Sydney was a charismatic leader and forceful manager, although not in the modern style. Toward the end of his career the new managerial enthusiasm was on the rise but its modes and mores were not to Sydney’s taste. His favoured planning tools were malt whisky and the back of an envelope, although he could work a committee expertly when it was necessary. And he took his role as a clinical leader seriously. He made no marked or unnecessary distinction between the role of the university and the NHS. To him both were organisations that should serve patients by promoting good practice and good practitioners. On the back of his office door was pinned a leaflet from the 1940s exhorting the virtues of the, then, new health service. He was an NHS man through and through. It was as a humane and skilled clinician that Sydney really shone. He cared about people ^ his patients, their families and his colleagues. He was involved in the best sense. Every inch the consultant but also down to earth and not at all ‘posh’, he was more likely to irritate his peers than his patients or those in less elevated roles. He was a dapper figure. He once published an article on ‘what every young man should know’; it gave instruction on how to knot a bow-tie ^ his habitual neckwear. Once at a formal dinner he was shocked and upset to find me wearing a ready-made bow-tie. Such sloppy short cuts were not for him either in dress or in clinical work. He ended his formal career as a postgraduate dean. He was also a vicepresident of the College. In so-called retirement he continued to work hard, energetically contributing to work with sick doctors and to the charity Childline. He made many trips to Rwanda, advising and contributing to aid work in the aftermath of the genocide. He always had plans for the future. He was a medical collector and amateur historian. He lived in a house that verged on being overwhelmed by his collection of feeding cups, instruments and medical memorabilia. He had hoped to write a book on the history of military psychiatry. Unfortunately, like his hope of mastering the French language, that ambition remained unfulfilled. Sydney was a delightful companion and colleague. He was a family man and is survived by his two daughters, one a lawyer and one a doctor. Over the years, 317 despite various illnesses, he seemed to remain the same. Only during his final struggle with ill health did his twinkle begin to grow dim. He died on 5 December 2001, leaving a sad gap but also happy memories and a continuing influence. Bob Palmer Sydney Brandon was outstanding: even in his appearance he stood out. He was of short, stocky, ‘pyknic’ physique. He had a shock of white hair, but what was unmistakable was his long, bushy sideburns that, together with the inevitable bow-tie he sported, gave him the dash of an Edwardian toff. And if, perchance, he was hidden in a crowd, he could be located by his infectious chuckle, audible at at-least a hundred paces. Despite being plagued in later years by ill health he always managed to retain his glow of cheerful optimism. Sydney was born in Washington, County Durham. His father, Thomas Brandon, was a deputy colliery manager, and his mother, Rhoda May (nee¤ Rook), is described as a housewife. In 1950 Sydney married Joanne (nee¤ Watson), a lecturer in social work. Professor Brandon was educated at Rutherford College, Newcastle-uponTyne, and studied medicine at King’s College, University of Durham, where he graduated in 1954, and at the Royal Victoria Infirmary, Newcastle. After graduation, Sydney became interested in paediatrics, but his face-toface involvement with the behaviour of disturbed children led him into psychiatry, which became his life’s work. Thus, as a junior, he was appointed Nuffield research assistant in child health to the children’s department, Royal Victoria Infirmary, Newcastle, where he worked from 1955^ 1959. From 1963^1964 he worked as a research fellow in psychiatry, Columbia University, New York, and from 1964^ 1966 he served as a lecturer in psychiatry at the University of Newcastle. His later appointments were as Nuffield Foundation Fellow in Psychiatry (senior lecturer) at the University of Newcastle (1966^ 1969), reader in psychiatry at the University of Manchester (1969^1973) and finally, in 1973, he was elected Professor in Psychiatry in the University of Leicester, a post he served with distinction until his retirement, after which he was created Emeritus Professor. From 1982 until his death he served as Civil Consultant Adviser to the RAF. He was singularly proud of his connection with the RAF, and he was a regular attender at the annual dinner of the Columns Reviews columns RAF medical officers at the RAF Club, London. His packed schedule still allowed space to give valuable service to the Royal College of Psychiatrists. There he rose to the office of vice-president, as well as sitting on various important committees. Furthermore, in his time he served as President of the Section of Psychiatry of the Royal Society of Medicine. He was a prolific writer: his publications included topics on eating disorders, carbon monoxide poisoning, panic disorders and sexual deviations. A particular interest in post-traumatic stress disorder was responsible for his concern with Rwanda, the unhappy country he visited frequently as a counsellor to the surviving victims of the appalling genocide. No picture of Sydney Brandon is complete without mentioning his interests and hobbies. He enjoyed the thrill of driving fast cars, but above all he was a bon viveur: he loved good food and good wines in the company of his friends, of which I am proud to have been one. He had a passionate interest in the history of medicine as witness his valuable and extensive collection of medical artefacts. His wife, Joanne, predeceased him, but he is survived by his two daughters and his devoted friends. Henry R. Rollin Arumugam Sittampalam Formerly Consultant Forensic Psychiatrist, Broadmoor Hospital, Crowthorne, Berkshire Arumugam Sittampalam died on 4 August 2001 after a stroke. Sitt, to his friends and colleagues, was born on 30 November 1922 in Jaffna, Sri Lanka. He qualified in 1949 at the University of Colombo, later obtaining the DPM, FRCP (Edin) and FRCPsych. From 1957^1971 he worked for the Ceylon Health Service as the senior psychiatrist. He left Sri Lanka in 1971 for Canada, where he was senior psychiatrist at the union hospital in Moose Jaw, Saskatchewan, but soon decided to come to the UK where he worked first from 1972^1979 as medical officer at HMP Brixton and then from 1979 as a consultant forensic psychiatrist at Rampton Hospital. This meant that he was separated from his family, who were settled in London, so in 1981 he moved to Broadmoor where he worked until his retirement in 1992. Sitt was a quietly spoken, modest and intensely private man dedicated to his family. At Broadmoor his wide clinical experience, his diligence and his sound judgment were a tremendous asset and a stabilising influence, making him admired and respected by friends and colleagues of all disciplines. Towards the end of his time at Broadmoor he founded a dining club for doctors who had worked there, but disappointingly this did not long survive his retirement. At Broadmoor his generosity will long be remembered. In the years following his retirement he spent his time with his grandchildren or gardening and watching sport. He leaves his wife, Puaneswary, and four sons and a daughter. David Tidmarsh re vie w s Cross-Cultural Psychiatry. A Practical Guide By Dinesh Bhugra and Kamaldeep Bhui. London: Arnold. 2001. 114 pp. »15.99. ISBN: 0-340-76379-5 In this increasingly diverse country an understanding of cross-cultural issues in the practice of psychiatry has become essential. However, the literature is spread across a number of specialities including sociology, anthropology, history, political science and medical biology. It can be hard to find the information that you need and when you find it, it can be impenetrable. Because of this many clinicians may not develop the understanding of crosscultural issues that would be commensurate with good clinical practice. Cross-Cultural Psychiatry. A Practical Guide aims to cut through this dense literature and offer some practical ways of understanding the challenges set by cross-cultural psychiatry. It is a jumpingon point, rather than a jumping-off point. It does not claim to be comprehensive but to ‘open doors for clinicians and other health professionals to start thinking seriously about differences and similarities across cultures and individuals’. The book is not targeted at specific cultural groups. General principles are considered more important than specifics. This parallels the position in the USA, where cultural competence training offers transferable broad skills that help people understand cross-cultural interactions. It is assumed that this is the best way to cope with the fact that cultures develop and that over time new groups of people and new generations will present different challenges to psychiatrists. A psychiatrist will not be able to be ‘culturally competent’ for all groups and so to be a good psychiatrist he/she will need to develop common strategies for identifying cross-cultural problems and dealing with them. The book is a good general introduction to the field and will become a ‘must read’ 318 for all those in training or who are new to the field. The book is not without problems. In my opinion the authors do not make it clear enough that the skills and strategies developed by the book are useful across the board ^ not just for ethnic minority groups. The reliance on UK ethnic minority groups for examples could lead the reader to believe that cross-cultural psychiatry refers to problems produced by an interaction between psychiatry and different ethnic groups, rather than the interaction of the cultural assumptions of psychiatric practice and different cultural groups. The majority of people in the UK somatise rather than psychologise their distress. A further problem is that there is little discussion of the impact of discrimination or of institutional racism in this volume. It is important for individual clinicians to improve their clinical assessment and treatment, but improvements in care can be limited by institutional causes of disparities in service delivery. An understanding of this is required if clinicians are to be able to offer the best care for their patients. Cross-cultural psychiatry is good psychiatry. Developing the knowledge base is fundamental to good practice. This short book is full of ideas and information and this is a good place to start. Kwame McKenzie Royal Free and University College Medical School, London Columns Reviews Assessing Forensic Mental Health Need. Policy,Theory and Research By Andrea Cohen and Nigel Eastman. London: Gaskell. 2000. 228 pp. »30.00 (hb). ISBN: 1-901242-42-0 with everything in the book. In the Survey approach chapter, the authors suggest ‘If only high security hospitals provide the high level of occupational facilities that some patients require, then, even if their risk to others infers that they only require medium security, their proper placement within existing services is high security.’ This confirmed for me that when one is drawn so far down the needs path, ethical judgements, for example, locking patients within category B prison type security, are not considered. But this is the point of the book ^ needs assessment is perhaps little more rational than other methods of service planning, and as the authors suggest, as an approach it is only as good as its assumptions and method. For MDOs the assumptions, the politics and the fears of the community complicate the whole process. Peter Snowden Consultant Forensic Psychiatrist, Edenfield Centre, Mental Health Services of Salford NHS Trust, Bury New Road, Manchester M25 3BL Developing Care Pathways. TheToolkit Some time ago I was asked by Gaskell if I would review the outline of a book ^ this book ^ in order to help them come to a view on possible publication. I suggested that it would have a narrow (forensic) audience, but it would be worthwhile to publish an authoritative book on needs assessment. I was both right and wrong. This book could almost be entitled ‘Everything you ever wanted to know about needs assessment, but was too afraid to ask’. I realised very early on in my reading that needs assessment was so much more complicated than I had first thought. Rationality in service planning is the goal, but at the same time it is also subjective, politically driven and resource managed. The authors offer a detailed description of needs assessment policy with an emphasis on mentally disordered offenders (MDOs) and a theoretical framework to enable the reader to understand the strengths and weaknesses of the various approaches (survey, rates under treatment, social indicator, key informant and community opinion). The detail and thoroughness of the reviews are impressive, but the over reliance on a historical approach makes some aspects of the book appear out of date. I was wrong in suggesting that the book would have a narrow audience. It may have ^ but it should not. The breadth of many of the chapters is such that I would commend it to the wider mental health constituency, in particular, general psychiatry. I did not find myself agreeing By Kathryn de Luc. Abingdon: Radcliffe Medical Press. 2001. 43 pp. »30.00 (sold with Handbook, pb). ISBN: 1-85775-499-9 account of care pathways, long on the obvious and short on how to overcome any difficulties. The book was disappointing in two main aspects. First, there was insufficient material provided as to the evidence that care pathways actually improve the process of care. It would have been useful to have evidence both for and against the use of such pathways rather than simply seeing them as a good thing. Second, it would have been useful to have had much more information about problems that exist in implementing pathways. For example, how does one overcome clinician resistance? Is the extra paperwork that will almost inevitably be involved be justified by the result? Are care pathways completed accurately by staff? Are deficiencies in care highlighted by care pathways remedied to bring about improved patient results? Although this book may be useful for someone who knows nothing about care pathways as an introduction to the concept, anyone who has had experience of developing their own care pathway will probably not learn anything new. L. Mynors-Wallis Medical Director, Dorset Healthcare NHS Trust Challenging Behaviour. Analysis and Intervention in People with Severe Intellectual Disabilities By Eric Emerson (2nd edn). Cambridge: Cambridge University Press. 2001. 210 pp. »29.95. ISBN: 0521-7944447. Care pathways have been developed in many areas of medicine. Such pathways can be a helpful way of ensuring that clinicians implement good practice guidelines. They can also be helpful as a way of empowering patients with the knowledge of what treatments they can expect and within what time-frame. Developing Care Pathways has been written to facilitate the development of care pathways: explaining what they are and how to go about producing one. Unfortunately, in spite of being in two volumes ^ a handbook and a toolkit ^ what has been produced is a simplistic 319 A substantial minority of people with severe learning disabilities behave in ways that cause problems for themselves, their carers and other members of society. This is frequently a reason for referral to a psychiatrist. Challenging behaviour has become the preferred term in recent years columns Columns Miscellany columns to describe such behaviours because it emphasises the social context. Professor Emerson, a psychologist well-known for his own research in the field of behavioural interventions, has written a comprehensive summary of current thinking about challenging behaviour. The opening chapter defines challenging behaviour as a social construction and later states that it is not a psychiatric diagnosis, although ‘it may be a secondary feature of a psychiatric disorder’. The second chapter describes the impact of challenging behaviour on the health, safety and quality of life of both the sufferer and his/her carers, which is inevitably significant. A detailed chapter on epidemiology follows, showing that these behaviours are common and tend to be persistent over years or even decades. Theoretical models are discussed in the fourth chapter. The book is concerned primarily with psychological and specifically behavioural approaches but in this second edition Emerson has expanded the section on neurobiological models and psychiatric disorders and this is welcome. The remaining chapters cover functional analysis, behavioural interventions, psychopharmacological interventions, the effectiveness of community-based supports and the challenges for future research. Although Emerson supports all his comments with references, the number of good case controlled studies to support either pharmacological or behavioural interventions is disappointingly small. The range of methods used by psychologists to measure and influence challenging behaviour are effectively communicated, and the usefulness of the various techniques is helpfully summarised in tables. The ethical implications of each model are considered. There are some omissions, for example the section on psychiatric disorders does not include consideration of the possible role of psychotic illness, the role of anxiety disorders is given insufficient attention and there is no discussion of the possible usefulness of a psychodynamic understanding and treatment of challenging behaviour. However, the book does succeed in its stated aim of providing a concise introduction to the field and drawing attention to recent advances in applied behaviour analysis. For this reason, and for its extensive references, I commend it to learning disability psychiatrists and other professionals who work with people who have learning disabilities and whose behaviour is challenging. Jane Radley Consultant in Learning Disability Psychiatry, Northgate and Prudhoe NHS Trust Management of Psychiatric Disorders in Pregnancy Edited by Kimberley Yonkers and Bertis Little. London: Arnold. 2001. 266 pp. »55.00 (hb). ISBN: 0-340-76126-1 There is increasing awareness of the impact of antenatal and postnatal psychiatric disorders on the pregnant woman, the foetus and, after delivery, the whole family. Many psychiatrists treat patients who become pregnant, but this is one of the few books in which one can find details on the natural history of psychiatric disorders during pregnancy, with discussion of treatment options, particularly whether or not to prescribe medication. Most chapters include a review of the relevant research literature, although not all give useful summaries of the clinical management of patients, which busy clinicians will probably be looking for. The chapters on the management of pregnancy in the woman with schizophrenia (J.K. Tekell) and bipolar disorder (L.L. Davis et al ) were particularly comprehensive and helpful. Psychological treatments in the pregnant woman generally received less attention than pharmacological, other than a sole chapter on interpersonal therapy. There was also no discussion of the different models of perinatal services or the vexed question of whether postpartum disorders, particularly postnatal depression, can be prevented or attenuated by interventions during pregnancy. Nevertheless this book is a useful resource and despite its multi-author nature, there was a consistent message. Clinicians must be aware of the risks and benefits of different interventions when treating pregnant women with psychiatric disorders, particularly as the adverse effects of psychiatric illness on the mother and foetus may be greater than those caused by psychotropic medication. There is a growing body of research into the effects of antenatal stress on the foetus, suggesting that psychiatric disorders may have subtle biological effects on the developing foetus, in addition to the genetic and psychosocial consequences of these disorders. This book is therefore timely in providing a useful summary of many of the management issues in pregnancy for psychiatrists, obstetricians and primary care professionals. Louise M. Howard Research Fellow, Health Services Research Department, Institute of Psychiatry miscellany The Douglas Bennett prize The Section of Social and Rehabilitation Psychiatry has recently inaugurated a prize to the value of »200 to commemorate the work of Douglas Bennett, whom many regard as the father of rehabilitation psychiatry. Readers are encouraged to submit an original paper (2000 words maximum) on aspects of long-term care, service development for people with severe mental illness or on relevant health or social care policy for consideration for this prize. Critical reviews of specific treatments or service evaluations will also be considered. A selected shortlist of papers may be presented to the Prize Adjudication Committee at the Section Annual Residential Meeting in Bournemouth on 320 14^15 November 2002. The Douglas Bennett prize will be awarded for the best paper, which may be submitted for presentation at the College Annual General Meeting 2003. Submissions (clearly entitled) or enquiries should be sent to Dr Sarah Davenport, Women’s Service, Ashworth Hospital, Maghull, Liverpool L31 1HW by 15 October 2002. for thc oming e vent s The 60th Residential Revision Course for the MRCPsych Examinations will be held at the University of Surrey, Guildford, on 7^14 August 2002 (Part I) and 14^22 August 2002 (Part II). Further details can be obtained from Mrs S. Caines, Belmont Postgraduate Psychiatric Centre, Chiltern Wing, Sutton Hospital, Sutton, Surrey SM2 5NF (tel: 020 8296 4177). Applications are now invited for semester one of the MRCPsych Course run by University College London. Part I takes place on Monday afternoons commencing 2 September 2002 and Part II runs Tuesday afternoons commencing 3 September 2002. The course has been updated in keeping with the Royal College of Psychiatrists 2002 syllabus and includes mock exams, theme-specific revision sessions, research methodology and the College’s critical appraisal paper for the Part II exam. For further information and an application form please contact Lee Jameson, Course Administrator (tel: 020 7679 9475; e-mail: mrcpsych@ ucl.ac.uk). The Andrew Sims Centre for Professional Development would like to announce: Mental Health Act: Section 12 Induction Course, a comprehensive 2-day course accredited for practitioners who require approval under Section 12 of the Mental Health Act. It is also valuable as an in-depth update for those practitioners who are already approved but wish to keep their knowledge and practice current. This course is taking place in Leeds on two occasions: 19^20 September 2002 and 30^31 January 2003; Safe and Sound, a 2-day child protection conference is specially designed for those working with children in the NHS and will focus exclusively on the responsibility and accountability of those in the front-line. This event takes place in Leeds on 10^11 September 2002; and Obsessive ^ Compulsive Disorder, a professional development seminar presented by Dr Chris Freeman and held on 17 September 2002 in Leeds. For further information on all these courses please contact the Andrew Sims Centre Course Administrator (tel: 0113 305 6044; fax: 0113 305 6041; e-mail: [email protected]). The University of Manchester, Department of Psychiatry, would like to announce a Course on Psychodynamic Interpersonal Therapy, taking place on 16^20 September 2002. This is an intensive week-long course in psychodynamic interpersonal therapy aiming to provide a brief theoretical introduction to the model; acquaint participants with the main features of the model; and enable participants to use the model with patients with the following conditions: somatisation, depression, deliberate self-harm and complex chronic conditions. The course is organised by Professor Else Guthrie. Application forms and further details are available from Mrs Una Dean, Secretary to Professor E. Guthrie, University Department of Psychiatry, Rawnsley Building, Manchester Royal Infirmary, Manchester M13 9WL (tel: 0161 276 5383; fax: 0161 273 2135; e-mail: Una.Dean@ man.ac.uk). The Royal College of Anaesthetists, in association with the Conscious Sedation Society of the UK, will be holding a Symposium on Safe Sedation Practice on 31 October 2002. The symposium is aimed primarily at clinical personnel who are involved in the provision of conscious sedation for diagnostic or therapeutic purposes. The aim of the meeting is to provide an update on national recommendations, review current techniques and to discuss training and education in conscious sedation. The structure will consist of short presentations and discussions of topics to include: overview of conscious sedation in clinical practice; safety of conscious sedation; drug choice for conscious sedation; and multiprofessional education in conscious sedation. For further information please contact the Courses and Meetings Department of the Royal College of Anaesthetists, 48/49 Russell Square, London WC1B 4JY (tel: 020 7813 1900; fax: 020 7636 8280; e-mail: educ @rcoa.ac.uk). The University College London’s Department of Psychiatry and Behavioural Sciences is inviting applications for a 2-year, part-time MSc in Psychiatric Theory and Research, starting in October 2002. The MSc is intended for senior house officers and specialist registrars in psychiatry and aims to provide a firm grounding in research methodology. The first year of the course will involve seminars, tutorials and workshops on research methodology, with an emphasis on both conceptual learning and academic skills, as well as lectures covering the MRCPsych Part II curriculum. In the second year students will conduct a research project under supervision and submit a dissertation. Places on the course are limited to 15 students, so early application is advisable. For an application form and prospectus please contact Lydia Clinton, Course Administrator, on tel: 020 7679 9475, or by e-mail: [email protected]. BBR Beynon, Bishop, Ross Medical Education Ltd are the organisers of the following MRCPsych Course: Part II Clinical. This will take place on 9^10 November 2002. For further details please contact BBR, 82 The Maltings, Roydon Road, Stanstead Abbotts, Hertfordshire SG12 8HG (tel/fax: 01920 872 407; e-mail: [email protected]). columns Acute hospital care K. A. L. A. Kuruppuarachchi and S. S. Williams Psychiatric Bulletin 2002, 26:315. Access the most recent version at DOI: 10.1192/pb.26.8.315 References Reprints/ permissions You can respond to this article at Downloaded from This article cites 1 articles, 1 of which you can access for free at: http://pb.rcpsych.org/content/26/8/315.1#BIBL To obtain reprints or permission to reproduce material from this paper, please write to [email protected] /letters/submit/pbrcpsych;26/8/315 http://pb.rcpsych.org/ on February 16, 2015 Published by The Royal College of Psychiatrists To subscribe to BJPsych Bulletin go to: http://pb.rcpsych.org/site/subscriptions/
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